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Pejic SR, Deska JC. Biased Beliefs About White Releasees' Sensitivity to Social Pain. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2023:1461672231207952. [PMID: 37970814 DOI: 10.1177/01461672231207952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The accurate perception of others' pain is a prerequisite to provide needed support. However, social pain perception is prone to biases. Multiple characteristics of individuals bias both physical and social pain judgments (e.g., ethnicity and facial structure). The current work extends this research to a chronically stigmatized population: released prisoners (i.e., releasees). Recognizing the large United States releasee rates and the significant role support plays in successful re-integration, we conducted four studies testing whether people have biased judgments of White male releasees' sensitivity to social pain. Compared with the noncriminally involved, people judged releasees as less sensitive to social pain in otherwise identical situations (Studies 1a-3), an effect that was mediated by perceived life hardship (Study 2). Finally, judging releasees' as relatively insensitive to social pain undermined perceivers' social support judgments (Study 3). The downstream consequences of these findings on re-integration success are discussed.
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2
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Cohen GH, Wang R, Sampson L, Lowe SR, Ettman CK, Abdalla SM, Wellenius GA, Cabral H, Ruggiero K, Galea S. Depression and PTSD among Houston Residents who Experienced Hurricane Harvey and COVID-19: Implications for Urban Areas Affected by Multiple Disasters. J Urban Health 2023; 100:860-869. [PMID: 37550501 PMCID: PMC10447846 DOI: 10.1007/s11524-023-00767-2] [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] [Accepted: 06/22/2023] [Indexed: 08/09/2023]
Abstract
Little is known about the combined impact of the COVID-19 pandemic and other major disasters on mental health. Hurricane Harvey hit the Gulf Coast in 2017, resulting in substantial costs, significant levels of displacement, and approximately 100 deaths, and was followed in 2020 by the COVID-19 pandemic. We randomly sampled 1167 Houstonians from 88 designated super-neighborhoods and surveyed them about their demographics, event-specific traumas and stressors, and symptoms of current depression and post-traumatic stress disorder (PTSD). We estimated the prevalence of depression (5.8%) and PTSD (12.6%) more than three years after Hurricane Harvey, and assessed the relative influence of event-specific stressors and traumas on current mental health. Overall, we observed evidence for two key findings that are salient for residents of urban environments in the context of multiple disasters. First, stressors were primary influences on depression, whereas both stressors and traumas influenced PTSD. Second, the influences of stressors and traumas on depression and PTSD symptoms faded with time.
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Affiliation(s)
- Gregory H Cohen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Ruochen Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Laura Sampson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Catherine K Ettman
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Salma M Abdalla
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Kenneth Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Dean's Office, Boston University School of Public Health, Boston, MA, USA
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Martínez-Levy GA, Bermúdez-Gómez J, Flores-Torres RP, Merlín-García I, Nani A, Cruz-Fuentes CS, Briones-Velasco M. Clinical, environmental, and molecular factors associated to the occurrence and persistence of posttraumatic stress disorder after an earthquake. J Psychiatr Res 2022; 154:102-110. [PMID: 35933853 DOI: 10.1016/j.jpsychires.2022.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a common and disabling condition with high incidence after an earthquake. The objective of the present study was to identify risk factors associated with the occurrence and persistence of PTSD. Individuals (18-65 years old) who experienced the earthquake of September 19th, 2017, attended the National Institute of Psychiatry (INPRFM) between October and November 2017 (baseline n = 68). Participants were followed 4-6 (first follow-up, n = 40) and 7-9 (second follow-up n = 41) months after the earthquake. Delay returning to normal activities, a negative emotional valence to a previous earthquake, comorbidity with depression, history of childhood maltreatment, and low expression of Glucocorticoid Receptor (GR) were associated with PTSD in the basal assessment. The earthquake-related variable associated with the persistence of PTSD at the second follow-up was that the earthquake had directly affected the participants, either because they were evicted, had damage to their homes, or suffered some injury. Comorbidity with dysthymia, history of childhood maltreatment, and higher severity of PTSD in the basal assessment were associated with persistent PTSD in the second follow-up. The lower expression of the FK506 binding protein 5 (FKBP5) in participants with persistent PTSD in the second follow-up was better explained by childhood physical abuse than with PTSD severity. These findings suggest that acute exposure to earthquake-related stressful situations is relevant for the initial risk of PTSD, while potential long-term stressful conditions are associated with its persistence. Likewise, molecular markers associated with hypothalamus-pituitary-adrenal-axis dysregulation were differentially associated with PTSD diagnosis at the different assessment times.
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Affiliation(s)
- G A Martínez-Levy
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Av. Mexico-Xochimilco 101, Huipulco, Tlalpan, Mexico City, 14370, Mexico.
| | - J Bermúdez-Gómez
- Servicios Clínicos, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Av. Mexico-Xochimilco 101, Huipulco, Tlalpan, Mexico City, 14370, Mexico.
| | - R P Flores-Torres
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Av. Mexico-Xochimilco 101, Huipulco, Tlalpan, Mexico City, 14370, Mexico.
| | - I Merlín-García
- Servicios Clínicos, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Av. Mexico-Xochimilco 101, Huipulco, Tlalpan, Mexico City, 14370, Mexico.
| | - A Nani
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Av. Mexico-Xochimilco 101, Huipulco, Tlalpan, Mexico City, 14370, Mexico.
| | - C S Cruz-Fuentes
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Av. Mexico-Xochimilco 101, Huipulco, Tlalpan, Mexico City, 14370, Mexico.
| | - M Briones-Velasco
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Av. Mexico-Xochimilco 101, Huipulco, Tlalpan, Mexico City, 14370, Mexico.
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Abdalla SM, Cohen GH, Tamrakar S, Sampson L, Moreland A, Kilpatrick DG, Galea S. Mitigating the mental health consequences of mass shootings: An in-silico experiment. EClinicalMedicine 2022; 51:101555. [PMID: 35898317 PMCID: PMC9310116 DOI: 10.1016/j.eclinm.2022.101555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND There is emerging evidence that mass shootings are associated with adverse mental health outcomes at the community level. Data from other mass-traumatic events examined the effectiveness of usual care (UC), (i.e., psychological first aid approaches without triage), and stepped care (SC) approaches, with triage, in reducing the burden of post-traumatic stress disorder (PTSD) in a community. METHODS We built an agent-based model of 118,000 people that was demographically comparable to the population of Parkland and Coral Springs, Florida, US. We parametrized the model with data from other traumatic events. Using simulations, we then estimated the community prevalence of PTSD one month following the Stoneman Douglas High School (Florida, US) shooting and reported the potential reach, effectiveness, and cost effectiveness of different what-if treatment scenarios (SC or UC) over a two-year period. FINDINGS One month following the mass shooting, PTSD prevalence in the community was 11.3% (95% CI: 11.1-11.5%). The reach of SC was 3461 (95% CI: 3573-3736) per 10,000 and the reach of UC was 2457 (95% CI: 2401-2510) per 10,000. SC was superior to UC in reducing PTSD prevalence, yielding, after two years, a risk difference of -0.044 (95% CI, -0.046 to -0.042) and a risk ratio of 0.452 (95% CI, 0.437-0.468). SC was also superior to UC in reducing the persistence of PTSD, yielding, after two years, a risk difference of -0.39 (95% CI, -0.401 to -0.379) and a risk ratio of 0.452 (95% CI, 0.439-0.465). The incremental cost-effectiveness of SC compared to UC was $2718.49 per DALYs saved, and $0.47 per PTSD-free day. INTERPRETATION This simulation demonstrated the potential benefits of different community-level approaches in mitigating the burden of PTSD following a mass shooting. These results warrant further research on community-based interventions to mitigate the mental health consequences of mass shootings. FUNDING None.
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Affiliation(s)
- Salma M. Abdalla
- Epidemiology Department, School of Public Health, Boston University, Boston, United States
- Corresponding author at: Epidemiology Department, School of Public Health, Boston University, 715 Albany Street - Talbot 510E, Boston, MA 02118.
| | - Gregory H. Cohen
- Epidemiology Department, School of Public Health, Boston University, Boston, United States
| | - Shailesh Tamrakar
- Epidemiology Department, School of Public Health, Boston University, Boston, United States
| | - Laura Sampson
- Epidemiology Department, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Angela Moreland
- Medical University of South Carolina, South Carolina, United States
| | | | - Sandro Galea
- Epidemiology Department, School of Public Health, Boston University, Boston, United States
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Goldstick JE, Jay J. Agent-Based Modeling: an Underutilized Tool in Community Violence Research. CURR EPIDEMIOL REP 2022; 9:135-141. [PMID: 35821794 PMCID: PMC9263807 DOI: 10.1007/s40471-022-00292-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/27/2022]
Abstract
Purpose of Review Recent Findings Summary
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Affiliation(s)
- Jason E. Goldstick
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109-2800 USA
- Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109 USA
- Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48105 USA
| | - Jonathan Jay
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118 USA
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McLaughlin KA, Rosen ML, Kasparek SW, Rodman AM. Stress-related psychopathology during the COVID-19 pandemic. Behav Res Ther 2022; 154:104121. [PMID: 35642991 PMCID: PMC9110305 DOI: 10.1016/j.brat.2022.104121] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic has introduced widespread societal changes that have required ongoing adaptation. Unsurprisingly, stress-related psychopathology has increased during the pandemic, in both children and adults. We review these patterns through the lens of several leading conceptual models of the link between stress and psychopathology. Some of these models focus on characteristics of environmental stressors-including cumulative risk, specific stressor types, and stress sensitization approaches. Understanding the specific aspects of environmental stressors that are most likely to lead to psychopathology can shed light on who may be in most need of clinical intervention. Other models center on factors that can buffer against the onset of psychopathology following stress and the mechanisms through which stressors contribute to emergent psychopathology. These models highlight specific psychosocial processes that may be most usefully targeted by interventions to reduce stress-related psychopathology. We review evidence for each of these stress models in the context of other widescale community-level disruptions, like natural disasters and terrorist attacks, alongside emerging evidence for these stress pathways from the COVID-19 pandemic. We discuss clinical implications for developing interventions to reduce stress-related psychopathology during the pandemic, with a focus on brief, digital interventions that may be more accessible than traditional clinical services.
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Affiliation(s)
| | - Maya L Rosen
- Department of Psychology, Harvard University, USA
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Cerdá M, Hamilton AD, Tracy M, Branas C, Fink D, Keyes KM. Would restricting firearm purchases due to alcohol- and drug-related misdemeanor offenses reduce firearm homicide and suicide? An agent-based simulation. Inj Epidemiol 2022; 9:17. [PMID: 35681243 PMCID: PMC9185952 DOI: 10.1186/s40621-022-00381-x] [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: 11/24/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Substance-related interactions with the criminal justice system are a potential touchpoint to identify people at risk for firearm violence. We used an agent-based model to simulate the change in firearm violence after disqualifying people from owning a firearm given prior alcohol- and drug-related misdemeanors.
