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Đorović Đ, Lazarevic V, Aranđelović J, Stevanović V, Paslawski W, Zhang X, Velimirović M, Petronijević N, Puškaš L, Savić MM, Svenningsson P. Maternal deprivation causes CaMKII downregulation and modulates glutamate, norepinephrine and serotonin in limbic brain areas in a rat model of single prolonged stress. J Affect Disord 2024; 349:286-296. [PMID: 38199412 DOI: 10.1016/j.jad.2024.01.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Early life stress is a major risk factor for later development of psychiatric disorders, including post-traumatic stress disorder (PTSD). An intricate relationship exists between various neurotransmitters (such as glutamate, norepinephrine or serotonin), calcium/calmodulin-dependent protein kinase II (CaMKII), as an important regulator of glutamatergic synaptic function, and PTSD. Here, we developed a double-hit model to investigate the interaction of maternal deprivation (MD) as an early life stress model and single prolonged stress (SPS) as a PTSD model at the behavioral and molecular levels. METHODS Male Wistar rats exposed to these stress paradigms were subjected to a comprehensive behavioral analysis. In hippocampal synaptosomes we investigated neurotransmitter release and glutamate concentration. The expression of CaMKII and the content of monoamines were determined in selected brain regions. Brain-derived neurotrophic factor (BDNF) mRNA was quantified by radioactive in situ hybridization. RESULTS We report a distinct behavioral phenotype in the double-hit group. Double-hit and SPS groups had decreased hippocampal presynaptic glutamatergic function. In hippocampus, double-hit stress caused a decrease in autophosphorylation of CaMKII. In prefrontal cortex, both SPS and double-hit stress had a similar effect on CaMKII autophosphorylation. Double-hit stress, rather than SPS, affected the norepinephrine and serotonin levels in prefrontal cortex, and suppressed BDNF gene expression in prefrontal cortex and hippocampus. LIMITATIONS The study was conducted in male rats only. The affected brain regions cannot be restricted to hippocampus, prefrontal cortex and amygdala. CONCLUSION Double-hit stress caused more pronounced and distinct behavioral, molecular and functional changes, compared to MD or SPS alone.
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Affiliation(s)
- Đorđe Đorović
- Neuro Svenningsson, Department of Clinical Neuroscience, Karolinska Institutet, 171 76 Stockholm, Sweden; Institute of Anatomy "Niko Miljanic", School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Vesna Lazarevic
- Neuro Svenningsson, Department of Clinical Neuroscience, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Jovana Aranđelović
- Department of Pharmacology, Faculty of Pharmacy, University of Belgrade, 450 Vojvode Stepe St, 11000 Belgrade, Serbia
| | - Vladimir Stevanović
- Department of Pharmacology, Faculty of Pharmacy, University of Belgrade, 450 Vojvode Stepe St, 11000 Belgrade, Serbia
| | - Wojciech Paslawski
- Neuro Svenningsson, Department of Clinical Neuroscience, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Xiaoqun Zhang
- Neuro Svenningsson, Department of Clinical Neuroscience, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Milica Velimirović
- Institute of Clinical and Medical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nataša Petronijević
- Institute of Clinical and Medical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Laslo Puškaš
- Institute of Anatomy "Niko Miljanic", School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miroslav M Savić
- Department of Pharmacology, Faculty of Pharmacy, University of Belgrade, 450 Vojvode Stepe St, 11000 Belgrade, Serbia
| | - Per Svenningsson
- Neuro Svenningsson, Department of Clinical Neuroscience, Karolinska Institutet, 171 76 Stockholm, Sweden
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Davis JP, Prindle J, Saba S, Lee DS, Leightley D, Tran DD, Sedano A, Fitzke R, Castro CA, Pedersen ER. Childhood adversity, combat experiences, and military sexual trauma: a test and extension of the stress sensitization hypothesis. Psychol Med 2023; 53:4055-4063. [PMID: 35440343 DOI: 10.1017/s0033291722000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND U.S. veterans report high rates of traumatic experiences and mental health symptomology [e.g. posttraumatic stress disorder (PTSD)]. The stress sensitization hypothesis posits experiences of adversity sensitize individuals to stress reactions which can lead to greater psychiatric problems. We extend this hypothesis by exploring how multiple adversities such as early childhood adversity, combat-related trauma, and military sexual trauma related to heterogeneity in stress over time and, subsequently, greater risk for PTSD. METHODS 1230 veterans were recruited for an observational, longitudinal study. Veterans responded to questionnaires on PTSD, stress, and traumatic experiences five times over an 18-month study period. We used latent transition analysis to understand how heterogeneity in adverse experiences is related to transition into stress trajectory classes. We also explored how transition patterns related to PTSD symptomology. RESULTS Across all models, we found support for stress sensitization. In general, combat trauma in combinations with other types of adverse experiences, namely early childhood adversity and military sexual trauma, imposed a greater probability of transitioning into higher risk stress profiles. We also showed differential effects of early childhood and military-specific adversity on PTSD symptomology. CONCLUSION The present study rigorously integrates both military-specific and early life adversity into analysis on stress sensitivity, and is the first to examine how sensitivity might affect trajectories of stress over time. Our study provides a nuanced, and specific, look at who is risk for sensitization to stress based on previous traumatic experiences as well as what transition patterns are associated with greater PTSD symptomology.
