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Sanghvi DE, Chen MS, Bonanno GA. Prospective trajectories of depression predict mortality in cancer patients. J Behav Med 2024; 47:682-691. [PMID: 38615300 DOI: 10.1007/s10865-024-00485-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/14/2024] [Indexed: 04/15/2024]
Abstract
An ever-growing body of empirical evidence has demonstrated the relationship between depression and cancer. The objective of this study was to examine whether depression trajectories predict mortality risk above and beyond demographics and other general health-related factors. Participants (n = 2,345) were a part of the Health and Retirement Study. The sample consisted of patients who were assessed once before their cancer diagnosis and thrice after. Depressive symptoms and general health-related factors were based on self-reports. Mortality risk was determined based on whether the patient was alive or not at respective time points. Latent Growth Mixture Modeling was performed to map trajectories of depression, assess differences in trajectories based on demographics and general health-related factors, and predict mortality risk. Four trajectories of depression symptoms emerged: resilient (69.7%), emerging (13.5%), recovery (9.5%), and chronic (7.2%). Overall, females, fewer years of education, higher functional impairment at baseline, and high mortality risk characterized the emerging, recovery, and chronic trajectories. In comparison to the resilient trajectory, mortality risk was highest for the emerging trajectory and accounted for more than half of the deaths recorded for the participants in emerging trajectory. Mortality risk was also significantly elevated, although to a lesser degree, for the recovery and chronic trajectories. The data highlights clinically relevant information about the depression-cancer association that can have useful implications towards cancer treatment, recovery, and public health.
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Affiliation(s)
- Drishti Enna Sanghvi
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA.
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
- New York Presbyterian Hospital-Westchester Behavioral Health Center, White Plains, NY, USA.
| | - Mark Shuquan Chen
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - George A Bonanno
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
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2
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Arch JJ, Slivjak ET, Finkelstein LB. A Novel Intervention to Reduce Fear of Progression and Trauma Symptoms in Advanced Cancer Using Written Exposure to Worst-Case Scenarios. J Palliat Med 2024; 27:1009-1017. [PMID: 38579139 DOI: 10.1089/jpm.2023.0658] [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: 04/07/2024] Open
Abstract
Background: Adults with advanced cancer experience profound future uncertainty, reflected in elevated fear of cancer progression (FoP) and cancer-related trauma symptoms. These symptoms are associated with physical symptom burden and poorer quality of life, and few interventions exist to manage them. Objective: To develop and pilot a written exposure-based coping intervention (EASE) focused on worst-case scenarios among adults with advanced cancer reporting elevated cancer-related trauma symptoms or FoP. Design: A single-arm intervention development and pilot trial. Participants: The trial enrolled 29 U.S. adults with stage III or stage IV solid tumor cancer (n = 24) or incurable or higher-risk blood cancer (n = 5) reporting elevated cancer-related trauma symptoms or FoP. Among those screened, 74% were eligible, with an eligible-to-enrolled rate of 85%. Design/Measurements: EASE was delivered over five 1:1 videoconferencing sessions. Feasibility and acceptability were evaluated via attendance, surveys, and exit interviews. Outcomes were assessed at five time points through 3-month (FU1, main assessment of interest) and 4.5-month (FU2) follow-up. Results: Participant and interventionist feedback was used to iteratively refine EASE. Among participants, 86% (25/29) completed all five sessions and FU1; surveys and exit interviews indicated high acceptability. Primary outcomes of cancer-related trauma symptoms and FoP improved significantly from pre to both follow-ups by predominantly large effect sizes. Secondary outcomes of anxiety, depression, hopelessness, fear of death/dying, and fatigue, and most process measures improved significantly by FU1 or FU2. Conclusions: EASE, a novel adaptation of written exposure therapy, is a promising approach to reducing FoP and cancer-related trauma symptoms among adults with advanced cancer that warrants further study.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Division of Cancer Prevention and Control, University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elizabeth T Slivjak
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Lauren B Finkelstein
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
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3
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Princip M, Ledermann K, Altwegg R, von Känel R. Cardiac disease-induced trauma and stress-related disorders. Herz 2024; 49:254-260. [PMID: 38990256 PMCID: PMC11286693 DOI: 10.1007/s00059-024-05255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE This review aims to present an updated overview of cardiac disease-induced trauma and stress-related disorders such as acute stress disorder (ASD), adjustment disorder (AjD), and posttraumatic stress disorder (PTSD). First, the prevalence of these disorders, their diagnostic criteria, and their differences from other trauma-related disorders are described. Special challenges in diagnosis and treatment are identified, with various screening tools being evaluated for symptom assessment. Additionally, the risk factors studied so far for the development of symptoms of cardiac-induced posttraumatic stress disorder and the bidirectional relationship between posttraumatic stress disorder and cardiovascular diseases are summarized. Various therapeutic interventions, including pharmacological approaches, are also discussed. Finally, various areas for future research are outlined. BACKGROUND Experiencing a cardiovascular disease, particularly a life-threatening cardiac event, can potentially lead to stress-related disorders such as ASD, AjD, and cardiac disease-induced PTSD (CDI-PTSD). If left untreated, these disorders are associated with a worsening cardiac prognosis and higher mortality rates. Approaching treatment through a trauma-focused lens may be beneficial for managing CDI-PTSD and stress-related disorders. CONCLUSION Future research should explore treatment options for both the patients and the caregivers as well as investigate the long-term effects of trauma-focused interventions on physical and mental health outcomes.
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MESH Headings
- Humans
- Stress Disorders, Post-Traumatic/therapy
- Stress Disorders, Post-Traumatic/etiology
- Stress Disorders, Post-Traumatic/diagnosis
- Heart Diseases/etiology
- Heart Diseases/therapy
- Risk Factors
- Adjustment Disorders/diagnosis
- Adjustment Disorders/therapy
- Adjustment Disorders/etiology
- Adjustment Disorders/psychology
- Prevalence
- Comorbidity
- Stress Disorders, Traumatic, Acute/therapy
- Stress Disorders, Traumatic, Acute/diagnosis
- Stress Disorders, Traumatic, Acute/etiology
- Stress Disorders, Traumatic, Acute/psychology
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Affiliation(s)
- Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Haldenbachstrasse 16/18, 8091, Zurich, Switzerland.
| | - Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Haldenbachstrasse 16/18, 8091, Zurich, Switzerland
- Department of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Rahel Altwegg
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Haldenbachstrasse 16/18, 8091, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Haldenbachstrasse 16/18, 8091, Zurich, Switzerland
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4
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McBain S, Cordova MJ. Medical traumatic stress: Integrating evidence-based clinical applications from health and trauma psychology. J Trauma Stress 2024. [PMID: 38970812 DOI: 10.1002/jts.23075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 07/08/2024]
Abstract
Medical events in both childhood and adulthood, including components of the illness or injury and subsequent medical intervention, recovery, and disability, are increasingly being recognized as potentially traumatic. There has been an increased focus on scholarly work related to medical trauma and medically induced posttraumatic stress disorder (PTSD). Existing evidence suggests that trauma-focused treatment can promote both physical and psychological recovery. However, there continues to be a dearth of clinical guidance on how to (a) best identify and treat prior trauma exposure that complicates adjustment to illness and increases the risk for medically induced PTSD and (b) address medically induced PTSD while concurrently targeting health-related concerns (e.g., pain, adjustment to illness, acquired disability) that may negatively impact recovery. Originally presented as a premeeting institute at the 2023 Annual Meeting of the International Society for Traumatic Stress Studies, this paper describes the biopsychosocial impacts of medical trauma on adults and considerations for assessment and intervention in both traditional trauma and integrated care settings. This includes clinical applications, including assessment, case conceptualization, and health and rehabilitation interventions, that can promote health-related adjustment and coping within the context of trauma-focused treatment.
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Affiliation(s)
- Sacha McBain
- Departments of Psychiatry and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Matthew J Cordova
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
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Berne P, Usai F, Silva E, Melis I, Fancello T, Onida A, Merella P, Figus F, Brugada J, Casu G. Diagnosis of Brugada syndrome affects quality of life and psychological status. Front Cardiovasc Med 2024; 11:1429814. [PMID: 39022618 PMCID: PMC11251888 DOI: 10.3389/fcvm.2024.1429814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Background Chronic diseases have a negative impact on quality of life (QOL) and psychological health. There are limited related data regarding this topic in Brugada syndrome (BrS). We evaluated the effects of the diagnosis of BrS on health-related QOL and psychological status among patients and their relatives. Methods Patients with BrS and their relatives underwent psychological evaluation at diagnosis (T0), 1 and 2 years after diagnosis (T1 and T2) using questionnaires on mental QOL, anxiety, depression, stress, post-traumatic stress, and resilience resources. Results Sixty-one patients and 39 relatives were enrolled. Compared with controls, patients showed increased physical QOL (54.1 ± 6.5 vs. 50.1 ± 8.0, p = 0.014), reduced mental QOL (43.2 ± 11.8 vs. 49.6 ± 9.1, p = 0.018) and increased anxiety (9.9 ± 6.6 vs. 6.9 ± 7.7, p = 0.024) at T0; reduced resilience scores (3.69 ± 0.40 vs. 3.96 ± 0.55, p = 0.008) at T1; and reduced resilience (3.69 ± 0.35 vs. 3.96 ± 0.55, p = 0.019) and increased anxiety scores (16.4 ± 12.8 vs. 6.9 ± 7.7, p = 0.006) at T2. Relatives presented higher stress (17.63 ± 3.77 vs. 12.90 ± 6.0, p = 0.02) at T0 and higher anxiety scores at T0 (13.5 ± 7.6 vs. 6.9 ± 7.7, p < 0.001), T1 (12.0 ± 8.7 vs. 6.9 ± 7.7, p = 0.005), and T2 (16.4 ± 12.8 vs. 6.9 ± 7.7, p = 0.006) than controls. Female sex was significantly independently associated with worse mental QOL scores in patients at T0 (odds ratio = 0.10; 95% confidence interval = 0.05-0.94; p = 0.04). Conclusions The diagnosis of BrS impairs the QOL and psychological status of patients and their relatives. Female sex is independently associated with worse mental QOL in patients at diagnosis.
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Affiliation(s)
- Paola Berne
- Cardiology Department, Ospedale Santissima Annunziata, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - Francesca Usai
- Cardiology Department, Ospedale Santissima Annunziata, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - Etelvino Silva
- Cardiology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz, Grupo GADICOR, Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cadiz, Spain
| | - Irene Melis
- Integrated Assistance and Territorial Evaluation Unit, ASL1, Sassari, Italy
| | - Tatiana Fancello
- Cardiology Department, Ospedale Santissima Annunziata, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - Alessandra Onida
- Neurology Department, Ospedale San Francesco, ASL3, Nuoro, Italy
| | - Pierluigi Merella
- Cardiology Department, Ospedale Santissima Annunziata, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - Francesco Figus
- Cardiology Department, Ospedale Santissima Annunziata, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
- Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Gavino Casu
- Cardiology Department, Ospedale Santissima Annunziata, Azienda Ospedaliera Universitaria, Sassari, Italy
- Medical School, Department of Cardiovascular Diseases, University of Sassari, Sassari, Italy
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6
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Curran L, Mahoney A, Hastings B. A Systematic Review of Trajectories of Clinically Relevant Distress Amongst Adults with Cancer: Course and Predictors. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10011-x. [PMID: 38704756 DOI: 10.1007/s10880-024-10011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 05/07/2024]
Abstract
To improve interventions for people with cancer who experience clinically relevant distress, it is important to understand how distress evolves over time and why. This review synthesizes the literature on trajectories of distress in adult patients with cancer. Databases were searched for longitudinal studies using a validated clinical tool to group patients into distress trajectories. Twelve studies were identified reporting trajectories of depression, anxiety, adjustment disorder or post-traumatic stress disorder. Heterogeneity between studies was high, including the timing of baseline assessments and follow-up intervals. Up to 1 in 5 people experienced persistent depression or anxiety. Eight studies examined predictors of trajectories; the most consistent predictor was physical symptoms or functioning. Due to study methodology and heterogeneity, limited conclusions could be drawn about why distress is maintained or emerges for some patients. Future research should use valid clinical measures and assess theoretically driven predictors amendable to interventions.