Methods We created a population of 800,000 agents reflecting a 15% sample of the adult New York City population. Results Disqualification from purchasing firearms for 5 years after an alcohol-related misdemeanor conviction reduced population-level rates of firearm homicide by 1.0% [95% CI 0.4–1.6%] and suicide by 3.0% [95% CI 1.9–4.0%]. Disqualification based on a drug-related misdemeanor conviction reduced homicide by 1.6% [95% CI 1.1–2.2%] and suicide by 4.6% [95% CI 3.4–5.8%]. Reductions were generally 2 to 8 times larger for agents meeting the disqualification criteria. Conclusions Denying firearm access based on a history of drug and alcohol misdemeanors may reduce firearm violence among the high-risk group. Enactment of substance use-related firearms denial criteria needs to be balanced against concerns about introducing new sources of disenfranchisement among already vulnerable populations.
Supplementary Information The online version contains supplementary material available at 10.1186/s40621-022-00381-x.
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Affiliation(s)
- Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA. .,Department of Population Health, Grossman School of Medicine, NYU Langone Health, 180 Madison Avenue, Room 416, New York, NY, 10016, USA.
| | - Ava D Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Charles Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Keyes KM, Hamilton A, Tracy M, Kagawa RMC, Pear VA, Fink D, Branas CC, Cerdá M. Simulating the bounds of plausibility: Estimating the impact of high-risk versus population-based approaches to prevent firearm injury. PLoS One 2022; 17:e0269372. [PMID: 35653403 PMCID: PMC9162316 DOI: 10.1371/journal.pone.0269372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/02/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Firearm violence remains a persistent public health threat. Comparing the impact of targeted high-risk versus population-based approaches to prevention may point to efficient and efficacious interventions. We used agent-based modeling to conduct a hypothetical experiment contrasting the impact of high-risk (disqualification) and population-based (price increase) approaches on firearm homicide in New York City (NYC). METHODS We simulated 800,000 agents reflecting a 15% sample of the adult population of NYC. Three groups were considered and disqualified from all firearm ownership for five years, grouped based on prevalence: low prevalence (psychiatric hospitalization, alcohol-related misdemeanor and felony convictions, 0.23%); moderate prevalence (drug misdemeanor convictions, domestic violence restraining orders, 1.03%); and high prevalence (all other felony/misdemeanor convictions, 2.30%). Population-level firearm ownership was impacted by increasing the price of firearms, assuming 1% price elasticity. RESULTS In this hypothetical scenario, to reduce firearm homicide by 5% in NYC, 25% of the moderate prevalence group, or 12% of the high prevalence group needed to be effectively disqualified; even when all of the low prevalence group was disqualified, homicide did not decrease by 5%. An 18% increase in price similarly reduced firearm homicide by 5.37% (95% CI 4.43-6.31%). Firearm homicide declined monotonically as the proportion of disqualified individuals increased and/or price increased. A combined intervention that both increased price and effectively disqualified "high-risk" groups achieved approximately double the reduction in homicide as any one intervention alone. Increasing illegal firearm ownership by 20%, a hypothetical response to price increases, did not meaningfully change results. CONCLUSION A key takeaway of our study is that adopting high-risk versus population-based approaches should not be an "either-or" question. When individual risk is variable and diffuse in the population, "high-risk approaches" to firearm violence need to focus on relatively prevalent groups and be highly efficacious in disarming people at elevated risk to achieve meaningful reductions in firearm homicide, though countering issues of social justice and stigma should be carefully considered. Similar reductions can be achieved with population-based approaches, such as price increases, albeit with fewer such countering issues.
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Affiliation(s)
- Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Ava Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, State University of New York at Albany, Albany, New York, United States of America
| | - Rose M. C. Kagawa
- Department of Emergency Medicine, Violence Prevention Research Program, School of Medicine, University of California, Davis, Sacramento, California, United States of America
| | - Veronica A. Pear
- Department of Emergency Medicine, Violence Prevention Research Program, School of Medicine, University of California, Davis, Sacramento, California, United States of America
| | - David Fink
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York, United States of America
| | - Charles C. Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Magdalena Cerdá
- Department of Population Health, New York University Langone Health, New York, New York, United States of America
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Mooney SJ, Shev AB, Keyes KM, Tracy M, Cerdá M. G-Computation and Agent-Based Modeling for Social Epidemiology: Can Population Interventions Prevent Posttraumatic Stress Disorder? Am J Epidemiol 2022; 191:188-197. [PMID: 34409437 PMCID: PMC8897987 DOI: 10.1093/aje/kwab219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
Agent-based modeling and g-computation can both be used to estimate impacts of intervening on complex systems. We explored each modeling approach within an applied example: interventions to reduce posttraumatic stress disorder (PTSD). We used data from a cohort of 2,282 adults representative of the adult population of the New York City metropolitan area from 2002-2006, of whom 16.3% developed PTSD over their lifetimes. We built 4 models: g-computation, an agent-based model (ABM) with no between-agent interactions, an ABM with violent-interaction dynamics, and an ABM with neighborhood dynamics. Three interventions were tested: 1) reducing violent victimization by 37.2% (real-world reduction); 2) reducing violent victimization by100%; and 3) supplementing the income of 20% of lower-income participants. The g-computation model estimated population-level PTSD risk reductions of 0.12% (95% confidence interval (CI): -0.16, 0.29), 0.28% (95% CI: -0.30, 0.70), and 1.55% (95% CI: 0.40, 2.12), respectively. The ABM with no interactions replicated the findings from g-computation. Introduction of interaction dynamics modestly decreased estimated intervention effects (income-supplement risk reduction dropped to 1.47%), whereas introduction of neighborhood dynamics modestly increased effectiveness (income-supplement risk reduction increased to 1.58%). Compared with g-computation, agent-based modeling permitted deeper exploration of complex systems dynamics at the cost of further assumptions.
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Affiliation(s)
- Stephen J Mooney
- Correspondence to Dr. Stephen Mooney, 1959 NE Pacific Street, Health Sciences Building F-262, Box 357236, Seattle, WA 98195 (e-mail: )
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Amaya S, Gray MJ. Cultural Considerations in the Treatment of Latina Survivors of Sexual Assault. JOURNAL OF LOSS & TRAUMA 2021. [DOI: 10.1080/15325024.2021.1926175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stephanie Amaya
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Matt J. Gray
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
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Sakuma A, Ueda I, Shoji W, Tomita H, Matsuoka H, Matsumoto K. Trajectories for Post-traumatic Stress Disorder Symptoms Among Local Disaster Recovery Workers Following the Great East Japan Earthquake: Group-based Trajectory Modeling. J Affect Disord 2020; 274:742-751. [PMID: 32664010 PMCID: PMC7261355 DOI: 10.1016/j.jad.2020.05.152] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND As many local municipality and medical workers were involved in disaster recovery duties following the Great East Japan Earthquake (GEJE) on March 11, 2011, the aim of this work was to elucidate the distinct trajectories for post-traumatic stress disorder (PTSD) symptoms and associated factors among these personnel. They confronted a diverse range of stressors both as survivors and as relief workers; however, little is known about their longitudinal PTSD symptoms. METHODS The participants were 745 local municipality and hospital medical workers [average age: 43.6 ± 9.5 years, range: 20 - 66 years; 306 (59%) women] involved in disaster recovery duties following the GEJE. PTSD symptoms were measured using the Japanese version of the PTSD Checklist Specific Version (PCL-S) at four time points: 14, 30, 43, and 54 months after the GEJE. Using group-based trajectory modeling, distinct trajectories were elucidated. RESULTS We identified five distinct PTSD symptoms profiles: resistance (n = 467, 62.7%), subsyndromal (n = 181, 24.3%), recovery (n = 47, 6.3%), fluctuating (n = 26, 3.5%), and chronic (n = 24, 3.2%). The trajectories differed according to the post-disaster working conditions and personal disaster experiences. LIMITATIONS Potential selection bias resulting from the limited number of participants who completed all waves. The survey was conducted in one region of the disaster area. CONCLUSIONS The majority of participants remained stable, with a relatively small group classified as chronic and fluctuating. Our results highlight the importance of improved working conditions and sustained monitoring of workers responding to natural disasters.
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Affiliation(s)
- Atsushi Sakuma
- Department of Psychiatry, Tohoku University Hospital; Miyagi Disaster Mental Health Care Center.
| | - Ikki Ueda
- Department of Psychiatry, Tohoku University Hospital,Miyagi Disaster Mental Health Care Center
| | - Wataru Shoji
- Department of Human Science, Faculty of Liberal Arts, Tohoku Gakuin University,Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine
| | - Hiroaki Tomita
- Miyagi Disaster Mental Health Care Center,Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine,Department of Psychiatry, Tohoku University Graduate School of Medicine
| | - Hiroo Matsuoka
- Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine
| | - Kazunori Matsumoto
- Miyagi Disaster Mental Health Care Center,Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine,Department of Psychiatry, Tohoku University Graduate School of Medicine
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Hamwey MK, Gargano LM, Friedman LG, Leon LF, Petrsoric LJ, Brackbill RM. Post-Traumatic Stress Disorder among Survivors of the September 11, 2001 World Trade Center Attacks: A Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4344. [PMID: 32560511 PMCID: PMC7344905 DOI: 10.3390/ijerph17124344] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022]
Abstract
Prior reviews of 9/11-related post-traumatic stress disorder (PTSD) have not focused on the civilian survivors most directly exposed to the attacks. Survivors include those individuals who were occupants of buildings in or near the World Trade Center (WTC) towers, those whose primary residence or workplace was in the vicinity, and persons who were on the street passing through the area. This review reports published information on the prevalence of and risk factors for PTSD, as well as comorbidities associated with PTSD among 9/11 survivors. Articles selected for inclusion met the following criteria: (1) full-length, original peer-reviewed empirical articles; (2) published in English from 2002-2019; (3) collected data from persons directly exposed; (4) adult populations; and (5) focused on non-rescue or recovery workers (i.e., survivors). Data were extracted with focus on study design, sample size, time frame of data collection post-9/11, PTSD assessment instrument, and PTSD prevalence, risk factors, and comorbidities. Our review identified the use of cross-sectional and longitudinal designs, finding multiple direct comorbidities with PTSD, as well as the prevalence and persistence of PTSD. Future research would benefit from incorporating more mixed methods designs, and exploring the mediating mechanisms and protective factors of the known associations of PTSD among the 9/11 survivor population.
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Affiliation(s)
| | | | | | | | | | - Robert M. Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (M.K.H.); (L.M.G.); (L.G.F.); (L.F.L.); (L.J.P.)
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Keyes KM, Hamilton A, Swanson J, Tracy M, Cerdá M. Simulating the Suicide Prevention Effects of Firearms Restrictions Based on Psychiatric Hospitalization and Treatment Records: Social Benefits and Unintended Adverse Consequences. Am J Public Health 2020; 109:S236-S243. [PMID: 31242005 DOI: 10.2105/ajph.2019.305041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate the number of lives saved from firearms suicide with expansions of gun restrictions based on mental health compared with the number who would be unnecessarily restricted. Methods. Agent-based models simulated effects on suicide mortality resulting from 5-year ownership disqualifications in New York City for individuals with any psychiatric hospitalization and, more broadly, anyone receiving psychiatric treatment. Results. Restrictions based on New York State Office of Mental Health-identified psychiatric hospitalizations reduced suicide among those hospitalized by 85.1% (95% credible interval = 36.5%, 100.0%). Disqualifications for anyone receiving psychiatric treatment reduced firearm suicide rates among those affected and in the population; however, 244 820 people were prohibited from firearm ownership who would not have died from firearm suicide even without the policy. Conclusions. In this simulation, denying firearm access to individuals in psychiatric treatment reduces firearm suicide among those groups but largely will not affect population rates. Broad and unfeasible disqualification criteria would needlessly restrict millions at low risk, with potential consequences for civil rights, increased stigma, and discouraged help seeking.