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Affiliation(s)
- Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Shaddy Saba
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Daniel S Lee
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | | | - Denise D Tran
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Angeles Sedano
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Reagan Fitzke
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Carl A Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Eric R Pedersen
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
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The Moderating Effect of Contact with Children on the Relationship between Adverse Childhood Experiences and Depression in Adulthood among a Chinese Adult Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158901. [PMID: 35897272 PMCID: PMC9331561 DOI: 10.3390/ijerph19158901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Abstract
The effect of adverse childhood experiences (ACEs) on depression in adulthood has been identified in many studies; however, the underlying mechanisms remain unclear. To understand the moderating effect of ACEs on depression, a moderation analysis using the interaction effect model was performed based on data obtained from the China Health and Retirement Longitudinal Study. This study found that people with ACEs had significantly lower depression scores than those without ACEs, particularly in categories such as physical abuse, emotional neglect, sibling death, parental illness/disability, parental depression, hunger, violence, and bullying. In addition, the results indicated that contact with children moderated the relationship between ACEs and depression in adulthood. Increased levels of contact with children reduced the adverse effects of parental drug abuse and the experience of starvation, but not physical abuse. This study highlights the role of family support in eliminating health disparities, which can reduce the effects of ACEs on depression in adulthood.
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Avidor S, Zerach G, Solomon Z. Aging together in the aftermath of war: marital adjustment and subjective age of veterans and their spouses. Aging Ment Health 2022; 26:1479-1486. [PMID: 33896297 DOI: 10.1080/13607863.2021.1916877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Trauma has long-term effects on those directly exposed to it, but it also impacts those closest to them, particularly one's spouse, as the marital relationship is of central importance for late-life development. Furthermore, traumatic experiences have been shown to be involved in an acceleration of aging, whether through physical health, or via psychological pathways, through an older subjective age. The present work seeks to examine the mutual connections between marital adjustment and the psychological accelerated aging of both spouses among military veterans of the Israeli 1973 Yom Kippur War. METHOD Data from two assessments were drawn from a larger longitudinal study. In 2008 (T1) and again in 2015 (T2), 247 veterans and their wives were interviewed on their subjective age, marital adjustment, and PTSD symptoms. RESULTS An actor-partner interdependence model combined with an autoregressive cross-lagged model, controlling for T1 PTSD symptoms revealed that men's subjective age at T1 was associated with women's subjective age at T2, and women's subjective age at T1 was associated with men's subjective age at T2. Women's marital adjustment at T1 was associated with men's marital adjustment at T2 but not the other way around. CONCLUSION Spousal relationships are an important arena in the lives of older adult veterans. The present study contributes new knowledge regarding the paths that predict subjective age by taking account of the subjective age of one's spouse, as well as levels of marital adjustment. Insights regarding secondary traumatization, as well as gender differences, for the aging process are discussed.
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Affiliation(s)
- Sharon Avidor
- Faculty of Social and Community Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Gadi Zerach
- Department of Behavioral Sciences and Psychology, Ariel University, Ariel, Israel
| | - Zahava Solomon
- I-Core Research Center for Mass Trauma, Bob Shapell School of Social Work, Tel-Aviv University, Tel Aviv, Israel
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Suntai Z, White B. Social isolation among older veterans: findings from the National Health and Aging Trends Study. Aging Ment Health 2022; 26:1345-1352. [PMID: 34192481 DOI: 10.1080/13607863.2021.1942434] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Social isolation is a critical public health issue that affects multiple domains of well-being among older adults, but little is known about social isolation among older military veterans. As such, the purpose of this study was to estimate the prevalence of social isolation among older veterans and to examine risk factors for social isolation among older veterans. METHOD Data were derived from Round 1 of the National Health and Aging Trends Study, which is an annual, longitudinal panel survey of Medicare beneficiaries aged 65 and older. The sample included 1,683 veterans, who were primarily White and male. Weighted logistic regression models were used to predict severe social isolation (having no social participation) and social isolation (having only one source of social participation) among older veterans, while controlling for age, sex, race, marital status, education, income, and metropolitan residency. RESULTS After accounting for other predictors, results show that veterans who are 85 and older, male, White, unmarried or unpartnered, with lower educational attainment and lower income are greatly at risk of both severe social isolation and social isolation. CONCLUSION The results of this study support past research showing that veterans with limited social and economic capital are at great risk of experiencing adverse outcomes in older adulthood, including social isolation. Interventions should therefore aim to improve social connectedness among this population and should address the risk-factors that contribute to social isolation among older veterans.
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Affiliation(s)
- Zainab Suntai
- School of Social Work, Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Bethany White
- School of Social Work, Samford University, Birmingham, AL, USA
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Evaluating the implementation of robotic thoracic surgery on a Veterans Administration Hospital. J Robot Surg 2022; 17:365-374. [PMID: 35670989 PMCID: PMC9170878 DOI: 10.1007/s11701-022-01427-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
Robotic thoracic surgery has demonstrated benefits. We aimed to evaluate implementation of a robotic thoracic surgery program on postoperative outcomes at our Veteran’s Administration Medical Center (VAMC). We retrospectively reviewed our VAMC database from 2015 to 2021. Patients who underwent surgery with intention to treat lung nodules were included. Primary outcome was patient length of stay (LOS). Patients were grouped by surgical approach and stratified to before and after adoption of robotic surgery. Univariate comparison of postoperative outcomes was performed using Wilcoxon rank sums and chi-squared tests. Multivariate regression was performed to control for ASA class. P values < 0.05 were considered significant. Outcomes of 108 patients were assessed. 63 operations (58%) occurred before and 45 (42%) after robotic surgery implementation. There were no differences in patient preoperative characteristics. More patients underwent minimally invasive surgery (MIS) in the post-implementation era than pre-implementation (85% vs. 42%, p < 0.001). Robotic operations comprised 53% of operations post-implementation. On univariate analysis, patients in the post-implementation era had a shorter LOS vs. pre-implementation, regardless of surgical approach (mean 4.7 vs. 6.0 days, p = 0.04). On multivariate analysis, patients who underwent MIS had a shorter LOS [median 4 days (IQR 2–6 days) vs. 7 days (6–9 days), p < 0.001] and were more likely to be discharged home than to inpatient facilities [OR (95% CI) 13.00 (1.61–104.70), p = 0.02]. Robotic thoracic surgery program implementation at a VAMC decreased patient LOS and increased the likelihood of discharging home. Implementation at other VAMCs may be associated with improvement in some patient outcomes.