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Affiliation(s)
- Leah Curran
- Health@Business Research Network, School of Management and Governance, University of New South Wales, High Street, Kensington, Australia.
- The Kinghorn Cancer Centre, St Vincent's Hospital Network, 370 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Network, 390 Victoria Street, Darlinghurst, Australia
- School of Psychiatry, University of New South Wales, High Street, Kensington, Australia
| | - Bradley Hastings
- Health@Business Research Network, School of Management and Governance, University of New South Wales, High Street, Kensington, Australia
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Cornelius T, Edmondson D, Abdalla M, Scott A, Sedano BF, Hiti D, Sullivan AM, Schwartz JE, Kronish IM, Shechter A. Prospective Bidirectional Relationship Between Sleep Duration and Posttraumatic Stress Disorder Symptoms After Suspected Acute Coronary Syndrome. Psychosom Med 2024; 86:283-288. [PMID: 38724037 PMCID: PMC11090408 DOI: 10.1097/psy.0000000000001279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
OBJECTIVE Sleep disturbance is a "hallmark" symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD symptoms when PTSD is induced by acute coronary syndrome (ACS). We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year after hospital evaluation for ACS. METHODS Participants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration ("During the past month, how many hours of actual sleep did you get at night?") and cardiac event or hospitalization-induced PTSD symptoms (PTSD Checklist) were assessed at 1, 6, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms. RESULTS The sample included 1145 participants; 16% screened positive for probable PTSD (PTSD Checklist score ≥33). Mean sleep duration across time points was 6.1 hours. Higher PTSD symptoms predicted shorter sleep duration at the next time point (i.e., 1-6 and 6-12 months; B = -0.14 hours/10-point difference, SE = 0.03, p < .001). Shorter sleep duration was associated with higher PTSD symptoms at the next time point (B = -0.25 points/hour, SE = 0.12, p = .04). CONCLUSIONS Short sleep duration and PTSD symptoms are mutually reinforcing across the first year after ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Allie Scott
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Brandon Fernandez Sedano
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - David Hiti
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Alexandra M. Sullivan
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook, NY
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Center of Excellence for Sleep & Circadian Research, Columbia University Irving Medical Center, New York, NY
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Negri-Schwartz O, Lavidor M, Shilton T, Gothelf D, Hasson-Ohayon I. Post-traumatic growth correlates among parents of children with chronic illnesses: A systematic review and meta-analysis. Clin Psychol Rev 2024; 109:102409. [PMID: 38422715 DOI: 10.1016/j.cpr.2024.102409] [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] [Received: 11/21/2023] [Revised: 01/28/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
Parenting a child with a chronic illness presents a complex journey marked by various challenges, along with possible personal growth following these challenges. In this systematic review we present three meta-analyses, in order to examine the associations of post-traumatic growth (PTG) among parents of children with diverse chronic illnesses, and psychological distress, social support, and resilience. Analyzing 34 studies encompassing a total of 5328 parents, the results reveal several key findings. First, PTG was found to be prevalent among the parents. Second, there was no significant correlation between PTG and psychological distress, suggesting that these two processes may exist independently. Third, a positive correlation was observed between PTG and both social support and resilience-related factors, underscoring the role of these factors in fostering growth among parents of children with chronic illnesses. Additionally, illness type emerged as a moderator, affecting the strength of the above-mentioned correlations with PTG. Specifically, in the case of psychiatric illnesses, correlations of PTG with social support and resilience were stronger than in the context of other illnesses. Overall, this review emphasizes the significance of recognizing and addressing PTG correlates among parents of children with chronic illnesses, offering insights for clinical practice.
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Affiliation(s)
| | - Michal Lavidor
- Psychology Department, Bar-Ilan University, Israel; Gonda Brain Research Center, Bar-Ilan University, Israel
| | - Tal Shilton
- Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Gothelf
- Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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9
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Fan Y, Yu B, Liu H, Ma H, Ma C, Li Y, Feng C, Jia P, Yang S. Network analysis of illness perception, stigma, and resilience with cognition in old people living with HIV. J Psychosom Res 2024; 177:111565. [PMID: 38128387 DOI: 10.1016/j.jpsychores.2023.111565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/12/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Old people living with HIV (PLWH) are highly susceptible to HIV-related psychological and neurocognitive disorders, which are multidimensional and inseparably intertwined. Despite this, few studies have investigated the interrelationship between these disorders. We aimed to estimate the detailed associations and identify potential intervention points between HIV-related psychological factors and cognitive function in old PLWH. METHODS This cross-sectional study drew on the Older People with HIV Infections Cohort from 65 communities in Sichuan, China. Three HIV-related psychological factors, including illness perception, HIV stigma perception and resilience, were collected using a self-reported questionnaire. Cognitive function was measured using the MoCA-B scale. Network analysis was used to estimate the interrelationships between HIV-related psychological factors and cognitive function dimensions in old PLWH, and to identify factors that act as bridges in connecting these factors in the network. RESULTS Of the 1587 old PLWH, 47.0% had mild or severe cognitive function impairment. Network analysis revealed that better visual perception was directly connected with poorer negative self-image (edge weight: 0.13), and poorer illness comprehensibility was connected with poor visual perception (-0.09) and executive functioning (-0.13). The cognitive illness perceptions (bridge strength: 0.41), illness comprehensibility (0.36) and negative self-image (0.39) were identified as bridges connecting HIV-related psychological and cognitive function. CONCLUSIONS The interconnection of HIV-related illness perception, stigma perception, and resilience with cognition may be achieved through the links of negative self-image, illness comprehensibility and cognitive illness perceptions. These factors may serve as potential non-pharmaceutical action points to improve psychological and cognitive health among old PLWH.
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Affiliation(s)
- Yunzhe Fan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bin Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China; Sichuan Research Center of Sexual Sociology and Sex Education, Chengdu, China
| | - Hongyun Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Hua Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chunlan Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yuchen Li
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Department of Geography, the Ohio State University, Columbus, OH, USA; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Chuanteng Feng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China
| | - Peng Jia
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; Hubei Luojia Laboratory, Wuhan, China; School of Public Health, Wuhan University, Wuhan, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; Department of Clinical Medical College, Affiliated Hospital of Chengdu University, Chengdu, China.
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10
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Birk JL, Cumella R, Lopez-Veneros D, Agarwal S, Kronish IM. Feasibility of a remote heart rate variability biofeedback intervention for reducing anxiety in cardiac arrest survivors: A pilot trial. Contemp Clin Trials Commun 2024; 37:101251. [PMID: 38312473 PMCID: PMC10837694 DOI: 10.1016/j.conctc.2023.101251] [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] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 04/12/2023] [Accepted: 12/22/2023] [Indexed: 02/06/2024] Open
Abstract
Background Heart rate variability biofeedback (HRVB) is a promising non-pharmacologic approach for reducing anxiety. This intervention's feasibility needs testing in psychologically distressed cardiac patients for whom heart-related anxiety is a core concern. To enhance scalability and convenience, remote delivery of HRVB also needs to be assessed. Accordingly, we evaluated the feasibility of remote HRVB in survivors of cardiac arrest (CA) with elevated CA-related psychological distress. Methods The intervention was comprised of daily sessions of diaphragmatic paced breathing and real-time monitoring of cardiac activity guided by a smartphone app and heart rate monitor. This single-arm feasibility trial assessed the percentage of eligible contacted patients who consented and engaged in the study and the self-reported acceptability, feasibility, appropriateness, and usability of the intervention. Exploratory analyses assessed pre-to-post changes in trait anxiety, negative affect, cardiac-related interoceptive fear, and resting-state HRV. Results Of 12 eligible CA survivors contacted, 10 enrolled. All 10 patients completed the virtual study visits and the majority (>50 %) of prescribed training sessions. Ninety percent reported good scores for intervention acceptability and feasibility, and 80 % reported good scores for its appropriateness and usability for reducing fear. Trait anxiety decreased significantly pre-to-post intervention. There were no changes in negative affect, interoceptive fear, or resting state HRV. Conclusion A remotely delivered HRVB intervention was acceptable, feasible, and useable for cardiac patients with CA-related psychological distress. A phase 2 randomized controlled trial evaluating the efficacy of HRVB on cardiac patients' psychological distress, health behaviors, and autonomic dysfunction may be warranted.
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Affiliation(s)
- Jeffrey L. Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, 10032, United States
| | - Robin Cumella
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, 10032, United States
| | - David Lopez-Veneros
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, 10032, United States
| | - Sachin Agarwal
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center, 177 Fort Washington Avenue, Milstein Hospital, 8GS-300, New York, 10032, United States
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, 10032, United States
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11
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Birk JL, Cornelius T, Kronish IM, Shechter A, Diaz KM, Schwartz JE, Garcia OG, Cruz GJ, Shaw K, Sanchez GJ, Agarwal S, Edmondson D. Association between cardiac event-induced PTSD symptoms and daily intrusive thoughts about cardiac risk: An ecological momentary assessment study. Gen Hosp Psychiatry 2024; 86:103-107. [PMID: 38181710 PMCID: PMC10872378 DOI: 10.1016/j.genhosppsych.2023.11.014] [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] [Received: 07/30/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Posttraumatic stress symptoms (PSS) due to acute cardiac events are common and may lead patients to avoid secondary prevention behaviors. However, patients' daily experience of cardiac event-induced PSS has not been studied after a potentially traumatic cardiac hospitalization. METHOD In an observational cohort study, 108 mostly male patients with coronary heart disease were recruited after evaluation for suspected acute coronary syndrome (ACS). One month later, PSS were assessed via telephone-administered PTSD Checklist for DSM-5 (PCL-5). The exposure of interest was elevated (PCL-5 ≥ 20) vs. non-elevated PSS (PCL-5 ≤ 5). The occurrence and severity of cardiac-related intrusive thoughts were assessed 5 times daily for 2 weeks via electronic surveys on a wrist-worn device. RESULTS Moderate-to-severe intrusive thoughts were experienced by 48.1% of patients but more commonly by elevated-PSS (n = 36; 66.7%) than non-elevated-PSS (n = 72; 38.9%) patients. After adjustment for demographic and clinical characteristics, elevated- vs. non-elevated-PSS patients had a 9-fold higher odds of experiencing a moderate-to-severe intrusive thought during each 2-h assessment interval (adjusted OR = 9.14, 95% CI [2.99, 27.92], p < .01). After adjustment, intrusive thoughts on a 0-to-6 point scale were over two times as intense for elevated-PSS vs. non-elevated-PSS patients. CONCLUSIONS Intrusive thoughts about cardiac risk were common in patients recently evaluated for ACS, but much more prevalent and intense in those with elevated vs non-elevated PSS.
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Affiliation(s)
- Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA.
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Othanya G Garcia
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Gaspar J Cruz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Kaitlin Shaw
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
| | - Gabriel J Sanchez
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA; Psychology Department, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA
| | - Sachin Agarwal
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, Milstein Hospital, 177 Fort Washington Avenue, New York, NY 8GS-300, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, New York, NY 10032, USA
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12
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Pięta-Lendzion M, Rzeszutek M, Tsukayama E, Blackie LER, Gruszczyńska E. Daily emotional dynamics and changes in posttraumatic growth and posttraumatic depreciation among people living with HIV. J Psychosom Res 2024; 176:111552. [PMID: 37988937 DOI: 10.1016/j.jpsychores.2023.111552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 11/12/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Posttraumatic growth (PTG), and its negative reflection, posttraumatic depreciation (PTD), are two aspects of response to trauma. This study explores whether daily emotional dynamics (inertia and innovation) can translate into positive versus negative changes among people living with HIV (PLWH) in the form of long-term changes in PTG or PTD. METHODS The study combined a classical longitudinal approach with two assessments of PTG and PTD within one year and a measurement burst diary design with three weekly electronic diaries. In total, 249 PLWH participated in this study, filling out an expanded version of the Posttraumatic Growth and Depreciation Inventory (PTGDI-X) and a survey of sociodemographic and clinical data. In addition, they assessed their positive affect (PA) and negative affect (NA) at the end of each day in online diaries using a shortened version of the PANAS-X. RESULTS Although we observed stable significant inertia and innovation of PA and NA across all bursts, these parameters of daily emotional dynamics were unrelated to the longitudinal changes in PTG and PTD. The same null results were also noted for the average levels of NA and PA. CONCLUSIONS The results indicated the relative stability of emotion regulation in PLWH over the course of one year and contributed to understanding its dynamic mechanisms in terms of trait-like characteristics. The null result of the relationship between the PTG and PTD change might suggest a weak role of emotion regulation in shaping these trajectories as well as a lack of validity of the PTG/PTD measures.