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Affiliation(s)
- Katherine M Keyes
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| | - Ava Hamilton
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| | - Jeffrey Swanson
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| | - Melissa Tracy
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| | - Magdalena Cerdá
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
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Amygdala functional connectivity in the acute aftermath of trauma prospectively predicts severity of posttraumatic stress symptoms. Neurobiol Stress 2020; 12:100217. [PMID: 32435666 PMCID: PMC7231977 DOI: 10.1016/j.ynstr.2020.100217] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/20/2020] [Accepted: 03/27/2020] [Indexed: 12/20/2022] Open
Abstract
Understanding neural mechanisms that confer risk for posttraumatic stress disorder (PTSD) is critical for earlier intervention, yet longitudinal work has been sparse. The amygdala is part of a core network consistently implicated in PTSD symptomology. Most neural models of PTSD have focused on the amygdala's interactions with the dorsal anterior cingulate cortex, ventromedial prefrontal cortex, and hippocampus. However, an increasing number of studies have linked PTSD symptoms to aberrations in amygdala functional connections with other brain regions involved in emotional information processing, self-referential processing, somatosensory processing, visual processing, and motor control. In the current study, trauma-exposed individuals (N = 54) recruited from the emergency department completed a resting state fMRI scan as well as a script-driven trauma recall fMRI task scan two-weeks post-trauma along with demographic, PTSD, and other clinical symptom questionnaires two-weeks and six-months post-trauma. We examined whether amygdala-whole brain functional connectivity (FC) during rest and task could predict six-month post-trauma PTSD symptoms. More negative amygdala-cerebellum and amygdala-postcentral gyrus FC during rest as well as more negative amygdala-postcentral gyrus and amygdala-midcingulate cortex during recall of the trauma memory predicted six-month post-trauma PTSD after controlling for scanner type. Follow-up multiple regression sensitivity analyses controlling for several other relevant predictors of PTSD symptoms, revealed that amygdala-cerebellum FC during rest and amygdala-postcentral gyrus FC during trauma recall were particularly robust predictors of six-month PTSD symptoms. The results extend cross-sectional studies implicating abnormal FC of the amygdala with other brain regions involved in somatosensory processing, motor control, and emotional information processing in PTSD, to the prospective prediction of risk for chronic PTSD. This work may contribute to earlier identification of at-risk individuals and elucidate potential intervention targets.
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15
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Espinosa A, Rudenstine S. The contribution of financial well-being, social support, and trait emotional intelligence on psychological distress. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 59:224-240. [PMID: 31889323 DOI: 10.1111/bjc.12242] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/28/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES While financial deprivation, social isolation, and low emotional intelligence (EI) have been separately identified as important predictors of mental illness, no research has assessed the contribution of these factors together in understanding early markers of severe psychological distress. This information can have key implications for the development of comprehensive interventions and psychological treatment programmes. This study investigated the shared and unique contribution of financial well-being, social support, and trait EI on different types of psychological distress. DESIGN A total of 309 patients seeking psychological treatment at an outpatient mental health clinic in the United States provided consent to participate in this study. Patients responded to online questionnaires corresponding to symptomatology, demographic characteristics, and psychometric assessments. METHODS Hierarchical linear regressions identified the common and unique role of each set of variables in predicting nine different symptom clusters of psychological distress. RESULTS Financial well-being, social support, and trait EI were negatively related to the majority of symptom clusters, together explaining between 20% and 53% of the variance. Whereas financial well-being and social support uniquely captured a significant amount of the variance in all outcomes, trait EI, most notably the well-being and self-control dimensions, captured the most. CONCLUSIONS The results highlight the importance of all factors in understanding variations in mental health among help-seeking urban individuals. Furthermore, the results identify well-being and self-control as emotional facets to consider in therapeutic programmes in as much as to mitigate the risk of severe psychological distress within this population. PRACTITIONER POINTS Together, financial well-being, social support, and trait emotional intelligence (EI) can help prevent psychological distress in help-seeking urban individuals. Perceived social support and social contact differentially contributed to improved symptoms of psychological distress. Studies should examine the impact of targeting well-being and self-control in psychological treatment. The correlational nature of this study highlights the need to replicate findings via experimental or longitudinal designs.
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Affiliation(s)
- Adriana Espinosa
- Department of Psychology, City College of New York, CUNY, New York, USA
| | - Sasha Rudenstine
- Department of Psychology, City College of New York, CUNY, New York, USA.,The Graduate Center, CUNY, New York, USA
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16
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Jensen HJ, Oldenburg M. Potentially traumatic experiences of seafarers. J Occup Med Toxicol 2019; 14:17. [PMID: 31164911 PMCID: PMC6544912 DOI: 10.1186/s12995-019-0238-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 05/24/2019] [Indexed: 11/16/2022] Open
Abstract
Background The aim of the present study is to assess the extent to which seafarers had been affected by severe mental stress situations and what possible psychological effects they may have. Methods During the voyages of 22 German ships, a psychologically trained investigator interviewed 323 seafarers about severe mental stress or potentially traumatic events on board (participation rate 88.5%). Furthermore, a psychologist conducted semi-standardized interviews in 12 shipping companies and in 8 stations of the German Seafarers’ Mission on seafarers’ traumatic experiences. Results Of the seafarers surveyed on board, 116 (35.9%) experienced ship wrecks/severe accidents and 55 (17.0%) piracy on board. Experiences with stowaways were indicated by 126 seafarers (39.0%). Repeatedly having to unintentionally think about these events, being reminded of them by certain noises, smells, etc., or often dreaming of them were after-effects in 97 (83.6%) of the affected seafarers after ship wrecks/serious personal accidents on board and in 42 crew members (76.4%) after threats of piracy. Experiences of threat from stowaways had particularly affected non-European seafarers or ratings. According to the interviews with the shipping companies, a total of 14 deaths occurred in the last 3 years in the 12 interviewed shipping companies (due to heart attacks (3), severe cancer (3), very serious accidents (3), suicides (2) and 3 with unknown causes of death). In relation to the container ships of the investigated shipping companies, these frequencies correspond to a mortality rate of 78.4 per 100,000 seafarer years. According to the interviews in 8 Seafarers’ Missions, these organizations are in charge of emergency counselling in the form of crisis intervention when a seafarer has experienced serious psychological stress. Discussion A serious injury or even the death of a member is a serious psychological stress experience for the other crew members in the closed social system on board. These events are particularly distressing for Filipino seafarers with their strong sociocentric bonds and religious values. Priestly support is often required in order to stabilize the Filipino crew members. Conclusion As a preventive measure, psychoeducation for seafarers should be established for coping with extreme mental stress situations.
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Affiliation(s)
| | - Marcus Oldenburg
- 2Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstrasse 10, 20459 Hamburg, Germany
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17
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McLafferty M, O’Neill S, Armour C, Murphy S, Ferry F, Bunting B. The impact of childhood adversities on the development of Posttraumatic Stress Disorder (PTSD) in the Northern Ireland population. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2019. [DOI: 10.1016/j.ejtd.2018.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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18
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Longitudinal Change of PTSD Symptoms in Community Members after the World Trade Center Destruction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071215. [PMID: 30987367 PMCID: PMC6479401 DOI: 10.3390/ijerph16071215] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 12/26/2022]
Abstract
The World Trade Center (WTC) Environmental Health Center (EHC) is a treatment program for community members with exposure to the 9/11 terrorist attack and its physical and emotional aftermath. Compared to the general responders program, the WTC EHC is diverse with equal gender distribution, representation of many races and ethnicities, and a wide range of social economic status. Patients in the WTC EHC were initially enrolled for physical symptoms, most of which were respiratory, however a large portion of the enrollees scored positive for probable posttraumatic stress disorder (PTSD). In this paper we identify patient characteristics associated with probable PTSD. We also determine the characteristics associated with the longitudinal change of PTSD symptoms, including persistence and remittance, using the widely used Posttraumatic Check List-17 (PCL) cut-off value of 44, as well as changes in PCL total score and symptom cluster scores in patients of Low and High PTSD symptom severity. Few patients with elevated scores achieved a score below 44. However, longitudinal improvement in PCL score at follow-up was identified for patients with High PTSD scores (PCL > 57.5). Changes in PCL symptom clusters differed between those with High and Low PCL scores. These data suggest improvement over time in PCL score that differs depending on the severity of the score and variable responses in the PCL symptom clusters.
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19
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Castillo-Carniglia A, Pear VA, Tracy M, Keyes KM, Cerdá M. Limiting Alcohol Outlet Density to Prevent Alcohol Use and Violence: Estimating Policy Interventions Through Agent-Based Modeling. Am J Epidemiol 2019; 188:694-702. [PMID: 30608509 DOI: 10.1093/aje/kwy289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/27/2022] Open
Abstract
Increasing alcohol outlet density is well-documented to be associated with increased alcohol use and problems, leading to the policy recommendation that limiting outlet density will decrease alcohol problems. Yet few studies of decreasing problematic outlets and outlet density have been conducted. We estimated the association between closing alcohol outlets and alcohol use and alcohol-related violence, using an agent-based model of the adult population in New York City. The model was calibrated according to the empirical distribution of the parameters across the city's population, including the density of on- and off-premise alcohol outlets. Interventions capped the alcohol outlet distribution at the 90th to the 50th percentiles of the New York City density, and closed 5% to 25% of outlets with the highest levels of violence. Capping density led to a lower population of light drinkers (42.2% at baseline vs. 38.1% at the 50th percentile), while heavy drinking increased slightly (12.0% at baseline vs. 12.5% at the 50th percentile). Alcohol-related homicides and nonfatal violence remained unchanged. Closing the most violent outlets was not associated with changes in alcohol use or related problems. Results suggest that focusing solely on closing alcohol outlets might not be an effective strategy to reduce alcohol-related problems.
