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da Silva HC, Vilete L, Coutinho ESF, Luz MP, Mendlowicz M, Portela CM, Figueira I, Ventura P, Mari JDJ, Quintana MI, Ribeiro WS, Andreoli SB, Berger W. The role of childhood cumulative trauma in the risk of lifetime PTSD: An epidemiological study. Psychiatry Res 2024; 336:115887. [PMID: 38642421 DOI: 10.1016/j.psychres.2024.115887] [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: 11/21/2023] [Revised: 03/11/2024] [Accepted: 03/29/2024] [Indexed: 04/22/2024]
Abstract
Cumulative trauma is usually devastating and can lead to severe psychological consequences, including posttraumatic stress disorder (PTSD). Exposure to various types of traumas, particularly during childhood, can be even more deleterious than the sheer number of events experienced. This epidemiological study is the first to investigate the impact of discrete childhood traumatic exposure on the risk of developing lifetime PTSD in a representative sample of the general population of the two biggest Brazilian cities. Participants were aged between 15 and 75 years old, living in São Paulo and Rio de Janeiro, Brazil, who had experienced traumatic events (N = 3,231). The PTSD diagnosis was assessed using the DSM-IV criteria through the version 2.1 of Composite International Diagnostic Interview. To operationalize childhood cumulative trauma, we considered the sum of 15 different childhood trauma categories that occurred before PTSD onset. The final multivariate logistic regression model indicated a strong relationship between the number of discrete types of childhood traumas and the likelihood of the lifetime PTSD development. The lifetime PTSD risk increased 28 % with each different type of childhood trauma when adjusted by confounds. Our study strengthens the evidence associating childhood cumulative trauma to increased lifetime PTSD risk.
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Affiliation(s)
- Herika Cristina da Silva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Liliane Vilete
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mariana Pires Luz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauro Mendlowicz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Carla Marques Portela
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ivan Figueira
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula Ventura
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil; Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, United Kingdom
| | - Maria Inês Quintana
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Wagner Silva Ribeiro
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | | | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Dokkedahl SB, Vang ML, Elklit A. Does tonic immobility mediate the effects of psychological violence on PTSD and complex PTSD? EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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van Sint Fiet A, de la Rie S, van der Aa N, Bloemen E, Wind T. The relevance of social capital and sense of coherence for mental health of refugees. SSM Popul Health 2022; 20:101267. [PMID: 36281249 PMCID: PMC9587331 DOI: 10.1016/j.ssmph.2022.101267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Migration puts refugees in a completely new social context when simultaneously some have to deal with previously experienced traumatic events and post-migration stressors. Social capital and sense of coherence could be key resources to improve mental health of refugees. This study aims to examine the interplay between social capital (structural and cognitive), sense of coherence and mental health of refugees in the Netherlands. Objective The present study was conducted to i) examine if social capital (structural and cognitive) and mental health are related in a population of Dutch refugees, and ii) test if sense of coherence has a moderating and/or a mediating effect on this relation. Method Data were collected through questionnaires (n = 154) in a cross-sectional survey at different locations throughout the Netherlands. The data were analysed with multiple regression analyses and nonparametric bootstrapping using SPSS. Results Social capital (structural and cognitive) was positively related to mental health. In addition a positive relation between sense of coherence and mental health of refugees was found. The relationship between cognitive social capital and mental health was completely mediated by sense of coherence. No moderation effect of sense of coherence on the relation between social capital and mental health was found. Conclusions The current study contributed to understanding the social mechanism that determines refugee mental health: participating in social groups (structural social capital) and having supportive and trusting relationships (cognitive social capital), whilst experiencing life as comprehensible, manageable, and meaningful (sense of coherence) are positively related to better mental health of refugees. Findings indicate that preventive interventions aiming to enhance refugees' mental health may be more effective when targeting and promoting both social capital and sense of coherence, from a relatively early stage after arrival in the Netherlands. Structural and cognitive social capital are positively related to mental health of refugees. A positive relation is found between sense of coherence and mental health of refugees. Sense of coherence mediates this relation between cognitive social capital and mental health. Including resiliency factors and strengthening social mechanisms may create more effective mental health interventions.
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Affiliation(s)
- Antoine van Sint Fiet
- ARQ National Psychotrauma Center, Nienoord 5, 1112 XE, Diemen, the Netherlands
- Corresponding author. Arq Centrum ’45, Nienoord 5, 1112 XE Diemen, the Netherlands.
| | - Simone de la Rie
- ARQ National Psychotrauma Center, Nienoord 5, 1112 XE, Diemen, the Netherlands
| | - Niels van der Aa
- ARQ National Psychotrauma Center, Nienoord 5, 1112 XE, Diemen, the Netherlands
| | - Evert Bloemen
- Pharos, Dutch Centre of Expertise on Health Disparities, Arthur van Schendelstraat 600, 3511 MJ, Utrecht, the Netherlands
| | - Tim Wind
- ARQ National Psychotrauma Center, Nienoord 5, 1112 XE, Diemen, the Netherlands
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Barron I, Freitas F, Bosch CA. Pilot Randomized Control Trial: Efficacy of a Group-Based Psychosocial Program for Youth with PTSD in the Brazilian Favelas. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:335-345. [PMID: 34471452 PMCID: PMC8357894 DOI: 10.1007/s40653-020-00328-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2020] [Indexed: 06/13/2023]
Abstract
The study aimed to evaluate Teaching Recovery Techniques (TRT) delivered to Brazilian youth who experienced drug violence in one Favela. Thirty children, 8 to 14 years, were randomly assigned to TRT (n = 14) or to a treatment as usual group (n = 16) involving boxing/martial arts. Youth received five 90-min sessions over successive weeks. Standardized measures assessed Posttraumatic Stress and Depression at 2 weeks pre and post-test. An exploratory assessment of posttraumatic growth was also utilized. An interview with group leaders explored perceptions of delivering TRT within the favela. Medium effect sizes were found for PTSD and Depression, and a small effect size for posttraumatic growth. Group leaders emphasized understanding the favela context for program adaptation. In conclusion, TRT was found to be effective for children with PTSD and Depression who experienced drug violence in a Brazilian favela. TRT is recommended for future delivery. Larger scale RCTs are needed in Brazilian favelas.
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Affiliation(s)
- Ian Barron
- Center for International Education, College of Education, University of Massachusetts Amherst, Amherst, MA USA
| | | | - Christina Anderson Bosch
- Center for International Education, College of Education, University of Massachusetts Amherst, Amherst, MA USA
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Abstract
PURPOSE OF REVIEW The basic hypothesis of this paper is that, in Latin America, the nature of the set of variables or determinants regarding the relationships of urbanization (and correlated processes of social change, modernization, acculturation, and economic inclusion) and mental health varies with the political context or historical phase considered. To assess the validity of the hypothesis, I propose a periodization of the economic, political, and social changes that occurred in Latin America in the past decades. RECENT FINDINGS A brief review of recent studies on social determinants of mental health (with a focus on Brazil), considering research findings by historical context, shows that urbanization-modernization-migration variables were more present in the literature in the decades of 1980 and 1990, whereas social inequity factors (gender, ethnicity/race, and racism) came to be dominant as a research question after the year 2000. SUMMARY New approaches of the mental health situation of peripheral societies such as those in the Latin American continent have gone beyond the urban environment as a determinant and start to consider social determination processes and political contexts.