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Meynadasy MA, Brush CJ, Sheffler J, Mach R, Carr D, Kiosses D, Hajcak G, Sachs-Ericsson N. Emotion regulation and the late positive potential (LPP) in older adults. Int J Psychophysiol 2022; 177:202-212. [PMID: 35623475 DOI: 10.1016/j.ijpsycho.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 05/08/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022]
Abstract
Emotion regulation (ER) processes in older adults may be important for successful aging. Neural correlates of ER processes have been examined using event-related brain potentials (ERPs), such as the late-positive potential (LPP) during cognitive reappraisal paradigms. The current study sought to extend this research by examining the LPP from an ER task in a sample of 47 community-dwelling older adults between the ages of 60 and 84 years, scoring either high on emotional well-being (as measured by habitual ER use and resiliency; high WB group, n = 20) or low on emotional well-being (as measured by habitual ER use, resiliency, and depression; low WB group, n = 27). Participants viewed unpleasant and neutral images and were instructed to simply react to the images or reappraise their emotional response. Both pre- and post-instruction LPP amplitudes were scored, in addition to self-reported ratings of negative emotion collected during the task. We found greater LPP amplitude to emotionally salient compared to neutral stimuli, reduced LPP amplitude following instructions to reappraise emotional response to stimuli across groups, and a blunted LPP overall for individuals with higher depressive symptoms. Additionally, we demonstrated that older adults with low emotional well-being were less successful at reappraisal according to self-reported ratings of negative emotion, although this was not reflected in the LPP. Collectively, these data suggest that laboratory-based ER tasks might be used to understand abnormal ER use-though the LPP may be more sensitive to depression than individual differences in ER ability.
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Affiliation(s)
- Melissa A Meynadasy
- Department of Psychology, Florida State University, United States of America.
| | - C J Brush
- Department of Psychology, Florida State University, United States of America
| | - Julia Sheffler
- Center for Translational Behavioral Science, Florida State University, United States of America
| | - Russell Mach
- Department of Psychology, University of Arkansas, United States of America
| | - Dawn Carr
- Department of Sociology, Florida State University, United States of America
| | - Dimitris Kiosses
- Weill Cornell Medical College, Cornell University, United States of America
| | - Greg Hajcak
- Department of Psychology, Florida State University, United States of America
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Moye J, Kaiser AP, Cook J, Pietrzak RH. Post-traumatic Stress Disorder in Older U.S. Military Veterans: Prevalence, Characteristics, and Psychiatric and Functional Burden. Am J Geriatr Psychiatry 2022; 30:606-618. [PMID: 34823979 PMCID: PMC8983567 DOI: 10.1016/j.jagp.2021.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize the prevalence, characteristics, and comorbidities of subthreshold and full post-traumatic stress disorder (PTSD) in older U.S. military veterans. DESIGN AND SETTING A nationally representative web-based survey of older U.S. military veterans who participated in the National Health and Resilience in Veterans Study (NHRVS) between November 18, 2019 and March 8, 2020. PARTICIPANTS U.S. veterans aged 60 and older (n = 3,001; mean age = 73.2, SD: 7.9, range: 60-99). MEASUREMENTS PTSD was assessed using the PTSD Checklist for DSM-5. Self-report measures assessed sociodemographic characteristics, trauma exposures, suicidal behaviors, psychiatric and substance use disorders, as well as mental, cognitive, and physical functioning. Multivariable analyses examined correlates of subthreshold and full PTSD. RESULTS The vast majority of the sample (n = 2,821; 92.7%) reported exposure to one or more potentially traumatic events. Of those exposed to such events, 262 (9.6%, 95% confidence interval [CI]: 8.4%-10.9%) and 68 (1.9%, 95% CI: 1.3%-2.6%) screened positive for subthreshold and full PTSD, respectively. The prevalence of subthreshold and full PTSD was significantly higher in female veterans and veterans who use VA as their primary healthcare. Subthreshold and full PTSD groups endorsed more adverse childhood experiences and total traumas than the no/minimal PTSD symptom group, the most common traumatic experiences endorsed were combat exposure, physical or sexual assault, and life-threatening illness or injury. Veterans with subthreshold and full PTSD were also more likely to screen positive for depression, substance use disorders, suicide attempts, nonsuicidal self-injury, and suicidal ideation, and reported lower mental, cognitive, and physical functioning. CONCLUSION Subthreshold PTSD and full PTSD are prevalent and associated with substantial clinical burden in older U.S. veterans. Results underscore the importance of assessing both subthreshold and full PTSD in this population.
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Affiliation(s)
- Jennifer Moye
- VA New England Geriatric Research Education and Clinical Center (GRECC) (JM), Boston, MA; VA Boston Healthcare System (JM, APK), Boston, MA; Department of Psychiatry, Harvard Medical School (JM), Boston, MA.