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Affiliation(s)
| | - Marcin Rzeszutek
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland
| | - Eli Tsukayama
- Business Administration Division, University of Hawai'i-West O'ahu, 91-1001 Farrington Hwy, Kapolei, HI 96707, United States
| | - Laura E R Blackie
- School of Psychology, University of Nottingham, East Dr, Nottingham NG7 2RD, United Kingdom
| | - Ewa Gruszczyńska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska 19/31, 03-815 Warsaw, Poland
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13
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Khan N, Iqra Tanveer Khan S, Joti S, Malik J, Faraz M, Ashraf A. Association of Cardiovascular Diseases With Post-Traumatic Stress Disorder: An Updated Review. Cardiol Rev 2023:00045415-990000000-00174. [PMID: 37966219 DOI: 10.1097/crd.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The intricate relationship between post-traumatic stress disorder (PTSD) and cardiovascular disease (CVD) has garnered increasing attention due to its bidirectional impact and potential for significant health consequences. Epidemiological evidence suggests that PTSD may serve as a risk factor for incident CVD, while acute CVD events can trigger PTSD, subsequently increasing the risk of recurrent cardiovascular events. This dynamic interplay is characterized by the human stress response, disrupted behavioral and lifestyle factors, and potential physiological mechanisms. Notably, the immediate aftermath of a cardiovascular event presents a critical window for intervention, offering the possibility of preventing the development of PTSD and its associated physiological and behavioral sequelae. However, while candidate mechanisms linking PTSD and CVD have been identified, determining which mechanisms are most amenable to intervention remains a challenge. This article emphasizes the urgency of addressing key unanswered questions in this domain. Despite an evolving understanding of the association between PTSD and CVD, causal relationships remain to be firmly established. Comprehensive investigations into the intricate interplay of behavioral and biological mechanisms are essential for identifying precise targets for intervention. Innovations in research methodologies, including the exploration of PTSD symptom dynamics and their impact on cardiovascular function, hold the potential for identifying crucial intervention points. Drawing parallels from prior challenges in translating identified risk factors into effective interventions, the field must prioritize systematic investigations and early-phase intervention trials. By doing so, researchers and clinicians can potentially develop strategies to mitigate CVD risk in the context of PTSD and improve both cardiovascular and mental health outcomes.
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Affiliation(s)
- Naqeeb Khan
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
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14
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Stahl A, Barnett K, Wilson AK, Ren S, Neuberg D, Park HS, Parnes A. Posttraumatic stress disorder and posttraumatic stress symptoms among adults with hemophilia A and B. Res Pract Thromb Haemost 2023; 7:102241. [PMID: 38193061 PMCID: PMC10772881 DOI: 10.1016/j.rpth.2023.102241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 09/03/2023] [Accepted: 09/22/2023] [Indexed: 01/10/2024] Open
Abstract
Background Persons with hemophilia may encounter various traumatic experiences related to their bleeding disorder throughout their lifetime. Little is known about the clinical impact of disease-related trauma on this population. Objectives To explore the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms in adults with hemophilia A and B and characterize the traumatic experiences they report. Methods An online survey tool collecting data on participant characteristics and a validated questionnaire containing the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders 5 were distributed via Research Electronic Data Capture to adults with hemophilia A and B during their annual visit to their hemophilia treatment center. Participants were asked about traumatic experiences specific to their hemophilia prior to self-administering the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders 5 questionnaire. Results Survey responses from 178 individuals across 3 hemophilia treatment centers were included in the analysis, representing a 70% response rate. One hundred one (56.7%) participants identified a hemophilia-related traumatic event, and 21 (11.8%) participants met criteria for a provisional diagnosis of PTSD. Multivariable analysis showed higher odds of a positive PTSD screen in participants with noninfectious (odds ratio [OR], 13.89; 95% CI, 2.23-86.62) and infectious comorbidities (OR, 11.18; 95% CI, 1.34-93.45) and in participants with >1 mental health comorbidity (OR, 10.07; 95% CI, 2.39-42.52). On the contrary, age >46 years (OR, 0.6; 95% CI, 0.01-0.62) and higher education (OR, 0.25; 95% CI, 0.07-0.88) reduced odds of PTSD. Conclusion Persons with hemophilia are at risk of developing PTSD and posttraumatic stress symptoms. These data support the need for trauma screening, psychosocial services in the bleeding disorders community, and provision of trauma-informed care by providers.
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Affiliation(s)
- Amanda Stahl
- Division of Hematology, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Kaitlin Barnett
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy K. Wilson
- M Health Fairview Center for Bleeding and Clotting Disorders, Minneapolis, Minnesota, USA
| | - Siyang Ren
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Donna Neuberg
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Hae Soo Park
- Division of Hematology, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Aric Parnes
- Division of Hematology, Brigham & Women’s Hospital, Boston, Massachusetts, USA
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15
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Wang AWT, Hsu WY, Chang CS. Curvilinear prediction of posttraumatic growth on quality of life: a five-wave longitudinal investigation of breast cancer survivors. Qual Life Res 2023; 32:3185-3193. [PMID: 37344728 DOI: 10.1007/s11136-023-03464-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Do cancer survivors experience positive changes (i.e., posttraumatic growth; PTG) resulting in better quality of life? The issue has yet to yield consistent notions. This longitudinal study extends the literature on the role of PTG by examining the curvilinear relationship between PTG and Health-Related Quality of Life (HRQoL), and explored whether PTG predicts subsequent HRQoL in a quadratic relationship across 2 years following surgery. METHODS Women with breast cancer (N = 359; Mage = 47.5) were assessed at five waves over two years. On every measurement occasion, PTG measured by the posttraumatic growth inventory and HRQoL measured by SF-36 were assessed. The five waves reflect major medical demands and related challenges in the breast cancer trajectory, in which 1-day, 3 months, 6 months, 12 months, and 24 months after surgery were adopted as the survey timing. In a series of hierarchical linear modeling (HLM) analyses, the time-lagged predictions of PTG (i.e., linear, quadratic) on HRQoL were examined, controlling demographic and medical covariates. RESULTS The results revealed that the quadratic term of PTG consistently significantly predicted physical and mental health quality of life (PCS and MCS), while the linear term of PTG did not significantly predict PCS or MCS. CONCLUSION With multi-wave longitudinal data, this study demonstrated that the relationship between PTG and HRQoL is curvilinear, and this finding extends to PTG's prediction of subsequent HRQoL. The quadratic relationship has critical implications for clinical assessment and intervention. Details are discussed.
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Affiliation(s)
- Ashley Wei-Ting Wang
- Department of Psychology, Soochow University, No.70, Linhsi Road, Shihlin District, Taipei, 111, Taiwan, ROC.
| | - Wen-Yau Hsu
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Cheng-Shyong Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Health care Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
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16
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Mitchell HR, Antoni MH, Shaffer KM, Kim Y. Correlates of posttraumatic stress in cancer patients and their family caregivers across two years following diagnosis. Psychooncology 2023; 32:1736-1743. [PMID: 37789570 DOI: 10.1002/pon.6227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/14/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To examine risk-factors of cancer-related PTSS in the 2-years post-diagnosis in adult colorectal cancer patients and caregivers. METHODS Patients with colorectal cancer and their caregivers (N = 130 dyads) self-reported sociodemographic, psychosocial, and medical factors at diagnosis/treatment initiation (T1), at 1- (T2), and 2-year (T3) post-diagnosis. Cancer-related PTSS were assessed, and path analysis examined associations between proposed correlates and PTSS. RESULTS Among patients, higher neuroticism and greater physical symptom distress were concurrently associated with higher PTSS (Bs ≥ 0.10, ps ≤ 0.02); greater physical symptom distress at T1 and greater social support at T2 were associated with higher PTSS at T3 (Bs ≥ 0.37, ps ≤ 0.04). Among caregivers, female gender, higher neuroticism (Bs ≥ 0.12, ps < 0.01), and lower social support (Bs ≤ -0.24, ps ≤ 0.02) were associated with higher concurrent PTSS; lower patient physical symptom distress and social support at T1 (Bs ≤ -0.27, ps ≤ 0.03) and longer hours spent caregiving at T2 (B = 0.03, p = 0.05) were associated with higher PTSS at T3. CONCLUSIONS Findings identify cancer-specific risk factors (physical symptoms, hours caregiving), in addition to established risk factors (female, neuroticism, social support) in non-medical populations. The identified subgroups should receive ongoing screening and psychosocial referral for cancer-related PTSS.
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Affiliation(s)
- Hannah-Rose Mitchell
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Youngmee Kim
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
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17
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Mutuyimana C, Maercker A. Elements of cultural scripts of trauma sequelae among trauma victims in East Africa. Front Psychol 2023; 14:1206503. [PMID: 37928575 PMCID: PMC10623154 DOI: 10.3389/fpsyg.2023.1206503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
Background As a new, unifying approach to mapping the cultural expressions of trauma sequelae, cultural scripts of trauma sequelae are empirically investigated here for the first time in a primarily qualitative study. Elements of Cultural Scripts of Trauma (CST) include the typical symptoms and appraisals of changes of those who have experienced traumatic events. These elements refer to the value orientations in the given culture. Aims To identify post-traumatic cultural scripts' elements and their groupings, as expressed by trauma survivors from the East African population, and to explore the cultural values that serve as a reference to such scripts' elements. Methods Semi-structured, in-depth interviews were conducted in nine focus groups of trauma survivors and trauma experts. Grounded theory was the basis for the content analysis, and MAXQDA was used for coding and grouping. Semi-quantitative analyses of the frequency of groupings followed. Results The study extracted 270 elements of the cultural scripts of trauma. Three stages of cultural scripts' elements were identified including unspeakable, heart wounds and painful scars and growth. The reported elements are only those in the three last stages and they are grouped into six categories, such as cognitive appraisals, worldview, interpersonal relationships, body-related, positive changes and changes in family interest and management, while the elements of the first stages are not codable as the survivors do not yet get the words of their expressions. The cultural values that served as a reference consisted of holding the sadness, Christianity, community reputation, solidarity, social connectedness, social cynicism, and reproductiveness, among others. Discussion This comprehensive study with participants from several countries in East Africa collected a large number of elements of cultural scripts of trauma for this regional area. Notably, these elements were based mostly on man-made traumas, such as the genocide against the Tutsis in Rwanda. Further steps in the CST investigation are subject to future studies, such as a more systematic investigation of the relationship with cultural values and the temporal relationships within the scripts.
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Affiliation(s)
- Celestin Mutuyimana
- Division of Psychopathology and Clinical Intervention, Department of Psychology, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Andreas Maercker
- Division of Psychopathology and Clinical Intervention, Department of Psychology, Institute of Psychology, University of Zurich, Zurich, Switzerland
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18
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Gillam W, Godbole N, Sangam S, DeTommaso A, Foreman M, Lucke-Wold B. Neurologic Injury-Related Predisposing Factors of Post-Traumatic Stress Disorder: A Critical Examination. Biomedicines 2023; 11:2732. [PMID: 37893106 PMCID: PMC10604790 DOI: 10.3390/biomedicines11102732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/30/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
The present review aimed to identify the means through which neurologic injury can predispose individuals to Post-Traumatic Stress Disorder (PTSD). In recent years, comprehensive studies have helped to clarify which structures in the central nervous system can lead to distinct PTSD symptoms-namely, dissociative reactions or flashbacks-when damaged. Our review narrowed its focus to three common neurologic injuries, traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), and stroke. We found that in each of the three cases, individuals may be at an increased risk of developing PTSD symptoms. Beyond discussing the potential mechanisms by which neurotrauma may lead to PTSD, we summarized our current understanding of the pathophysiology of the disorder and discussed predicted associations between the limbic system and PTSD. In particular, the effect of noradrenergic neuromodulatory signaling on the hypothalamic pituitary adrenal (HPA) axis as it pertains to fear memory recall needs to be further explored to better understand its effects on limbic structures in PTSD patients. At present, altered limbic activity can be found in both neurotrauma and PTSD patients, suggesting a potential causative link. Particularly, changes in the function of the limbic system may be associated with characteristic symptoms of PTSD such as intrusive memories and acute psychological distress. Despite evidence demonstrating the correlation between neurotrauma and PTSD, a lack of PTSD prognosis exists in TBI, SAH, and stroke patients who could benefit from early treatment. It should be noted that PTSD symptoms often compound with pre-existing issues, further deteriorating health outcomes for these patients. It is ultimately our goal to clarify the relationship between neurotrauma and PTSD so that earlier diagnoses and appropriate treatment are observed in clinic.
