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Emrich M, Gnall KE, Garnsey CL, George JR, Park CL, Mazure CM, Hoff RA. Associations of Posttraumatic Stress Disorder Symptom Clusters and Pain Interference in Post-9/11 Veterans: Exploring Sleep Impairment and Physical Activity as Underlying Mechanisms. Int J Behav Med 2024:10.1007/s12529-024-10268-4. [PMID: 38438749 DOI: 10.1007/s12529-024-10268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) symptoms and pain are highly prevalent and comorbid, particularly in veterans, but mechanisms explaining their linkage remain unclear. The aims of this study were to determine: (1) whether sleep impairment and physical activity (PA) mediate relations between PTSD symptoms and pain interference (assessed both longitudinally and as residual change) and (2) the unique roles of each PTSD symptom cluster in those relationships. METHODS The present study is a secondary analysis of a longitudinal observational investigation of 673 post-9/11 veterans (45.8% women). Surveys were administered at baseline and 3-month and 6-month follow-ups. RESULTS PTSD symptoms were significantly associated with pain interference longitudinally and worsening pain interference over time. Sleep impairment, but not PA, significantly mediated the relationship between PTSD symptoms and subsequent pain interference. Hyperarousal symptoms were found to be the primary driver of the relationship between PTSD symptoms and pain interference and re-experiencing symptoms were associated with change in pain interference via sleep impairment. Men and women did not differ on any of the study variables with the exception of PA. CONCLUSION Findings underscore the importance of targeting sleep as a key modifiable health factor linking PTSD symptoms to pain interference in post-9/11 veterans.
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Affiliation(s)
- Mariel Emrich
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA.
| | - Katherine E Gnall
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Camille L Garnsey
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Jamilah R George
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT, USA
| | - Rani A Hoff
- Northeast Program Evaluation Center (NEPEC), VA Connecticut Healthcare System, West Haven, CT, USA
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Gnall KE, Sacco SJ, Sinnott SM, Park CL, Mazure CM, Hoff RA. Physical activity, posttraumatic stress, and gender: A longitudinal study of post-9/11 veterans. J Health Psychol 2024:13591053241233380. [PMID: 38400566 DOI: 10.1177/13591053241233380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Given the importance of physical activity (PA) for both physical and mental health, the present study characterizes post-9/11 veterans' leisure-time PA engagement over time. Further, this study examines the relationship between PA and posttraumatic stress symptoms (PTSS), as well as whether this relation differs by gender and time since military discharge. This study was a secondary analysis of a 12-month longitudinal observational investigation of 410 (39.5% female) post-9/11 veterans. Participants completed self-report questionnaires at baseline and 12 months. Over a third of post-9/11 veterans were not engaging in any weekly leisure-time PA at study baseline and PA engagement significantly decreased in the subsequent year. The longitudinal relationship between PA and PTSS depended on both gender and time since military discharge. These results underscore the importance of considering both gender and time since discharge when tailoring interventions to support leisure-time PA as a key health habit in post-9/11 veterans.
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Affiliation(s)
| | | | | | | | | | - Rani A Hoff
- Yale School of Medicine, USA
- Northeast Program Evaluation Center (NEPEC), USA
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3
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Mazure CM, Husky MM, Pietrzak RH. Stress as a Risk Factor for Mental Disorders in a Gendered Environment. JAMA Psychiatry 2023; 80:1087-1088. [PMID: 37672277 DOI: 10.1001/jamapsychiatry.2023.3138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
This Viewpoint discusses the value of assessing specific stressors that may vary by gender when assessing mental health to better inform our knowledge of stress effects and aid in developing better targeted, gender-informed prevention and treatment efforts in psychiatry.