| | - Anica Pless Kaiser
- VA Boston Healthcare System (JM, APK), Boston, MA; National Center for PTSD (APK), Boston MA; Boston University School of Medicine (APK), Boston, MA
| | - Joan Cook
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System (JC, RHP), West Haven, CT; Department of Psychiatry, Yale School of Medicine (JC, RHP), New Haven, CT
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System (JC, RHP), West Haven, CT; Department of Psychiatry, Yale School of Medicine (JC, RHP), New Haven, CT; Department of Social and Behavioral Sciences, Yale School of Public Health (RHP), New Haven, CT
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Karel MJ, Wray LO, Adler G, Hannum AOR, Luci K, Brady LA, McGuire MH. Mental Health Needs of Aging Veterans: Recent Evidence and Clinical Recommendations. Clin Gerontol 2022; 45:252-271. [PMID: 31971092 DOI: 10.1080/07317115.2020.1716910] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Large numbers of older Americans have a history of military service, which may be positively or negatively associated with mental health in late life. We reviewed literature with the aim of better understanding the mental health needs of older Veterans.Methods: Articles included those published in 2009-2018 and focused on prevalence/risk for mental illness and suicide among older Veterans; utilization of mental health services; effectiveness of evidence-based behavioral treatments; and pertinent care delivery models.Results: Older Veterans are generally resilient. A significant minority experience mental health concerns that are associated with poor outcomes including a substantial number of suicides. Most published research is based on the approximately one third of Veterans who use the Veterans Health Administration (VHA) for care. Older Veterans with mental health diagnoses are less likely to utilize mental health services compared to younger Veterans, but as likely to benefit once engaged. Integrated care models in primary and geriatric care settings are promising.Conclusions: Aging Veterans are a large subset of Americans whose mental health needs are complex and deserve attention.Clinical Implications: Clinicians should ask about history of military service (i.e., Veteran status) and utilize available resources when providing care for older Veterans.
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Affiliation(s)
- Michele J Karel
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, DC, United States
| | - Laura O Wray
- VA Center for Integrated Healthcare, VA Western New York Health Care System, Buffalo, New York, United States.,Jacobs School of Medicine and Biomedical Sciences, SUNY University at Buffalo, Buffalo, New York, United States
| | - Geri Adler
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
| | - Alisa O' Riley Hannum
- Mental Health Service, VA Eastern Colorado Healthcare System, Colorado Springs, Colorado, United States
| | - Katherine Luci
- Center for Aging and Neurocognitive Services, Salem VA Medical Center, Salem, Virginia, United States.,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Blacksburg, Virginia, United States
| | - Laura A Brady
- Jacobs School of Medicine and Biomedical Sciences, SUNY University at Buffalo, Buffalo, New York, United States
| | - Marsden H McGuire
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, DC, United States
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Stellman JM, Stellman SD, Spiro A, Pless Kaiser A, Smith BN. Impact of Military Service in Vietnam on Coping and Health Behaviors of Aging Veterans During the COVID-19 Pandemic. Front Public Health 2022; 9:809357. [PMID: 35111722 PMCID: PMC8802994 DOI: 10.3389/fpubh.2021.809357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Many Vietnam War veterans who experienced military trauma still exhibit PTSD symptomatology. Little is known about how new stressful situations, like the COVID-19 pandemic, affect previously traumatized people or whether they will react differently to them. We explore whether military combat experiences in Vietnam affect veterans' perceived abilities to cope with COVID-19 and whether current PTSD symptoms and later-adulthood reengagement with trauma memories are related to coping. We examine the extent that current PTSD symptoms and trauma reengagement relate to preventive practices. Participants were part of a randomly sampled cohort of American Legionnaires who responded to two previous surveys (1984, 1998), were born 1945-1953 and deployed to Vietnam 1963-1973, thus representing an aging veteran population. A survey supplement assessed coping with the pandemic and adherence to public health guidelines. The response rate was 74% (N = 507); 422 (61.6%) completed the COVID-19 supplement. Military experiences were found to affect coping with 41.4% reporting they affected ability to cope with COVID-19. Medium- and high-combat veterans were more likely to report that military experience affected coping than low-combat (OR 2.4, 95% CI 1.51–3.96; 2.6, 95% CI 1.41–4.61, respectively). Those with high PTSD scores had 7.7-fold (95% CI 4.3–13.17) increased likelihood of reporting that their coping was affected, compared to low-PTSD scorers. Few adopted social distancing (4%), staying at home (17%), or ceasing usual activities (32%); high-combat veterans were least likely to stay home. Veterans who practiced handwashing, sanitizer use, mask-wearing, and surface disinfection had significantly higher PTSD scores than those who did not. Veterans with higher scores on the LOSS-SF scale associated more reengagement with trauma memories and were more likely to engage in personal preventive strategies. Analysis of open-ended responses supported these findings. We conclude that fifty years after returning from Vietnam, PTSD scores were high for high-combat veterans, suggestive of PTSD diagnosis. Military experiences affected coping with COVID both positively and negatively, and may have helped instill useful personal health behaviors. Veterans, especially those with PTSD symptomatology, may have special needs during stressful times, like the COVID-19 pandemic, affecting compliance with recommended practices, as well as their overall health and well-being.
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Affiliation(s)
- Jeanne M. Stellman
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, United States
- *Correspondence: Jeanne M. Stellman
| | - Steven D. Stellman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System and Departments of Epidemiology and Psychiatry, Boston University Schools of Public Health and Medicine, Boston, MA, United States
| | - Anica Pless Kaiser
- National Center for PTSD Behavioral Science Division at VA Boston Healthcare System and Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Brian N. Smith
- National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System and Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
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Yang MS, Quach L, Lee LO, Spiro A, Burr JA. Subjective well-being among male veterans in later life: the enduring effects of early life adversity. Aging Ment Health 2022; 26:107-115. [PMID: 33170037 PMCID: PMC9239431 DOI: 10.1080/13607863.2020.1842999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study investigated the association between childhood and young adult adversities and later-life subjective well-being among older male veterans. We also explored whether early-life parent-child relationships and later-life social engagement served as moderators and mediators, respectively. METHODS Data were from the 2008 to 2012 waves of the Health and Retirement Study for male veterans (N = 2026). Subjective well-being measures included depressive symptoms, self-rated health, and life satisfaction. Linear regression with the Process macro was employed to estimate the relationships. RESULTS Adverse childhood experiences (ACEs) were positively associated with number of depressive symptoms and negatively related to life satisfaction. Combat exposure, a young adulthood adversity experience, was positively associated with depressive symptoms, but not with self-rated health or life satisfaction. Later-life social engagement mediated the relationship between ACEs and subjective well-being indices. Parent-child relationship quality did not moderate the association between the measures of adversity and any measure of subjective well-being. DISCUSSION Childhood adversity and combat exposure were related to worse later life subjective well-being. Also, later-life social engagement mediated the association of two early life adversity measures and subjective well-being. Future research should examine subjective well-being and early life adversity for female veterans and should employ more detailed information about combat exposure.