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Does the use of antidepressants change the subjective well- being of individuals with ICD-10 depressive disorder identified in the general population? JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Longo MSDC, Vilete LMP, Figueira I, Quintana MI, Mello MF, Bressan RA, Mari JDJ, Ribeiro WS, Andreoli SB, Coutinho ESF. Comorbidity in post-traumatic stress disorder: A population-based study from the two largest cities in Brazil. J Affect Disord 2020; 263:715-721. [PMID: 31780134 DOI: 10.1016/j.jad.2019.11.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/07/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study investigated the patterns of comorbidity between PTSD and depression, other anxiety disorders, alcohol-related disorders using the DSM-IV and ICD-10 criteria. The temporal sequence of the comorbid diagnoses was also investigated. METHODS We used data from a large population-based survey carried out between 2007 and 2008 in the two largest cities in Brazil: São Paulo and Rio de Janeiro. RESULTS Diagnoses of depression, other anxiety disorders, and alcohol-related disorder were more prevalent in the people with PTSD than in those without PTSD. Using the DSM-IV criteria, approximately 67% of cases presenting PTSD were also diagnosed with another mental disorder. The diagnosis category of other anxiety disorders presented the highest proportion of comorbidity (53%). Depression was found in 34% person with PTSD whilst alcohol-related disorders were observed in 7%. Considering the temporal relationship, the onset of comorbid depression was uniformly distributed through the periods before, within the same year and after PTSD's onset. When other anxiety disorders were comorbid with PTSD, in almost 90% of the cases the other anxiety disorders preceded PTSD. For comorbidity between of alcohol-related disorders and PTSD, in 50% of the cases alcohol-related disorders preceded the diagnosis of PTSD. LIMITATIONS The cross-sectional design imposes limitations on establishing a temporal relationship between the onset of psychiatric disorders due to memory bias. CONCLUSIONS Our findings indicate that among individuals presenting comorbid PTSD and other anxiety disorders, this diagnosis tend to precede PTSD. Comorbid cases are more frequent and more severe, and this should be taken into account in therapeutic research and clinical practice.
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Affiliation(s)
| | | | - Ivan Figueira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Inês Quintana
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Feijó Mello
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rodrigo A Bressan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, UK
| | - Jair de Jesus Mari
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Wagner Silva Ribeiro
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | | | - Evandro Silva Freire Coutinho
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública, Rio de Janeiro, Brazil; Instituto de Medicina Social da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Fillenbaum GG, Blay SL, Mello MF, Quintana MI, Mari JJ, Bressan RA, Andreoli SB. Use of mental health services by community-resident adults with DSM-IV anxiety and mood disorders in a violence-prone area: São Paulo, Brazil. J Affect Disord 2019; 250:145-152. [PMID: 30856491 PMCID: PMC7391382 DOI: 10.1016/j.jad.2019.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/01/2019] [Accepted: 03/03/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND While under-use of mental health services by adults with anxiety and/or depression is well established, use in a violence-prone area, and as a function of diagnosis and personality characteristics such resilience, is little known. We examine the sociodemographic and personality characteristics (specifically resilience), associated with use of mental health services in a violence-prone city by those with anxiety, depression, and their comorbidity. METHODS The structured Composite International Diagnostic Interview was used to identify 12-month DSM-IV- and ICD-10-defined anxiety and depression in a cross-sectional, representative, community-resident sample age 15-75y (N = 2536) in São Paulo, Brazil, and their use of mental health services. Resilience was determined by the Wagnild and Young scale. Analyses, using weighted, design-corrected statistical tests, included frequency measures and multivariable logistic regression. RESULTS Mental health services were used by 10% with only anxiety, 22% with only depression, and 34% with comorbidity, with odds of use in controlled analyses doubling from anxiety to depression to comorbidity. Use was significantly higher among those who were white, older (age >30 years, with substantial social support, low resilience, living in low homicide rate areas; use was not affected by experience of traumatic events. Psychiatrists, general practitioners, and psychologists were the primary providers. LIMITATIONS Cross-sectional design CONCLUSIONS: Contrary to expectation, use was greater among residents of lower homicide areas, and was not associated with personal traumatic experience. This may reflect increased immunity to violence in higher homicidal rate areas, lower resilience, and poorer access to services. Increased access to mental health services is needed.
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Affiliation(s)
- Gerda G. Fillenbaum
- Center for the Study of Aging and Human Development, Duke
University Medical Center, Durham, NC, USA.,Corresponding author: Gerda G.
Fillenbaum, PhD, Center for the Study of Aging and Human Development, Box 3003,
Duke University Medical Center, Durham, NC 27710, USA,
| | - Sergio L Blay
- Department of Psychiatry, Federal University of Sao Paulo,
Sao Paulo, Sao Paulo, Brazil (Escola Paulista de Medicina - UNIFESP)
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of Sao Paulo,
Sao Paulo, Sao Paulo, Brazil (Escola Paulista de Medicina - UNIFESP)
| | - Maria I. Quintana
- Department of Psychiatry, Federal University of Sao Paulo,
Sao Paulo, Sao Paulo, Brazil (Escola Paulista de Medicina - UNIFESP)
| | - Jair J. Mari
- Department of Psychiatry, Federal University of Sao Paulo,
Sao Paulo, Sao Paulo, Brazil (Escola Paulista de Medicina - UNIFESP)
| | - Rodrigo A. Bressan
- Department of Psychiatry, Federal University of Sao Paulo,
Sao Paulo, Sao Paulo, Brazil (Escola Paulista de Medicina - UNIFESP)
| | - Sergio B. Andreoli
- Department of Psychiatry, Federal University of Sao Paulo,
Sao Paulo, Sao Paulo, Brazil (Escola Paulista de Medicina - UNIFESP)
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Blay SL, Fillenbaum GG, Mello MF, Quintana MI, Mari JJ, Bressan RA, Andreoli SB. 12-month prevalence and concomitants of DSM-IV depression and anxiety disorders in two violence-prone cities in Brazil. J Affect Disord 2018; 232:204-211. [PMID: 29499502 PMCID: PMC6039111 DOI: 10.1016/j.jad.2018.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/29/2018] [Accepted: 02/15/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Estimating 12-month prevalence of depression, anxiety, and comorbid anxiety/depression in noninstitutionalized adults (age 15-75) in two violence-prone cities. METHODS The Composite International Diagnostic Interview v2.1 (Portuguese), administered in population-representative surveys (age 15-75) in São Paulo (N = 2536) and Rio de Janeiro (N = 1208), yielded 12-month prevalence of violent events experienced, and DSM-IV diagnoses of depression and anxiety, which were classified into mutually exclusive groups: 1) no anxiety/depression; 2) anxiety only; 3) depression only; 4) comorbid anxiety/depression. Weighted analyses estimated 12-month prevalence, multinomial logistic regression compared the demographic characteristics of the diagnosis groups, and association with experienced violence. RESULTS Twelve-month prevalence of anxiety alone, depression alone, and comorbid anxiety/depression was 12.7% (of whom 24.9% were also depressed), 4.9% (of whom 46.2% had anxiety), and 4.2% respectively for São Paulo; and 12.1% (18.2% of whom were depressed), 4.6% (37.0% with anxiety), and 2.7% respectively for Rio de Janeiro. All conditions were approximately twice as prevalent in women than in men in both cities. In São Paulo, comorbidity was associated with age under 60, depression alone was more prevalent among 30-59 year olds, but in 23-29 year-olds in Rio de Janeiro. Exposure to violence increased the odds of anxiety, depression, and their comorbidity. With rare exception, marital status, education, and race/ethnicity were not associated with anxiety, depression, or their comorbidity. LIMITATIONS Cross-sectional design. CONCLUSIONS Prevalence rates for all conditions were high, and particularly associated with exposure to violence. Means to ameliorate violence, and its mental health effects, particularly for women, are needed.