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Affiliation(s)
- Wiley Gillam
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (W.G.)
| | - Nikhil Godbole
- School of Medicine, Tulane University, New Orleans, LA 70112, USA;
| | - Shourya Sangam
- College of Liberal Arts and Sciences, University of Florida, Gainesville, FL 32603, USA
| | - Alyssa DeTommaso
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL 32827, USA
| | - Marco Foreman
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (W.G.)
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
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19
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Presciutti AM, Bannon SM, Yamin JB, Newman MM, Parker RA, Elmer J, Wu O, Donnino MW, Perman SM, Vranceanu AM. The relationship between mindfulness and enduring somatic threat severity in long-term cardiac arrest survivors. J Behav Med 2023; 46:890-896. [PMID: 36892781 PMCID: PMC9995732 DOI: 10.1007/s10865-023-00405-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Cardiac arrest (CA) survivors experience continuous exposures to potential traumas though chronic cognitive, physical and emotional sequelae and enduring somatic threats (ESTs) (i.e., recurring somatic traumatic reminders of the event). Sources of ESTs can include the daily sensation of an implantable cardioverter defibrillator (ICD), ICD-delivered shocks, pain from rescue compressions, fatigue, weakness, and changes in physical function. Mindfulness, defined as non-judgmental present-moment awareness, is a teachable skill that might help CA survivors cope with ESTs. Here we describe the severity of ESTs in a sample of long-term CA survivors and explore the cross-sectional relationship between mindfulness and severity of ESTs. METHODS We analyzed survey data of long-term CA survivors who were members of the Sudden Cardiac Arrest Foundation (collected 10-11/2020). We assessed ESTs using 4 cardiac threat items from the Anxiety Sensitivity Index-revised (items range from 0 "very little" to 4 "very much") which we summed to create a score reflecting total EST burden (range 0-16). We assessed mindfulness using the Cognitive and Affective Mindfulness Scale-Revised. First, we summarized the distribution of EST scores. Second, we used linear regression to describe the relationship between mindfulness and EST severity adjusting for age, gender, time since arrest, COVID-19-related stress, and loss of income due to COVID. RESULTS We included 145 CA survivors (mean age: 51 years, 52% male, 93.8% white, mean time since arrest: 6 years, 24.1% scored in the upper quarter of EST severity). Greater mindfulness (β: -30, p = 0.002), older age (β: -0.30, p = 0.01) and longer time since CA (β: -0.23, p = 0.005) were associated with lower EST severity. Male sex was also associated with greater EST severity (β: 0.21, p = 0.009). CONCLUSION ESTs are common among CA survivors. Mindfulness may be a protective skill that CA survivors use to cope with ESTs. Future psychosocial interventions for the CA population should consider using mindfulness as a core skill to reduce ESTs.
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Affiliation(s)
- Alexander M Presciutti
- Massachusetts General Hospital, Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Boston, United States.
- Harvard Medical School, Department of Psychiatry, Boston, United States.
| | - Sarah M Bannon
- Massachusetts General Hospital, Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Boston, United States
- Harvard Medical School, Department of Psychiatry, Boston, United States
| | - Jolin B Yamin
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Emergency Medicine, Center for Resuscitation Science, Boston, United States
| | - Mary M Newman
- Sudden Cardiac Arrest Foundation, Wexford, United States
| | - Robert A Parker
- Harvard Medical School, Department of Medicine, Boston, United States
- Massachusetts General Hospital, Department of Medicine, Biostatistics Center, Boston, United States
| | - Jonathan Elmer
- Departments of Emergency Medicine, Critical Care Medicine, and Neurology, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - Ona Wu
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Boston, United States
- Harvard Medical School, Department of Radiology, Boston, United States
| | - Michael W Donnino
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Emergency Medicine, Center for Resuscitation Science, Boston, United States
| | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, United States
| | - Ana-Maria Vranceanu
- Massachusetts General Hospital, Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Boston, United States
- Harvard Medical School, Department of Psychiatry, Boston, United States
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20
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Fuss A, Lease S. Moderating the Relationship Between Ulcerative Colitis and Crohn's Disease and Symptoms of PTSD: The Role of Remission. J Clin Gastroenterol 2023; 57:816-823. [PMID: 35997689 DOI: 10.1097/mcg.0000000000001748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/11/2022] [Indexed: 12/10/2022]
Abstract
GOALS This study examined whether inflammatory bowel disease (IBD) patients endorse clinically significant symptoms of post-traumatic stress disorder (PTSD), and tested whether remission status and remission expectations effectively moderate the relationship between endorsements of PTSD symptoms and aspects of IBD. BACKGROUND STUDY The enduring somatic threat model speaks to the presentation of symptoms of trauma that result from ongoing somatic concerns rather than discrete external events. Literature shows patients living with acute conditions experience symptoms of PTSD; however, few studies extend this to the IBD population. In addition, literature suggests remission may serve as a protective factor for the impact of IBD; as such, aspects of remission may serve as moderators in the relationship between aspects of IBD and PTSD symptoms. RESULTS Among a sample of adults with IBD, results showed that 32.8% of participants met the established cutoff for PTSD symptoms warranting further diagnostic evaluation. The findings further showed several aspects of remission moderated the relationship between multiple distinct IBD related concerns and PTSD symptoms. CONCLUSIONS Given the results of this study, it would be beneficial for providers to maintain awareness of the potential impact of PTSD symptoms, including the ways in which these symptoms may influence patient engagement/presentation. Ultimately, these results inform efforts to continue appropriate referral to mental health professionals for follow up.
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21
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F SS, R H, A S, E J, S A, Z H, R N. Addressing PTSD in Implantable Cardioverter Defibrillator Patients: State-of-the-Art Management of ICD Shock and PTSD. Curr Cardiol Rep 2023; 25:1029-1039. [PMID: 37486571 DOI: 10.1007/s11886-023-01924-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW This paper reviews the unique processes and treatments of post-traumatic stress in implantable cardioverter-defibrillator (ICD) patients and posits specific clinical management recommendations. RECENT FINDINGS PTSD is a common presenting problem for a prospective ICD patient and is a common response to ICD shocks. Approximately 32% of patients with sudden cardiac arrest report significant PTSD symptoms. Following ICD shock, approximately 20% experience PTSD from the shocks. Regardless, PTSD can interrupt and undermine clinical management from a cardiologist perspective and create significant disturbance in patients and families. Few cardiology clinics are outfitted to effectively manage psychological distress, in general, and PTSD, in particular. Effective management of PTSD patients can be achieved with both direct care in the cardiac clinic, as well as indirect care via multidisciplinary consultation and expertise. The importance of emotional validation, return to physical activity, and family engagement is emphasized in current management.
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Affiliation(s)
- Sears S F
- Department of Psychology, East Carolina University, Greenville, NC, USA.
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA.
| | - Harrell R
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Sorrell A
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Jordan E
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Anthony S
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Hashmath Z
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Nekkanti R
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
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22
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Wajer IMCH, Kal J, Robe PA, van Zandvoort MJE, Ruis C. Awake craniotomy does not lead to increased psychological complaints. Acta Neurochir (Wien) 2023; 165:2505-2512. [PMID: 37225975 PMCID: PMC10477129 DOI: 10.1007/s00701-023-05615-5] [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] [Received: 11/04/2022] [Accepted: 04/20/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Patients with brain tumours are increasingly treated by using the awake craniotomy technique. Some patients may experience anxiety when subjected to brain surgery while being fully conscious. However, there has been only limited research into the extent to which such surgeries actually result in anxiety or other psychological complaints. Previous research suggests that undergoing awake craniotomy surgery does not lead to psychological complaints, and that post-traumatic stress disorders (PTSD) are uncommon following this type of surgery. It must be noted, however, that many of these studies used small random samples. METHOD In the current study, 62 adult patients completed questionnaires to identify the degree to which they experienced anxiety, depressive and post-traumatic stress complaints following awake craniotomy using an awake-awake-awake procedure. All patients were cognitively monitored and received coaching by a clinical neuropsychologist during the surgery. RESULTS In our sample, 21% of the patients reported pre-operative anxiety. Four weeks after surgery, 19% of the patients reported such complaints, and 24% of the patients reported anxiety complaints after 3 months. Depressive complaints were present in 17% (pre-operative), 15% (4 weeks post-operative) and 24% (3 months post-operative) of the patients. Although there were some intra-individual changes (improvement or deterioration) in the psychological complaints over time, on group-level postoperative levels of psychological complaints were not increased relative to the preoperative level of complaints. The severity of post-operative PTSD-related complaints were rarely suggestive of a PTSD. Moreover, these complaints were seldom attributed to the surgery itself, but appeared to be more related to the discovery of the tumour and the postoperative neuropathological diagnosis. CONCLUSIONS The results of the present study do not indicate that undergoing awake craniotomy is associated with increased psychological complaints. Nevertheless, psychological complaints may well exist as a result of other factors. Consequently, monitoring the patient's mental wellbeing and offering psychological support where necessary remain important.
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Affiliation(s)
- I M C Huenges Wajer
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
| | - J Kal
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - P A Robe
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J E van Zandvoort
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - C Ruis
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
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Meinhausen C, Sanchez GJ, Edmondson D, Kronish IM, Schwartz JE, Hinrichs R, Jovanovic T, Sumner JA. Skin Conductance Reactivity as a Predictor of Stroke-induced Posttraumatic Stress Disorder Symptoms: A Dimensional Approach. Depress Anxiety 2023; 2023:6671337. [PMID: 39015247 PMCID: PMC11250708 DOI: 10.1155/2023/6671337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
Background Posttraumatic stress disorder (PTSD) symptoms can develop following acute, life-threatening medical events. This study explores a potential biomarker of PTSD risk that is novel to a medical trauma population: a noninvasive, mobile skin conductance (SC) measurement. Methods Participants (N=64) were enrolled in-hospital following a stroke or transient ischemic attack (TIA). Mobile measurement of SC reactivity to recalling the stroke/TIA traumatic event was conducted at hospital bedside in the days following the stroke/TIA. PTSD symptoms that developed in response to the stroke/TIA were measured at 1-month follow-up. We tested the association between SC reactivity and total 1-month PTSD symptoms, as well as PTSD symptom dimensions of fear and dysphoria. Results In unadjusted analyses, there were significant positive associations between in-hospital SC reactivity to recalling the stroke/TIA traumatic event and higher-order fear-related symptoms (r=.30, p=.016), as well as lower-order fear-related symptoms of anxious arousal (r=.27, p=.035) and avoidance (r=.25, p=.043) at 1 month. Associations between SC reactivity and the fear, anxious arousal, and avoidance symptom dimensions remained significant in multivariable regression models that adjusted for relevant covariates including age, gender, stroke severity, medical comorbidity, and psychosocial factors. Although there was a positive association observed between SC reactivity to recalling the stroke/TIA event and total PTSD symptom severity at 1-month follow-up, it did not reach the level of statistical significance (r=.23, p=.070). Further, no significant association was detected for dysphoria-related symptoms (r=.11, p=.393). Conclusions This is the first study to test the prospective association of SC reactivity with PTSD symptom development following a medical trauma. The findings indicate that mobile measures of SC reactivity may be useful for in-hospital identification of individuals at risk for fear-related PTSD symptom development following a medical event and highlight the potential mechanisms involved in the development of these symptoms following a medical event.
