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Crede M, Tynan M, Harms PD, Lester PB. Clarifying the association between adverse childhood experiences and postdeployment posttraumatic stress disorder symptom severity: A meta-analysis and large-sample investigation. J Trauma Stress 2023; 36:700-711. [PMID: 37282808 DOI: 10.1002/jts.22940] [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: 04/07/2022] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 06/08/2023]
Abstract
We report on two studies designed to shed light on the association between adverse childhood experiences (ACEs) and posttraumatic stress disorder (PTSD) symptom severity in military personnel. In particular, we examined the evidence for both additive and multiplicative associations between ACEs and combat exposure in predicting PTSD symptom severity. Study 1 was a meta-analysis of 50 samples (N > 50,000), and we found evidence for a moderate linear association between ACEs and PTSD symptom severity, ρ = .24. We also found that ACEs explained substantial variance in PTSD symptom severity after controlling for combat exposure, ΔR2 = .048. In Study 2, which is preregistered, we relied on a large sample of combat-deployed U.S. soldiers (N > 6,000) to examine evidence of a multiplicative association between ACEs and combat exposure in predicting PTSD symptom severity. In line with theoretical arguments that individuals who have experienced childhood trauma are more vulnerable to subsequent trauma exposure, we found a weak but meaningful interaction effect, ΔR2 = .00, p < .001, between ACEs and deployment-related traumatic events in the prediction of PTSD symptom severity. Implications for clinical applications and future research are discussed.
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Affiliation(s)
- Marcus Crede
- Department of Psychology, Iowa State University, Ames, Iowa, USA
| | - Michael Tynan
- Department of Psychology, Iowa State University, Ames, Iowa, USA
| | - Peter D Harms
- School of Management, University of Alabama, Tuscaloosa, Alabama, USA
| | - Paul B Lester
- Graduate School of Defense Management, Naval Postgraduate School, Monterey, California, USA
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2
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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: 0] [Impact Index Per Article: 0] [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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Ojeahere MI, Uwakwe R, Piwuna CG, Audu M, Goar SG, Armiyau A, Afolaranmi T. Assessment of full and subsyndromal PTSD and quality of life of internally displaced older adults in northern Nigeria. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2021.100040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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4
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Simor P, Polner B, Báthori N, Sifuentes-Ortega R, Van Roy A, Albajara Sáenz A, Luque González A, Benkirane O, Nagy T, Peigneux P. Home confinement during the COVID-19: day-to-day associations of sleep quality with rumination, psychotic-like experiences, and somatic symptoms. Sleep 2021; 44:zsab029. [PMID: 33567067 PMCID: PMC7928634 DOI: 10.1093/sleep/zsab029] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/27/2021] [Indexed: 12/14/2022] Open
Abstract
Due to the coronavirus disease 2019 (COVID-19) pandemic, populations from many countries have been confined at home for extended periods of time in stressful environmental and media conditions. Cross-sectional studies already evidence deleterious psychological consequences, with poor sleep as a risk factor for impaired mental health. However, limitations of cross-sectional assessments are response bias tendencies and the inability to track daily fluctuations in specific subjective experiences in extended confinement conditions. In a prospective study conducted across three European countries, we queried participants (N = 166) twice a day through an online interface about their sleep quality and their negative psychological experiences for two consecutive weeks. The focus was set on between- and within-person associations of subjective sleep quality with daytime experiences, such as rumination, psychotic-like experiences, and somatic complaints about the typical symptoms of the coronavirus. The results show that daily reports of country-specific COVID-19 deaths predicted increased negative mood, psychotic-like experiences, and somatic complaints during the same day and decreased subjective sleep quality the following night. Disrupted sleep was globally associated with negative psychological outcomes during the study period, and a relatively poorer night of sleep predicted increased rumination, psychotic-like experiences, and somatic complaints the following day. This temporal association was not paralleled by daytime mental complaints predicting relatively poorer sleep quality on the following night. Our findings show that night-to-night changes in sleep quality predict how individuals cope the next day with daily challenges induced by home confinement.