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Affiliation(s)
- Carolyn M Mazure
- Women's Health Research at Yale, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Mathilde M Husky
- Bordeaux Population Health Research Center, ACTIVE Team, INSERM U1219, University of Bordeaux, Bordeaux, France
| | - Robert H Pietrzak
- Translational Psychiatric Epidemiology Laboratory, US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut
- Yale University School of Medicine, New Haven, Connecticut
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4
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Gnall KE, Sacco SJ, Park CL, Mazure CM, Hoff RA. Life meaning and mental health in post-9/11 veterans: the mediating role of perceived stress. Anxiety Stress Coping 2023; 36:743-756. [PMID: 36542555 DOI: 10.1080/10615806.2022.2154341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Post-9/11 veterans frequently experience diminished mental health following military service. Life meaning is related to better mental health in veterans, yet its mechanism of action is unknown. A meaning-making model suggests that life meaning can reduce perceived stress, thus enhancing mental health. The present study tested this meaning-making model by predicting multiple dimensions of mental health (i.e., symptoms of posttraumatic stress disorder, anxiety, insomnia, and depression, and mental health quality of life) from life meaning as mediated by perceived stress. DESIGN AND METHODS The present study was a secondary analysis of a 12-month observational study of 367 post-9/11 veterans. Participants completed demographic and health surveys at baseline, 6-month, and 12-month follow-ups. A multivariate mediation model was created predicting changes in dimensions of mental health from 6 months to 12 months. RESULTS Higher life meaning at baseline predicted changes in all dimensions of mental health between 6 and 12 months, an effect mediated by changes in perceived stress between baseline and 6 months. CONCLUSIONS Across dimensions of mental health, the meaning-making model was supported. Understanding post-9/11 veteran mental health from this theoretical perspective may help better tailor healthcare efforts and enhance veteran health overall.
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Affiliation(s)
- Katherine E Gnall
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Shane J Sacco
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Women's Health Research at YaleYale School of Medicine, New Haven, CT, USA
| | - Rani A Hoff
- Northeast Program Evaluation Center (NEPEC), VA Connecticut Healthcare System, West Haven, CT, USA
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5
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Davis DR, Krishnan-Sarin S, Mazure CM. Considerations of Sex and Gender in FDA Tobacco Regulation. JAMA 2023:2805568. [PMID: 37233997 DOI: 10.1001/jama.2023.6803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Danielle R Davis
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | | | - Carolyn M Mazure
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Department of Psychology, Yale School of Medicine, New Haven, Connecticut
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6
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Martin K, Marshall AL, Mazure CM. The value of teaching the influence of sex and gender on health outcomes. Lancet Haematol 2023; 10:e318-e319. [PMID: 37142343 PMCID: PMC10154001 DOI: 10.1016/s2352-3026(23)00055-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Kelsey Martin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Women's Health Research at Yale, Yale School of Medicine, New Haven, CT, USA.
| | - Ariela L Marshall
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Women's Health Research at Yale, Yale School of Medicine, New Haven, CT, USA
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7
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Hennein R, Lowe SR, Feingold JH, Feder A, Peccoralo LA, Ripp JA, Mazure CM, Pietrzak RH. Pre- and peri-traumatic event stressors drive gender differences in chronic stress-related psychological sequelae: A prospective cohort study of COVID-19 frontline healthcare providers. J Psychiatr Res 2023; 162:88-94. [PMID: 37105023 DOI: 10.1016/j.jpsychires.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/07/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
Women are at heightened risk for chronic stress-related psychological sequelae (SRPS), including major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) in response to potentially traumatic events, including the COVID-19 pandemic. However, few studies have examined pre- and peri-event stressors that could account for gender differences in chronic SRPS. To address this gap, we conducted a prospective cohort study of healthcare providers (HCPs) caring for patients with COVID-19 at a large tertiary care hospital in New York City, and measured mental health risk factors and symptoms of MDD, GAD, and PTSD at baseline (April 2020) and at a 7-month follow-up (December 2020). We defined chronic SRPS as the presence of probable MDD, GAD, and/or PTSD at both timepoints. We conducted a mediation analysis to evaluate whether pre- and peri-event stressors explained women's increased risk for chronic SRPS. Among our sample of 786 HCPs, 571 (72.6%) were women. Compared with men, women were twice as likely to have chronic SRPS (18.7% vs. 8.8%, χ2[1] = 11.38, p < 0.001). However, after accounting for pre- and peri-event stressors, being a woman was no longer associated with chronic SRPS (p = 0.58). The pre- and peri-event stressors that accounted for this heightened risk among women included being in a woman-prevalent profession (specifically nursing; estimate = 0.08, SE = 0.04, p = 0.05), pre-pandemic burnout (estimate = 0.11, SE = 0.05, p = 0.04), greater family-related (estimate = 0.09, SE = 0.03, p = 0.004), infection-related (estimate = 0.06, SE = 0.02, p = 0.007), and work-related concerns (estimate = 0.11, SE = 0.03, p < 0.001), and lower leadership support (estimate = 0.07, SE = 0.03, p = 0.005). These findings can inform institutional interventions to mitigate the risk of chronic SRPS among women HCPs.