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Affiliation(s)
- Sergio L Blay
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil.
| | - Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Marcelo F Mello
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil
| | - Maria I Quintana
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil
| | - Jair J Mari
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil
| | - Sergio B Andreoli
- Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina - UNIFESP), São Paulo, SP, Brazil
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Blay SL, Laks J, Marinho V, Figueira I, Maia D, Coutinho ESF, Quintana IM, Mello MF, Bressan RA, Mari JJ, Andreoli SB. Prevalence and Correlates of Elder Abuse in São Paulo and Rio de Janeiro. J Am Geriatr Soc 2017; 65:2634-2638. [PMID: 28898387 DOI: 10.1111/jgs.15106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the prevalence of elder abuse and to investigate potential sociodemographic, health behavior, and medical correlates. DESIGN Cross-sectional data were collected in face-to-face assessments. SETTING São Paulo and Rio de Janeiro, Brazil. PARTICIPANTS Individuals aged 60 to 75. MEASUREMENTS Information on elder abuse was obtained using the Brazil-adapted, nine-item Hwalek-Sengstock Elder Abuse Screening Test. Sampling design-adjusted descriptive statistics and logistic regression were used in analyses. RESULTS The overall prevalence of abuse was 14.4% (n = 46/259, 95% confidence interval (CI) = 9.82-20.61) in São Paulo and 13.3% (n = 27/197, 95% CI = 8.76-19.74) in Rio de Janeiro. Unadjusted analyses indicated that poor education, low physical activity, unemployment, heart disease, and psychiatric problems were associated with abuse, but in adjusted analyses, self-reported elder abuse was significantly associated only with psychiatric problems (São Paulo: OR = 4.48, 95% CI = 1.75-11.45; Rio de Janeiro: OR = 21.61, 95% CI = 6.39-73.14). CONCLUSION Elder abuse is prevalent in São Paulo and Rio de Janeiro, but whether concomitants of abuse are cause, effect, or both is unclear because this was a cross-sectional study. These findings highlight the importance of the problem, as well as the need to develop measures to increase awareness, facilitate prevention, and fight against abuse of elderly adults.
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Affiliation(s)
- Sergio L Blay
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Postgraduation Program in Translational Biomedicine, Universidade do Grande Rio, Caxias, Brazil
| | - Valeska Marinho
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Deborah Maia
- National School of Public Health, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Ines M Quintana
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Jair J Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Sergio B Andreoli
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
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Ramos LD, Guimarães FS, Ventriglio A, de Andrade AG, Bhugra D, Lotufo-Neto F, Castaldelli-Maia JM. DSM-5 Post-Traumatic Stress Disorder Criteria in "Precious" (2009): Media Content Analysis for Educational Purposes. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:396-404. [PMID: 28364404 DOI: 10.1007/s40596-017-0682-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 02/09/2017] [Indexed: 06/07/2023]
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Sexual trauma is more strongly associated with tonic immobility than other types of trauma - A population based study. J Affect Disord 2017; 215:71-76. [PMID: 28319694 DOI: 10.1016/j.jad.2017.03.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/18/2017] [Accepted: 03/05/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tonic immobility is an involuntary motor and vocal inhibition reaction, considered the last-ditch response of the defensive cascade model. It is elicited in context of inescapable threat and perception of entrapment. Our aim was to investigate the association between different traumatic events and peritraumatic tonic immobility (PTI) in a representative sample of the general population. METHODS This is a cross-sectional study of general population from Rio de Janeiro and São Paulo with 3231 victims of traumatic events aged 15-75 years who completed the Tonic Immobility Scale (TIS). We calculated the frequency of the different traumatic events and estimated the mean scores with 95% confidence intervals for each traumatic event, controlling for the potential confounders using multiple linear regression models. Finally, we calculated the proportion of individual scoring zero in TIS for the 16 traumatic events. RESULTS PTI scores in child sexual abuse and adult sexual violence were almost twice as high as in other types of traumatic events, even when controlled for gender and educational level. Torture and war also showed high PTI scores, but these were based on very small number of cases and need to be interpreted with caution. Furthermore, victims of sexual trauma had the lowest proportion of individuals with total absence of PTI symptoms. LIMITATIONS This is a cross-sectional study and causal inferences must be drawn with caution. CONCLUSIONS Peritraumatic tonic immobility is more strongly associated with sexual trauma, particularly in childhood, than to other types of trauma in the general population.
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Abreu PBD, Cogo-Moreira H, Pose RA, Laranjeira R, Caetano R, Gaya CM, Madruga CS. Brazilian cross-cultural adaptation and validation of the List of Threatening Events Questionnaire (LTE-Q). BRAZILIAN JOURNAL OF PSYCHIATRY 2017; 39:330-336. [PMID: 28538757 PMCID: PMC7111402 DOI: 10.1590/1516-4446-2016-2132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/29/2016] [Indexed: 02/02/2023]
Abstract
Objective: To perform a construct validation of the List of Threatening Events Questionnaire (LTE-Q), as well as convergence validation by identifying its association with drug use in a sample of the Brazilian population. Methods: This is a secondary analysis of the Second Brazilian National Alcohol and Drugs Survey (II BNADS), which used a cross-cultural adaptation of the LTE-Q in a probabilistic sample of 4,607 participants aged 14 years and older. Latent class analysis was used to validate the latent trait adversity (which considered the number of events from the list of 12 item in the LTE experienced by the respondent in the previous year) and logistic regression was performed to find its association with binge drinking and cocaine use. Results: The confirmatory factor analysis returned a chi-square of 108.341, weighted root mean square residual (WRMR) of 1.240, confirmatory fit indices (CFI) of 0.970, Tucker-Lewis index (TLI) of 0.962, and root mean square error approximation (RMSEA) score of 1.000. LTE-Q convergence validation showed that the adversity latent trait increased the chances of binge drinking by 1.31 time and doubled the chances of previous year cocaine use (adjusted by sociodemographic variables). Conclusion: The use of the LTE-Q in Brazil should be encouraged in different research fields, including large epidemiological surveys, as it is also appropriate when time and budget are limited. The LTE-Q can be a useful tool in the development of targeted and more efficient prevention strategies.
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Affiliation(s)
- Patrícia B de Abreu
- Instituto Nacional de Pesquisa em Álcool e Outras Drogas (INCT INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Hugo Cogo-Moreira
- Instituto Nacional de Pesquisa em Álcool e Outras Drogas (INCT INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Regina A Pose
- Escola de Saúde, Universidade Municipal de São Caetano do Sul (USCS), São Caetano do Sul, SP, Brazil
| | - Ronaldo Laranjeira
- Instituto Nacional de Pesquisa em Álcool e Outras Drogas (INCT INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Raul Caetano
- Instituto Nacional de Pesquisa em Álcool e Outras Drogas (INCT INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Pacific Institute for Research and Evaluation, Oakland, CA, USA
| | - Carolina M Gaya
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Clarice S Madruga
- Instituto Nacional de Pesquisa em Álcool e Outras Drogas (INCT INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Luz MP, Coutinho ESF, Berger W, Mendlowicz MV, Vilete LMP, Mello MF, Quintana MI, Bressan RA, Andreoli SB, Mari JJ, Figueira I. Conditional risk for posttraumatic stress disorder in an epidemiological study of a Brazilian urban population. J Psychiatr Res 2016; 72:51-7. [PMID: 26540404 DOI: 10.1016/j.jpsychires.2015.10.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/17/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Conditional risk for PTSD is the risk of developing PTSD after exposure to traumatic events. This epidemiological study of the general urban population from the two largest cities in Brazil reports exposure to traumatic events; conditional risk for PTSD; and proportion/estimated number of PTSD cases secondary to each type of traumatic event. METHOD Cross-sectional study of general population (15-75 y.o.) from Rio de Janeiro and São Paulo. PTSD was assessed through Composite International Diagnostic Interview 2.1. RESULTS Our main findings, from 3744 participants, were: 1) high prevalence of traumatic events (86%), urban violence being the most common; 2) conditional risk for PTSD was 11.1%; 3) women (15.9%) have overall conditional risk 3 times higher than men (5.1%); 4) war-related trauma (67.8%), childhood sexual abuse (49.1%) and adult sexual violence (44.1%) had the highest conditional risks; 5) 35% of PTSD cases (estimated 435,970 individuals) were secondary to sudden/unexpected death of a close person, and 40% secondary to interpersonal violence. CONCLUSIONS Brazilian urban population is highly exposed to urban violence, and overall conditional risk for PTSD was 11.1%. Violence prevention and enhancement of resilience should be part of public policies, and mental health sequelae of trauma should be better recognized and treated.