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Affiliation(s)
- Péter Simor
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Center for Research in Cognition and Neurosciences and UNI – ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Bertalan Polner
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
| | - Noémi Báthori
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
| | - Rebeca Sifuentes-Ortega
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Center for Research in Cognition and Neurosciences and UNI – ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Anke Van Roy
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Center for Research in Cognition and Neurosciences and UNI – ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Ariadna Albajara Sáenz
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Center for Research in Cognition and Neurosciences and UNI – ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Alba Luque González
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Oumaima Benkirane
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Center for Research in Cognition and Neurosciences and UNI – ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Tamás Nagy
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Philippe Peigneux
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Center for Research in Cognition and Neurosciences and UNI – ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
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5
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Karsberg S, Hesse M, Pedersen MM, Charak R, Pedersen MU. The impact of poly-traumatization on treatment outcomes in young people with substance use disorders. BMC Psychiatry 2021; 21:140. [PMID: 33685430 PMCID: PMC7941934 DOI: 10.1186/s12888-021-03129-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is believed that clients with psychological trauma experiences have a poor prognosis with regard to treatment participation and outcomes for substance use disorders. However, knowledge on the effect of the number of trauma experiences is scarce. METHODS Using data from drug use disorder (DUD) treatment in Denmark, we assessed the impact of having experienced multiple potentially traumatic experiences on DUD treatment efficacy. Baseline and follow-up data from 775 young participants (mean age = 20.2 years, standard deviation = 2.6) recruited at nine treatment centers were included in analyses. RESULTS Analyses showed that participants who were exposed multiple trauma experiences also reported a significantly higher intake of cannabis at treatment entry, and a lower well-being score than participants who reported less types or no types of victimization experiences. During treatment, patients with multiple types of trauma experiences showed a slower rate of reduction of cannabis than patients with few or no trauma experiences. The number of trauma types was not associated with number of sessions attended or the development of well-being in treatment. CONCLUSION Overall, the results show that although traumatized youth in DUD treatment show up for treatment, helping them to reduce substance use during treatment is uniquely challenging. TRIAL REGISTRATION ISRCTN88025085 , date of registration: 29.08.2016, retrospectively registered.
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Affiliation(s)
- Sidsel Karsberg
- grid.7048.b0000 0001 1956 2722Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000 Aarhus, Denmark
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000, Aarhus, Denmark.
| | - Michael Mulbjerg Pedersen
- grid.7048.b0000 0001 1956 2722Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000 Aarhus, Denmark
| | - Ruby Charak
- grid.449717.80000 0004 5374 269XDepartment of Psychological Science, The University of Texas Rio Grande Valley, 1201 W. University Dr, Edinburg, TX USA
| | - Mads Uffe Pedersen
- grid.7048.b0000 0001 1956 2722Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000 Aarhus, Denmark
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King CD, Joyce VW, Nash CC, Buonopane RJ, Black JM, Zuromski KL, Millner AJ. Fear of sleep and sleep quality mediate the relationship between trauma exposure and suicide attempt in adolescents. J Psychiatr Res 2021; 135:243-247. [PMID: 33508543 DOI: 10.1016/j.jpsychires.2021.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/17/2020] [Accepted: 01/18/2021] [Indexed: 12/26/2022]
Abstract
Prior work has established bivariate associations between suicidal thoughts and behaviors, trauma exposure and sleep disturbance broadly. Specifically, this study tested whether fear of sleep and sleep quality mediated the association between trauma exposure and suicide attempt. Participants (N = 100) were adolescents admitted to an inpatient psychiatric program for suicidality. Trauma exposure history was retrieved from admission notes and participants completed self-report surveys assessing sleep quality, fear of sleep and number of suicide attempts within the previous month. Structural equation modelling was used to investigate the relationships between childhood trauma, fear of sleep, sleep quality, and suicide attempt. Path analysis was used to investigate the indirect effects from trauma exposure to suicide attempt through fear of sleep, and sleep quality. Path analysis revealed a significant indirect effect from trauma exposure to suicide attempt through fear of sleep and sleep quality. Our findings suggest that a significant portion of the association between trauma exposure and suicide attempts in adolescence may be explained by the negative impact of trauma exposure on sleep. Fear of sleep may increase the risk of a suicide attempt by negatively impacting sleep quality. Future studies should investigate whether interventions targeting sleep and fear of sleep reduce the association between trauma and suicide attempt.
