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Serier KN, Magruder KM, Spiro A, Kimerling R, Frayne SM, Kilbourne AM, Pless Kaiser A, Smith BN. Associations between Posttraumatic Stress Disorder and Diabetes in Vietnam-Era Women Veterans in the HealthViEWS Study. J Womens Health (Larchmt) 2024; 33:926-937. [PMID: 38738844 DOI: 10.1089/jwh.2023.0838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is associated with incident diabetes. However, past studies have often included predominantly male samples, despite important sex and gender differences in diabetes. To address this limitation, this study examined the association between PTSD and diabetes in older Veteran women, a population with a high burden of PTSD. Materials and Methods: Data were collected from 4,105 women (Mage = 67.4 years), participating in the Health of Vietnam-Era Veteran Women's Study (HealthViEWS; Department of Veterans Affairs Cooperative Studies Program #579). Participants completed self-report measures of demographics, health conditions, and health behaviors. Information on military service was obtained through service records. A structured clinical interview was conducted by telephone to assess current and lifetime PTSD and other mental health disorders. Weighted descriptive and logistic regression analyses were used to examine associations between PTSD and diabetes. Results: The prevalence of diabetes was 28.4% among women with current full PTSD compared to 23.4%, 17.6%, and 17.5% for current subthreshold, remitted, and no PTSD. In unadjusted analyses, women with current full and subthreshold PTSD were 1.87 [1.49; 2.33] and 1.44 [1.11; 1.85] times more likely to have diabetes compared to women with no PTSD. Remitted PTSD was not associated with increased odds of diabetes. Effects were attenuated but remained significant after adjustment for relevant covariates. Conclusions: Vietnam-era women with current PTSD, including subthreshold symptoms, had a greater likelihood of diabetes compared to women without PTSD. These findings suggest that women with PTSD may benefit from increased diabetes prevention efforts.
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Affiliation(s)
- Kelsey N Serier
- National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Kathryn M Magruder
- Departments of Psychiatry and Behavioral Sciences and Public Health, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Rachel Kimerling
- Department of Veterans Affairs, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Amy M Kilbourne
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Quality Enhancement Research Initiative (QUERI), U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Anica Pless Kaiser
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- National Center for PTSD Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts, USA
- VA New England Geriatric Research Education and Clinical Center (GRECC), Boston, Massachusetts, USA
| | - Brian N Smith
- National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Kazlou A, Bornukova K, Wickham A, Slaykovskiy V, Peven K, Klepchukova A, Ponzo S, Garfinkel S. Effects of stress on pain in females using a mobile health app in the Russia-Ukraine conflict. NPJ MENTAL HEALTH RESEARCH 2024; 3:2. [PMID: 38609485 PMCID: PMC10956037 DOI: 10.1038/s44184-023-00043-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/27/2023] [Indexed: 04/14/2024]
Abstract
The chronic and acute effects of stress can have divergent effects on health; long-term effects are associated with detrimental physical and mental health sequelae, while acute effects may be advantageous in the short-term. Stress-induced analgesia, the attenuation of pain perception due to stress, is a well-known phenomenon that has yet to be systematically investigated under ecological conditions. Using Flo, a women's health and wellbeing app and menstrual cycle tracker, with a world-wide monthly active usership of more than 57 million, women in Ukraine were monitored for their reporting of stress, pain and affective symptoms before, and immediately after, the onset of the Russian-Ukrainian conflict. To avoid potential selection (attrition) or collider bias, we rely on a sample of 87,315 users who were actively logging multiple symptoms before and after the start of the war. We found an inverse relationship between stress and pain, whereby higher reports of stress predicted lower rates of pain. Stress did not influence any other physiological symptoms with a similar magnitude, nor did any other symptom have a similar effect on pain. This relationship generally decreased in magnitude in countries neighbouring and surrounding Ukraine, with Ukraine serving as the epicentre. These findings help characterise the relationship between stress and health in a real-world setting.