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Affiliation(s)
- Mai See Yang
- Center on Demography and Economics of Aging, University of Chicago
| | - Lien Quach
- Department of Veterans Affairs, Boston Healthcare System and University of Massachusetts Boston
| | - Lewina O. Lee
- Boston University and Department of Veterans Affairs, Boston Healthcare System
| | - Avron Spiro
- Department of Veterans Affairs, Boston Healthcare System and Boston University
| | - Jeffrey A. Burr
- Department of Gerontology, University of Massachusetts Boston
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Abstract
Posttraumatic stress disorder (PTSD) can occur at any point in the life span and can last for decades. Chronic PTSD can affect quality of life and have a negative impact on physical function and health in the elderly and may be associated with premature aging and dementia. It is critical that clinicians screen for trauma-based symptoms and to treat as appropriate.
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Affiliation(s)
- Rebekah J Jakel
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 3950, Durham, NC 27710, USA.
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13
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Albright DL, McDaniel J, Suntai Z, Wallace J. Alcohol misuse among older military veterans: an intersectionality theory perspective. J Addict Dis 2021; 39:504-512. [PMID: 33709881 DOI: 10.1080/10550887.2021.1897201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Alcohol misuse among older adults is an emerging public health issue. Older veterans are particularly at risk of developing substance use dependency due to the enduring impacts of military service. The purpose of this study was to test the theory of intersectionality on alcohol misuse by veteran status and age, veteran status and sex, and veteran status and race. METHODS Combined data from the 2016, 2017, and 2018 Brief Risk Factor Resilience Survey (BRFSS) from the Centers for Disease Control and Prevention (CDC) were used in this cross-sectional study. The BRFSS is conducted annually with adults via landline or cellular telephones in all 50 states in the United States, as well as in the District of Columbia, Puerto Rico, and Guam. Alcohol misuse among individuals aged 65+ was examined by veteran status and the interaction between age, race, and sex using survey-weighted logistic regression models. RESULTS Results show no interaction between veteran status and age or sex. For the interaction between veteran status and race, significant disparities were found. Black/Other race veterans were significantly more likely to engage in binge drinking and heavy drinking compared to nonveterans of the same race, White veterans, and White nonveterans. CONCLUSION Older veterans who are also Black, Indigenous and/or people of color (BIPOC) are at great risk of engaging in alcohol misuse due to the combined stressors from their intersectional identities. Interventions targeting this population should consider the historical, cultural, and systemic factors that contribute to a disproportionally higher rate of binge drinking and heavy drinking among BIPOC veterans.
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Affiliation(s)
- David L Albright
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Justin McDaniel
- School of Human Sciences, Southern Illinois University, Carbondale, IL, USA
| | - Zainab Suntai
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Juliane Wallace
- School of Human Sciences, Southern Illinois University, Carbondale, IL, USA
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Sachs-Ericsson N, Carr D, Sheffler J, Preston TJ, Kiosses D, Hajcak G. Cognitive reappraisal and the association between depressive symptoms and perceived social support among older adults. Aging Ment Health 2021; 25:453-461. [PMID: 31876170 DOI: 10.1080/13607863.2019.1698516] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES There is an association between depression and diminished social support; indeed, interpersonal dysfunction is often a central feature of depression. The purpose of this study is to examine the role that an emotion regulation (ER) strategy, cognitive reappraisal, plays in influencing the association between depressive symptoms and perceived social support in older adults. METHOD Data for this cross-sectional study come from a community-based survey of older adults (60+, N = 910). We examined the effects of depressive symptoms and cognitive reappraisal on perceived social support. We then examined the potential moderating role of cognitive reappraisal on the association between depressive symptoms and perceived social support. RESULTS Depressive symptoms were associated with lower levels of perceived social support. Cognitive reappraisal was associated with higher levels of perceived social support. Cognitive reappraisal moderated the negative consequences of depressive symptoms on perceived social support. Whereas depressive symptoms had a negative effect on perceived social support, the negative effect was greater for those with lower levels of cognitive reappraisal compared to those with higher levels of cognitive reappraisal. DISCUSSION ER strategies may play a role in attenuating the negative consequences of depressive symptoms on social support in older age. It may be possible to help individuals maintain social support in later life, even in the face of mental health challenges, if they cultivate ER skills.
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Affiliation(s)
| | - Dawn Carr
- Department of Sociology, Florida State University, Tallahassee, FL, USA
| | - Julia Sheffler
- Center for Translational Behavioral Science, Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Thomas J Preston
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Dimitris Kiosses
- Department of Clinical Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Greg Hajcak
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Yang MS, Hedeker D. A life-span approach to examining older vulnerable population's subjective well-being: the role of adversity and trauma. Aging Ment Health 2020; 24:2043-2052. [PMID: 31402675 PMCID: PMC9239433 DOI: 10.1080/13607863.2019.1652245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Using the life course guidance, the goal of this study was to examine the degree to which previously experienced adversity and trauma was associated with subjective well-being among older adults. METHODS Data from the Health and Retirement Study (1992-2012) was used to examine these trends over time. We used multilevel models to test for specific individual change across time. The study sample included older community dwellers aged 55 and over (N = 5,649). RESULTS In terms of early childhood adversities, 77% experienced at least one trauma and 72% experienced at least one trauma in adulthood. Adverse childhood experiences and adulthood trauma were predictors of depressive symptoms, poorer self-rated health, and worse life satisfaction. Older black, other race, and Hispanic groups have poorer subjective well-being overtime compared to whites. CONCLUSION Findings suggested exposure to childhood adversities and adulthood trauma increases depressive symptoms, poor self-rated health, and low satisfaction of life over time. Findings from this study provide insight into how life course exposure of adversity and trauma among older adults showed a negative trend over time.