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Affiliation(s)
- Christopher D King
- Franciscan Children's, Brighton, MA, United States; McLean Hospital, Belmont, MA, United States
| | | | - Carol C Nash
- Franciscan Children's, Brighton, MA, United States
| | - Ralph J Buonopane
- Franciscan Children's, Brighton, MA, United States; McLean Hospital, Belmont, MA, United States
| | - Jessica M Black
- Boston College School of Social Work, Newton, MA, United States
| | - Kelly L Zuromski
- Franciscan Children's, Brighton, MA, United States; Harvard University, Department of Psychology, Cambridge, MA, United States
| | - Alexander J Millner
- Franciscan Children's, Brighton, MA, United States; Harvard University, Department of Psychology, Cambridge, MA, United States.
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Agarwal TM, Muneer M, Asim M, Awad M, Afzal Y, Al-Thani H, Alhassan A, Mollazehi M, El-Menyar A. Psychological trauma in different mechanisms of traumatic injury: A hospital-based cross-sectional study. PLoS One 2020; 15:e0242849. [PMID: 33253298 PMCID: PMC7703890 DOI: 10.1371/journal.pone.0242849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background Psychological distress following traumatic injury can influence the patient health, well-being and quality of life; however, this impact may partly vary according to the type and severity of injury. We aimed to study the predominant distress causing cluster and individual symptoms of Post-Traumatic Stress Disorders (PTSD) at the clinical and subthreshold level in patients with traumatic injuries, based on the mechanism of injury (MOI). Methods A hospital based cross-sectional study was conducted at a Level 1 Trauma Center utilizing PTSD Checklist to diagnose PTSD after one month of the traumatic event. All patients suffering from psychological distresses were assessed by a clinical psychologist in the trauma section. PTSD diagnostic criteria from DSM-5 were used to classify the patients. The inclusion criteria comprised of adult trauma patients who were directly involved in traumatic injuries and admitted under the Trauma Surgery services for a minimum of one day; have ability to provide written informed consent and can be assessed with the PCL-5 checklist after 4 weeks post-injury. Results Two hundred patients completed PCL-5 checklist, of them 26 (13.0%) were positive for PTSD and 174 (87%) had subthreshold scores. The mean age of participants was 34.4±11.8 years and males constituted 90.5%. Road traffic injury (RTI) was most the frequent injury mechanism (59%). PTSD positive patients with RTI, fall of heavy objects, pedestrian injury and assaults had highest average scores on clusters of negative alterations in mood and cognitions (16.9, 18.0, 18.5, 17.0 respectively), followed by hyperarousal. Symptom of always being on the guard and having repeated unwanted or disturbing memories of the incident, was reported by nearly 100% PTSD positive patients. Patients with subthreshold scores also reported distressing symptoms on all four clusters of PTSD. Conclusions Patients with different MOI showed a broad range of psychological problems with respect to symptom clusters. Negative alteration in mood and cognition followed by hyperarousal caused higher level of distress in patients post traumatic injuries. Subthreshold symptoms of PTSD are more common and deserve more attention.