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Affiliation(s)
| | - Kateryna Bornukova
- BEROC Economic Research Center, Minsk, Belarus
- Universidad Carlos III de Madrid, Department of Economics, Madrid, Spain
| | | | | | | | | | - Sonia Ponzo
- Flo Health UK Limited, London, United Kingdom
- University College London, Institute of Health Informatics, London, United Kingdom
| | - Sarah Garfinkel
- University College London, Institute of Cognitive Neuroscience, London, United Kingdom
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Galovski TE, Street AE, Creech S, Lehavot K, Kelly UA, Yano EM. State of the Knowledge of VA Military Sexual Trauma Research. J Gen Intern Med 2022; 37:825-832. [PMID: 36042078 PMCID: PMC9481813 DOI: 10.1007/s11606-022-07580-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
Despite substantial efforts to counter sexual assault and harassment in the military, both remain persistent in the Armed Services. In February 2021, President Biden directed the U.S. Department of Defense to establish a 90-day Independent Review Commission on Sexual Assault in the Military (IRC) to assess the department's efforts and make actionable recommendations. As servicemembers discharge from the military, effects of military sexual trauma (MST) are often seen in the Veterans Health Administration (VA). In response to an IRC inquiry about VA MST research, we organized an overview on prevalence, adverse consequences, and evidence-based treatments targeting the sequelae of MST. Women are significantly more likely to experience MST than their male counterparts. Other groups with low societal and institutional power (e.g., lower rank) are also at increased risk. Although not all MST survivors experience long-term adverse consequences, for many, they can be significant, chronic, and enduring and span mental and physical health outcomes, as well as cumulative impairments in functioning. Adverse consequences of MST come with commonalities shared with sexual trauma in other settings (e.g., interpersonal betrayal, victim-blaming) as well as unique aspects of the military context, where experiences of interpersonal betrayal may be compounded by perceptions of institutional betrayal (e.g., fear of reprisal or ostracism, having to work/live alongside a perpetrator). MST's most common mental health impact is posttraumatic stress disorder, which rarely occurs in isolation, and may coincide with major depression, anxiety, eating disorders, substance use disorders, and increased suicidality. Physical health impacts include greater chronic disease burden (e.g., hypertension), and impaired reproductive health and sexual functioning. Advances in treatment include evidence-based psychotherapies and novel approaches relying on mind-body interventions and peer support. Nonetheless, much work is needed to enhance detection, access, care, and support or even the best interventions will not be effective.
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Affiliation(s)
- Tara E Galovski
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Street, Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - Amy E Street
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Street, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Suzannah Creech
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas VA, Waco, TX, USA
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Keren Lehavot
- VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ursula A Kelly
- Atlanta VA Health Care System, Atlanta, GA, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
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Maguen S, Griffin BJ, Copeland LA, Perkins DF, Richardson CB, Finley EP, Vogt D. Trajectories of functioning in a population-based sample of veterans: contributions of moral injury, PTSD, and depression. Psychol Med 2022; 52:2332-2341. [PMID: 33234177 PMCID: PMC9527674 DOI: 10.1017/s0033291720004249] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although research has shown that exposure to potentially traumatic and morally injurious events is associated with psychological symptoms among veterans, knowledge regarding functioning impacts remains limited. METHODS A population-based sample of post-9/11 veterans completed measures of intimate relationship, health, and work functioning at approximately 9, 15, 21, and 27 months after leaving service. Moral injury, posttraumatic stress, and depression were assessed at ~9 months post-separation. We used Latent Growth Mixture Models to identify discrete classes characterized by unique trajectories of change in functioning over time and to examine predictors of class membership. RESULTS Veterans were assigned to one of four functioning trajectories: high and stable, high and decreasing, moderate and increasing, and moderate and stable. Whereas posttraumatic stress, depression, and moral injury associated with perpetration and betrayal predicted worse outcomes at baseline across multiple functioning domains, moral injury associated with perpetration and depression most reliably predicted assignment to trajectories characterized by relatively poor or declining functioning. CONCLUSIONS Moral injury contributes to functional problems beyond what is explained by posttraumatic stress and depression, and moral injury due to perpetration and depression most reliably predicted assignment to trajectories characterized by functional impairment over time.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Health Care System, San Francisco, CA, USA
- University of California – San Francisco, San Francisco, CA, USA
| | - Brandon J. Griffin
- Central Arkansas VA Healthcare System, Little Rock, AR, USA
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Laurel A. Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Erin P. Finley
- South Texas Veterans Health Care System, San Antonio, TX, USA
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Dawne Vogt
- National Center for PTSD at VA Boston Health Care System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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Cypel Y, Schnurr PP, Schneiderman AI, Culpepper WJ, Akhtar FZ, Morley SW, Fried DA, Ishii EK, Davey VJ. The mental health of Vietnam theater veterans-the lasting effects of the war: 2016-2017 Vietnam Era Health Retrospective Observational Study. J Trauma Stress 2022; 35:605-618. [PMID: 35290689 PMCID: PMC9310606 DOI: 10.1002/jts.22775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/11/2022]
Abstract
Mental health data from the 2016-2017 Vietnam Era Health Retrospective Observational Study (VE-HEROeS) were analyzed by cohort, represented by United States Vietnam theater veterans (VTs) who served in Vietnam, Cambodia, and Laos; nontheater veterans (NTs) without theater service; and age- and sex-matched nonveterans (NVs) without military service. The exposure of interest was Vietnam theater service. Surveys mailed to random samples of veterans (n = 42,393) and nonveterans (n = 6,885) resulted in response rates of 45.0% for veterans (n = 6,735 VTs, Mage = 70.09, SE = 0.04; n = 12,131 NTs) and 67.0% for NVs (n = 4,530). We examined self-report data on four mental health outcomes: probable posttraumatic stress disorder (PTSD), depression, psychological distress, and overall mental health functioning. Weighted adjusted odds ratios (aORs) between each outcome and cohort were estimated, controlling for covariates in four models: cohort plus sociodemographic variables (Model 1), Model 1 plus physical health variables (Model 2), Model 2 plus potentially traumatic events (PTEs; Model 3), and Model 3 plus other military service variables (Model 4). Mental health outcome prevalence was highest for VTs versus other cohorts, with the largest aOR, 2.88, for PTSD, 95% CI [2.46, 3.37], p < .001 (Model 4, VT:NT). Physical health and PTEs contributed most to observed effects; other service variables contributed least to aORs overall. Mental health dysfunction persists among VTs years after the war's end. The present results reaffirm previous findings and highlight the need for continued mental health surveillance in VTs.