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Affiliation(s)
- Rachel Hennein
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA
| | - Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Jordyn H Feingold
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren A Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan A Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carolyn M Mazure
- Yale School of Medicine, New Haven, CT, USA; Women's Health Research at Yale, Yale School of Medicine, New Haven, CT, USA
| | - Robert H Pietrzak
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Colic L, Clark A, Sankar A, Rathi DJ, Goldman DA, Kim JA, Villa LM, Edmiston EK, Lippard ETC, Pittman B, Constable RT, Mazure CM, Blumberg HP. Gender-related association among childhood maltreatment, brain structure and clinical features in bipolar disorder. Eur Neuropsychopharmacol 2022; 63:35-46. [PMID: 36037590 PMCID: PMC9593266 DOI: 10.1016/j.euroneuro.2022.07.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022]
Abstract
Bipolar disorder (BD) and exposure to childhood maltreatment (CM), which is present at high rates in BD, are both associated with hippocampus and prefrontal cortex structural alterations thought to contribute to clinical features. Gender-related differences are implicated in BD for CM exposure, brain structure and clinical features. However, relationships among these factors in BD are understudied. This study aimed to investigate associations among gender, CM, hippocampus and prefrontal gray matter structure and clinical features in BD. Childhood trauma questionnaire, structured clinical assessments and 3 Tesla structural magnetic resonance imaging were obtained for 236 adults (18-63 years, 32.0 ± 12.6): 119 with BD (58.8% women) and 117 healthy controls (HCs, 50.4% women). Women with BD reported higher CM severity than men with BD and HCs (B=-14.34, 95% confidence intervals (CI)[-22.71,-5.97], p<.001). CM and gender showed a significant interaction for left hippocampus (B=-7.41, 95% CI[-14.10,-0.71], p<.05); CM severity was negatively associated with left hippocampus only in women with BD. In women with BD, CM was associated with post-traumatic stress disorder comorbidity (B = 25.68, 95% CI[15.11,36.25], p<.001). In men with BD, CM severity was associated with lower left frontal pole (B=-0.71, 95% CI[-1.14,-0.28], p<.05) and right superior frontal (B=-17.78, 95% CI[-30.66,-4.90], p<.05) surface area; the latter related to earlier age of first mood symptoms (B = 33.97, 95% CI[7.61, 60.33], p<.05). Findings support gender-related effects of CM on frontotemporal structure and clinical features of BD. The findings bring novel perspectives for gendered pathophysiological models of effects of CM in BD.