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Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Chile, Santiago, Chile
- Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis, Sacramento, California
| | - Veronica A Pear
- Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis, Sacramento, California
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Albany, New York
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Magdalena Cerdá
- Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis, Sacramento, California
- Department of Population Health, New York University School of Medicine, New York, New York
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20
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Cohen GH, Tamrakar S, Lowe S, Sampson L, Ettman C, Kilpatrick D, Linas BP, Ruggiero K, Galea S. Improved social services and the burden of post-traumatic stress disorder among economically vulnerable people after a natural disaster: a modelling study. Lancet Planet Health 2019; 3:e93-e101. [PMID: 30797416 DOI: 10.1016/s2542-5196(19)30012-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Hurricanes and other natural disasters produce public health and economic consequences that last well beyond their immediate aftermath. Resource loss is a core driver of post-traumatic stress disorder (PTSD) after large-scale traumatic events. We examined the effect of restoration of residential and housing-related financial resources on recovery from PTSD in post-disaster contexts. METHODS We built an agent-based model, empiricised with observational and experimental data, to test the effects of differing health service approaches on PTSD recovery, measured by prevalence and persistence. We tested a social services case management (SSCM) approach similar to Psychological First Aid, featuring shelter-based social service provision and linkage to mental health treatment for people who were displaced and had income loss, by comparing the treatment effectiveness of usual care alone, usual care with SSCM, stepped care alone, and stepped care with SSCM. FINDINGS An SSCM approach to restore housing and provide linkage to mental health services among people who were displaced and had income loss after a large-scale natural disaster resulted in between 1·56 (95% CI 1·55-1·57) and 5·73 (5·04-6·91) times as many remitted PTSD cases as non-SSCM conditions at the end of the first year, and between 1·16 (1·16-1·17) and 2·28 (2·25-2·32) times as many remitted cases at the end of the second year. INTERPRETATION Restoring economic and housing resources to populations affected by a natural disaster would significantly reduce the mental health burden in populations, particularly those with resource loss, after a disaster. FUNDING US Department of Health and Human Services.
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Affiliation(s)
- Gregory H Cohen
- School of Public Health, Boston University, Boston, MA, USA; Mailman School of Public Health, Columbia University, New York, NY, USA.
| | | | - Sarah Lowe
- Department of Psychology, Montclair State University, Montclair, NJ, USA
| | - Laura Sampson
- School of Public Health, Boston University, Boston, MA, USA
| | | | - Dean Kilpatrick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Benjamin P Linas
- School of Public Health, Boston University, Boston, MA, USA; School of Medicine, Boston University, Boston, MA, USA
| | - Kenneth Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
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21
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Armes SE, Seponski DM, Kao S, Khann S, Lahar CJ, Bryant CM, Bride BE, Wickrama KS, Bunnak P, Schunert T. Exploring Contextual Trauma in Cambodia: A Sociointerpersonal Perspective on Posttraumatic Stress Disorder. J Trauma Stress 2019; 32:97-107. [PMID: 30694567 DOI: 10.1002/jts.22365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 10/25/2018] [Accepted: 10/31/2018] [Indexed: 11/06/2022]
Abstract
Trauma literature has proposed multiple theories of trauma development, maintenance, and transmission, which has led to a lack of clarity surrounding trauma in individuals, families, and communities. We investigated the impact of community-level trauma experiences on individual posttraumatic stress disorder (PTSD) symptoms using a sociointerpersonal model of PTSD (Maerker & Horn, 2013). A nationally representative sample (N = 2, 690) of Cambodian households across all regions of the country was surveyed regarding individual trauma experiences during and after the Khmer Rouge regime, symptoms of PTSD, and current stressors. Individual experiences of war trauma and current stressors were aggregated based on the district in which each individual lived. District mean and individual war trauma and current stressors were included in a multilevel model as predictors of individual levels of PTSD. Findings indicated that mean trauma experiences, β = .05, p < .001, and current stressors, β = .10, p < .001, in the district in which individuals live were positively and significantly associated with their individual PTSD symptoms. Individual war trauma, β = .02, p < .001, and current stressors, β = .08, p < .001, were also positively and significantly associated with individual PTSD symptoms. District trauma experiences accounted for 7% of the variance in individual PTSD symptoms, R2 Level 1 = .21, R2 Level 2 = .80. Additionally, current stressors at both the individual and district levels had a greater impact on individual PTSD symptoms than war trauma at either level of the model. Implications for policy and intervention are presented.
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Affiliation(s)
- Stephanie E Armes
- Department of Human Development and Family Science, University of Georgia, Athens, Georgia, USA
| | - Desiree M Seponski
- Department of Human Development and Family Science, University of Georgia, Athens, Georgia, USA
| | - Sovandara Kao
- Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Sareth Khann
- Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Cindy J Lahar
- University of South Carolina Beaufort, Beaufort, South Carolina, USA
| | - Chalandra M Bryant
- Department of Human Development and Family Science, University of Georgia, Athens, Georgia, USA
| | - Brian E Bride
- School of Social Work, University of Georgia, Athens, Georgia, USA
| | - Kanudra S Wickrama
- Department of Human Development and Family Science, University of Georgia, Athens, Georgia, USA
| | - Poch Bunnak
- Secretary of State of Ministry of Planning, Phnom Penh, Cambodia
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Keyes KM, Shev A, Tracy M, Cerdá M. Assessing the impact of alcohol taxation on rates of violent victimization in a large urban area: an agent-based modeling approach. Addiction 2019; 114:236-247. [PMID: 30315599 PMCID: PMC6314891 DOI: 10.1111/add.14470] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/22/2018] [Accepted: 10/05/2018] [Indexed: 02/03/2023]
Abstract
AIMS To use simulation to estimate the impact of alcohol taxation on drinking, non-fatal violent victimization and homicide in New York City (NYC). We simulate the heterogeneous effects of alcohol price elasticities by income, level of consumption and beverage preferences, and examine whether taxation can reduce income inequalities in alcohol-related violence. DESIGN Agent-based modeling simulation. SETTING NYC, USA. PARTICIPANTS Adult population aged 18-64 years in the year 2000 in the 59 community districts of NYC. The population of 256 500 agents approximates a 5% sample of the NYC population. MEASUREMENTS Agents were parameterized through a series of rules that governed alcohol consumption and engagement in violence. Six taxation interventions were implemented based on extensive reviews and meta-analyses, increasing universal alcohol tax by 1, 5 and 10%, and beer tax by 1, 5 and 10%. FINDINGS Under no tax increase, approximately 12.2% [95% credible interval (prediction interval, PI) = 12.1-12.3%] were heavy drinkers. Taxation decreased the proportion of heavy drinkers; a 10% tax decreased heavy drinking to 9.6% (95% PI = 9.4-9.8). Beer taxes had the strongest effect on population consumption. Taxation influenced those in the lowest income groups more than the highest income groups. Alcohol-related homicide decreased from 3.22 per 100 000 (95% PI = 2.50-3.73) to 2.40 per 100 000 under a 10% universal tax (95% PI = 1.92-2.94). This translates into an anticipated benefit of ~1200 lives/year. CONCLUSION Reductions in alcohol consumption in a large urban environment such as New York City can be sustained with modest increases in universal taxation. Alcohol tax increases also have a modest effect on alcohol-related violent victimization. Taxation policies reduce income inequalities in alcohol-related violence.
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Affiliation(s)
- Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Aaron Shev
- Department of Emergency Medicine, School of Medicine, University of California at Davis, Sacramento, CA
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, State University of New York at Albany, Albany, NY
| | - Magdalena Cerdá
- Department of Emergency Medicine, School of Medicine, University of California at Davis, Sacramento, CA
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Adams SW, Allwood MA, Bowler RM. Posttraumatic Stress Trajectories in World Trade Center Tower Survivors: Hyperarousal and Emotional Numbing Predict Symptom Change. J Trauma Stress 2019; 32:67-77. [PMID: 30667549 DOI: 10.1002/jts.22357] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 01/01/2023]
Abstract
There is a paucity of knowledge concerning the underlying symptomatology of heterogeneous posttraumatic stress symptom (PTSS) trajectories following mass trauma, such as a terrorist attack. This study examined longitudinal PTSS trajectories using latent growth mixture modeling in 2,355 World Trade Center (WTC) tower survivors surveyed by the WTC Health Registry an average of 2.5, 5.5, and 10.5 years after the September 11, 2001 terrorist attacks. Covariates included sociodemographic characteristics, WTC-related exposure, and other traumas/stressors. Four curvilinear PTSS trajectories were identified: low symptom (74.9%), recovering (8.0%), worsening (6.7%), and chronic (10.4%). The majority of WTC survivors (85.3%) maintained stable symptom trajectories over time, with PTSS changes occurring less often. Although WTC-related exposure was associated with initial PTSS severity, exposure was not associated with chronicity or change of PTSS over time. Male gender and a higher number of post-WTC disaster life-stressors were associated with worsening symptom severity over time. Individuals with more severe hyperarousal symptoms at Wave 1, particularly of anxious arousal, were more likely to have PTSS that worsened over time, adjusted odds ratio (aOR) = 1.55. Less severe emotional numbing symptoms, particularly of dysphoria, at Wave 1, were marginally significantly associated with subsequent PTSS recovery, aOR = 0.75. Interventions that target hyperarousal and emotional numbing symptoms may mitigate a worsening of symptoms and facilitate posttraumatic recovery following future mass traumas, such as terrorist attacks. Further clinical implications are discussed.
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Affiliation(s)
- Shane W Adams
- Department of Psychology, John Jay College of Criminal Justice of The City University of New York, New York, New York, USA.,Department of Psychology, The Graduate Center of The City University of New York, New York, New York, USA
| | - Maureen A Allwood
- Department of Psychology, John Jay College of Criminal Justice of The City University of New York, New York, New York, USA.,Department of Psychology, The Graduate Center of The City University of New York, New York, New York, USA
| | - Rosemarie M Bowler
- Department of Psychology, San Francisco State University, San Francisco, California, USA
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Hansen MB, Berthelsen M, Nissen A, Heir T. Sick leave before and after a work-place targeted terror attack. Int Arch Occup Environ Health 2018; 92:327-335. [PMID: 30519967 PMCID: PMC6420468 DOI: 10.1007/s00420-018-1390-8] [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] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To estimate the rate of sick leave and sick leave diagnosis among employees before and after a work-place targeted terror attack, and to compare sick leave in subgroups of employees based on gender and trauma exposure. METHODS Data on sick leave and diagnosis in ministerial employees from the period 3 years before to 3 years after the 2011 bombing in the governmental district of Oslo was retrieved from the Norwegian Social Insurance Administration Registries. RESULTS Prior to the attack, sick leave was twice as high in women as in men. Compared to the period prior to the attack, sick leave increased the first year after the attack, for both women and men that were directly exposed to the event. Sick leave stabilized to the initial level 3 years after the incident. For indirectly exposed employees, i.e., those who were not present at the site of the attack, there was no significant increase in sick leave from before to after the attack. There were no statistical significant changes in diagnoses applied before and after the terrorist attack. However, there was a tendency towards an increase in sick leave due to psychological diagnoses among the directly exposed women. CONCLUSIONS After a work-place terrorist attack a transient increase in sick leave may occur among employees who were present at the site of the attack. The increase may seem relatively modest and last for 1-3 years.