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Affiliation(s)
- Corinne Meinhausen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gabriel J. Sanchez
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
- Department of Psychology, St. John’s University, Queens, NY, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, Emory University, School of Medicine, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Cuneo AA, Outram S, Marsac ML, Vendlinski S, Heyman MB, Ly N, von Scheven E, Perito ER. Medical traumatic stress in cystic fibrosis: A qualitative analysis. J Cyst Fibros 2023; 22:763-771. [PMID: 36925385 DOI: 10.1016/j.jcf.2022.12.008] [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] [Received: 06/29/2022] [Revised: 11/18/2022] [Accepted: 12/16/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND People living with cystic fibrosis (PwCF) face a lifetime of potentially traumatic illness-related experiences that can lead to posttraumatic stress symptoms. Existing criteria for this type of posttraumatic stress, called medical traumatic stress (MTS), may not fully capture the CF experience. In this study we aimed to explore: 1) illness-related experiences perceived as traumatic in the setting of CF, 2) perceived MTS symptoms in PwCF, and 3) perceived health-related functional impairments from MTS. METHODS Informed by our aims, we developed and piloted guides for semi-structured interviews and focus groups with PwCF, family members of PwCF, and CF medical providers. We then conducted a series of interviews and focus groups. The qualitative analytical process followed Deterding and Waters' three stages of flexible coding for in-depth interviews, generating key themes and sub-themes in each domain of study inquiry. RESULTS We recruited 51 participants, including 24 PwCF, 7 family members of PwCF, and 20 CF care team members. Illness-related experiences perceived as traumatic were often characterized by themes of loss of agency, threats of bodily harm, and shifts in identity. Prominent MTS symptoms included shame, survivor guilt, burden guilt, germaphobia, and symptom panic. Health-related themes of functional impairments perceived to result from MTS included poor adherence and strained relationships between providers and patients/families. CONCLUSIONS This is the first study to explore the specific experiences of MTS in PwCF. It highlights the need for screening that includes these specific exposure types and symptoms, which may be mitigatable with medical trauma-focused interventions.
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Affiliation(s)
- Addison A Cuneo
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
| | - Simon Outram
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Meghan L Marsac
- Department of Pediatrics, Kentucky Children's Hospital, Lexington, KY, USA
| | - Siena Vendlinski
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Melvin B Heyman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Ngoc Ly
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Emily von Scheven
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Emily R Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
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25
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Cornelius T, Casey JA, Just AC, Rowland ST, Edmondson D. Temperature and socioeconomic vulnerability: associations with cardiac event-induced posttraumatic stress symptoms. Front Psychol 2023; 14:1092106. [PMID: 37325741 PMCID: PMC10267367 DOI: 10.3389/fpsyg.2023.1092106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Background Posttraumatic stress symptoms (PTSS) are common after acute coronary syndrome (ACS) and predict increased morbidity and mortality. Climate change contributes to worse mental and cardiovascular health outcomes, thus, PTSS represent a potential mechanism linking climate change to adverse cardiovascular outcomes. Because people living in areas with lower socioeconomic status (SES) experience greater climate vulnerability, have worse cardiovascular health, and may be more susceptible to PTSS, any effect of temperature on PTSS could be amplified in this population. Methods Spatial regression models were estimated to test the association of temperature and temperature variability (within-day variability, directed change over time, and absolute change over time), census tract-level SES, and their interaction with PTSS 1 month post-hospital discharge in a longitudinal cohort study comprising 956 patients evaluated for ACS at an urban U.S. academic medical center between November 2013-May 2017. PTSS were self-reported in relation to the ACS event that brought the patient to the hospital. Census tract-level was computed as a composite score from the CDC Social Vulnerability Index, with higher values indicating lower SES. Results No temperature or temperature variability metrics were associated with PTSS. Lower census tract-level SES was associated with greater PTSS at 1 month. There was a marginally significant interaction of SES with ACS status, such that we only observed evidence of an association among those with ACS. Conclusion Temperature exposures were not associated with acute CVD-induced PTSS, which could be a result of a small sample size, mismatched timescale, or lack of a true effect. Conversely, lower census tract-level SES was associated with developing worse PTSS 1 month after evaluation for an ACS. This association appeared stronger in individuals with a true ACS. Early interventions to prevent PTSS could promote better mental and CVD outcomes in this at-risk population.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Joan A. Casey
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Allan C. Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sebastian T. Rowland
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
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Princip M, Ledermann K, von Känel R. Posttraumatic Stress Disorder as a Consequence of Acute Cardiovascular Disease. Curr Cardiol Rep 2023; 25:455-465. [PMID: 37129760 DOI: 10.1007/s11886-023-01870-1] [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] [Accepted: 03/20/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE OF REVIEW To provide an update of the current evidence of cardiac disease-induced posttraumatic stress disorder (CDI-PTSD) with a focus on acute coronary events. RECENT FINDINGS A cardiovascular disease, particularly a life-threatening cardiac event is often a highly stressful experience that can induce PTSD in patients and their caregivers, taking a chronic course if left untreated. There are several features distinguishing CDI-PTSD from "traditional" PTSD induced by external trauma, namely enduring somatic threat, inability to avoid trauma-related cues and hyperarousal with internal body sensations leading to constant fear of recurrent cardiac events. An increased risk of recurrent CVD events may be explained by pathophysiological changes, an unhealthy lifestyle and non-adherence to cardiac treatment. A trauma-focused approach might be useful to treat CDI-PTSD. Treatment options for patients and caregivers as well as long-term effects of trauma-focused interventions on physical and mental health outcomes should be future research directions.
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Affiliation(s)
- Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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27
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Taft TH, Carlson DA, Marchese SH, Pandolfino JE. Initial assessment of medical post-traumatic stress among patients with chronic esophageal diseases. Neurogastroenterol Motil 2023; 35:e14540. [PMID: 36703507 PMCID: PMC10133015 DOI: 10.1111/nmo.14540] [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] [Received: 11/11/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Diagnosis and management of chronic esophageal disease requires the use of potentially traumatic medical procedures, performed with or without sedation. Medical trauma and post-traumatic stress (PTS) are emerging as important considerations in patients with digestive illness. To date, no study assesses medical PTS from procedures in patients with esophageal disease. METHODS Adult patients with achalasia, eosinophilic esophagitis, gastroesophageal reflux disease, or functional esophageal disease at a university-based gastroenterology clinic completed: Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5), Gastroesophageal Disease Questionnaire, Brief Esophageal Dysphagia Questionnaire, Northwestern Esophageal Quality of Life scale (HRQoL), NIH-PROMIS Depression scale, and a study-specific questionnaire about esophageal procedures (endoscopy with sedation; functional lumen imaging probe (FLIP) with sedation; high-resolution manometry (HRM); wireless pH testing; or 24-h pH-impedance testing). KEY RESULTS Half of 149 participants reported at least one traumatic procedure, with HRM most often cited. Only 2.7% met the cutoff for PTS on PCL-5. This increased to 7.1% for patients with a traumatic procedure combined with experiencing intense fear. Rates of moderate-severe PTS ranged from 7.4%-12% for all patients and 14%-29% for those with a traumatic procedure with fear. Medical PTS was associated with poorer HRQoL, and increased esophageal symptoms, depression, and hypervigilance and symptom anxiety. CONCLUSIONS & INFERENCES Preliminary evidence suggests medical PTS affects few patients with esophageal disease. However traumatic procedures, most often associated with HRM, significantly increase PTS symptoms. The potential impacts of medical PTS on esophageal patient assessment and outcomes are considerable and warrants further study.
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Affiliation(s)
- Tiffany H Taft
- Division of Gastroenterology & Hepatology Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dustin A Carlson
- Division of Gastroenterology & Hepatology Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sara H Marchese
- Division of Gastroenterology & Hepatology Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John E Pandolfino
- Division of Gastroenterology & Hepatology Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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28
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Rzeszutek M, Pięta M, Van Hoy A, Zawistowska M, Grymowicz M, Pięta W, Gołoś S, Walicka M. Coping profiles, depression, and body image anxiety during the Covid-19 pandemic: Comparative analysis of females with thyroid diseases and a non-clinical sample. PLoS One 2023; 18:e0282302. [PMID: 36857371 PMCID: PMC9977061 DOI: 10.1371/journal.pone.0282302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 02/12/2023] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES This study aimed to compare profiles of coping among females with thyroid disorders and females from a healthy control group regarding depression levels and body image anxiety. We also wanted to check whether subjectively experienced Covid-19-related psychological distress moderated the above-mentioned association in both groups of participants. METHOD The study sample comprised 564 females, of which 329 were diagnosed with a thyroid disease and 235 formed the healthy control group. Participants filled out paper-and-pencil or online versions of psychometric questionnaires to assess coping strategies, depression, and body image anxiety. RESULTS In general, we observed higher depression intensity and a higher level of body image anxiety among females with thyroid diseases than among the healthy control group. Latent profile analysis revealed adaptive vs. maladaptive coping profiles from both study samples. Depression symptoms were significantly higher if coping was maladaptive in both the clinical and control groups. Still, there were no significant differences in body image anxiety between participants with adaptive and maladaptive coping profiles. Covid-19-related distress did not moderate the link between coping profiles, depression, and body image anxiety in either group. CONCLUSION Greater focus should be placed on the role of body image in females struggling with thyroid diseases. Bodily therapy may help these patients to cope better with co-occurring thyroid diseases and mental disorders, whose relationship is still not fully understood.
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Affiliation(s)
- Marcin Rzeszutek
- Faculty of Psychology, University of Warsaw, Stawki, Warsaw, Poland
- * E-mail:
| | - Małgorzata Pięta
- Faculty of Psychology, University of Warsaw, Stawki, Warsaw, Poland
| | - Angelika Van Hoy
- Faculty of Psychology, University of Warsaw, Stawki, Warsaw, Poland
| | | | - Monika Grymowicz
- Department of Gynecological Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Pięta
- Department of Gynecological Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Sara Gołoś
- Department of Gynecological Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Walicka
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Warsaw, Poland
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29
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Meinhausen C, Sanchez GJ, Robles TF, Edmondson D, Kronish IM, Hinrichs R, Jovanovic T, Sumner JA. Correlates of Skin Conductance Reactivity to Stroke-Related Trauma Reminders During Hospitalization for Stroke. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2023; 7:24705470231156571. [PMID: 36814781 PMCID: PMC9940223 DOI: 10.1177/24705470231156571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
Objective Although several risk factors for stroke-induced posttraumatic stress disorder (PTSD) have been identified, objective risk measures that can be detected in the acute aftermath of these events are needed. This study is the first to collect an objective measure of psychophysiological arousal-skin conductance (SC) reactivity to a trauma interview-in patients after stroke or transient ischemic attack (TIA) and investigate correlates of SC reactivity. Methods Mobile SC measurement during a resting baseline and standardized trauma interview was performed in-hospital in 98 individuals following stroke/TIA. We examined associations between several stroke-induced PTSD risk factors (sociodemographic, psychosocial, and medical characteristics) and SC reactivity to a trauma interview involving a free-response recalling of the stroke/TIA event. Results Of the sociodemographic, psychosocial, medical characteristics examined as correlates to SC reactivity to recalling the stroke/TIA event, 2 factors reflecting aspects of prior and in-hospital experience were significantly associated with this indicator of sympathetic nervous system activation. A greater cumulative trauma burden was significantly associated with greater SC reactivity (r = .23, P = .04). Additionally, individuals administered benzodiazepines in-hospital had significantly greater SC reactivity to recalling the stroke/TIA event (M = 1.51, SD = 1.52) than those who were not (M = 0.76, SD = 1.16; P = .01). Greater cumulative trauma burden remained significantly associated with greater SC reactivity when adjusting for age and in-hospital benzodiazepine administration (β=0.22, P = .04). Conclusion This study demonstrated that SC reactivity was related to both behavioral and psychological risk factors for PTSD after a stroke/TIA event. Additionally, we demonstrated the feasibility of a low-cost, mobile measurement of SC that can be conducted in-hospital in a novel patient population: individuals with a medical trauma. With this measure, we were able to identify those individuals with the greatest trauma-related sympathetic nervous system reactivity in the days following a medical trauma. Future research is needed to determine whether SC reactivity may be leveraged in the development of brief, noninvasive screening measures for enhancing PTSD risk prediction.