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Affiliation(s)
- Yasmin Cypel
- Epidemiology Program, Health Outcomes of Military Exposures (12POP5)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - Paula P. Schnurr
- National Center for PTSDU.S. Department of Veterans AffairsWhite River JunctionVermontUSA,Department of PsychiatryGeisel School of Medicine at DartmouthHanoverNew HampshireUSA
| | - Aaron I. Schneiderman
- Epidemiology Program, Health Outcomes of Military Exposures (12POP5)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - William J. Culpepper
- Epidemiology Program, Health Outcomes of Military Exposures (12POP5)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - Fatema Z. Akhtar
- Epidemiology Program, Health Outcomes of Military Exposures (12POP5)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - Sybil W. Morley
- VISN 2 Center of Excellence for Suicide PreventionU.S. Department of Veterans AffairsCanandaiguaNew YorkUSA
| | - Dennis A. Fried
- War Related Injury & Illness Study CenterU.S. Department of Veterans AffairsEast OrangeNew JerseyUSA
| | - Erick K. Ishii
- Population Health Services (10P4V)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - Victoria J. Davey
- Office of Research & Development (14RD)U.S. Department of Veterans AffairsWashingtonD.C.USA
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Stevens SM, Gustavson DE, Fang B, Tu X, Logue M, Lyons MJ, Reynolds CA, Kremen WS, Franz CE. Predicting Health-Related Quality of Life in Trauma-Exposed Male Veterans in Late Midlife: A 20 Year Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124554. [PMID: 32599875 PMCID: PMC7345107 DOI: 10.3390/ijerph17124554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/05/2022]
Abstract
Trauma-exposed adults with high levels of posttraumatic stress symptoms (PTSS) report poorer health-related quality of life (HRQOL), but less is known about the persistence of this relationship over time. Participants from the Vietnam Era Twin Study of Aging reported on PTSS, health, and sociodemographic characteristics at average age 38; 775 participants reported having been exposed to trauma. Later, at average ages 56 and 62, mental and physical HRQOL were assessed with the Short-Form 36. Premorbid risk for anxiety/neuroticism was evaluated with a polygenic risk score derived from a large genome-wide association study meta-analysis. In multivariate mixed models, having higher levels of PTSS, poorer self-rated health, lower income, and less education at age 38 were associated with worse physical and mental HRQOL two decades later. Chronic health problems at age 38 predicted midlife physical but not mental HRQOL. Although genetic risk for neuroticism was correlated with HRQOL and PTSS, it was no longer significant in multivariate models. Health-related quality of life (HRQOL) predicts morbidity and mortality independently of objective health measures; early interventions may help to mitigate the ongoing impact of trauma on quality of life.
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Affiliation(s)
- Samantha M. Stevens
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Department of Psychology, The Pennsylvania State University, State College, PA 16801, USA
| | - Daniel E. Gustavson
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Bin Fang
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
| | - Xin Tu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA 92093, USA;
| | - Mark Logue
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA; (M.L.); (M.J.L.)
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA; (M.L.); (M.J.L.)
| | - Chandra A. Reynolds
- Department of Psychology, University of California Riverside, Riverside, CA 92521, USA;
| | - William S. Kremen
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, University of California San Diego, La Jolla, CA 92093, USA
| | - Carol E. Franz
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (S.M.S.); (D.E.G.); (B.F.); (W.S.K.)
- Correspondence: ; Tel.: +1-858-822-1793
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Goodman A, Bergbower H, Perrotte V, Chaudhary A. Survival after Sexual Violence and Genocide: Trauma and Healing for Yazidi Women in Northern Iraq. Health (London) 2020. [DOI: 10.4236/health.2020.126046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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