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Affiliation(s)
- Marianne Bang Hansen
- Norwegian Centre for Violence and Traumatic Stress Studies, Nydalen, Post Box 181, 0409, Oslo, Norway.
| | - Mona Berthelsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Nydalen, Post Box 181, 0409, Oslo, Norway
| | - Alexander Nissen
- Norwegian Centre for Violence and Traumatic Stress Studies, Nydalen, Post Box 181, 0409, Oslo, Norway
| | - Trond Heir
- Norwegian Centre for Violence and Traumatic Stress Studies, Nydalen, Post Box 181, 0409, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Cerdá M, Tracy M, Keyes KM. Reducing Urban Violence: A Contrast of Public Health and Criminal Justice Approaches. Epidemiology 2018; 29:142-150. [PMID: 28926374 PMCID: PMC5718925 DOI: 10.1097/ede.0000000000000756] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cities are investing millions in Cure Violence, a public health approach to reduce urban violence by targeting at-risk youth and redirecting conflict to nonviolent responses. The impact of such a program compared with criminal justice responses is unknown because experiments directly comparing criminal justice and public health approaches to violence prevention are infeasible with observational data. We simulated experiments to test the influence of two interventions on violence: (1) Cure Violence and (2) directed police patrol in violence hot spots. METHODS We used an agent-based model to simulate a 5% sample of the New York City (NYC) adult population, with agents placed on a grid representing the land area of NYC, with neighborhood size and population density proportional to land area and population density in each community district. Agent behaviors were governed by parameters drawn from city data sources and published estimates. RESULTS Under no intervention, 3.87% (95% CI, 3.84, 3.90) of agents were victimized per year. Implementing the violence interrupter intervention for 10 years decreased victimization by 13% (to 3.35% [3.32, 3.39]). Implementing hot-spots policing and doubling the police force for 10 years reduced annual victimization by about 11% (to 3.46% [3.42, 3.49]). Increasing the police force by 40% combined with implementing the violence interrupter intervention for 10 years decreased violence by 19% (to 3.13% [3.09, 3.16]). CONCLUSIONS Combined investment in a public health, community-based approach to violence prevention and a criminal justice approach focused on deterrence can achieve more to reduce population-level rates of urban violence than either can in isolation. See video abstract at, http://links.lww.com/EDE/B298.
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Cohen GH, Tamrakar S, Lowe S, Sampson L, Ettman C, Linas B, Ruggiero K, Galea S. Comparison of Simulated Treatment and Cost-effectiveness of a Stepped Care Case-Finding Intervention vs Usual Care for Posttraumatic Stress Disorder After a Natural Disaster. JAMA Psychiatry 2017; 74:1251-1258. [PMID: 28979968 PMCID: PMC6583387 DOI: 10.1001/jamapsychiatry.2017.3037] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Psychiatric interventions offered after natural disasters commonly address subsyndromal symptom presentations, but often remain insufficient to reduce the burden of chronic posttraumatic stress disorder (PTSD). OBJECTIVE To simulate a comparison of a stepped care case-finding intervention (stepped care [SC]) vs a moderate-strength single-level intervention (usual care [UC]) on treatment effectiveness and incremental cost-effectiveness in the 2 years after a natural disaster. DESIGN, SETTING, AND PARTICIPANTS This study, which simulated treatment scenarios that start 4 weeks after landfall of Hurricane Sandy on October 29, 2012, and ending 2 years later, created a model of 2 642 713 simulated agents living in the areas of New York City affected by Hurricane Sandy. INTERVENTIONS Under SC, cases were referred to cognitive behavioral therapy, an evidence-based therapy that aims to improve symptoms through problem solving and by changing thoughts and behaviors; noncases were referred to Skills for Psychological Recovery, an evidence-informed therapy that aims to reduce distress and improve coping and functioning. Under UC, all patients were referred only to Skills for Psychological Recovery. MAIN OUTCOMES AND MEASURES The reach of SC compared with UC for 2 years, the 2-year reduction in prevalence of PTSD among the full population, the 2-year reduction in the proportion of PTSD cases among initial cases, and 10-year incremental cost-effectiveness. RESULTS This population of 2 642 713 simulated agents was initialized with a PTSD prevalence of 4.38% (115 751 cases) and distributions of sex (52.6% female and 47.4% male) and age (33.9% aged 18-34 years, 49.0% aged 35-64 years, and 17.1% aged ≥65 years) that were comparable with population estimates in the areas of New York City affected by Hurricane Sandy. Stepped care was associated with greater reach and was superior to UC in reducing the prevalence of PTSD in the full population: absolute benefit was clear at 6 months (risk difference [RD], -0.004; 95% CI, -0.004 to -0.004), improving through 1.25 years (RD, -0.015; 95% CI, -0.015 to -0.014). Relative benefits of SC were clear at 6 months (risk ratio, 0.905; 95% CI, 0.898-0.913), with continued gains through 1.75 years (risk ratio, 0.615; 95% CI, 0.609-0.662). The absolute benefit of SC among cases was much stronger, emerging at 3 months (RD, -0.006; 95% CI, -0.007 to -0.005) and increasing through 1.5 years (RD, -0.338; 95% CI, -0.342 to -0.335). Relative benefits of SC among cases were equivalent to those observed in the full population. The incremental cost-effectiveness of SC compared with UC was $3428.71 to $6857.68 per disability-adjusted life year avoided, and $0.80 to $1.61 per PTSD-free day. CONCLUSIONS AND RELEVANCE The results of this simulation study suggest that SC for individuals with PTSD in the aftermath of a natural disaster is associated with greater reach than UC, more effectiveness than UC, and is well within the range of acceptability for cost-effectiveness. Results should be considered in light of limitations inherent to agent-based models.
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Affiliation(s)
- Gregory H. Cohen
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Shailesh Tamrakar
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Sarah Lowe
- Department of Psychology, Montclair State University, Montclair, New Jersey
| | - Laura Sampson
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Catherine Ettman
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Ben Linas
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts,Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Kenneth Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Hansen MB, Birkeland MS, Nissen A, Blix I, Solberg Ø, Heir T. Prevalence and Course of Symptom-Defined PTSD in Individuals Directly or Indirectly Exposed to Terror: A Longitudinal Study. Psychiatry 2017; 80:171-183. [PMID: 28767337 DOI: 10.1080/00332747.2016.1230983] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE It is well established that direct exposure to terrorism can result in posttraumatic stress disorder (PTSD). However, individuals indirectly exposed to terrorism may also develop symptoms of PTSD. This study examined the prevalence and course of symptom-defined PTSD in employees who were present and not present at the site of a workplace terror attack. METHODS Survey data from ministerial employees were collected 10, 22, and 34 months after the 2011 bombing in the government district of Oslo. A total of 3,520 employees were initially invited to the study. Response rates of eligible participants were 56% (N = 1,974) at T1, 55% (N = 1,780) at T2, and 54% (N = 1,578) at T3. PTSD was measured using the Post-traumatic Stress Disorder Checklist-Specific (PCL-S). Symptom-defined PTSD was specified as meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), B, C, and D criteria. RESULTS Our findings showed a low and declining prevalence of symptom-defined PTSD in employees indirectly exposed to a workplace terror attack (4%, 3%, and 2% at the three respective times). In employees present at the site of the explosion, PTSD was six- to eightfold more prevalent (24%, 17%, and 17%). CONCLUSIONS Individuals indirectly exposed to terrorism may develop long-lasting posttraumatic stress reactions fulfilling PTSD symptom criteria. Due to the large number of individuals that may be indirectly exposed to terrorism, even a low risk of PTSD may result in high numbers of individuals with substantial posttraumatic stress. Our findings have implications for the planning and implementation of health care services beyond those directly exposed after large-scale terror events.
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Kirchner TR, Shiffman S. Spatio-temporal determinants of mental health and well-being: advances in geographically-explicit ecological momentary assessment (GEMA). Soc Psychiatry Psychiatr Epidemiol 2016; 51:1211-23. [PMID: 27558710 PMCID: PMC5025488 DOI: 10.1007/s00127-016-1277-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/05/2016] [Indexed: 11/05/2022]
Abstract
PURPOSE Overview of geographically explicit momentary assessment research, applied to the study of mental health and well-being, which allows for cross-validation, extension, and enrichment of research on place and health. METHODS Building on the historical foundations of both ecological momentary assessment and geographic momentary assessment research, this review explores their emerging synergy into a more generalized and powerful research framework. RESULTS Geographically explicit momentary assessment methods are rapidly advancing across a number of complimentary literatures that intersect but have not yet converged. Key contributions from these areas reveal tremendous potential for transdisciplinary and translational science. CONCLUSIONS Mobile communication devices are revolutionizing research on mental health and well-being by physically linking momentary experience sampling to objective measures of socio-ecological context in time and place. Methodological standards are not well-established and will be required for transdisciplinary collaboration and scientific inference moving forward.
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Affiliation(s)
- Thomas R Kirchner
- College of Global Public Health, New York University, 41 E. 11th St., 7th Floor, New York, NY, 10003, USA.
- Center for Urban Science and Progress, New York University, New York, NY, USA.
- Department of Population Health, New York University Medical Center, New York, NY, USA.
| | - Saul Shiffman
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
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Welch AE, Caramanica K, Maslow CB, Brackbill RM, Stellman SD, Farfel MR. Trajectories of PTSD Among Lower Manhattan Residents and Area Workers Following the 2001 World Trade Center Disaster, 2003-2012. J Trauma Stress 2016; 29:158-66. [PMID: 26954702 DOI: 10.1002/jts.22090] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 02/01/2016] [Accepted: 02/04/2016] [Indexed: 11/06/2022]
Abstract
Group-based trajectory modeling was used to explore empirical trajectories of symptoms of posttraumatic stress disorder (PTSD) among 17,062 adult area residents/workers (nonrescue/recovery workers) enrolled in the World Trade Center (WTC) Health Registry using 3 administrations of the PTSD Checklist (PCL) over 9 years of observation. Six trajectories described PTSD over time: low-stable (48.9%), moderate-stable (28.3%), moderate-increasing (8.2%), high-stable (6.0%), high-decreasing (6.6 %), and very high-stable (2.0%). To examine factors associated with improving or worsening PTSD symptoms, groups with similar intercepts, but different trajectories were compared using bivariate analyses and logistic regression. The adjusted odds of being in the moderate-increasing relative to the moderate-stable group were significantly greater among enrollees reporting low social integration (OR = 2.18), WTC exposures (range = 1.34 to 1.53), job loss related to the September 11, 2001 disaster (OR = 1.41), or unmet mental health need/treatment (OR = 4.37). The odds of being in the high-stable relative to the high-decreasing group were significantly greater among enrollees reporting low social integration (OR = 2.23), WTC exposures (range = 1.39 to 1.45), or unmet mental health need/treatment (OR = 3.42). The influence of severe exposures, scarce personal/financial resources, and treatment barriers on PTSD trajectories suggest a need for early and ongoing PTSD screening postdisaster.
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Affiliation(s)
- Alice E Welch
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Kimberly Caramanica
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Carey B Maslow
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Steven D Stellman
- New York City Department of Health and Mental Hygiene, Queens, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
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30
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Hoffman KM, Trawalter S. Assumptions about life hardship and pain perception. GROUP PROCESSES & INTERGROUP RELATIONS 2016. [DOI: 10.1177/1368430215625781] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present work examines whether people assume that those who have faced hardship feel less pain than those who have not, and whether this belief contributes to the perception that Blacks feel less pain than Whites. In Experiments 1 and 2, participants received information about a Black and/or White target person’s life hardship and then rated the target person’s pain. Participants reported that the target individual would feel less pain if s/he had experienced greater hardship. Importantly, racial bias emerged but only when hardship information was consistent with expectations about race and life hardship; that is, participants reported that the Black (vs. White) target individual would feel less pain only if s/he had experienced greater hardship. In Experiment 3, participants read that hardship either toughens or weakens the body, and then rated a Black or White target person’s pain. Racial bias emerged but only when supported by lay beliefs. Specifically, participants reported that the Black (vs. White) target individual would feel less pain but only if they endorsed the belief that hardship leads to toughness. Taken together, these findings suggest that perceptions of hardship shape perceptions of pain and contribute to racial bias in pain perception. These findings also suggest that eliminating this racial bias will require challenging lay beliefs; it will require the recognition that people who have faced great hardship feel just as much, if not more, pain.