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Affiliation(s)
| | - Mohammed Muneer
- Department of Surgery, Plastic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Malaz Awad
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Yousra Afzal
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmed Alhassan
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Monira Mollazehi
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
- * E-mail:
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Holmstrup ME, Jensen BT, Glasgow AC, Heffernan KS. Sex differences in the association between PTSD symptoms with cardiac autonomic function and subclinical atherosclerotic risk. Clin Physiol Funct Imaging 2020; 40:390-398. [PMID: 32813936 DOI: 10.1111/cpf.12657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/11/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a public health concern that may elevate the risk for cardiovascular disease (CVD). There are established sex differences in both PTSD risk and CVD risk. PURPOSE To examine sex-specific associations between subclinical PTSD symptom severity and subclinical CVD risk in young men and women. METHODS A total of 61 young adults (women: n = 29, mean age: 26 ± 7 years) completed the post-traumatic stress disorder civilian checklist (PCL) and the Center for Epidemiologic Studies Depression Scale (CES-D). Aortic stiffness was measured as carotid-femoral pulse wave velocity (cfPWV). Peripheral vasomotor function was measured as flow-mediated slowing (FMS) of carotid-radial PWV following 5-min forearm occlusion. Heart rate variability was used to assess sympathovagal balance as LF/HF ratio. RESULTS PCL score was positively correlated with CES-D score (r = 0.79, p < .001), cfPWV (r = 0.33, p = .03) and LF/HF ratio (r = 0.42, p = .009) in men. PCL score was positively correlated to CES-D score (r = 0.80, p < .001) in women, but was inversely correlated to cfPWV (r = -0.38, p = .02) and LF/HF ratio (r = -0.34, p = .04). PCL score was also inversely associated with FMS in women (r = -0.49, p = .01). CONCLUSION There are sex differences in the association of PTSD symptoms and subclinical atherosclerosis. In men, increased PTSD symptoms may increase CVD risk by increasing sympathovagal balance and aortic stiffness. In women, increased PTSD symptoms may increase CVD risk via reducing vasomotor function.
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Affiliation(s)
- Michael E Holmstrup
- Department of Exercise Science, Slippery Rock University, Slippery Rock, PA, USA
| | - Brock T Jensen
- Department of Exercise Science, Slippery Rock University, Slippery Rock, PA, USA
| | - Alaina C Glasgow
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
| | - Kevin S Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
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Psychosocial Underpinnings of Pain and Sleep Disturbance in Safety-Net Primary Care Patients. Pain Res Manag 2020; 2020:5932018. [PMID: 32399128 PMCID: PMC7206878 DOI: 10.1155/2020/5932018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 11/17/2022]
Abstract
Objective The aim of this study was to uncover possible psychosocial underpinnings of pain and sleep disturbance in a safety-net primary care sample. Methods Patients (n = 210) awaiting care in a safety-net primary care clinic waiting room completed measures of cynical hostility, social support, mental health, sleep disturbance, and pain. This study was cross-sectional and observational. Results A structural equation model suggested that higher cynical hostility was associated with lower social support, which in turn was associated with poorer mental health, which then corresponded with higher pain and sleep disturbance. All possible indirect (mediational) effects within this model were statistically significant, suggesting a possible route through which cynical hostility may shape pain and sleep, two common presenting problems in primary care. Conclusions These findings illustrate the interplay of psychosocial factors with chronic pain and sleep disturbance in a sample of low-income, predominantly African-American patients seeking care at a safety-net primary care clinic. The findings support integrated primary care as a way to target not only behavioral health issues but also the psychosocial factors entangled with physical health.