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Affiliation(s)
- Lejla Colic
- Department of Psychiatry, Yale School of Medicine, USA; Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health, Halle/Jena/Magdeburg, Germany.
| | - Alexis Clark
- Department of Psychiatry, Yale School of Medicine, USA
| | - Anjali Sankar
- Department of Psychiatry, Yale School of Medicine, USA; Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Denmark
| | - Durga J Rathi
- Department of Psychiatry, Yale School of Medicine, USA
| | - Danielle A Goldman
- Department of Psychiatry, Yale School of Medicine, USA; Interdepartmental Neuroscience Program, Yale School of Medicine, USA
| | - Jihoon A Kim
- Department of Psychiatry, Yale School of Medicine, USA
| | - Luca M Villa
- Department of Psychiatry, Yale School of Medicine, USA; Department of Psychiatry, University of Oxford, UK
| | - E Kale Edmiston
- Department of Psychiatry, Yale School of Medicine, USA; Department of Psychiatry, University of Pittsburgh, USA
| | - Elizabeth T C Lippard
- Department of Psychiatry, Yale School of Medicine, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, USA; Department of Psychiatry and Behavioral Sciences and Institute of Early Life Adversity Research, Dell Medical School, University of Texas, USA
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, USA
| | - R Todd Constable
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, USA
| | | | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, USA; Child Study Center, Yale School of Medicine, USA
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9
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Jan J, Osho A, Murphy CC, Mazure CM, Singal AG, Rich NE. Gender, Age, Racial and Ethnic Disparities in Clinical Trial Enrollment for Primary Liver Cancer. Gastroenterology 2022; 163:14-20.e2. [PMID: 35288115 PMCID: PMC9232956 DOI: 10.1053/j.gastro.2022.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Jenny Jan
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX
| | - Azeez Osho
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX
| | - Caitlin C. Murphy
- School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Carolyn M. Mazure
- Department of Psychiatry; Women’s Health Research at Yale, Yale University School of Medicine, New Haven, CT
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX
| | - Nicole E. Rich
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX
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10
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Stachenfeld NS, Mazure CM. Precision medicine requires understanding how both sex and gender influence health. Cell 2022; 185:1619-1622. [DOI: 10.1016/j.cell.2022.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/09/2022] [Accepted: 04/07/2022] [Indexed: 02/03/2023]
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11
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Mazure CM, Williams ML. Introduction and purpose: The House of Medicine & Dermatology. Int J Womens Dermatol 2022; 7:517-518. [PMID: 35005173 PMCID: PMC8721084 DOI: 10.1016/j.ijwd.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Mary L Williams
- University of California San Francisco, San Francisco, California
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12
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Mazure CM, Spungen NW, Bildner JL, Williams ML. Dedication of the IJWD Special Issue on the House of Medicine & Dermatology to Dr. Jenny Murase. Int J Womens Dermatol 2022; 7:519. [PMID: 35005174 PMCID: PMC8721067 DOI: 10.1016/j.ijwd.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Carolyn M Mazure
- Professor of Psychiatry and Psychology Director, Women's Health Research at Yale Yale University School of Medicine New Haven, Connecticut
| | - Norma Weinberg Spungen
- Professor of Psychiatry and Psychology Director, Women's Health Research at Yale Yale University School of Medicine New Haven, Connecticut
| | - Joan Lebson Bildner
- Professor of Psychiatry and Psychology Director, Women's Health Research at Yale Yale University School of Medicine New Haven, Connecticut
| | - Mary L Williams
- Clinical Professor of Dermatology and Pediatrics University of California San Francisco, San Francisco, California
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13
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Lowe SR, Hennein R, Feingold JH, Peccoralo LA, Ripp JA, Mazure CM, Pietrzak RH. Are Women Less Psychologically Resilient Than Men? Background Stressors Underlying Gender Differences in Reports of Stress-Related Psychological Sequelae. J Clin Psychiatry 2021; 83. [PMID: 34936244 DOI: 10.4088/jcp.21br14098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Corresponding author: Sarah R. Lowe, PhD, Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510
| | - Rachel Hennein
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Jordyn H Feingold
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lauren A Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan A Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carolyn M Mazure