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Affiliation(s)
- Mariana Pires Luz
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil.
| | - Evandro S F Coutinho
- National School of Public Health (ENSP/FIOCRUZ), Rua Leopoldo Bulhões 1480/823, Manguinhos, Rio de Janeiro, RJ 21041-210, Brazil
| | - William Berger
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil
| | - Mauro V Mendlowicz
- Fluminense Federal University (UFF), Rua Miguel de Frias 9, Icaraí, Niterói, RJ 24220-008, Brazil
| | - Liliane M P Vilete
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil
| | - Marcelo F Mello
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Maria Inês Quintana
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Sérgio B Andreoli
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Jair J Mari
- Department of Psychiatry of the Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570, São Paulo, SP 04038-000, Brazil
| | - Ivan Figueira
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB-UFRJ), Av. Venceslau Brás 71 Fundos, Botafogo, Rio de Janeiro, RJ 22290-140, Brazil
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Health-related quality of life in posttraumatic stress disorder: 4 years follow-up study of individuals exposed to urban violence. Psychiatry Res 2015; 228:741-5. [PMID: 26115841 DOI: 10.1016/j.psychres.2015.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 02/28/2015] [Accepted: 05/24/2015] [Indexed: 11/22/2022]
Abstract
Evidence suggests that Posttraumatic Stress Disorder (PTSD) is associated with substantially reduced Health-related quality of life (HRQoL). This study aimed to explore the impact of PTSD symptoms in HRQoL and its predictors in individuals exposed to urban violence. We follow-up a cohort of 267 individuals exposed to urban violence, derived from an epidemiological survey and clinical cases from an outpatient program of victims of violence, with and without PTSD, by assessing symptoms and other measures at two intervals, approximately 4 years apart. PTSD symptom severity was associated with poorer quality of life at baseline and at follow-up. Higher levels of depression and anxiety, new trauma experiences, more traumas in childhood and more PTSD arousal symptoms were all predictors of lower HRQoL over time. Results strongly suggest the need to assess HRQoL in addition to symptoms in order to assess the true severity of PTSD. These results have implications for the functional recovery in the treatment of PTSD.
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Quintana MI, Andreoli SB, Peluffo MP, Ribeiro WS, Feijo MM, Bressan RA, Coutinho ESF, Mari JDJ. Psychotropic Drug Use in São Paulo, Brazil--An Epidemiological Survey. PLoS One 2015; 10:e0135059. [PMID: 26252517 PMCID: PMC4529275 DOI: 10.1371/journal.pone.0135059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 07/17/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of one month psychotropic drug use in São Paulo, Brazil, and to assess the gap treatment between the presence of mental disorders and psychotropic drug users. METHOD A probabilistic sample of non-institutionalized individuals from the general population of São Paulo (n = 2336; turnout: 84.5%) who were 15 years or older were interviewed by a trained research staff, applying the Composite International Diagnostic Interview 2.1 (CIDI WHO) (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and an inventory investigating psychotropic drug use during the 12-month and one-month periods immediately preceding the interview. Logistic models were fitted to investigate associations between psychotropic drug use as well as socio-demographic and clinical variables. RESULTS The one month prevalence of psychotropic drug use in São Paulo was 5.89%, the most commonly used drugs were antidepressants (3.15%) and tranquilizers (2.67%). A higher consumption of psychotropic drugs (overall, antidepressants and tranquilizers) was observed among women (OR:2.42), older individuals (OR:1.04), individuals with higher levels of formal education (1.06), and individuals with a family (OR:2.29) or personal history of mental illness (OR:3.27). The main psychotropic drug prescribers were psychiatrists (41%), followed by general practitioners (30%); 60% of psychotropic drugs were obtained through a government-run dispensing program. Most individuals who obtained a positive diagnosis on the CIDI 2.1 during the previous month were not using psychotropic medication (85%). Among individuals with a diagnosis of moderate to severe depression, 67.5% were not on any pharmacological treatment. CONCLUSION There is a change in the type of psychotropic more often used in São Paulo, from benzodiazepines to antidepressants, this event is observed in different cultures. The prevalence of use is similar to other developing countries. Most of the patients presenting a psychiatric illness in the month prior to testing were not receiving any sort of psychiatric medication. This may be explained by a failure to identify cases in primary care, which could be improved (and access to treatment could be facilitated) if professionals received more specialized training in managing cases with mental health problems.
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Affiliation(s)
- Maria Ines Quintana
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
- * E-mail:
| | - Sergio Baxter Andreoli
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
- Universidade Catolica de Santos, Santos, Brazil
| | | | - Wagner Silva Ribeiro
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| | - Marcelo M. Feijo
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| | - Rodrigo Affonseca Bressan
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| | | | - Jair de Jesus Mari
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
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Kalaf J, Vilete LMP, Volchan E, Fiszman A, Coutinho ESF, Andreoli SB, Quintana MI, de Jesus Mari J, Figueira I. Peritraumatic tonic immobility in a large representative sample of the general population: association with posttraumatic stress disorder and female gender. Compr Psychiatry 2015; 60:68-72. [PMID: 25891640 DOI: 10.1016/j.comppsych.2015.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 03/06/2015] [Accepted: 04/02/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tonic immobility is an involuntary response to inescapable life-threatening events. Peritraumatic tonic immobility has been reported in convenience samples of female victims of sexual assault and in mixed-gender victims of different types of trauma. This study evaluated peritraumatic tonic immobility in a representative general population sample and its association with posttraumatic stress disorder (PTSD) and gender. METHODS 3231 victims of traumatic events aged 15-75 years responded to the Tonic Immobility Scale. PTSD and traumatic events were assessed using the Composite International Diagnostic Interview (CIDI 2.1). We calculated the means and the standard deviations of Tonic Immobility Scale scores stratified by PTSD and gender. The association between tonic immobility scores and gender was explored controlling for potential confounders through a multiple linear regression model. RESULTS Tonic immobility scores were more than double in those who met criteria for PTSD and were almost four points higher in women. Gender differences remained statistically significant even after adjustment for confounding variables. LIMITATIONS The cross-sectional and retrospective design may have given rise to recall bias. Results presented here may not apply to small and medium rural areas and the CIDI 2.1 can lead to a certain degree of misclassification. CONCLUSIONS We have expanded the scope of previous investigations on peritraumatic tonic immobility which were based on convenience samples only, showing its occurrence in victims of traumatic events using a large representative sample of the general population. Furthermore, we confirmed in an unbiased sample the association between peritraumatic tonic immobility and PTSD and female gender.