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Hoopsick RA, Homish DL, Bartone PT, Homish GG. Developing a Measure to Assess Emotions Associated with Never Being Deployed. Mil Med 2019; 183:e509-e517. [PMID: 29547934 DOI: 10.1093/milmed/usy005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/06/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Much research has focused on stress related to deployments; however, a substantial proportion of soldiers never deploy. In a study of 1.3 million veterans, suicide risk was higher among veterans who had never deployed. Thus, not being deployed may have an impact on soldiers' well-being; however, no measures exist to assess emotions regarding non-deployment. We aimed to develop and test an original measure of non-deployment emotions. METHODS We examined the Non-Deployment Emotions (NDE) questionnaire, a novel four-item measure of guilt, unit value, unit camaraderie, and unit connectedness in a sample of never-deployed male and female US Army Reserve/National Guard (USAR/NG) soldiers (N = 174). Data are from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing survey-based study examining the health of USAR/NG soldiers and their partners. The protocol was approved by the Institutional Review Board at the State University of New York at Buffalo. The relationship between each of the items was examined by calculating correlation and alpha coefficients. Latent class analyses tested for the existence of distinct levels of negative emotions related to non-deployment. Negative binomial regression models examined the cross-sectional associations between NDE summary score and each of the following outcomes, separately: anger, anxiety, depression, and post-traumatic stress. FINDINGS More than half of never-deployed USAR/NG soldiers expressed negative emotions for having not been deployed. "Guilt," "value," "camaraderie," and "connectedness" were each positively correlated with each other (p < 0.001) and the internal consistency reliability was high (male soldier α = 0.90, female soldier α = 0.93). Latent class analyses revealed a superior three-class model with well-delineated class membership (entropy = 0.93): "Class 1" (low NDE; 47.6%), "Class 2" (moderate NDE; 33.8%), and "Class 3" (high NDE; 18.6%). Regression models demonstrated that greater non-deployment emotions were independently associated with more severe anger (RR = 1.02, 95% CI: 1.01, 1.03, p < 0.001), anxiety (RR = 1.06, 95% CI: 1.01, 1.11, p < 0.05), depression (RR = 1.06, 95% CI: 1.01, 1.11, p < 0.05), and PTSD (RR = 1.10, 95% CI: 1.04, 1.16, p < 0.01). DISCUSSION Findings demonstrate that negative emotions regarding non-deployment are prevalent among never-deployed USAR/NG soldiers and that these emotions are related to a mental health. The NDE provides a measure of "guilt," "value," "camaraderie," and "connectedness" specific to non-deployed soldiers and is able to well discriminate between soldiers that have low, moderately, and highly negative non-deployment emotions. These findings suggest that all military personnel, regardless of deployment status, could be at risk for negative outcomes. As with any survey-based study, there is a potential for response bias; however, given the range of responses collected with the NDE, social desirability is unlikely. Further work is needed to confirm our findings in other components of the military and to examine soldiers in the rear detachment.
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Affiliation(s)
- Rachel A Hoopsick
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY
| | - D Lynn Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY
| | - Paul T Bartone
- Center for Technology & National Security Policy, Institute for National Strategic Studies, National Defense University, 300 5th Avenue SW, Building 62, Fort Lesley J. McNair, Washington, DC
| | - Gregory G Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY
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11
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Blaskovich B, Reichardt R, Gombos F, Spoormaker VI, Simor P. Cortical hyperarousal in NREM sleep normalizes from pre- to post- REM periods in individuals with frequent nightmares. Sleep 2019; 43:5574411. [DOI: 10.1093/sleep/zsz201] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/23/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study Objectives
Frequent nightmares have a high prevalence and constitute a risk factor for psychiatric conditions, but their pathophysiology is poorly understood. Our aim was to examine sleep architecture and electroencephalographic markers—with a specific focus on state transitions—related to sleep regulation and hyperarousal in participants with frequent nightmares (NM participants) versus healthy controls.
Methods
Healthy controls and NM participants spent two consecutive nights in the sleep laboratory. Second night spectral power during NREM to REM sleep (pre-REM) and REM to NREM (post-REM) transitions as well as during NREM and REM periods were evaluated for 22 NM participants compared to 22 healthy controls with a similar distribution of age, gender, and dream recall frequency.
Results
We found significant differences between the groups in the pre-REM to post-REM changes in low- and high-frequency domains. NM participants experienced a lower amount of slow-wave sleep and showed increased beta and gamma power during NREM and pre-REM periods. No difference was present during REM and post-REM phases. Furthermore, while increased pre-REM high-frequency power seems to be mainly driven by post-traumatic stress disorder (PTSD) symptom intensity, decreased low-frequency activity occurred regardless of PTSD symptom severity.