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Women's Health Research at Yale, Yale School of Medicine, New Haven, Connecticut
| | - Robert H Pietrzak
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
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14
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Thomas MM, Pietrzak RH, Nguyen DR, Ryan D, Southwick SM, Mazure CM. Psychological Resilience in West Point Graduates: Results From a Nationally Representative Study. Chronic Stress (Thousand Oaks) 2021; 5:24705470211053850. [PMID: 34761141 PMCID: PMC8573692 DOI: 10.1177/24705470211053850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
Background: The purpose of this study was to examine factors associated with psychological resilience in a nationally representative sample of West Point graduates. Aims: The aims of this study were to (a) employ a dimensional approach to operationalizing psychological resilience in a trauma-exposed population that had been highly trained and educated in persisting in the face of stress, was previously unstudied, and in which we could examine correlates of resilience, (b) identify key psychosocial factors, character traits, health variables, military experiences, and coping strategies as potential correlates of psychological resilience; and (c) examine whether reported gender moderated any of these associations in this population. Methods: A nationally representative sample of 1342 West Point graduates after gender integration from classes 1980 to 2011 were surveyed. Psychological resilience was operationalized using a discrepancy-based approach in which a measure of composite psychological distress (current posttraumatic stress disorder, generalized anxiety and depression symptoms) was regressed on measures of cumulative trauma burden. A multivariable linear regression model was then employed to identify factors that were independently associated with psychological resilience scores. Results: Purpose in life (29.8% of relative variance explained [RVE]), fewer perceived negative experiences in the military (20.6% RVE), social support (9.6% RVE), and grit (9.5% RVE) were the strongest correlates of psychological resilience scores for both women and men. Time in service was positively associated with resilience in women only. Conclusion: This study identifies key correlates of psychological resilience in West Point graduates, individuals who are highly trained to persevere in the face of stress and then were trauma-exposed. Most of these factors are modifiable and can be targeted in stress prevention and treatment interventions, especially for high-stress professions such as the military, frontline health care providers, and first responders.
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Affiliation(s)
| | | | | | - Diane Ryan
- Jonathan M. Tisch College of Civic Life, Tufts University, Medford, MA, USA
| | | | - Carolyn M Mazure
- Yale School of Medicine, Women's Health Research at Yale, New Haven, CT, USA
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15
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Park CL, Sacco SJ, Kraus SW, Mazure CM, Hoff RA. Influences of religiousness/spirituality on mental and physical health in OEF/OIF/OND military veterans varies by sex and race/ethnicity. J Psychiatr Res 2021; 138:15-23. [PMID: 33798785 DOI: 10.1016/j.jpsychires.2021.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/02/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Religiousness/spirituality (R/S) has been associated with greater mental wellbeing in US military veterans, but this work has been conducted primarily with older veterans, cross-sectionally, using a constrained set of R/S and mental health constructs, and lacking consideration of the influence of sex and race/ethnicity. Further, few studies have focused on associations of R/S with veterans' physical health. METHOD We investigated the relationship of R/S to mental and physical health in a sample of 410 Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn veterans within five years of military separation and one year later. RESULTS In the full sample, R/S coping, R/S organized practices and private prayer minimally related to mental or physical wellbeing, yet R/S struggle related inversely to concurrent and subsequent mental and physical health. For women only, higher baseline organized R/S was associated with lower subsequent stress, anxiety, and insomnia. For men only, baseline R/S coping predicted subsequent poorer physical quality of life and baseline R/S struggle predicted subsequent increased pain. For minority race but not white veterans, higher baseline private prayer predicted increased current pain level at 12 months; for Latinx ethnicity only, higher baseline R/S coping predicted increased quality of life a year later and higher baseline R/S struggle predicted higher subsequent levels of anxiety. CONCLUSIONS R/S, broadly conceptualized, may relate to wellbeing in military veterans in different ways depending on sex and race/ethnicity, with implications for the role of R/S and R/S struggle in personalizing mental and physical health services.