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Affiliation(s)
- Juliana Kalaf
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, RJ, Brazil.
| | | | - Eliane Volchan
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (IBCCF-UFRJ), Rio de Janeiro, RJ, Brazil
| | - Adriana Fiszman
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, RJ, Brazil
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Revictimization of violence suffered by those diagnosed with alcohol dependence in the general population. BIOMED RESEARCH INTERNATIONAL 2015; 2015:805424. [PMID: 26000304 PMCID: PMC4427086 DOI: 10.1155/2015/805424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 01/27/2015] [Indexed: 11/17/2022]
Abstract
Objective. To verify the association between violence and alcohol dependence syndrome in sample populations. Method. Population-wide survey with multistage probabilistic sample. 3,744 individuals of both genders, aged from 15 to 75 years, were interviewed from the cities of São Paulo and Rio de Janeiro using the Composite International Diagnostic Interview (CIDI 2.1). Results. In both cities, alcohol dependence was associated with the male gender, having suffered violence related to criminality, and having suffered familial violence. In both cities, urban violence, in more than 50% of cases, and familial violence, in more than 90% of cases, preceded alcohol dependence. The reoccurrence of traumatic events occurred in more than half of individuals dependent on alcohol. In São Paulo, having been diagnosed with PTSD is associated with violence revictimization (P = 0.014; Odds = 3.33). Conclusion. Alcohol dependence syndrome is complexly related to urban and familial violence in the general population. Violence frequently precedes alcoholism, but this relationship is dependent on residence and traumatic events. This vicious cycle contributes to perpetuating the high rates of alcoholism and violence in the cities. Politicians ordering the reduction of violence in the large metropolises can, potentially, reduce alcoholism and contribute to the break of this cycle.
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José Diez J, Eduardo Vigo D, Pedro Cardinali D, Pérez-Chada D. Sleep habits, daytime sleepiness and working conditions in short-distance bus drivers. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2014. [DOI: 10.1108/ijwhm-02-2013-0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Driving needs high levels of alertness. Increased somnolence is the most important negative influence to maintain proper watchfulness and vigilance. Drowsiness, working conditions and their affective impact must be taken into account to determine driving safety. The purpose of this paper is to assess excessive daytime sleepiness, sleep habits, quality of sleep, stress-related symptoms, and working conditions in a large sample of short-distance bus drivers in the city of Buenos Aires.
Design/methodology/approach
– This was a cross-sectional study performed to evaluate sleep habits and obstructive apnea risk in short-distance bus drivers of the Metropolitan Area of Buenos Aires, Argentina. Questionnaires regarding anthropometric data, sleep habits, snoring, daytime sleepiness (Epworth Sleepiness Scale), quality of sleep (Pittsburgh Quality of Sleep Index, PQSI), working conditions and fatigue and anxiety related to work were administered to professional short-distance bus drivers (n=1023).
Findings
– A prevalence of 34.6 percent of obesity and 80 percent of snoring was observed. Mean sleep time during workdays was 6.5±0.1 h and bad sleep quality was reported by 54.6 percent of the subjects. Excessive daytime sleepiness had a prevalence of 48.8 percent and was independently associated with reduced sleep time, increased sleep debt, long time to wake up, snoring, and short resting time along the working day (p<0.05).
Originality/value
– Short-distance drivers in Buenos Aires, the largest urban area of Argentina, are a partially sleep-deprived, overweighted population, showing a high daytime somnolence, poor work-rest conditions and high levels of anxiety and fatigue. This association can be very harmful in view of the demanding working conditions considered.
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Reduction of anterior cingulate in adults with urban violence-related PTSD. J Affect Disord 2014; 168:13-20. [PMID: 25033473 DOI: 10.1016/j.jad.2014.06.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 06/24/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND To evaluate differences in limbic structure volume of subjects exposed to urban violence during adulthood, between those who developed posttraumatic stress disorder (with PTSD) and resilient matched controls (without PTSD). METHODS Limbic volumetric measures of 32 subjects with PTSD and 32 subjects without PTSD who underwent brain MRI were analyzed in an epidemiological study in the city of Sao Paulo. The hippocampus, amygdala, cingulate, and parahipocampal gyri volumes were estimated using FreeSurfer software. We also investigated the association between limbic volumetric measurements, symptom´s severity, and early life stress history (measure by Early Trauma Inventory - ETI). RESULTS Subjects with PTSD presented reduced volume of the right rostral part of the anterior cingulate, compared to subjects without PTSD, after controlling for intracranial volume, ETI, and depressive symptoms. Subjects with PTSD presented larger bilateral hippocampus and right amygdala, but secondary to the higher ETI. In PTSD group there was a positive correlation between ETI with bilateral hippocampus, bilateral amygdala, and left parahippocampus. LIMITATIONS First, the cross-sectional study design precludes causal interpretation of limbic structure reduction in PTSD, consequence of PTSD, or other life events. Finally, since the sample size was not sufficiently large, we could not observe whether or not limbic structure volume could be related to the type of trauma. CONCLUSIONS The present study provides evidence of a reduced anterior cingulate volume in subjects with PTSD than in resilient subjects exposed to urban violence. Enlargement of hippocampus and amygdala volume was observed in subjects with PTSD, however secondary to early trauma experience.
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Vilete L, Figueira I, Andreoli SB, Ribeiro W, Quintana MI, de Jesus Mari J, Coutinho ESF. Resilience to trauma in the two largest cities of Brazil: a cross-sectional study. BMC Psychiatry 2014; 14:257. [PMID: 25261277 PMCID: PMC4196199 DOI: 10.1186/s12888-014-0257-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/29/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Resilience is a dynamic process involving the interaction between intrapsychic and social factors of risk and protection. For resilience to be recognized there must be a significant threat to the individual, such as a traumatic event, and a good quality of adjustment. The aim of this study was to identify predisposing factors and possible mechanisms associated with resilience to traumatic events in the general population. METHODS We conducted a cross-sectional study with a random sample, aged 15-75 years, living in the two largest cities in Brazil, who were exposed to trauma (N = 3,231). Positive adaptation to trauma was defined as the lifetime absence of anxiety (including posttraumatic stress disorder), depression and alcohol related disorders in the presence of at least one traumatic event. Logistic regression models predicting resilience were used to estimate the incidence density ratio. This measure expresses the extent to which the rate of resilience differs from the exposed group to the non-exposed group. Moreover, we explored the relationship between positive/negative affect and resilience, using linear regression models. RESULTS Male gender was a predisposing factor to positive adaptation (incidence density ratio [IDR] = 1.34; p < 0.001). There was an inverse linear relationship between childhood violence and resilience (IDR = 0.67; 0.53; 0.19; p < 0.001). Our findings suggest that the absence of parental mental disease (IDR = 1.35; p = 0.07) also predisposes individuals to positive adaptation. CONCLUSIONS This study provides results that help to identify vulnerable groups and protective factors that may lead to a positive adaptation following traumatic experiences.
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Affiliation(s)
- Liliane Vilete
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Av: Venceslau=Brás 71 - fundos - Botafogo CEP, Rio de Janeiro 22290-140, Brazil.
| | - Ivan Figueira
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Av: Venceslau=Brás 71 – fundos – Botafogo CEP, Rio de Janeiro, 22290-140 Brazil
| | - Sérgio Baxter Andreoli
- Universidade Católica de Santos, São Paulo, Brazil ,Universidade Federal de São Paulo, Departamento de Psiquiatria, São Paulo, Brazil
| | - Wagner Ribeiro
- Universidade Federal de São Paulo, Departamento de Psiquiatria, São Paulo, Brazil ,King’s College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK
| | - Maria Ines Quintana
- Universidade Federal de São Paulo, Departamento de Psiquiatria, São Paulo, Brazil
| | - Jair de Jesus Mari
- Universidade Federal de São Paulo, Departamento de Psiquiatria, São Paulo, Brazil ,King’s College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK
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Reichenheim M, Souza W, Coutinho ESF, Figueira I, Quintana MI, de Mello MF, Bressan RA, de Jesus Mari J, Andreoli SB. Structural validity of the tonic immobility scale in a population exposed to trauma: evidence from two large Brazilian samples. PLoS One 2014; 9:e94367. [PMID: 24747437 PMCID: PMC3991625 DOI: 10.1371/journal.pone.0094367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/13/2014] [Indexed: 11/30/2022] Open
Abstract
Background Tonic Immobility is a temporary state of motor inhibition in situations involving extreme fear. The first scale developed for its assessment was the 10-item Tonic Immobility Scale (TIS). However, there are still few studies on its structural (dimensional) validity. The objective of this study was to reassess the factor structure of the TIS applied to representative samples exposed to general trauma of two Brazilian mega-cities. Methods The sample comprised 3,223 participants reporting at least one traumatic experience. In São Paulo (n = 2,148), a Confirmatory Factor Analysis (CFA) first tested the originally proposed two-dimensional structure. This was followed by sequential Exploratory Structural Equation Models to identify the best fitting model, and subsequently tested in Rio de Janeiro (n = 1,075) via CFA. Alternative reduced versions were further explored using the aggregate sample. Model-based Item Response Theory (IRT) location parameters were also investigated. Results An absence of factor-based convergent and discriminant validity rejected the original proposition. However, the one-dimensional structure still held several residual correlations. Further exploration indicated the sustainability of reduced versions with seven (alternative A) and six (alternative B) items. Both presented excellent fit and no relevant residual item correlation. According to the IRT location parameters, items in alternative B covered a wider range of the latent trait. The Loevinger's H scalability coefficients underscored this pattern. Conclusions The original model did not hold. A one-factor solution was the most tenable in both large samples, but with significant item residual correlations, indicating that content redundancies persisted. Further reduced and simplified versions of the TIS proved promising. Although studies are yet to be carried out in other settings, it is the authors' impression that the restricted versions of the TIS are already apt for use in epidemiologic studies since the pros tend to outweigh the cons (as outlined in the Discussion section).