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Affiliation(s)
- Mai See Yang
- Center on Demography and Economics of Aging, University of Chicago
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago
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Bickel KE, Kennedy R, Levy C, Burgio KL, Bailey FA. The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis. J Gen Intern Med 2020; 35:505-513. [PMID: 31792872 PMCID: PMC7018872 DOI: 10.1007/s11606-019-05538-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/06/2019] [Accepted: 10/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) can be exacerbated by subsequent trauma, but it is unclear if symptoms are worsened by impending death. PTSD symptoms, including hyperarousal, negative mood and thoughts, and traumatic re-experiencing, can impact end-of-life symptoms, including pain, mood, and poor sleep. Thus, increased symptoms may lead to increased end-of-life healthcare utilization. OBJECTIVES To determine if veterans with PTSD have increased end-of-life healthcare utilization or medication use and to examine predictors of medication administration. DESIGN Secondary analysis of a stepped-wedge design implementation trial to improve end-of-life care for Veterans Affairs (VA) inpatients. Outcome variables were collected via direct chart review. Analyses included hierarchical, generalized estimating equation models, clustered by medical center. SUBJECTS Veterans, inpatient at one of six VA facilities, dying between 2005 and 2011. MAIN MEASURES Emergency room (ER) visits, hospitalizations, and medication administration in the last 7 days of life. KEY RESULTS Of 5341 veterans, 468 (8.76%) had PTSD. Of those, 21.4% (100/468) had major depression and 36.5% (171/468) had anxiety. Veterans with PTSD were younger (mean age 65.4 PTSD, 70.5 no PTSD, p < 0.0001) and had more VA hospitalizations and ER visits in the last 12 months of life (admissions: PTSD 2.8, no PTSD 2.4, p < 0.0001; ER visits: 3.2 vs 2.5, p < 0.0001). PTSD was associated with antipsychotic administration (OR 1.52, 95% CI 1.06-2.18). Major depression (333/5341, 6.2%) was associated with opioid administration (OR 1.348, 95% CI 1.129-1.609) and benzodiazepines (OR 1.489, 95% CI 1.141-1.943). Anxiety disorders (778/5341, 14.6%) were only associated with benzodiazepines (OR 1.598, 95% CI 1.194-2.138). CONCLUSIONS PTSD's association with increased end-of-life healthcare utilization and increased antipsychotic administration in the final days of life suggests increased symptom burden and potential for terminal delirium in individuals with PTSD. Understanding the burden of psychiatric illness and potential risks for delirium may facilitate the end-of-life care for these patients. TRIAL REGISTRATION NCT00234286.
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Affiliation(s)
- Kathleen E Bickel
- University of Colorado School of Medicine, Rocky Mountain VA Medical Center, Mail Stop B180, Academic Office One, 12631 E 17th Ave, Room 8407, Aurora, CO, 80045-2527, USA.
- Rocky Mountain Veterans Affairs Medical Center, Aurora, USA.
| | - Richard Kennedy
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cari Levy
- University of Colorado School of Medicine, Rocky Mountain VA Medical Center, Mail Stop B180, Academic Office One, 12631 E 17th Ave, Room 8407, Aurora, CO, 80045-2527, USA
- Rocky Mountain Veterans Affairs Medical Center, Aurora, USA
| | - Kathryn L Burgio
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - F Amos Bailey
- University of Colorado School of Medicine, Rocky Mountain VA Medical Center, Mail Stop B180, Academic Office One, 12631 E 17th Ave, Room 8407, Aurora, CO, 80045-2527, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
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Korinek K, Teerawichitchainan B, Zimmer Z, Brindle E, Nguyen TKC, Nguyen HM, Tran KT. Design and measurement in a study of war exposure, health, and aging: protocol for the Vietnam health and aging study. BMC Public Health 2019; 19:1351. [PMID: 31646987 PMCID: PMC6806496 DOI: 10.1186/s12889-019-7680-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survivors of war throughout the world experience illnesses and injuries that are crucial to understand, given the ongoing treatment and adaptation they demand. In developing countries like Vietnam, where population aging and chronic disease burdens are rapidly rising, aging populations have seen a disproportionate share of armed conflict and related casualties. This paper describes the Vietnam Health and Aging Study (VHAS), a unique resource for investigating mechanisms of association between diverse exposures to armed conflict during the Vietnam War and multiple dimensions of older adult health among survivors of that war. METHODS The VHAS utilizes a longitudinal design, the first wave of data collection conducted in 2018 among 2447 older adults. A second wave of follow-up data collection, scheduled to take place in 2021, will examine life course, social relational and health and mortality transitions. The VHAS was conducted in four northern Vietnamese districts purposively selected to represent a spectrum of war exposure as indicated by intensity of bombings. Additionally, VHAS uses random sampling within gender and military service subdomains to permit unique gender-specific analyses of military service, trauma exposure and health. The VHAS' face-to-face interviews include modules detailing war and military service experiences; warzone stressors; and multiple dimensions of health such as chronic disease, functional limitation, disability, health behaviors, cognition and psychological health. Biomarker data collected for the full VHAS sample includes anthropometric and functional tests such as grip strength and blood pressure, hair samples for cortisol assay, and capillary blood samples to assay C-reactive protein, cholesterol, HbA1c, and other markers of interest for cardiovascular and other disease risks and for testing the impact of early life stressors on later life health. Blood samples will also permit epigenetic analysis of biological aging. DISCUSSION Future VHAS investigations will examine dynamic linkages between war exposure, mortality and morbidity, while taking into account the selective nature of each of these processes. Longitudinal analyses will examine late-life health transitions and war-related resiliency.