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Golin CE, Haley DF, Wang J, Hughes JP, Kuo I, Justman J, Adimora AA, Soto-Torres L, O'Leary A, Hodder S. Post-traumatic Stress Disorder Symptoms and Mental Health over Time among Low-Income Women at Increased Risk of HIV in the U.S. J Health Care Poor Underserved 2016; 27:891-910. [PMID: 27180715 PMCID: PMC4970215 DOI: 10.1353/hpu.2016.0093] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Women living in poverty suffer more post-traumatic stress disorder (PTSD) symptoms than do members of the general population; however we know little about factors associated with changes in their PTSD symptoms over time. Using data from HPTN 064, a cohort of women from low-income, high-HIV-prevalence communities across six eastern states (n=1,860), we assessed the prevalence of and changes in PTSD symptoms over 12 months and the effect of potential predictors on symptom acquisition and remission (via the Primary Care-PTSD symptoms scale). Forty-three percent screened positive for PTSD symptoms. Those reporting food insecurity, ongoing abuse, depressive symptoms, or binge drinking were more likely to acquire PTSD symptoms. Those with ongoing abuse or depressive symptoms were less likely to experience PTSD symptom remission. Findings suggest a need to integrate programs to reduce abuse, depression, and economic hardship with those that address sexual health risks among women living in low-income, high-HIV-prevalence neighborhoods.
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33
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Adams RE, Ritter C, Bonfine N. Epidemiology of trauma: Childhood adversities, neighborhood problems, discrimination, chronic strains, life events, and daily hassles among people with a severe mental illness. Psychiatry Res 2015; 230:609-15. [PMID: 26603337 DOI: 10.1016/j.psychres.2015.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/16/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
Trauma during childhood and adolescence is a common event among people with a serious psychological disorder. Few studies assess a wide range of stressors for this population. This is surprising given that these stressful events are implicated in poorer outcomes related to course and treatment of mental health problems. This study of 214 people with serious mental illness examines the prevalence of childhood traumas, perceived neighborhood problems, discrimination, chronic strains, negative life events, and daily hassles. We use regression analyses to determine if these stressors are associated with quality of life. Results show that 95% of the sample report at least one childhood adversity. Perceived neighborhood problems, experiences of discrimination, chronic strains, life events, and daily hassles were also common. Examining the relationship between demographic factors and stressors suggests that older respondents, Whites, those who have never been married, and people diagnosed with Schizophrenia reported fewer stressors compared to those who are older, non-White, ever married, or suffering from other types of mental health problems. Finally, three of the six types of stressors were related to lower quality of life and depression. We discuss the implications of these findings for the treatment of severe psychological problems.
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Johannesson KB, Arinell H, Arnberg FK. Six years after the wave. Trajectories of posttraumatic stress following a natural disaster. J Anxiety Disord 2015; 36:15-24. [PMID: 26401968 DOI: 10.1016/j.janxdis.2015.07.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/29/2015] [Accepted: 07/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The characteristics of long-term trajectories of distress after disasters are unclear, since few studies include a comparison group. This study examines trajectories of recovery among survivors in comparison to individuals with indirect exposure. METHODS Postal surveys were sent to Swedish tourists, repatriated from the 2004 Indian Ocean tsunami (n=2268), at 1, 3, and 6 years after the tsunami to assess posttraumatic stress (PTS) and poor mental health. Items were used to ascertain high and moderate disaster exposure groups and an indirect exposure comparison group. RESULTS Long-term PTS trajectories were best characterized by a resilient (72.3%), a severe chronic (4.6%), a moderate chronic (11.2%) and a recovering (11.9%) trajectory. Trajectories reported higher levels of PTS than the comparison group. Exposure severity and bereavement were highly influential risk factors. CONCLUSIONS These findings have implications regarding anticipation of long-term psychological adjustment after natural disasters and need for interventions after a single traumatic event with few secondary stressors.
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Affiliation(s)
- Kerstin Bergh Johannesson
- National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden.
| | - Hans Arinell
- Department of Neuroscience, Psychiatry, Uppsala University, Akademiska Sjukhuset, Ing. 10, SE 751 85 Uppsala, Sweden.
| | - Filip K Arnberg
- National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden.
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Shao D, Gao QL, Li J, Xue JM, Guo W, Long ZT, Cao FL. Test of the stress sensitization model in adolescents following the pipeline explosion. Compr Psychiatry 2015; 62:178-86. [PMID: 26343483 DOI: 10.1016/j.comppsych.2015.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/21/2015] [Accepted: 07/24/2015] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The stress sensitization model states that early traumatic experiences increase vulnerability to the adverse effects of subsequent stressful life events. This study examined the effect of stress sensitization on development of posttraumatic stress disorder (PTSD) symptoms in Chinese adolescents who experienced the pipeline explosion. METHODS A total of 670 participants completed self-administered questionnaires on demographic characteristics and degree of explosion exposure, the Childhood Trauma Questionnaire (CTQ), and the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C). Associations among the variables were explored using MANOVA, and main effects and interactions were analyzed. RESULTS Overall MANOVA tests with the PCL-C indicated significant differences for gender (F=6.86, p=.000), emotional abuse (F=6.79, p=.000), and explosion exposure (F=22.40, p=.000). There were significant interactions between emotional abuse and explosion exposure (F=3.98, p=.008) and gender and explosion exposure (F=2.93, p=.033). CONCLUSIONS Being female, childhood emotional abuse, and a high explosion exposure were associated with high PTSD symptom levels. Childhood emotional abuse moderated the effect of explosion exposure on PTSD symptoms. Thus, stress sensitization influenced the development of PTSD symptoms in Chinese adolescents who experienced the pipeline explosion as predicted by the model.
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Affiliation(s)
- Di Shao
- School of Nursing, Shandong University, P.R. China
| | | | - Jie Li
- School of Nursing, Shandong University, P.R. China
| | - Jiao-Mei Xue
- School of Nursing, Shandong University, P.R. China
| | - Wei Guo
- School of Nursing, Shandong University, P.R. China
| | | | - Feng-Lin Cao
- School of Nursing, Shandong University, P.R. China.
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Cerdá M, Tracy M, Keyes KM, Galea S. To Treat or to Prevent?: Reducing the Population Burden of Violence-related Post-traumatic Stress Disorder. Epidemiology 2015; 26:681-9. [PMID: 26237744 PMCID: PMC4827920 DOI: 10.1097/ede.0000000000000350] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Violence-related post-traumatic stress disorder (PTSD) remains a prevalent and disabling psychiatric disorder in urban areas. However, the most effective allocation of resources into prevention and treatment to reduce this problem is unknown. We contrasted the impact of two interventions on violence-related PTSD: (1) a population-level intervention intended to prevent violence (i.e., hot-spot policing), and (2) an individual-level intervention intended to shorten PTSD duration (i.e., cognitive-behavioral therapy-CBT). METHODS We used agent-based modeling to simulate violence and PTSD in New York City under four scenarios: (1) no intervention, (2) targeted policing to hot spots of violence, (3) increased access to CBT for people who suffered from violence-related PTSD, and (4) a combination of the two interventions. RESULTS Combined prevention and treatment produced the largest decrease in violence-related PTSD prevalence: hot-spot policing plus a 50% increase in CBT for 5 years reduced the annual prevalence of violence-related PTSD from 3.6% (95% confidence interval = 3.5%, 3.6%) to 3.4% (3.3%, 3.5%). It would have been necessary to implement hot-spot policing or to increase CBT by 200% for 10 years for either intervention to achieve the same reduction in isolation. CONCLUSIONS This study provides an empirically informed demonstration that investment in combined strategies that target social determinants of mental illness and provide evidence-based treatment to those affected by psychiatric disorders can produce larger reductions in the population burden from violence-related PTSD than either preventive or treatment interventions alone. However, neither hot-spot policing nor CBT, alone or combined, will produce large shifts in the population prevalence of violence-related PTSD.
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Affiliation(s)
- Magdalena Cerdá
- Violence Prevention Research Program, University of California, Davis, Sacramento, CA
- Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, CA
| | - Melissa Tracy
- Department of Epidemiology, University at Albany School of Public Health, Rensselaer, NY
| | - Katherine M. Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA
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Polyvictimization, income, and ethnic differences in trauma-related mental health during adolescence. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1223-34. [PMID: 26048339 PMCID: PMC4521986 DOI: 10.1007/s00127-015-1077-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of the present study was to investigate ethnic differences in trauma-related mental health symptoms among adolescents, and test the mediating and moderating effects of polyvictimization (i.e., number of types of traumas/victimizations experienced by an individual) and household income, respectively. METHODS Data were drawn from the first wave of the National Survey of Adolescents-replication study (NSA-R), which took place in the US in 2005 and utilized random digit dialing to administer a telephone survey to adolescents ages 12-17. Participants included in the current analyses were 3312 adolescents (50.2 % female; mean age 14.67 years) from the original sample of 3614 who identified as non-Hispanic White (n = 2346, 70.8 %), non-Hispanic Black (n = 557, 16.8 %), or Hispanic (n = 409, 12.3 %). Structural equation modeling was utilized to test hypothesized models. RESULTS Non-Hispanic Black and Hispanic participants reported higher levels of polyvictimization and trauma-related mental health symptoms (symptoms of posttraumatic stress and depression) compared to non-Hispanic Whites, though the effect sizes were small (γ ≤ 0.07). Polyvictimization fully accounted for the differences in mental health symptoms between non-Hispanic Blacks and non-Hispanic Whites, and partially accounted for the differences between Hispanics and non-Hispanic Whites. The relation between polyvictimization and trauma-related mental health symptoms was higher for low-income youth than for high-income youth. CONCLUSIONS Disparities in trauma exposure largely accounted for racial/ethnic disparities in trauma-related mental health. Children from low-income family environments appear to be at greater risk of negative mental health outcomes following trauma exposure compared to adolescents from high-income families.
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Cone JE, Li J, Kornblith E, Gocheva V, Stellman SD, Shaikh A, Schwarzer R, Bowler RM. Chronic probable PTSD in police responders in the world trade center health registry ten to eleven years after 9/11. Am J Ind Med 2015; 58:483-93. [PMID: 25851164 DOI: 10.1002/ajim.22446] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Police enrolled in the World Trade Center Health Registry (WTCHR) demonstrated increased probable posttraumatic stress disorder (PTSD) after the terrorist attack of 9/11/2001. METHODS Police enrollees without pre-9/11 PTSD were studied. Probable PTSD was assessed by Posttraumatic Stress Check List (PCL). Risk factors for chronic, new onset or resolved PTSD were assessed using multinomial logistic regression. RESULTS Half of police with probable PTSD in 2003-2007 continued to have probable PTSD in 2011-2012. Women had higher prevalence of PTSD than men (15.5% vs. 10.3%, P = 0.008). Risk factors for chronic PTSD included decreased social support, unemployment, 2+ life stressors in last 12 months, 2+ life-threatening events since 9/11, 2+ injuries during the 9/11 attacks, and unmet mental health needs. CONCLUSION Police responders to the WTC attacks continue to bear a high mental health burden. Improved early access to mental health treatment for police exposed to disasters may be needed.