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Affiliation(s)
- Michael Reichenheim
- Department of Epidemiology, Institute of Social Medicine (IMS), State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
- * E-mail:
| | - Wanderson Souza
- Department of Psychology, Institute of Education, Federal Rural University of Rio de Janeiro (UFRRJ), Seropédica, RJ, Brazil
| | | | - Ivan Figueira
- Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Maria Inês Quintana
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marcelo Feijó de Mello
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sergio Baxter Andreoli
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Carvalho HWD, Andreoli SB, Lara DR, Patrick CJ, Quintana MI, Bressan RA, Mello MF, Mari JJ, Jorge MR. The joint structure of major depression, anxiety disorders, and trait negative affect. ACTA ACUST UNITED AC 2014; 36:285-92. [PMID: 25310205 DOI: 10.1590/1516-4446-2013-1329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/02/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Dimensional models of psychopathology demonstrate that two correlated factors of fear and distress account for the covariation among depressive and anxiety disorders. Nevertheless, these models tend to exclude variables relevant to psychopathology, such as temperament traits. This study examined the joint structure of DSM-IV-based major depression and anxiety disorders along with trait negative affect in a representative sample of adult individuals residing in the cities of São Paulo and Rio de Janeiro, Brazil. METHODS The sample consisted of 3,728 individuals who were administered sections D (phobic, anxiety and panic disorders) and E (depressive disorders) of the Composite International Diagnostic Interview (CIDI) 2.1 and a validated version of the Positive and Negative Affect Schedule. Data were analyzed using correlational and structural equation modeling. RESULTS Lifetime prevalence ranged from 2.4% for panic disorder to 23.2% for major depression. Most target variables were moderately correlated. A two-factor model specifying correlated fear and distress factors was retained and confirmed for models including only diagnostic variables and diagnostic variables along with trait negative affect. CONCLUSIONS This study provides support for characterization of internalizing psychopathology and trait negative affect in terms of correlated dimensions of distress and fear. These results have potential implications for psychiatric taxonomy and for understanding the relationship between temperament and psychopathology.
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Affiliation(s)
| | | | - Diogo R Lara
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | | | - Jair J Mari
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Miguel R Jorge
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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The impact of healthy parenting as a protective factor for posttraumatic stress disorder in adulthood: a case-control study. PLoS One 2014; 9:e87117. [PMID: 24489851 PMCID: PMC3906133 DOI: 10.1371/journal.pone.0087117] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 12/23/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early life social adversity can influence stress response mechanisms and is associated with anxious behaviour and reductions in callosal area later in life. OBJECTIVE To evaluate the association between perceptions of parental bonding in childhood/adolescence, hypothalamic-pituitary-adrenal (HPA) axis response, and callosal structural integrity in adult victims of severe urban violence with and without PTSD. METHODS Seventy-one individuals with PTSD and 62 without the disorder were assessed with the Parental Bonding Instrument (PBI). The prednisolone suppression test was administered to assess cortisol levels, and magnetic resonance imaging was used to assess the total area of the corpus callosum (CC), as well as the areas of callosal subregions. RESULTS The PBI items related to the perception of 'not having a controlling mother' (OR 4.84; 95%CI [2.26-10.3]; p=0.01), 'having a caring father' (OR 2.46; 95'%CI [1.18-5.12]; p=0.02), and 'not having controlling parents' (OR 2.70; 95%CI [1.10-6.63]; p=0.04) were associated with a lower risk of PTSD. The PTSD group showed a blunted response to the prednisolone suppression test, with lower salivary cortisol levels upon waking up (p=0.03). Individuals with PTSD had smaller total CC area than those without the disorder, but these differences were not statistically significant (e-value =0.34). CONCLUSIONS Healthy parental bonding, characterized by the perception of low parental control and high affection, were associated with a lower risk of PTSD in adulthood, suggesting that emotional enrichment and the encouragement of autonomy are protective against PTSD in adulthood.
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Flaks MK, Malta SM, Almeida PP, Bueno OFA, Pupo MC, Andreoli SB, Mello MF, Lacerda ALT, Mari JJ, Bressan RA. Attentional and executive functions are differentially affected by post-traumatic stress disorder and trauma. J Psychiatr Res 2014; 48:32-9. [PMID: 24199652 DOI: 10.1016/j.jpsychires.2013.10.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/07/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Among the neurocognitive impairments observed in patients with Post-traumatic Stress Disorder (PTSD), attentional and executive dysfunctions appear to correlate with negative effects on education, work, daily life activities, and social relations, as well as the re-experiencing, avoidance, and hyperarousal symptoms of PTSD. However, there is no consensus regarding which aspects of attentional and executive functions are impaired in PTSD patients. METHODS Attentional and executive functions were assessed using the digit span (WAIS-III) and spatial span (WMS-III) tests under forward and backward recall conditions, the Stroop Test, and the Wisconsin Card Sorting Test (WCST). Our sample was composed of victims of urban violence who developed PTSD (PTSD+) (n = 81), victims of urban violence who did not develop PTSD (PTSD-) (n = 70), and healthy controls not exposed to trauma (HC) (n = 50). RESULTS The PTSD+ group had poorer performance on the spatial span forward subtest (p = 0.023; eta(2) = 0.038) and poorer execution time (p = 0.023; eta(2) = 0.042) and accuracy (p = 0.019; eta(2) = 0.044) on the Stroop Test compared to HC. CONCLUSIONS These data suggest that there are few differences between the PTSD+ and HC groups, which are restricted to less complex measures of attentional and executive functional processes (short term capacity, selective attention, processing speed, and inhibitory control) and are related to visual stimuli. Therefore, cognitive impairments directly correlated with the manifestation of PTSD.
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Affiliation(s)
- Mariana K Flaks
- LiNC - Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de São Paulo (UNIFESP), Brazil; PROVE - Programa de Atendimento e Pesquisa em Violência, Universidade Federal de São Paulo (UNIFESP), Brazil.