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Affiliation(s)
- Kim Korinek
- Department of Sociology, University of Utah, 380 S 1530 E, Room 301, Salt Lake City, Utah, USA.
| | | | | | | | | | - Huu Minh Nguyen
- Vietnam Institute for Family and Gender Studies, Hanoi, Vietnam
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Carr DC, Taylor MG, Meyer A, Sachs-Ericsson NJ. The Role of Maternal Relationship in the Persisting Effect of Combat Exposure. Innov Aging 2019; 3:igz007. [PMID: 30972373 PMCID: PMC6450661 DOI: 10.1093/geroni/igz007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Indexed: 01/07/2023] Open
Abstract
Background and Objectives The veteran population is aging. Combat exposure is associated with negative health and psychological outcomes in some, but not all veterans; others even appear to experience gains. One mechanism driving these varied responses might be early life relationships. This study investigated the extent to which the quality of early maternal relationships influences the association between combat exposures and life satisfaction (LS) among older male veterans. Research Design and Methods Data were drawn from a pooled sample of male veterans in the Health and Retirement Study who completed the 2013 Veteran Mail Survey (N = 1,160). We used ordinary least squares regression to examine the association between combat exposures (with and without exposure to death) and LS, and the moderating effect of maternal relationship quality on this association. Results We found a significant positive association between maternal relationship quality and LS, and a significant association of combat that was dependent on maternal relationship quality. Specifically, combat-exposed veterans with poor maternal relationship quality reported lower LS, whereas combat-exposed veterans with high relationship quality reported higher LS—relative to their noncombat-exposed counterparts. The effects of exposure to death of hazardous toxins did not mediate or moderate this relationship. Discussion and Implications Findings indicate that maternal relationships had a lasting influence on whether combat contributed to a positive, negative, or neutral long-term effect on wellbeing. Findings support previous studies that suggest early life factors may play an important role in the fostering of resilient health outcomes over the life course. Implications for preventative strategies in soldiers are discussed.
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Affiliation(s)
- Dawn C Carr
- Department of Sociology, Pepper Institute on Aging and Social Policy, Tallahassee
- Address correspondence to: Dawn C. Carr, PhD, Department of Sociology, Florida State University, Tallahassee, FL 32306-1121. E-mail:
| | - Miles G Taylor
- Department of Sociology, Pepper Institute on Aging and Social Policy, Tallahassee
| | - Alex Meyer
- Department of Psychology, Florida State University, Tallahassee
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Cheng W, Han F, Shi Y. Neonatal isolation modulates glucocorticoid-receptor function and synaptic plasticity of hippocampal and amygdala neurons in a rat model of single prolonged stress. J Affect Disord 2019; 246:682-694. [PMID: 30611912 DOI: 10.1016/j.jad.2018.12.084] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/23/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Early life and stressful experiences affect hippocampal and amygdala structure and function. They also increase the incidence of mental and nervous system disorders in adults. However, prospective studies have yet to show if early-life experiences affect the risk/severity of post-traumatic stress disorder (PTSD). METHODS We applied neonatal isolation (NI) alone, single prolonged stress (SPS) alone and NI + SPS to rats. We evaluated anxiety-like behavior and spatial memory of behavior using open field, elevated plus maze, and Morris water maze tests. Then, we measured expression of glucocorticoid receptors (GRs) and synaptic-related proteins by immunofluorescence, immunohistochemistry and western blotting in the hippocampus and amygdala. RESULTS NI + SPS exacerbated the increased anxiety levels and impaired spatial memory induced by NI alone or SPS alone. NI alone or SPS alone induced varying degrees of change in expression of GRs and synaptic proteins (synapsin I and postsynaptic density protein-95) in the hippocampus and amygdala. There were opposite changes in GR expression in the hippocampal dentate gyrus and basolateral amygdala. The degree of such change was exacerbated considerably by NI + SPS. In addition, neuroligin (NLG)-1 and NLG-2 were distributed in postsynaptic sites of excitatory and inhibitory synapses, respectively. NI, SPS, and NI + SPS altered the patterns of NLG-1 and NLG-2 colocalization as well as their intensity. NI + SPS strengthened the increased ratio of NLG-1/NLG-2 in the hippocampus, but decreased this ratio in the amygdala. CONCLUSIONS NI and SPS together induced greater degrees of change in anxiety and spatial memory, as well as GR and synaptic protein levels, in the hippocampus and amygdala than the changes induced by NI alone or SPS alone.
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Affiliation(s)
- Wei Cheng
- PTSD Laboratory, Department of Histology and Embryology, Basic Medical Sciences College, China Medical University, 77, Puhe Road, Shenbei New District, 110001 Shenyang, China; Neonatal Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Fan Han
- PTSD Laboratory, Department of Histology and Embryology, Basic Medical Sciences College, China Medical University, 77, Puhe Road, Shenbei New District, 110001 Shenyang, China
| | - Yuxiu Shi
- PTSD Laboratory, Department of Histology and Embryology, Basic Medical Sciences College, China Medical University, 77, Puhe Road, Shenbei New District, 110001 Shenyang, China.