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Affiliation(s)
- James E. Cone
- New York City Department of Health and Mental Hygiene; New York New York
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene; New York New York
| | | | - Vihra Gocheva
- Department of Psychology; San Francisco State University; San Francisco California
| | - Steven D. Stellman
- New York City Department of Health and Mental Hygiene; New York New York
- Department of Epidemiology; Mailman School of Public Health; Columbia University; New York New York
| | - Annum Shaikh
- Emory University; Rollins School of Public Health; Atlanta Georgia
| | - Ralf Schwarzer
- Institute for Positive Psychology and Education; Faculty of Health Sciences; Australian Catholic University; Strathfield New South Wales Australia
| | - Rosemarie M. Bowler
- Department of Psychology; San Francisco State University; San Francisco California
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Abravanel BT, Sinha R. Emotion dysregulation mediates the relationship between lifetime cumulative adversity and depressive symptomatology. J Psychiatr Res 2015; 61:89-96. [PMID: 25528603 PMCID: PMC4308421 DOI: 10.1016/j.jpsychires.2014.11.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 10/07/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
Repeated exposure to stressful events across the lifespan, referred to as cumulative adversity, is a potent risk factor for depression. Research indicates that cumulative adversity detrimentally affects emotion regulation processes, which may represent a pathway linking cumulative adversity to vulnerability to depression. However, empirical evidence that emotion dysregulation mediates the relationship between cumulative adversity and depression is limited, particularly in adult populations. We examined the direct and indirect effects of cumulative adversity on depressive symptomatology in a large community sample of adults (n = 745) who were further characterized by risk status: never-depressed (n = 638) and "at-risk" remitted mood-disordered (n = 107). All participants completed the Cumulative Adversity Inventory (CAI), the Difficulties in Emotion Regulation Scale (DERS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Bootstrapped confidence intervals were computed to estimate the indirect effect of emotion dysregulation on the relationship between cumulative adversity and depressive symptomatology and to test whether this indirect effect was moderated by risk status. Emotion dysregulation partially and significantly mediated the relationship between cumulative adversity and depressive symptomatology independent of risk status. Overall, cumulative adversity and emotion dysregulation accounted for 50% of the variance in depressive symptomatology. These findings support the hypothesis that disruption of adaptive emotion regulation processes associated with repeated exposure to stressful life events represents an intrapersonal mechanism linking the experience of adverse events to depression. Our results support the utility of interventions that simultaneously emphasize stress reduction and emotion regulation to treat and prevent depressive vulnerability and pathology.
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Affiliation(s)
| | - Rajita Sinha
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA.
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Motzkin JC, Koenigs MR. Post-traumatic stress disorder and traumatic brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2015; 128:633-648. [PMID: 25701911 DOI: 10.1016/b978-0-444-63521-1.00039-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Disentangling the effects of "organic" neurologic damage and psychological distress after a traumatic brain injury poses a significant challenge to researchers and clinicians. Establishing a link between traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) has been particularly contentious, reflecting difficulties in establishing a unique diagnosis for conditions with overlapping and sometimes contradictory symptom profiles. However, each disorder is linked to a variety of adverse health outcomes, underscoring the need to better understand how neurologic and psychiatric risk factors interact following trauma. Here, we present data showing that individuals with a TBI are more likely to develop PTSD, and that individuals with PTSD are more likely to develop persistent cognitive sequelae related to TBI. Further, we describe neurobiological models of PTSD, highlighting how patterns of neurologic damage typical in TBI may promote or protect against the development of PTSD in brain-injured populations. These data highlight the unique course of PTSD following a TBI and have important diagnostic, prognostic, and treatment implications for individuals with a dual diagnosis.
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Affiliation(s)
- Julian C Motzkin
- Neuroscience Training Program, University of Wisconsin - Madison, Madison, WI, USA; Medical Scientist Training Program, University of Wisconsin - Madison, Madison, WI, USA
| | - Michael R Koenigs
- Department of Psychiatry, University of Wisconsin - Madison, Madison, WI, USA.
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41
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Goetz M, Shah A, Goldberg J, Cheema F, Shallenberger L, Murrah NV, Bremner JD, Vaccarino V. Posttraumatic stress disorder, combat exposure, and carotid intima-media thickness in male twins. Am J Epidemiol 2014; 180:989-96. [PMID: 25301813 PMCID: PMC4224362 DOI: 10.1093/aje/kwu225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is associated with an increased risk of ischemic heart disease, though the pathophysiologic mechanisms remain unclear. Carotid artery intima-media thickness (CIMT) is a measure of subclinical atherosclerosis. We examined whether PTSD and combat exposure were associated with CIMT in Vietnam War-era twins after controlling for shared genetic and childhood factors. Between 2002 and 2010, we studied 465 middle-aged twins from the Vietnam Era Twin Registry who were free from cardiovascular disease. PTSD was diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and CIMT was measured by ultrasound. Mixed-effects regression models were used to examine individual, between-pair, and within-pair associations. Approximately 13% of participants met the criteria for PTSD, and 45% served in the Vietnam Theater. PTSD was associated with 32.7 μm higher CIMT (95% confidence interval (CI): 0.9, 64.5) after adjustment for confounders. The average CIMT for the pair increased by 59.7 μm for each additional twin with PTSD (95% CI: 15.9, 104.2). We found no significant within-pair differences in CIMT when comparing PTSD-discordant co-twins. Results for combat exposure were similar, but its association with CIMT weakened after adjustment for PTSD (95% CI: 7.0, 45.3). Among Vietnam War-era veterans, combat exposure and PTSD are associated with CIMT, though the associations are largely mediated by shared childhood factors.
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Affiliation(s)
| | | | | | | | | | | | | | - Viola Vaccarino
- Correspondence to Dr. Viola Vaccarino, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Room 3011, Atlanta, GA 30322 (e-mail: )
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Sipahi L, Wildman DE, Aiello AE, Koenen KC, Galea S, Abbas A, Uddin M. Longitudinal epigenetic variation of DNA methyltransferase genes is associated with vulnerability to post-traumatic stress disorder. Psychol Med 2014; 44:3165-79. [PMID: 25065861 PMCID: PMC4530981 DOI: 10.1017/s0033291714000968] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Epigenetic differences exist between trauma-exposed individuals with and without post-traumatic stress disorder (PTSD). It is unclear whether these epigenetic differences pre-exist, or arise following, trauma and PTSD onset. METHOD In pre- and post-trauma samples from a subset of Detroit Neighborhood Health Study participants, DNA methylation (DNAm) was measured at DNA methyltransferase 1 (DNMT1), DNMT3A, DNMT3B and DNMT3L. Pre-trauma DNAm differences and changes in DNAm from pre- to post-trauma were assessed between and within PTSD cases (n = 30) and age-, gender- and trauma exposure-matched controls (n = 30). Pre-trauma DNAm was tested for association with post-trauma symptom severity (PTSS) change. Potential functional consequences of DNAm differences were explored via bioinformatic search for putative transcription factor binding sites (TFBS). RESULTS DNMT1 DNAm increased following trauma in PTSD cases (p = 0.001), but not controls (p = 0.067). DNMT3A and DNMT3B DNAm increased following trauma in both cases (DNMT3A: p = 0.009; DNMT3B: p < 0.001) and controls (DNMT3A: p = 0.002; DNMT3B: p < 0.001). In cases only, pre-trauma DNAm was lower at a DNMT3B CpG site that overlaps with a TFBS involved in epigenetic regulation (p = 0.001); lower pre-trauma DNMT3B DNAm at this site was predictive of worsening of PTSS post-trauma (p = 0.034). Some effects were attenuated following correction for multiple hypothesis testing. CONCLUSIONS DNAm among trauma-exposed individuals shows both longitudinal changes and pre-existing epigenetic states that differentiate individuals who are resilient versus susceptible to PTSD. These distinctive DNAm differences within DNMT loci may contribute to genome-wide epigenetic profiles of PTSD.
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Affiliation(s)
- Levent Sipahi
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI
| | - Derek E. Wildman
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Allison E. Aiello
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Karestan C. Koenen
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Sandro Galea
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Asad Abbas
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI
| | - Monica Uddin
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
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Tracy M, Morgenstern H, Zivin K, Aiello AE, Galea S. Traumatic event exposure and depression severity over time: results from a prospective cohort study in an urban area. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1769-82. [PMID: 24816599 PMCID: PMC6684030 DOI: 10.1007/s00127-014-0884-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 04/14/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE A substantial proportion of adults experience traumatic events each year, yet little is known about the effects of different types of traumatic events on depression severity over time. We prospectively assessed the effects of traumatic event exposure during a 1-year period on changes in depression severity during that period among a representative sample of adults living in Detroit, Michigan in the United States. METHODS We used data from 1,054 participants in the first two waves of the Detroit Neighborhood Health Study (2008-2010). Depression severity was measured with the Patient Health Questionnaire-9 (PHQ-9). Negative binomial regression was used to estimate the effect of traumatic event exposure on depression severity at Wave 2, adjusting for Wave 1 PHQ-9 score and potential confounders. RESULTS The mean depression severity score at Wave 2 among those exposed to at least one traumatic event during follow-up was 1.71 times higher than among those with no traumatic event exposure [95 % confidence interval (CI) 1.27-2.29]. Also positively associated with depression severity at Wave 2 (vs. no traumatic events) were assaultive violence (mean ratio 2.49, 95 % CI 1.41-4.38), injuries and other directly experienced shocking events (mean ratio 2.59, 95 % CI 1.62-3.82), and three or more traumatic events (mean ratio 2.58, 95 % CI 1.62-4.09). CONCLUSIONS Violence, injuries, and other directly experienced traumatic events increase depression severity and may be useful targets for interventions to alleviate the burden of depression in urban areas.
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Affiliation(s)
- Melissa Tracy
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St., Room 515, New York, NY, 10032, USA,
| | - Hal Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA,Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA,Department of Urology, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kara Zivin
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA,Department of Veterans Affairs, Ann Arbor, MI 48113, USA
| | - Allison E. Aiello
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sandro Galea
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St., Room 515, New York, NY 10032, USA
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Cerdá M, Tracy M, Ahern J, Galea S. Addressing population health and health inequalities: the role of fundamental causes. Am J Public Health 2014; 104 Suppl 4:S609-19. [PMID: 25100428 DOI: 10.2105/ajph.2014.302055] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES As a case study of the impact of universal versus targeted interventions on population health and health inequalities, we used simulations to examine (1) whether universal or targeted manipulations of collective efficacy better reduced population-level rates and racial/ethnic inequalities in violent victimization; and (2) whether experiments reduced disparities without addressing fundamental causes. METHODS We applied agent-based simulation techniques to the specific example of an intervention on neighborhood collective efficacy to reduce population-level rates and racial/ethnic inequalities in violent victimization. The agent population consisted of 4000 individuals aged 18 years and older with sociodemographic characteristics assigned to match distributions of the adult population in New York City according to the 2000 U.S. Census. RESULTS Universal experiments reduced rates of victimization more than targeted experiments. However, neither experiment reduced inequalities. To reduce inequalities, it was necessary to eliminate racial/ethnic residential segregation. CONCLUSIONS These simulations support the use of universal intervention but suggest that it is not possible to address inequalities in health without first addressing fundamental causes.