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Carvalho HWD, Andreoli SB, Lara DR, Patrick CJ, Quintana MI, Bressan RA, Melo MFD, Mari JDJ, Jorge MR. Structural validity and reliability of the Positive and Negative Affect Schedule (PANAS): Evidence from a large Brazilian community sample. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35:169-72. [DOI: 10.1590/1516-4446-2012-0957] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/22/2012] [Indexed: 11/21/2022]
Affiliation(s)
| | - Sérgio B. Andreoli
- Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Brazil; Universidade Católica de Santos, Brazil
| | - Diogo R. Lara
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
| | | | - Maria Inês Quintana
- Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Brazil
| | - Rodrigo A. Bressan
- Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Brazil
| | - Marcelo F. de Melo
- Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Brazil
| | - Jair de J. Mari
- Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Brazil
| | - Miguel R. Jorge
- Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Brazil
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Quintana MI, Andreoli SB, Moreira FG, Ribeiro WS, Feijo MM, Bressan RA, Coutinho ESF, Mari JJ. Epidemiology of psychotropic drug use in Rio de Janeiro, Brazil: gaps in mental illness treatments. PLoS One 2013; 8:e62270. [PMID: 23690934 PMCID: PMC3653914 DOI: 10.1371/journal.pone.0062270] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/19/2013] [Indexed: 12/05/2022] Open
Abstract
Objective Estimate the prevalence of psychotropic drugs use in the city of Rio de Janeiro, Brazil, and establish its relationship with the presence of mental disorders. Methods A probabilistic sample of non-institutionalized individuals, from the general population of Rio de Janeiro (n = 1208;turn out:81%), 15 years or older, who were interviewed using the Composite International Diagnostic Interview 2.1 (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and asked about their psychotropic use during a 12 and one-month period before the interview. Data were collected between June/2007-February/2008.The prevalence was estimated with a confidence interval of 95%. The associations between psychotropics use and mental disorders were analyzed through a logistic regression model (Odds Ration – OR). Results The one-month prevalence of psychotropic drug use was 6.55%, 3.19% for men and 9.13% for women. Antidepressants were the most frequently used drug (2.78%), followed by anorectics (1.65%), tranquilizers (1.61%) and mood stabilizers (1.23%). General practitioners issued the highest number of prescriptions (46.3%), followed by psychiatrists (29.3%); 86.6% of the psychotropic drugs used were paid for by the patient himself. Individuals with increased likelihood of using psychotropic drugs were those that had received a psychiatric diagnosis during a one-month period before the study (OR:3.93), females (OR:1.82), separated/divorced (OR:2.23), of increased age (OR:1.03), with higher income (OR:2.96), and family history of mental disorder (OR:2.59); only 16% of the individuals with a current DSM IV diagnosis were using a psychotropic drug; 17% among individuals with a depression-related diagnosis and 8% with Phobic Anxiety Disorders-related diagnosis used psychotropics. Conclusion Approximately 84% of individuals displaying some mental disorder did not use psychotropic drugs, which indicates an important gap between demand and access to treatment. A significant failure is evident in the health system for patients with mental disorders; this could be due to health workers' inability to recognize mental disorders among individuals.
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Affiliation(s)
- Maria Ines Quintana
- Federal University of São Paulo - Paulista Medical School, São Paulo, Brazil.
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Schoedl AF, Costa MP, Fossaluza V, Mari JJ, Mello MF. Specific traumatic events during childhood as risk factors for posttraumatic stress disorder development in adults. J Health Psychol 2013; 19:847-57. [PMID: 23520354 DOI: 10.1177/1359105313481074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To evaluate differences in early life events (ELE) on adult victims of severe interpersonal violence among patients who developed posttraumatic stress disorder (PTSD) and control group. Adult victims of interpersonal violence were evaluated to diagnose the presence of PTSD and ELE. 308 subjects were included, 141 in patient's group (PTSD+) and 167 in control group (PSTD-). PTSD+ group had more severe PTSD, depressive symptoms and higher ETI scores than PTSD- group. Patients in PTSD+ group had a more frequent history of ELE. Some ELE were more significant for the development of this predisposition.
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Oliveira CDL, Goncalez T, Wright D, Rocha PC, Miranda C, Capuani L, Carneiro-Proietti AB, Proietti FA, de Almeida-Neto C, Larsen NM, Sampaio D, Custer B. Relationship between social capital and test seeking among blood donors in Brazil. Vox Sang 2013; 104:100-9. [PMID: 22892075 PMCID: PMC3564582 DOI: 10.1111/j.1423-0410.2012.01643.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Higher risk of HIV infection could be associated with test seeking, which is one motivation for donating blood. Cognitive social capital is defined as the social support, trust and co-operation that guide community behaviour. Structural social capital refers to an individual's participation in institutions and organizations. The association between social capital and test seeking was assessed. MATERIALS AND METHODS A survey of over 7500 donors in three Brazilian blood centres was conducted. Test seeking was classified into four non-overlapping categories (non-test seeker, possible, presumed and self-disclosed test seekers) using one direct and two indirect questions. Social capital was summarized into cognitive and structural categorizations. Multivariable logistic regression analysis was performed. RESULTS Compared with non-test seekers (62% of survey respondents), cognitive social capital was higher for each category of test seeking (OR=1.1, 7.4, 7.1, P<0.05 respectively). Male gender, lower education and lower income were also significantly associated with test seeking. CONCLUSION As test seekers appear to have strong social networks, blood banks may leverage this to convince them to seek testing at other locations.
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Affiliation(s)
- C D L Oliveira
- Universidade Federal de São João del-Rei, Minas Gerais, Brazil.
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Baldaçara L, Borgio JGF, Araújo C, Nery-Fernandes F, Lacerda ALT, Moraes WADS, Montaño MBMM, Rocha M, Quarantini LC, Schoedl A, Pupo M, Mello MF, Andreoli SB, Miranda-Scippa A, Ramos LR, Mari JJ, Bressan RA, Jackowski AP. Relationship between structural abnormalities in the cerebellum and dementia, posttraumatic stress disorder and bipolar disorder. Dement Neuropsychol 2012; 6:203-211. [PMID: 29213799 PMCID: PMC5619331 DOI: 10.1590/s1980-57642012dn06040003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
New evidence suggests that the cerebellum has structural and functional abnormalities in psychiatric disorders. Objective In this research, the goal was to measure the volume of the cerebellum and its subregions in individuals with psychiatric disorders and to relate these findings to their symptoms. Methods Patients with different degrees of cognitive impairment (Epidemiology of the Elderly - UNIFESP) and patients with post-traumatic stress disorder (PTSD) from population studies were analyzed. Also, patients with bipolar disorder from an outpatient clinic (Center for the Study of Mood and Anxiety Disorders, Universidade Federal da Bahia) were recruited for this study. All subjects underwent a 1.5T structural magnetic resonance scan. Volumetric measures and symptom measurements, by psychometric scales, were performed and compared between patients and controls. Results The cerebellum volume was reduced in patients with cognitive impairment without dementia and with dementia, in patients with PTSD, and in patients with bipolar disorder compared to controls. In dementia and PTSD, the left cerebellar hemisphere and vermis volume were reduced. In bipolar disorder, volumes of both hemispheres and the vermis were reduced. In the first two studies, these cerebellar volumetric reductions correlated with symptoms of the disease. Conclusion The exact nature of cerebellar involvement in mental processes is still not fully understood. However, abnormalities in cerebellar structure and its functions have been reported in some of these diseases. Future studies with larger samples are needed to clarify these findings and investigate whether they are important for treatment and prognosis.