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Chukwuorji JBC, Ifeagwazi CM, Eze JE. Event centrality influences posttraumatic stress disorder symptoms via core beliefs in internally displaced older adults. Aging Ment Health 2019; 23:113-121. [PMID: 29099623 DOI: 10.1080/13607863.2017.1396580] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES There is substantial evidence regarding the role of event centrality (EC) in posttraumatic stress disorder (PTSD) symptoms, but little research has examined the explanatory pathways linking EC with PTSD symptoms severity. The present study examined whether core beliefs (CB) mediates the relationship between EC and PTSD symptoms in internally displaced older adults. METHOD Internally displaced older adults (N = 279; mean age = 62 years) sheltered in two camps located in north-central Nigeria, completed Tiv language versions of self-report measures, namely, the Harvard Trauma Questionnaire, the Centrality of Event Scale, Core Beliefs Inventory, and provided relevant demographic information. RESULTS Analysis indicated that EC and CB were linked to greater PTSD symptoms as well as re-experiencing/intrusion, avoidance and hyperarousal symptoms severity. The mediator path was significant which implies that CB was a pathway through which EC influences PTSD symptoms clusters and overall PTSD symptomatology. CONCLUSION A traumatic event becoming more central in a person's identity and life story distorts entrenched beliefs about oneself, others and the world, thereby resulting in greater PTSD symptoms. Our findings suggest that considerations of disrupted world assumptions may be a salient target for prevention and treatment efforts.
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Affiliation(s)
| | - Chuka Mike Ifeagwazi
- a Department of Psychology , University of Nigeria , Nsukka , Enugu state , Nigeria
| | - John E Eze
- a Department of Psychology , University of Nigeria , Nsukka , Enugu state , Nigeria
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Abstract
Purpose
The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas.
Design/methodology/approach
This is a descriptive paper summarizing population and program data about rural veterans.
Findings
VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas.
Originality/value
This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans.
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Abstract
Posttraumatic stress disorder (PTSD) can occur at any point in the life span and can last for decades. Chronic PTSD can affect quality of life and have a negative impact on physical function and health in the elderly and may be associated with premature aging and dementia. It is critical that clinicians screen for trauma-based symptoms and to treat as appropriate.
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Affiliation(s)
- Rebekah J Jakel
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 3950, Durham, NC 27710, USA.
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Hoy-Ellis CP, Shiu C, Sullivan KM, Kim HJ, Sturges AM, Fredriksen-Goldsen KI. Prior Military Service, Identity Stigma, and Mental Health Among Transgender Older Adults. THE GERONTOLOGIST 2017; 57:S63-S71. [PMID: 28087796 DOI: 10.1093/geront/gnw173] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/21/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Converging evidence from large community-based samples, Internet studies, and Veterans Health Administration data suggest that transgender adults have high rates of U.S. military service. However, little is known about the role of prior military service in their mental health later in life, particularly in relation to identity stigma. In this article, we examine relationships between prior military service, identity stigma, and mental health among transgender older adults. DESIGN AND METHODS We used a subsample of transgender older adults (n = 183) from the 2014 survey of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS). We employed weighted multivariate linear models to evaluate the relationships between psychological health-related quality of life (HRQOL), depressive symptomatology (Center for Epidemiological Studies Depression Scale [CES-D] scores), identity stigma, and prior military service, controlling for background characteristics. RESULTS Identity stigma was significantly related with higher depressive symptomatology and lower psychological HRQOL. Having a history of prior military service significantly predicted lower depressive symptomatology and higher psychological HRQOL. The relationships between psychological HRQOL, identity stigma, and prior military service were largely explained by depressive symptomatology. Prior military service significantly attenuated the relationship between identity stigma and depressive symptomatology. IMPLICATIONS By identifying the role of military service in the mental health of transgender older adults, this study provides insights into how prior military service may contribute to resilience and positive mental health outcomes. Directions for future research are discussed.
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Affiliation(s)
| | - Chengshi Shiu
- School of Social Work, University of Washington, Seattle
| | | | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
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Flatt JD, Williams BA, Barnes D, Goldenson J, Ahalt C. Post-traumatic stress disorder symptoms and associated health and social vulnerabilities in older jail inmates. Aging Ment Health 2017; 21:1106-1112. [PMID: 27367335 PMCID: PMC5580931 DOI: 10.1080/13607863.2016.1201042] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine post-traumatic stress disorder (PTSD) symptoms in older jail inmates, and to determine whether adverse social and health-related characteristics were associated with having PTSD symptoms. METHOD We performed an exploratory cross-sectional study of 238 older (age ≥55 years) jail inmates from a county jail. PTSD symptoms were determined using the Primary Care PTSD (PC-PTSD) screen. Reporting three or more PTSD symptoms was defined as a positive screen. Descriptive statistics and multiple regression analyses were used to examine the prevalence of a positive PTSD screen and associations with social and health-related characteristics. RESULTS The mean age was 59 years, 64% were Black, and 82% reported an annual income ≤$15,000. Nearly 40% of older jail inmates had a positive PTSD screen and 10% reported a prior PTSD diagnosis by a physician. Older jail inmates with a positive PTSD screen were significantly more likely than those with a negative PTSD screen to report medication insecurity in the past year, impairment in two or more activities of daily living, traumatic brain injury, pain in the past week, and poor self-rated health. CONCLUSION Over one in three of the older jail inmates in this study had a positive PTSD screen, though only one in five of those with a positive screen reported a prior PTSD diagnosis. Screening for PTSD in jails may help identify older inmates who would benefit from additional mental health treatment and reentry planning to improve health in this population.
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Affiliation(s)
- Jason D. Flatt
- Institute for Health & Aging, University of California, San Francisco, CA, USA,San Francisco Veteran Affairs Medical Center, San Francisco, CA, USA
| | - Brie A. Williams
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA,San Francisco Veteran Affairs Medical Center, San Francisco, CA, USA
| | - Deborah Barnes
- San Francisco Veteran Affairs Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Joe Goldenson
- Jail Health Services, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Cyrus Ahalt
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
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