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Affiliation(s)
- Corinne Meinhausen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA,Corinne Meinhausen, Department of Psychology, University of California, Los Angeles, Psychology Building 1285, Box 951563, Los Angeles, CA 90095-1563, USA.
| | - Gabriel J. Sanchez
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA,Department of Psychology, St. John's University, Queens, NY, USA
| | - Theodore F. Robles
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, Emory University, School of Medicine, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State, University, Detroit, MI, USA
| | - Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Pięta M, Rzeszutek M. Posttraumatic growth and posttraumatic depreciation among people living with HIV: the role of resilience and HIV/AIDS stigma in the person-centered approach. AIDS Care 2023; 35:230-237. [PMID: 36435972 DOI: 10.1080/09540121.2022.2141184] [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: 11/28/2022]
Abstract
Posttraumatic growth (PTG) among people living with HIV (PLWH) remains an understudied and controversial topic, and several research gaps need to be filled. In our study, we focused on one such gap by implementing parallel assessment of positive (PTG) and negative changes (posttraumatic depreciation [PTD]) following trauma related to HIV diagnosis, along with measurement of resilience and HIV/AIDS stigma and socio-medical data. The study sample comprised 509 PLWH, which completed the standardized psychometric inventories measuring the study variables. The results showed an unexpected positive relationship between PTG and PTD among participants. In addition, following the person-centered approach, we observed specific PTG/PTD clusters in the study sample with different resilience and HIV/AIDS stigma levels. Our study may shed some light on understanding PTG/PTD processes among PLWH and inspire planning for effective psychological help adjusted to patients' specific needs.
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Beck S, Whitaker K, Cropley M. Is rumination associated with psychological distress after a cancer diagnosis? A systematic review. J Psychosoc Oncol 2023; 41:584-609. [PMID: 36604965 DOI: 10.1080/07347332.2022.2145925] [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: 01/07/2023]
Abstract
Objective: The aim of this work was to review evidence on the association between psychological rumination and distress in those diagnosed with cancer. Methods: Six databases were searched for studies exploring rumination alongside overall assessments of psychological distress, depression, anxiety, or stress. Results: Sixteen studies were identified. Rumination was associated with distress cross-sectionally and longitudinally. However, once baseline depression was controlled for, the association was no longer seen. The emotional valence of ruminative thoughts and the style in which they were processed, rather than their topic, was associated with distress. Brooding and intrusive rumination were associated with increased distress, deliberate rumination had no association, and reflection/instrumentality had mixed findings. Conclusions: This review highlights that it is not necessarily the topic of content, but the style and valence of rumination that is important when considering its association with distress. The style of rumination should be the target of clinical intervention, including brooding and intrusion.
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Affiliation(s)
- Sarah Beck
- School of Psychology, University of Surrey, Guildford, UK
| | | | - Mark Cropley
- School of Psychology, University of Surrey, Guildford, UK
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32
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Ponomareva OY, Fenster RJ, Ressler KJ. Enhancing Fear Extinction: Pharmacological Approaches. Curr Top Behav Neurosci 2023; 64:289-305. [PMID: 37584834 DOI: 10.1007/7854_2023_443] [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: 08/17/2023]
Abstract
Extinction is the process by which the memory of a learned conditioned association decreases over time and with introduction of new associations. It is a vital part of fear learning, and it is critical to recovery in multiple fear-related disorders, including Specific and Social Phobias, Panic Disorder, Obsessive Compulsive Disorder (OCD), and Posttraumatic Stress Disorder (PTSD). The process of extinction is also the underlying mechanism for recovery in gold-standard therapies for PTSD, including prolonged exposure, cognitive processing therapy, eye movement desensitization and procession, as well as other empirically-based paradigms. Pharmacological modulators of extinction are thus promising targets for treatment of fear-related disorders. We focus here on emerging psychopharmacological treatments to facilitate extinction: D-cycloserine, scopolamine, losartan, ketamine, and 3,4-methylenedioxymethamphetamine. We also provide an overview of recent advances in molecular pathways that show promise as targets for extincion and inhibitory learning, including pathways related to cannabinoid, brain-derived neurotrophic factor, hypothalamic-pituitary-adrenal signaling, and promising work in neurosteroid compounds.
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Smart CM. Eye movement desensitization and reprocessing for post-stroke post-traumatic stress disorder: Case report using the three-phase approach. Brain Inj 2022; 36:1372-1381. [PMID: 36372972 DOI: 10.1080/02699052.2022.2140833] [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: 11/16/2022]
Abstract
Medically-induced post-traumatic stress disorder (PTSD) is substantially more prevalent than PTSD in the general population. In people with stroke, it can impact as many as 23% of patients, with negative effects on mental health as well as stroke-related disability. Medically-induced PTSD may have unique features compared to other forms of PTSD, and therefore there is a pressing need to evaluate existing treatments for PTSD in this context. The current study reports on the feasibility, safety, and efficacy of Eye Movement Desensitization and Reprocessing (EMDR) for PTSD subsequent to a pontine stroke. Using a quasi-experimental case design, a 44-year-old Caucasian woman received EMDR delivered via telehealth. Self-report measures were obtained at baseline, pre-EMDR, and post-EMDR, with brief neuropsychological testing pre/post-EMDR. After 3 sessions of EMDR, the patient no longer met criteria for PTSD, and showed clinically significant reductions in depressive and generalized anxiety symptoms. With proper safety provisions, it is feasible to deliver EMDR via telehealth to alleviate post-stroke PTSD. Reduced linguistic demands of EMDR may be particularly appealing for persons with neurological disorders as compared to other trauma therapies. Further work is also needed to understand the parameters of baseline neuropsychological function that could impact response to intervention.
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Affiliation(s)
- Colette M Smart
- Department of Psychology, University of Victoria, Victoria, Canada
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Polimanti R, Wendt FR, Pathak GA, Tylee DS, Tcheandjieu C, Hilliard AT, Levey DF, Adhikari K, Gaziano JM, O'Donnell CJ, Assimes TL, Stein MB, Gelernter J. Understanding the comorbidity between posttraumatic stress severity and coronary artery disease using genome-wide information and electronic health records. Mol Psychiatry 2022; 27:3961-3969. [PMID: 35986173 PMCID: PMC10986859 DOI: 10.1038/s41380-022-01735-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 02/07/2023]
Abstract
The association between coronary artery disease (CAD) and posttraumatic stress disorder (PTSD) contributes to the high morbidity and mortality observed for these conditions. To understand the dynamics underlying PTSD-CAD comorbidity, we investigated large-scale genome-wide association (GWA) statistics from the Million Veteran Program (MVP), the UK Biobank (UKB), the Psychiatric Genomics Consortium, and the CARDIoGRAMplusC4D Consortium. We observed a genetic correlation of CAD with PTSD case-control and quantitative outcomes, ranging from 0.18 to 0.32. To investigate possible cause-effect relationships underlying these genetic correlations, we performed a two-sample Mendelian randomization (MR) analysis, observing a significant bidirectional relationship between CAD and PTSD symptom severity. Genetically-determined PCL-17 (PTSD 17-item Checklist) total score was associated with increased CAD risk (odds ratio = 1.04; 95% confidence interval, 95% CI = 1.01-1.06). Conversely, CAD genetic liability was associated with reduced PCL-17 total score (beta = -0.42; 95% CI = -0.04 to -0.81). Because of these opposite-direction associations, we conducted a pleiotropic meta-analysis to investigate loci with concordant vs. discordant effects on PCL-17 and CAD, observing that concordant-effect loci were enriched for molecular pathways related to platelet amyloid precursor protein (beta = 1.53, p = 2.97 × 10-7) and astrocyte activation regulation (beta = 1.51, p = 2.48 × 10-6) while discordant-effect loci were enriched for biological processes related to lipid metabolism (e.g., triglyceride-rich lipoprotein particle clearance, beta = 2.32, p = 1.61 × 10-10). To follow up these results, we leveraged MVP and UKB electronic health records (EHR) to assess longitudinal changes in the association between CAD and posttraumatic stress severity. This EHR-based analysis highlighted that earlier CAD diagnosis is associated with increased PCL-total score later in life, while lower PCL total score was associated with increased risk of a later CAD diagnosis (Mann-Kendall trend test: MVP tau = 0.932, p < 2 × 10-16; UKB tau = 0.376, p = 0.005). In conclusion, both our genetically-informed analyses and our EHR-based follow-up investigation highlighted a bidirectional relationship between PTSD and CAD where multiple pleiotropic mechanisms are likely to be involved.
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Affiliation(s)
- Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA.
- VA CT Healthcare Center, West Haven, CT, USA.
| | - Frank R Wendt
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | - Daniel S Tylee
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | | | - Austin T Hilliard
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Daniel F Levey
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | - Keyrun Adhikari
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | - J Michael Gaziano
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Christopher J O'Donnell
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Themistocles L Assimes
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, Psychiatry Service, San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
- Departments of Genetics and of Neuroscience, Yale School of Medicine, New Haven, CT, USA
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Plys E, Beam R, Boxer RS, Portz JD. Behavioral Health Services with Short-Stay Residents in Skilled Nursing Facilities: A Qualitative Study of Clinicians and Administrators. Clin Gerontol 2022; 45:1189-1200. [PMID: 34128773 PMCID: PMC8671564 DOI: 10.1080/07317115.2021.1937425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The perspectives of professionals involved in behavioral health (BH) services with short-stay residents in skilled nursing facilities (SNFs) are rarely captured in the literature. This study examines the real-world experiences of BH clinicians and administrators in post-acute/subacute care units in SNFs. METHODS This qualitative study used semi-structured interviews with 18 clinicians (e.g., psychologists and social workers) and five administrators (e.g., directors of social services or BH company executives) involved in BH services with short-stay SNF residents. Interviews were recorded, transcribed, and analyzed by two independent coders using conventional thematic content analysis. RESULTS Three themes emerged from the data: (1) BH needs are high among short-stay residents and families during post-acute care transitions; (2) BH services offer multiple unique opportunities to enhance post-acute/subacute care in SNFs; and (3) barriers to providing optimal BH care exist at multiple levels and require action from BH clinicians and stakeholders. CONCLUSIONS Variability in clinician roles and barriers to optimized care suggest the need for future research targeting best practices and implementation strategies for BH services with short-stay SNF residents. CLINICAL IMPLICATIONS Results identified multiple ways in which BH services may enhance resident, family, and staff outcomes, as well as the milieu in SNFs.
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Affiliation(s)
- Evan Plys
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus
- Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus
| | | | | | - Jennifer D. Portz
- Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus
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Xiao PP, Ding SQ, Duan YL, Luo XF, Zhou Y, Cheng QQ, Liu XY, Xie JF, Cheng ASK. Metacognitions associated with reproductive concerns: A cross-sectional study of young adult female cancer survivors in China. Front Psychol 2022; 13:987221. [PMID: 36237684 PMCID: PMC9552999 DOI: 10.3389/fpsyg.2022.987221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Cancer and its treatments affect patients’ fertility potential. This study examined the prevalence of reproductive concerns and their relationship with metacognitions among Chinese young adult female cancer survivors (YAFCS). Methods A total of 318 YAFCS (aged 18–39) completed an online survey from March to December 2021. Participants reported sociodemographic characteristics, reproductive concerns and metacognitions. Reproductive concerns were measured using the Reproductive Concerns after Cancer scale (RCAC), and metacognitions were measured by the Short Form of Metacognitions Questionnaire (MCQ-30). We used Pearson correlation analysis to examine associations between metacognitions and reproductive concerns across multiple domains and multivariable linear regression to determine the influencing factors of reproductive concerns. Results The mean score of reproductive concern among YAFCS was 49.97 ± 12.52. A total of 57.9% of participants reported a high level of concern regarding at least one dimension of reproductive concerns, and they were most concerned about their child’s health and least concerned about partner disclosure of fertility status. We also found a moderate association between RCAC and MCQ-30 scores (r = 0.408, p < 0.001). In multivariate analyses, metacognitions, especially negative metacognitive beliefs had an impact on reproductive concerns among YAFCS (p < 0.001). Conclusion Higher reproductive concerns were associated with higher metacognitions among YAFCS, especially with negative metacognitive beliefs. Oncology professionals should pay attention to assessing reproductive concerns in patients who want to have children or who have no children. Moreover, metacognitive beliefs may be an intervention target for alleviating reproductive concerns among YAFCS.