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Affiliation(s)
- Leonardo Baldaçara
- Federal University of São Paulo, SP, Brazil.,Federal University of Tocantins, TO, Brazil
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Hoexter MQ, Fadel G, Felício AC, Calzavara MB, Batista IR, Reis MA, Shih MC, Pitman RK, Andreoli SB, Mello MF, Mari JJ, Bressan RA. Higher striatal dopamine transporter density in PTSD: an in vivo SPECT study with [(99m)Tc]TRODAT-1. Psychopharmacology (Berl) 2012; 224:337-45. [PMID: 22700036 DOI: 10.1007/s00213-012-2755-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/24/2012] [Indexed: 12/23/2022]
Abstract
RATIONALE Some evidence suggests a hyperdopaminergic state in posttraumatic stress disorder (PTSD). The 9-repetition allele (9R) located in the 3' untranslated region of the dopamine transporter (DAT) gene (SLC6A3) is more frequent among PTSD patients. In vivo molecular imaging studies have shown that healthy 9R carriers have increased striatal DAT binding. However, no prior study evaluated in vivo striatal DAT density in PTSD. OBJECTIVES The objective of this study was to evaluate in vivo striatal DAT density in PTSD. METHODS Twenty-one PTSD subjects and 21 control subjects, who were traumatized but asymptomatic, closely matched comparison subjects evaluated with the Clinician-Administered PTSD Scale underwent a single-photon emission computed tomography scan with [(99m)TC]-TRODAT-1. DAT binding potential (DAT-BP) was calculated using the striatum as the region of the interest and the occipital cortex as a reference region. RESULTS PTSD patients had greater bilateral striatal DAT-BP (mean ± SD; left, 1.80 ± 0.42; right, 1.78 ± 0.40) than traumatized control subjects (left, 1.62 ± 0.32; right, 1.61 ± 0.31; p = 0.039 for the left striatum and p = 0.032 for the right striatum). CONCLUSIONS These results provide the first in vivo evidence for increased DAT density in PTSD. Increases in DAT density may reflect higher dopamine turnover in PTSD, which could contribute to the perpetuation and potentiation of exaggerated fear responses to a given event associated with the traumatic experience. Situations that resemble the traumatic event turn to be interpreted as highly salient (driving attention, arousal, and motivation) in detriment of other daily situations.
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Affiliation(s)
- Marcelo Q Hoexter
- Instituto do Cérebro, Instituto de Ensino e Pesquisa do Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Baldaçara L, Jackowski AP, Schoedl A, Pupo M, Andreoli SB, Mello MF, Lacerda ALT, Mari JJ, Bressan RA. Reduced cerebellar left hemisphere and vermal volume in adults with PTSD from a community sample. J Psychiatr Res 2011; 45:1627-33. [PMID: 21824628 DOI: 10.1016/j.jpsychires.2011.07.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/14/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Traumatic events exposure is a necessary condition for developing posttraumatic stress disorder (PTSD), but not all individuals exposed to the same trauma will develop PTSD. Human studies have suggested that the cerebellum is involved in human fear perception, anticipation, and recollection. In this context, the current study evaluated whether cerebellar volume is associated with PTSD. METHODS Eighty-four victims of violence, 42 who fulfilled the DSM-IV-TR criteria for PTSD and 42 resilient controls, were identified through an epidemiologic survey conducted in the city of São Paulo. Subjects were evaluated using the Clinician-Administered PTSD Scale (CAPS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Early Trauma Inventory (ETI). All subjects underwent a magnetic resonance imaging (MRI) scan to evaluate their cerebellar hemispheres and vermis. RESULTS PTSD subjects had relative smaller left hemisphere (p = 0.04) and vermis (p < 0.01) volumes persisted after controlling for gender, age, and brain volume. In PTSD group, left cerebellar hemisphere volume correlated negatively with PTSD (p = 0.01) and depressive symptoms (p = 0.04). Vermal volume correlated negatively with PTSD symptoms (p < 0.01), early traumatic life events (p < 0.01), depressive symptoms (p = 0.04) and anxiety (p = 0.01). CONCLUSION The cerebellum is involved in emotion modulation, and our results suggest that cerebellar volumetric reduction is associated with mood, anxiety and PTSD symptoms. Early traumatic life experiences are related to vermal volume reduction and may be a risk factor for future PTSD development.
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Affiliation(s)
- Leonardo Baldaçara
- Psychiatry, Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo (UNIFESP), Brazil.
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Yeh MSL, Mari JJ, Costa MCP, Andreoli SB, Bressan RA, Mello MF. A double-blind randomized controlled trial to study the efficacy of topiramate in a civilian sample of PTSD. CNS Neurosci Ther 2011; 17:305-10. [PMID: 21554564 PMCID: PMC6493911 DOI: 10.1111/j.1755-5949.2010.00188.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and tolerability of topiramate in patients with posttraumatic stress disorder (PTSD). METHOD We conducted a 12-week double-blind, randomized, placebo-controlled study comparing topiramate to placebo. Men and women aged 18-62 years with diagnosis of PTSD according to DSM-IV were recruited from the outpatient clinic of the violence program of Federal University of São Paulo Hospital (Prove-UNIFESP), São Paulo City, between April 2006 and December 2009. Subjects were assessed for the Clinician-Administered Posttraumatic Stress Scale (CAPS), Clinical Global Impression, and Beck Depression Inventory (BDI). After 1-week period of washout, 35 patients were randomized to either group. The primary outcome measure was the CAPS total score changes from baseline to the endpoint. RESULTS 82.35% of patients in the topiramate group exhibited improvements in PTSD symptoms. The efficacy analysis demonstrated that patients in the topiramate group exhibited significant improvements in reexperiencing symptoms: flashbacks, intrusive memories, and nightmares of the trauma (CAPS-B; P= 0.04) and in avoidance/numbing symptoms associated with the trauma, social isolation, and emotional numbing (CAPS-C; P= 0.0001). Furthermore, the experimental group demonstrated a significant difference in decrease in CAPS total score (topiramate -57.78; placebo -32.41; P= 0.0076). Mean topiramate dose was 102.94 mg/d. Topiramate was generally well tolerated. CONCLUSION Topiramate was effective in improving reexperiencing and avoidance/numbing symptom clusters in patients with PTSD. This study supports the use of anticonvulsants for the improvement of symptoms of PTSD.
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Affiliation(s)
- Mary S L Yeh
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
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Valente NLM, Vallada H, Cordeiro Q, Miguita K, Bressan RA, Andreoli SB, Mari JJ, Mello MF. Candidate-Gene Approach in Posttraumatic Stress Disorder After Urban Violence: Association Analysis of the Genes Encoding Serotonin Transporter, Dopamine Transporter, and BDNF. J Mol Neurosci 2011; 44:59-67. [DOI: 10.1007/s12031-011-9513-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 03/07/2011] [Indexed: 12/28/2022]
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Valente NLM, Vallada H, Cordeiro Q, Bressan RA, Andreoli SB, Mari JJ, Mello MF. Catechol-O-methyltransferase (COMT) val158met polymorphism as a risk factor for PTSD after urban violence. J Mol Neurosci 2010; 43:516-23. [PMID: 21080103 DOI: 10.1007/s12031-010-9474-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 11/02/2010] [Indexed: 12/21/2022]
Abstract
PTSD is a psychiatric disorder that requires a traumatic event as diagnostic criteria. Brazil has high rates of violence, and it is expected that urban victims of violence would be at risk to the development of PTSD. Studies have associated the COMT val158met polymorphism with diminished stress resilience, reduced ability to extinguish conditioned fear, and the development of PTSD after multiple traumatic experiences. The aim of this study was to identify, in a case-control study, whether the val158met polymorphism (rs4860) is associated with the development of PTSD in a group of victims of urban violence. To our knowledge, this is the first study that examines the association between PTSD and urban violence. The polymorphism of COMT in PTSD patients (n=65) as well as in victims of violence without PTSD (n=34) and in a community control group (n=335) were genotyped. We found a significant relationship between the met allele (p<0.02) and PTSD among cases (PTSD+)and victims of violence without PTSD (PTSD-; OR 2.57) and between cases and community control group (p<0.003) Further analysis with larger samples and another ethnic group should be necessary to confirm our findings.
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Affiliation(s)
- Nina Leão Marques Valente
- Departamento de Psiquiatria, Universidade Federal de São Paulo, Rua Botucatu 431 - Villa Clementino, CEP 04023-061, São Paulo, SP, Brazil.
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