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Affiliation(s)
- Magdalena Cerdá
- Magdalena Cerdá, Melissa Tracy, and Sandro Galea are with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Jennifer Ahern is with the Department of Epidemiology, University of California, Berkeley
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Platt J, Keyes KM, Koenen KC. Size of the social network versus quality of social support: which is more protective against PTSD? Soc Psychiatry Psychiatr Epidemiol 2014; 49:1279-86. [PMID: 24310782 PMCID: PMC7864543 DOI: 10.1007/s00127-013-0798-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/17/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Supportive social networks are important to the post-traumatic response process. However, the effects of social network structure may be distinct from the perceived function of those networks. The present study examined the relative importance of role diversity and perceived strength of social support in mitigating post-traumatic stress disorder (PTSD). METHODS Data were drawn from respondents who report lifetime potentially traumatic events in the National Epidemiologic Survey on Alcohol and Related Conditions (N = 31,650). The Social Network Index (SNI) was used to measure the diversity of social connections. The Interpersonal Support Evaluation List (ISEL-12) was used to measure the perceived availability of social support within the network. Odds of current PTSD were compared among individuals representing four dichotomous types of social support: high diversity/high perceived strength, high diversity/low perceived strength, low diversity/high perceived strength, and low diversity/low perceived strength to examine which type of support is more protective against PTSD. RESULTS Unadjusted odds of PTSD were 1.59 (95 % CI 1.39-1.82) for those with low versus high perceived support strength, and 1.10 (0.94-1.28) among those with non-diverse versus diverse social networks. Compared to the reference group (high diversity/high perceived strength), the adjusted odds of current PTSD were higher for two groups: low diversity/low perceived strength (OR = 1.62; 1.33-1.99), and low diversity/high perceived strength (OR = 1.57; 1.3-1.91). The high diversity/low perceived strength group had no greater odds of PTSD (OR = 1.02; 0.81-1.28). CONCLUSION The diversity of a social network is potentially more protective against PTSD than the perception of strong social support. This suggests that programs, which engage individuals in social groups and activities may effectively attenuate the risk of PTSD. A better understanding of how these networks operate with respect to PTSD prevention and mitigation holds promise for improving psychiatric health.
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Affiliation(s)
- Jonathan Platt
- Columbia University Mailman School of Public Health, New York, NY, USA,
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Vanderheyden WM, Poe GR, Liberzon I. Trauma exposure and sleep: using a rodent model to understand sleep function in PTSD. Exp Brain Res 2014; 232:1575-84. [PMID: 24623353 DOI: 10.1007/s00221-014-3890-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/18/2014] [Indexed: 01/07/2023]
Abstract
Post-traumatic stress disorder (PTSD) is characterized by intrusive memories of a traumatic event, avoidance behavior related to cues of the trauma, emotional numbing, and hyper-arousal. Sleep abnormalities and nightmares are core symptoms of this disorder. In this review, we propose a model which implicates abnormal activity in the locus coeruleus (LC), an important modifier of sleep-wake regulation, as the source of sleep abnormalities and memory abnormalities seen in PTSD. Abnormal LC activity may be playing a key role in symptom formation in PTSD via sleep dysregulation and suppression of hippocampal bidirectional plasticity.
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Piotrowski A, Fillet AM, Perez P, Walkowiak P, Simon D, Corniere MJ, Cabanes PA, Lambrozo J. Outcome of occupational electrical injuries among French electric company workers: a retrospective report of 311 cases, 1996-2005. Burns 2013; 40:480-8. [PMID: 24028742 DOI: 10.1016/j.burns.2013.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 08/05/2013] [Accepted: 08/06/2013] [Indexed: 11/17/2022]
Abstract
This study reviewed records of all electrical incidents involving work-related injury to employees Electricité de France (EDF) from 1996 through 2005 and analysed data for 311 incidents. The results are compared with 1231 electrical incidents that occurred during 1970-1979 and 996 incidents during 1980-1989. A total of 311 electrical incidents were observed. The medical consequences of electrical incident remain severe and particularly, the current fatality rate (3.2%) is similar to that recorded in the 1980s (2.7%) and 1970s (3.3%). Among individuals with non-fatal incidents, any change has occurred in the prevalence of permanent functional sequelae (23.6% in the 1970s vs. 27.6% in the 1980s and 32.5% currently). An increase in the incidence of neuropsychiatric sequelae (5.4% in the 1980s vs. 13% currently) has been observed and they are now the second most common type of sequelae after those directly related to burns. Among the neurological sequelae, peripheral nervous system disorders are the most common, as observed in the 1980s. Since the definition of post-traumatic stress disorder (PTSD) has changed between the two periods, we can only report that the current prevalence of PTSD is 7.6%. This study emphasises the need for specific management of neurological and psychological impairments after electrical injuries, including especially early recognition and initiation of effective treatment.
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Affiliation(s)
- Aleksandra Piotrowski
- Medical Studies Department, General Direction of Safety and Health, Electricité de France, France.
| | - Anne-Marie Fillet
- Medical Studies Department, General Direction of Safety and Health, Electricité de France, France
| | - Philippe Perez
- Prevention and Safety Department, General Direction of Safety and Health, Electricité de France, France
| | - Philippe Walkowiak
- Prevention and Safety Department, General Direction of Safety and Health, Electricité de France, France
| | - Denis Simon
- Medical Department of Health Insurance fund, General Direction of Safety and Health, Electricité de France, France
| | - Marie-Jean Corniere
- Prevention and Safety Department, General Direction of Safety and Health, Electricité de France, France
| | - Pierre-André Cabanes
- Medical Studies Department, General Direction of Safety and Health, Electricité de France, France
| | - Jacques Lambrozo
- Medical Studies Department, General Direction of Safety and Health, Electricité de France, France
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Fifield K, Hebert M, Angel R, Adamec R, Blundell J. Inhibition of mTOR kinase via rapamycin blocks persistent predator stress-induced hyperarousal. Behav Brain Res 2013; 256:457-63. [PMID: 24001755 DOI: 10.1016/j.bbr.2013.08.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 08/27/2013] [Accepted: 08/29/2013] [Indexed: 12/21/2022]
Abstract
Traumatic, stressful life events are thought to trigger acquired anxiety disorders such as post-traumatic stress disorder (PTSD). Recent data suggests that the mammalian target of rapamycin (mTOR) plays a key role in the formation of traumatic memories. The predator stress paradigm allows us to determine whether mTOR mediates the formation of both context-dependent (associative) and context-independent (non-associative) fear memories. Predator stress involves an acute, unprotected exposure of a rat to a cat which causes long-lasting non-associative fear memories manifested as generalized hyperarousal and increased anxiety-like behavior. Here, we show that rapamycin, an mTOR inhibitor, attenuates predator stress-induced hyperarousal, lasting at least three weeks. In addition, rapamycin blocks a subset of anxiety-like behaviors as measured in the elevated plus maze and hole board. Furthermore, when re-exposed to the predator stress context, rapamycin-treated stressed rats showed increased activity compared to vehicle controls suggesting that rapamycin blocks predator stress-induced associative fear memory. Taken together with past research, our results indicate that mTOR regulation of protein translation is required for the formation of both associative and non-associative fear memories. Overall, these data suggest that mTOR activation may contribute to the development of acquired anxiety disorders such as PTSD.
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Affiliation(s)
- Kathleen Fifield
- Department of Psychology, Memorial University of Newfoundland, 232 Elizabeth Ave., St. John's, Newfoundland, Canada A1B 3X9
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Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med 2013; 43:897-910. [PMID: 22781489 DOI: 10.1017/s003329171200147x] [Citation(s) in RCA: 791] [Impact Index Per Article: 71.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The literature describing the global prevalence of anxiety disorders is highly variable. A systematic review and meta-regression were undertaken to estimate the prevalence of anxiety disorders and to identify factors that may influence these estimates. The findings will inform the new Global Burden of Disease study. Method A systematic review identified prevalence studies of anxiety disorders published between 1980 and 2009. Electronic databases, reference lists, review articles and monographs were searched and experts then contacted to identify missing studies. Substantive and methodological factors associated with inter-study variability were identified through meta-regression analyses and the global prevalence of anxiety disorders was calculated adjusting for study methodology. RESULTS The prevalence of anxiety disorders was obtained from 87 studies across 44 countries. Estimates of current prevalence ranged between 0.9% and 28.3% and past-year prevalence between 2.4% and 29.8%. Substantive factors including gender, age, culture, conflict and economic status, and urbanicity accounted for the greatest proportion of variability. Methodological factors in the final multivariate model (prevalence period, number of disorders and diagnostic instrument) explained an additional 13% of variance between studies. The global current prevalence of anxiety disorders adjusted for methodological differences was 7.3% (4.8-10.9%) and ranged from 5.3% (3.5-8.1%) in African cultures to 10.4% (7.0-15.5%) in Euro/Anglo cultures. CONCLUSIONS Anxiety disorders are common and the substantive and methodological factors identified here explain much of the variability in prevalence estimates. Specific attention should be paid to cultural differences in responses to survey instruments for anxiety disorders.
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Affiliation(s)
- A J Baxter
- Queensland Centre for Mental Health Research, Policy and Evaluation Group, Wacol, QLD, Australia.
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The course of posttraumatic stress symptoms and functional impairment following a disaster: what is the lasting influence of acute versus ongoing traumatic events and stressors? Soc Psychiatry Psychiatr Epidemiol 2013; 48:385-95. [PMID: 22878832 PMCID: PMC3504624 DOI: 10.1007/s00127-012-0560-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/20/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Ongoing traumatic events and stressors, rather than acute sources of trauma, may shape long-term post-disaster mental health. The purpose of this study was to compare the influence of acute hurricane-related exposures and ongoing post-hurricane exposures on the short- and long-term course of posttraumatic stress symptoms (PTSS) and functional impairment (FI). METHODS A random sample of adults (n = 658) in Galveston and Chambers Counties, Texas, was selected 2-6 months after Hurricane Ike and interviewed 3 times over 18 months. Hurricane-related exposures included traumatic events such as death of a family member due to the hurricane and stressors such as loss/damage to personal property due to the hurricane. Post-hurricane exposures included traumatic events such as sexual assault and stressors such as divorce or serious financial problems. RESULTS Experiencing an acute hurricane-related traumatic event or stressor was associated with initial post-hurricane PTSS [RR = 1.92 (95% CI = 1.13-3.26) and RR = 1.62 (1.36-1.94), respectively] and FI [RR = 1.76; (1.05-2.97) and RR = 1.74 (1.46-2.08)], respectively, and acute hurricane-related stressors were associated with a higher rate of increase in FI over time [RR = 1.09; (1.01-1.19)]. In contrast, ongoing post-hurricane daily stressors were not associated within initial PTSS and FI, but were associated with PTSS and FI at the second and third interviews. CONCLUSIONS While immediate postdisaster interventions may influence short-term mental health, investment in the prevention of ongoing stressors may be instrumental to manage long-term mental health status.
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