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Affiliation(s)
- Pan Pan Xiao
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Si Qing Ding
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Ying Long Duan
- Department of Emergency, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Fei Luo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yi Zhou
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Qin Qin Cheng
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xiang Yu Liu
- Hunan Cancer Hospital, Health Management Center, Changsha, China
| | - Jian Fei Xie
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Jian Fei Xie,
| | - Andy SK Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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Pięta M, Rzeszutek M. Trajectories of posttraumatic growth and posttraumatic depreciation: A one-year prospective study among people living with HIV. PLoS One 2022; 17:e0275000. [PMID: 36136984 PMCID: PMC9498953 DOI: 10.1371/journal.pone.0275000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Posttraumatic growth (PTG) and posttraumatic depreciation (PTD) are considered two sides of growth after trauma. Nevertheless, previous studies pointed out that in trauma living with a life-threatening illness, they may be experienced as two independently and share distinct predictors. In our study we aimed to find the different trajectories of PTG and PTD among a sample of people living with HIV (PLWH) and to investigate its predictors out of psychological resilience, and gain and loss of resources from the conservation of resources theory (COR). Methods We designed a longitudinal study that consisted of three measurements at 6-month intervals, and we recruited, respectively, 87, 85 and 71 PLWH. Each time participants filled out the following questionnaires: the expanded version of the PTG and PTD Inventory (PTGDI-X), the Brief Resilience Scale (BRS), the Conservation of Resources Evaluation (COR-E), and a survey on sociodemographic and medical data. Results We observed two separate trajectories of PTG and PTD within participants and found that each of the trajectories were related to different predictors from the studied variables. More specifically, we found a positive relationship between resilience and a descending PTD trajectory that stabilized over time. Gain of resources generally predicted a PTG trajectory, while loss of resources predicted the dynamics of PTD. Conclusions Including two parallel constructs, i.e., PTG and PTD, confirmed the independence of their mechanisms in growth processes among PLWH. The initial insight concerning the role of resilience and resources in PTG/PTD processes may inspire more effective planning for psychological help for PLWH, and it may stimulate studies on growth after trauma to further examine the two sides of this phenomenon.
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Affiliation(s)
- Małgorzata Pięta
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
- * E-mail:
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Yang Y, Zhang Y, Liang L, Liao X, Meng J, Cai R, Ye H, Hu J, He X, Shi L. Fear of progression and its associated factors in parents of children undergoing cancer treatment: A CROSS-SECTIONAL STUDY. Psychooncology 2022; 31:1737-1744. [PMID: 36073576 DOI: 10.1002/pon.6027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/04/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Fear of progression (FoP) is a common psychosocial problem among adult cancer patients, but data on parents of children undergoing cancer treatment are scarce. This study aimed to determine the prevalence of FoP in parents of children undergoing cancer treatment and explore the associated factors. METHODS Overall, 285 parents of children undergoing cancer treatment were recruited from three general hospitals in China. FoP in the parents was assessed using the Chinese version of the Fear of Progression Questionnaire-parent version (FoP-Q-SF/PR). Other questionnaires included the Self-Compassion Scale, Pittsburgh Sleep Quality Index, Posttraumatic Stress Disorder Checklist-Civilian Version, and items on socio-demographic and medical characteristics. Pearson correlation and multiple linear regression analysis were used to identify factors associated with FoP. RESULTS A total of 75.1% of the participants showed dysfunctional levels of FoP. The mean FoP-Q-SF/PR score was 39.98 (standard deviation=9.18). Parental FoP was significantly associated with a shorter time since diagnosis, lower levels of self-compassion, poor sleep quality, and severe posttraumatic stress symptoms (Adjusted R Squared=0.369, F=12.838, p<0.01). CONCLUSIONS FoP is a frequently reported problem among parents of children undergoing cancer treatment. In this cohort, parents of children with a shorter time since cancer diagnosis were at higher risk of suffering from FoP. Interventions to enhance self-compassion, improve sleep quality, and mitigate posttraumatic stress symptoms may help with the psychological adjustment and well-being of parents whose children are undergoing cancer treatment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yiling Yang
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Yuwei Zhang
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Lichan Liang
- Department of Pediatric Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaomei Liao
- Department of Pediatric Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jiangnan Meng
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruiqing Cai
- Department Pediatric Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hongyu Ye
- Department of Pediatric Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jiamin Hu
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaofeng He
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Lei Shi
- School of Nursing, Southern Medical University, Guangzhou, China
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Rzeszutek M, Oniszczenko W. Temperament profiles and posttraumatic stress disorder symptoms: A comparative study between uniformed services, HIV-infected patients and a nonclinical sample. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2022.111681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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40
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Mitchell HR, Smith SK, Gebert R, Applebaum AJ. Mobile Cognitive Behavioral Therapy for Posttraumatic Stress: Diving back in after Hematopoietic Stem Cell Transplant. Psychooncology 2022; 31:1802-1805. [PMID: 36050923 DOI: 10.1002/pon.6022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/09/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022]
Abstract
This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hannah-Rose Mitchell
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, US
| | - Sophia K Smith
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, US.,Duke School of Nursing, Duke University, Durham, NC, US
| | - Rebecca Gebert
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, US
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, US
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McBain SA, Stoycos S, Doenges T. Breaking Silos to Address Medical Trauma: The Need for Integration of Trauma and Health Psychology Training. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09897-2. [PMID: 35841442 DOI: 10.1007/s10880-022-09897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) following a traumatic injury is a significant public health concern impacting approximately a third of traumatically injured patients. In 2018, the American College of Surgeons (ACS) Committee on Trauma recommended implementation of PTSD screening and brief intervention in level 1 trauma centers to meet the mental health needs of this underserved population. In March 2022, ACS revised its standards to include a requirement for mental health screening and referral process in level 1 and level 2 trauma centers. However, implementation of these programs has been limited. One barrier to implementation has been the lack of cross-trained trauma and health psychologists to support the development and implementation of trauma-focused programs in acute and critical care settings. This paper is a call to action to bring together experts in the fields of trauma and health psychology to effectively address training gaps in post-injury PTSD and medical traumatic stress. Through development of trauma and health psychology cross-training models, the field of psychology can collaborate to meet the increasing demand for trauma-focused psychologists in acute and critical care settings.
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Affiliation(s)
- Sacha A McBain
- Departments of Psychiatry & Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA.
| | - Sarah Stoycos
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Tim Doenges
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, USA
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Presciutti A, Siry‐Bove B, Newman MM, Elmer J, Grigsby J, Masters KS, Shaffer JA, Vranceanu A, Perman SM. Qualitative Study of Long‐Term Cardiac Arrest Survivors’ Challenges and Recommendations for Improving Survivorship. J Am Heart Assoc 2022; 11:e025713. [PMID: 35861822 PMCID: PMC9707841 DOI: 10.1161/jaha.121.025713] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Cardiac arrest survivorship refers to the lived experience of long‐term survivors of cardiac arrest and the many postdischarge challenges they experience. We aimed to gather a nuanced understanding of these challenges and of survivors' perceptions of ways to improve the recovery process.
Methods and Results
We conducted 15 semistructured, one‐on‐one interviews with cardiac arrest survivor members of the Sudden Cardiac Arrest Foundation; the interviews were conducted by telephone and recorded and transcribed verbatim. We used thematic analysis, informed by the Framework Method, to identify underlying themes regarding cardiac arrest survivorship challenges and recommendations to improve cardiac arrest survivorship. Regarding challenges, the overarching theme was a feeling of unpreparedness to confront postarrest challenges because of lack of resources, education, and appropriate expectations for recovery. Regarding recommendations, we uncovered 3 overarching themes including systemic recommendations (eg, providing appropriate resources and expectations, educating providers about survivorship, following up with survivors, including caregivers in treatment planning), social recommendations (eg, attending peer support groups, spending time with loved ones, providing support resources for family members), and individual coping recommendations (eg, acceptance, resilience, regaining control, seeking treatment, focusing on meaning and purpose).
Conclusions
We described common challenges that survivors of cardiac arrest face, such as lacking resources, education, and appropriate expectations for recovery. Additionally, we identified promising pathways that may improve cardiac arrest survivorship at systemic, social, and individual coping levels. Future studies could use our findings as targets for interventions to support and improve survivorship.
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Affiliation(s)
- Alex Presciutti
- Department of Psychology University of Colorado Denver Denver CO
- Department of Psychiatry Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital Boston MA
- Department of Psychiatry Harvard Medical School Boston MA
| | - Bonnie Siry‐Bove
- Department of Emergency Medicine University of Colorado School of Medicine Denver CO
| | | | - Jonathan Elmer
- University of Pittsburgh School of Medicine, Departments of Emergency Medicine, Critical Care Medicine and Neurology Pittsburgh PA
| | - Jim Grigsby
- Department of Psychology University of Colorado Denver Denver CO
| | - Kevin S. Masters
- Department of Psychology University of Colorado Denver Denver CO
| | | | - Ana‐Maria Vranceanu
- Department of Psychiatry Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital Boston MA
- Department of Psychiatry Harvard Medical School Boston MA
| | - Sarah M. Perman
- Department of Emergency Medicine University of Colorado School of Medicine Denver CO
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İzgüden D, Erdem R. Disease-based traumas transform lives: A qualitative study focused on healthcare professionals. Soc Sci Med 2022; 305:115084. [PMID: 35660695 DOI: 10.1016/j.socscimed.2022.115084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/19/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
RATIONALE Traumas occur at unexpected moments and become a turning point in life and can cause people to experience transformations. While these transformations can progress negatively, it is also possible for people to experience positive transformations after trauma (post-traumatic growth). OBJECTIVE This study aims to reveal how the physicians and nurses with disease-based traumas make sense of their experiences to provide better insights into the transformative power of these traumas. Both social life and work-life were evaluated from the social dimensions of trauma. Also, the advantages and disadvantages of being a health professional in this process were examined. METHODS Qualitative research method was used in the study and data were obtained through interviews with 23 participants who experienced the case of disease-based trauma. As a result of the interviews, 253 pages of data were obtained. The data were subjected to thematic analysis and the Maxqda Program was used. RESULTS The data obtained through the interviews conducted within this attempt were categorized into parent themes such as being a health worker, post-traumatic transformations, changes in business life, and changes in the role of a service provider. CONCLUSIONS As a result of the study, it was seen that the social relations, philosophy of life, belief systems, and self-perceptions of healthcare professionals were transformed after the disease-based trauma and innovations occurred in their lives. Also, positive and negative changes have been determined in the relationships of healthcare professionals who have experienced disease-based trauma with their colleagues and managers their sense of belonging to the organization, the way they provide health services, and their approach to patients.
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Affiliation(s)
- Dilruba İzgüden
- Department of Health Management, Suleyman Demirel University, Isparta, Turkey.
| | - Ramazan Erdem
- Department of Health Management, Suleyman Demirel University, Isparta, Turkey.