Conclusion
Our findings indicate that NM participants had increased high-frequency spectral power during NREM and pre-REM periods, as well as relatively reduced slow frequency and increased fast frequency spectral power across pre-and post-REM periods. This combination of reduced sleep-protective activity and increased hyperarousal suggests an imbalance between sleep regulatory and wake-promoting systems in NM participants.
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Affiliation(s)
- Borbála Blaskovich
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
| | - Richárd Reichardt
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
| | - Ferenc Gombos
- Department of General Psychology, Pázmány Péter Catholic University, Budapest, Hungary
- MTA-PPKE Adolescent Development Research Group, Budapest, Hungary
| | - Victor I Spoormaker
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Péter Simor
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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Bhardwaj V, Angkaw AC, Franceschetti M, Rao R, Baker DG. Direct and indirect relationships among posttraumatic stress disorder, depression, hostility, anger, and verbal and physical aggression in returning veterans. Aggress Behav 2019; 45:417-426. [PMID: 30835866 DOI: 10.1002/ab.21827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/04/2019] [Accepted: 02/21/2019] [Indexed: 12/27/2022]
Abstract
Hostility, anger, and aggression are conceptually related but unique constructs found to occur more often among veterans with posttraumatic stress disorder (PTSD) than among civilians or veterans without PTSD. However, the pathways between PTSD, depression, hostility, anger, and aggression have not been comprehensively characterized. Therefore, drawing on a sample of returning Operation Enduring Freedom/Operation Iraqi Freedom combat veterans ( N = 175; 95% male; mean age 30 years), this study sought to examine the direct and indirect relationships among PTSD, depression, hostility, anger, and four types of aggression: verbal, and physical toward self, others, and objects. Functional modeling of direct effects was done using multiple least-squares regression and bootstrapped mediation analyses were carried out to test indirect effects. Results indicate that PTSD is not the overall direct contributor to different forms of aggression, supporting the mediating role of depression and trait anger. Depression symptoms explain part of the relationships between PTSD and verbal aggression, physical aggression toward objects, and physical aggression toward self and trait anger explains part of the relationships between PTSD and verbal aggression, physical aggression toward objects, and physical aggression toward others. Our findings support the importance of assessing for anger, depression, and different types of aggression among veterans presenting for PTSD treatment to develop individualized treatment plans that may benefit from early incorporation of interventions.
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Affiliation(s)
- Vinnu Bhardwaj
- Qualcomm InstituteUniversity of CaliforniaSan Diego CA
- Department of ECEUniversity of CaliforniaSan Diego CA
| | - Abigail C. Angkaw
- Veterans Affairs San Diego Healthcare SystemSan Diego CA
- Department of PsychiatryUniversity of CaliforniaSan Diego CA
| | - Massimo Franceschetti
- Qualcomm InstituteUniversity of CaliforniaSan Diego CA
- Department of ECEUniversity of CaliforniaSan Diego CA
| | - Ramesh Rao
- Qualcomm InstituteUniversity of CaliforniaSan Diego CA
- Department of ECEUniversity of CaliforniaSan Diego CA
| | - Dewleen G. Baker
- Veterans Affairs San Diego Healthcare SystemSan Diego CA
- VA Center of Excellence for Stress and Mental HealthSan Diego CA
- Department of PsychiatryUniversity of CaliforniaSan Diego CA