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Mitchell HR, Kim Y, Llabre MM, Ironson G. Four-symptom model of medical-related posttraumatic stress among adult cancer patients. Health Psychol 2022; 41:492-501. [PMID: 35587888 PMCID: PMC10710860 DOI: 10.1037/hea0001187] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Four symptoms of posttraumatic stress (PTSS: intrusion, avoidance, alterations in arousal and reactivity, and negative alterations in cognitions and mood) were put forth by the Diagnostic and Statistical Manual of Mental Disorder (DSM-5). Patients with chronic major medical illness and their family caregivers often perceive the illness experience as traumatic, yet DSM-5 criteria precludes medical illness as a potential traumatic exposure. In this article, we address the applicability of the four symptoms to a medical population. METHOD Adult patients with colorectal cancer (n = 130, M = 55.83 years old, 60.0% female, 46.9% Hispanic) and their family caregivers (n = 160, M = 51.01 years old, 72.5% female, 49.0% Hispanic) completed questionnaires around the time of cancer diagnosis and treatment initiation (Time 1 [T1]), and 1- (Time 2 [T2]) and 2- (Time 3 [T3]) year postdiagnosis. Intrusion, avoidance, and alterations in arousal and reactivity symptoms were assessed using the Impact of Events Scale-Revised and negative alterations in cognitions and mood were quantified with selected conceptually congruent items from various psychosocial measures. RESULTS Confirmatory factor analysis revealed good fit of the four-symptom model of PTSS for caregivers at all three times and for patients at T2. Factor loadings of the four symptoms were high, ranging from .47-.97 and .62-.96 among patients and caregivers, respectively. CONCLUSIONS Findings extend the application of the four posttraumatic stress symptoms to patients with chronic major medical illness (cancer) and their family caregivers. Assessment and treatment of subclinical, yet substantial psychological distress precipitated by major medical illness like cancer are warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Gimigliano F, Young VM, Arienti C, Bargeri S, Castellini G, Gianola S, Lazzarini SG, Moretti A, Heinemann AW, Negrini S. The Effectiveness of Behavioral Interventions in Adults with Post-Traumatic Stress Disorder during Clinical Rehabilitation: A Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7514. [PMID: 35742762 PMCID: PMC9224304 DOI: 10.3390/ijerph19127514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND This review examined the effectiveness of behavioral interventions for adults with post-traumatic stress disorder (PTSD) triggered by physical injury or medical trauma. It discusses implications in support of rehabilitation management for COVID-19 survivors diagnosed with PTSD. METHODS This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Interim Guidance from the Cochrane Rapid Reviews Methods Group. The authors searched for randomized control trials in PubMed, Embase, and CENTRAL databases up to 31 March 2021. RESULTS Five studies (n = 459) met the inclusion criteria. Each study measured a different comparison of interventions. The certainty of the evidence was judged to be very low for all outcomes. Post-traumatic stress disorder symptom reduction was found to be in favor of trauma-focused cognitive-behavioral therapy, cognitive therapy, and cognitive-behavioral therapy. Cognitive function improvements were observed in favor of the cognitive processing therapy control intervention. CONCLUSIONS Overall, there is uncertainty about whether behavioral interventions are effective in reducing PTSD symptoms and improving functioning and quality of life when the disorder is triggered by a physical or medical trauma rather than a psychological trauma. Further research should investigate their efficacy in the context of rehabilitation management and gather evidence on this population.
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Affiliation(s)
- Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Vanessa M. Young
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ 85051, USA
| | - Chiara Arienti
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (C.A.); (S.G.L.)
| | - Silvia Bargeri
- Unit of Clinical Epidemiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (S.B.); (G.C.); (S.G.)
| | - Greta Castellini
- Unit of Clinical Epidemiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (S.B.); (G.C.); (S.G.)
| | - Silvia Gianola
- Unit of Clinical Epidemiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (S.B.); (G.C.); (S.G.)
| | - Stefano G. Lazzarini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (C.A.); (S.G.L.)
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Allen W. Heinemann
- Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University La Statale, 20122 Milan, Italy;
- Laboratory of Evidence-Based Rehabilitation, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
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46
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Smith TW. Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management. Curr Cardiol Rep 2022; 24:761-774. [PMID: 35380384 PMCID: PMC8981884 DOI: 10.1007/s11886-022-01695-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD. RECENT FINDINGS Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence-and are influenced by-stressful aspects of acute coronary crises and longer-term patient adjustment and management. Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.
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Affiliation(s)
- Timothy W Smith
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.
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Pięta M, Rzeszutek M. Posttraumatic growth and well-being among people living with HIV: A systematic review and meta-analysis in recognition of 40 years of HIV/AIDS. Qual Life Res 2022; 31:1269-1288. [PMID: 34518989 PMCID: PMC9023429 DOI: 10.1007/s11136-021-02990-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to synthesize, analyze, and critically review existing studies on the relationship between posttraumatic growth (PTG) and psychological well-being (operationalized either via positive or negative well-being indicators) among people living with HIV (PLWH). We also investigated whether this association varies as a function of socio-demographic, clinical characteristics, and study publication year. METHOD We conducted a structured literature search on Web of Science, Scopus, MedLine, PsyARTICLES, ProQuest, and Google Scholar. The most important inclusion criteria encompassed quantitative and peer-reviewed articles published in English. RESULTS After selection, we accepted 27 articles for further analysis (N = 6333 participants). Eight studies used positive indicators of well-being. The other 19 studies focused on negative indicators of well-being. Meta-analysis revealed that there was a negative weak-size association between PTG and negative well-being indicators (r = - 0.18, 95% CI [- 0.23; - 0.11]) and a positive medium-size association between PTG and positive well-being measures (r = 0.35, 95% CI [0.21; 0.47]). We detected no moderators. CONCLUSIONS The present meta-analysis and systematic review revealed expected negative and positive associations between PTG and negative versus positive well-being indicators among PLWH. Specifically, the relationship between PTG and positive well-being indicators was more substantial than the link between PTG and negative well-being measures in these patients. Finally, observed high heterogeneity between studies and several measurement problems call for significant modification and improvement of PTG research among PLWH.
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Affiliation(s)
- Małgorzata Pięta
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland
| | - Marcin Rzeszutek
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland
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48
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von Känel R, Meister-Langraf RE, Zuccarella-Hackl C, Znoj H, Pazhenkottil AP, Schmid JP, Barth J, Schnyder U, Princip M. Association Between Changes in Post-hospital Cardiac Symptoms and Changes in Acute Coronary Syndrome-Induced Symptoms of Post-traumatic Stress. Front Cardiovasc Med 2022; 9:852710. [PMID: 35498017 PMCID: PMC9046908 DOI: 10.3389/fcvm.2022.852710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
BackgroundAfter acute coronary syndrome (ACS), one in eight patients develops clinically significant symptoms of Post-traumatic stress disorder (PTSD). We hypothesized that changes in cardiac symptoms from 3 to 12 months after ACS are associated with changes in ACS-induced PTSD symptoms.MethodsAt 3 (n = 154) and/or 12 months (n = 106) post-ACS, patients (n = 156, mean age 59 years, 85% men) completed a clinical interview assessing chest tightness/pain (at rest and/or during exertion), heartbeat symptoms (heart palpitations, racing of heart, heart stumbling or skipping a beat) and PTSD symptoms during the prior 4 weeks. Random mixed regression models examined the association between the onset (or remission) from 3 to 12 months in cardiac symptoms with changes in PTSD symptoms, adjusting for a range of potential predictors of ACS-induced PTSD symptoms.ResultsThe onset of chest tightness/pain [estimate = 0.588, 95% confidence interval: 0.275, 0.090; p < 0.001] and of heartbeat symptoms [0.548 (0.165, 0.931); p = 0.005] from 3 to 12 months was independently associated with an increase in total PTSD symptoms. There were also independent associations between the onset of chest tightness/pain and heartbeat symptoms with an increase in PTSD symptom clusters. Specifically, the onset of chest tightness/pain showed associations with an increase in re-experiencing [0.450 (0.167, 0.733); p = 0.027] and avoidance/numbing [0.287 (0.001, 0.574); p = 0.049]. The onset of heartbeat symptoms showed associations with an increase in re-experiencing [0.392 (0.045, 0.739); p = 0.002], avoidance/numbing [0.513 (0.161, 0.864); p = 0.004] and hyperarousal [0.355 (0.051, 0.659); p = 0.022]. An increase in the total number of cardiac symptoms (score range 0–6) was also associated with an increase in total PTSD symptoms [0.343 (0.202, 0.484); p < 0.001]. Psychotherapy in the post-hospital period moderated the association between the change in heartbeat symptoms and the change in total PTSD symptoms [−0.813 (−1.553, −0.074); p = 0.031 for interaction]; the association between the onset of heart beat symptoms and an increase in total PTSD symptoms was weaker in patients who attended psychotherapy [0.437 (−0.178, 1.052); p = 0.16] than in those who did not [0.825 (0.341, 1.309); p < 0.001].ConclusionChanges in cardiac symptoms between 3 and 12 months after hospitalization are associated with changes in ACS-induced PTSD symptoms. ClinicalTrials.gov #NCT01781247.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- *Correspondence: Roland von Känel
| | - Rebecca E. Meister-Langraf
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clienia Schlössli AG, Zurich, Switzerland
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hansjörg Znoj
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
| | - Aju P. Pazhenkottil
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jean-Paul Schmid
- Department of Internal Medicine and Cardiology, Clinic Gais AG, Gais, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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49
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Sommer JL, Mota N, Thompson JM, Asmundson GJ, Sareen J, Bernstein CN, Marrie RA, El-Gabalawy R. Associations between courses of posttraumatic stress disorder and physical health conditions among Canadian military personnel. J Anxiety Disord 2022; 87:102543. [PMID: 35168002 DOI: 10.1016/j.janxdis.2022.102543] [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: 05/11/2021] [Revised: 10/15/2021] [Accepted: 01/14/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and physical health conditions commonly co-occur and are both prevalent among military personnel. This study examined how courses of PTSD (no PTSD, remitted, new onset, persistent/recurrent) are associated with physical health conditions, among a population-based sample of Canadian military personnel. METHOD We analyzed data from the 2002 Canadian Community Health Survey-Mental Health and Well-being-Canadian Forces supplement (CCHS-CF) and the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey (CAFVMHS; N = 2941). Multivariable logistic regressions examined associations between PTSD courses (reference = no PTSD) and physical health conditions. RESULTS In general, physical health conditions were more prevalent among symptomatic PTSD courses compared to no PTSD. After adjustment, new onset PTSD was associated with increased odds of all physical health conditions with the exception of ulcers and cancer (AOR range: 1.41-2.31) and remitted PTSD was associated with increased odds of diabetes (AOR = 2.31). CONCLUSION Results suggest that new onset PTSD may be most strongly associated with physical health conditions. Findings may inform targeted screening and intervention methods among military personnel with PTSD and physical health conditions.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2 Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2 Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada
| | - James M Thompson
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Gordon Jg Asmundson
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan, S4S 0A2 Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada
| | - Charles N Bernstein
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9 Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9 Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2 Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2 Canada; Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada; Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada; CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9 Canada.
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50
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Duncan-Park S, Danziger-Isakov L, Armstrong B, Williams N, Odim J, Shemesh E, Sweet S, Annunziato R. Posttraumatic stress and medication adherence in pediatric transplant recipients. Am J Transplant 2022; 22:937-946. [PMID: 34837457 PMCID: PMC8897237 DOI: 10.1111/ajt.16896] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 01/25/2023]
Abstract
Adolescent transplant recipients may encounter a range of potentially traumatic events (PTEs) pre- and posttransplant, yet little is known about the relationship between posttraumatic stress symptoms (PTSS) and medication adherence in this population. In the present study, adolescent recipients and caregivers completed psychosocial questionnaires at enrollment. Outpatient tacrolimus trough level data were collected over 1 year to calculate the Medication Level Variability Index (MLVI), a measure of medication adherence. Nonadherence (MLVI ≥2) was identified in 34.8% of patients, and most (80.7%) reported ≥1 PTE exposure. Levels of PTSS indicating likely posttraumatic stress disorder (PTSD) were endorsed by 9.2% of patients and 43.7% of caregivers. PTSS and MLVI were significantly correlated in the liver subgroup (r = .30, p = .04). Hierarchical multivariable linear regression analyses revealed overall patient PTSS were significantly associated with QoL (p < .001). PTEs are common in adolescent recipients; a minority may meet criteria for PTSD. PTSS screening to identify nonadherence risk requires further investigation and addressing PTSS may improve QoL. Caregivers appear at greater risk for PTSD and may require their own supports. The study was approved by each participating center's Institutional Review Board.
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Affiliation(s)
- Sarah Duncan-Park
- Icahn School of Medicine at Mount Sinai, NY, NY
- Fordham University, Bronx, NY
| | | | | | | | | | | | | | - Rachel Annunziato
- Icahn School of Medicine at Mount Sinai, NY, NY
- Fordham University, Bronx, NY
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