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Ullah MI, Campbell DG, Bhagat R, Lyons JA, Tamanna S. Improving PTSD Symptoms and Preventing Progression of Subclinical PTSD to an Overt Disorder by Treating Comorbid OSA With CPAP. J Clin Sleep Med 2017; 13:1191-1198. [PMID: 28859723 DOI: 10.5664/jcsm.6770] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/06/2017] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) and posttraumatic stress disorder (PTSD) are common in United States veterans. These conditions often coexist and symptoms overlap. Previous studies reported improvement in PTSD symptoms with continuous positive airway pressure (CPAP) therapy for comorbid OSA but its effect has not been assessed in a non-PTSD cohort. We have prospectively assessed the effect of CPAP therapy on clinical symptom improvement as a function of CPAP compliance levels among PTSD and non-PTSD veterans. METHODS Veterans in whom OSA was newly diagnosed were enrolled in our study (n = 192). Assignment to PTSD and non-PTSD cohorts was determined by chart review. Each patient completed the military version of the PTSD Checklist (PCL), Epworth Sleepiness Scale (ESS), and reported nightmare frequency (NMF) at baseline and 6 months after CPAP therapy. CPAP adherence was objectively documented from machine compliance data. RESULTS We had complete data for 177 veterans (PTSD n = 59, non-PTSD n = 118) for analysis. The mean ages were 51.24 years in the PTSD cohort and 52.36 years in the non-PTSD cohort (P = .30). In the PTSD cohort, the mean total PCL score (baseline = 66.06, post-CPAP = 61.27, P = .004, d = -0.34) and NMF (baseline = 4.61, post-CPAP = 1.49, P = .0001, d = -0.51) decreased after 6 months of CPAP treatment. Linear regression analysis showed that the CPAP compliance was the only significant predictor for these changes among veterans with PTSD (PCL score: P = .033, R2 = .65; NMF; P = .03, R2 = .61). Further analysis by CPAP compliance quartiles in this cohort (Q1 = 0% to 25%, Q2 = 26% to 50%, Q3 = 51% to 75%, Q4 > 75%) revealed that mean total PCL score declined in Q2 (change = -3.91, P = .045, d = 0.43), Q3 (change = -6.6, P = .002, d = 0.59), and Q4 (change = -7.94, P = .037, d = 0.49). In the non-PTSD cohort, the PCL score increased despite CPAP therapy in lower CPAP compliance quartiles Q1 (change = 8.71, P = .0001, d = 0.46) and Q2 (change = 4.51, P = .046, d = 0.27). With higher CPAP compliance (in Q3 and Q4) in this cohort, the mean total PCL scores slightly improved with CPAP but they were not statistically significant (P > .05). CONCLUSIONS CPAP treatment reduces total PCL score and NMF in veterans with PTSD and OSA. Those with overt PTSD respond to even lower CPAP compliance, whereas non-PTSD patients require higher compliance to achieve any symptom improvement. Poor CPAP compliance results in increased PCL score in non-PTSD veterans and may lead to overt PTSD if the OSA remains undertreated. COMMENTARY A commentary on this article appears in this issue on page 1121.
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Affiliation(s)
- M I Ullah
- University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Rajesh Bhagat
- G. V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi
| | - Judith A Lyons
- University of Mississippi Medical Center, Jackson, Mississippi.,G. V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi
| | - Sadeka Tamanna
- G. V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi
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Cox RC, Tuck BM, Olatunji BO. Sleep Disturbance in Posttraumatic Stress Disorder: Epiphenomenon or Causal Factor? Curr Psychiatry Rep 2017; 19:22. [PMID: 28321643 DOI: 10.1007/s11920-017-0773-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to integrate recent findings on sleep disturbance and PTSD, examine sleep disturbance as a causal factor in the development of PTSD, and identify future directions for research, treatment, and prevention. RECENT FINDINGS Recent research highlights a relationship between both objective and subjective sleep disturbance and PTSD across diverse samples. Sleep disturbance also predicts PTSD over time. Finally, treatments targeting sleep disturbance lead to decreased PTSD symptoms, while standard PTSD treatments conclude with residual sleep disturbance. Sleep disturbance may be more than a mere epiphenomenon of PTSD. Future research examining the causal role of sleep disturbance in the development of PTSD, as well as the utility of targeting sleep disturbance in prevention and treatment, is necessary to fully understand the likely bidirectional relationship between sleep disturbance and PTSD.
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Affiliation(s)
- Rebecca C Cox
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Breanna M Tuck
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA.
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