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Affiliation(s)
- Crystal L Park
- University of Connecticut, Department of Psychological Sciences, USA.
| | - Shane J Sacco
- University of Connecticut, Department of Allied Health Sciences, USA.
| | - Shane W Kraus
- University of Nevada, Las Vegas, Department of Psychology, USA.
| | - Carolyn M Mazure
- Women's Health Research at Yale, Department of Psychiatry, Yale School of Medicine, USA.
| | - Rani A Hoff
- Northeast Program Evaluation Center (NEPEC), VA Connecticut Healthcare System, USA.
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16
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Finkelstein-Fox L, Sinnott SM, Lee SY, Carney LM, Park CL, Mazure CM, Hoff R. Meaningful military engagement among male and female post-9/11 veterans: An examination of correlates and implications for resilience. J Clin Psychol 2021; 77:2167-2186. [PMID: 33960411 DOI: 10.1002/jclp.23150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/03/2021] [Accepted: 03/30/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Post-9/11 military deployment is commonly reported as stressful and is often followed by psychological distress after returning home. Yet veterans also frequently report experiencing meaningful military engagement (MME) that may buffer detrimental effects of military stressors. Focusing on the under-investigated topic of association of MME with post-deployment psychological adjustment, this study tests gender differences in MME and post-deployment outcomes. METHOD This cross-sectional study examined the relationship of MME with deployment stressors, subsequent psychological distress (posttraumatic stress symptoms (PTSS) and depression), and gender among 850 recent-era U.S. veterans (41.4% female). RESULTS On average, both male and female veterans reported high MME. Greater MME was associated with less PTSS and depression following combat and general harassment, and more depression after sexual harassment. For men only, MME associated with less PTSS after sexual harassment. CONCLUSIONS MME is high among post-9/11 veterans, but its stress-buffering effects depend on gender and specific stressor exposure.
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Affiliation(s)
- Lucy Finkelstein-Fox
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Sinead M Sinnott
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Sharon Y Lee
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Lauren M Carney
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Women's Health Research at Yale, New Haven, Connecticut, USA
| | - Rani Hoff
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Women's Health Research at Yale, New Haven, Connecticut, USA.,VISN1 MIRECC, VA Connecticut Healthcare System, West Haven, Connecticut, USA
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17
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Abstract
Depression is a common and debilitating condition that adversely affects functioning and the capacity to work and establish economic stability. Women are disproportionately burdened by depression, and low-income pregnant and parenting women have particularly high rates of depression and often lack access to treatment. As depression can be treated, it is a modifiable risk factor for poor economic outcomes for women, and thus for children and families. Recent national and state health care policy changes offer the opportunity for community-based psychological and economic interventions that can reduce the number of pregnant and parenting women with clinically significant depressive symptoms. Moreover, there is strong evidence that in addition to benefiting women's well-being, such reforms bolster children's emotional and social development and learning and help families rise out of poverty. This review summarizes the mental health and economic literature regarding how maternal depression perpetuates intergenerational poverty and discusses recommendations regarding policies to treat maternal depression in large-scale social services systems.
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Affiliation(s)
- Megan V Smith
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA; .,The Child Study Center, Yale University School of Medicine, New Haven, Connecticut 06519, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut 06510, USA.,Women's Health Research at Yale, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA; .,Women's Health Research at Yale, Yale University School of Medicine, New Haven, Connecticut 06510, USA.,Department of Psychology, Yale University, New Haven, Connecticut 06511, USA
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18
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Scoglio AA, Shirk SD, Hoff RA, Potenza MN, Mazure CM, Park CL, McKee SA, Porter EA, Kraus SW. Gender-Specific Risk Factors for Psychopathology and Reduced Functioning in a Post-9/11 Veteran Sample. J Interpers Violence 2021; 36:NP1359-1374NP. [PMID: 29295023 PMCID: PMC6461523 DOI: 10.1177/0886260517746182] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
U.S. combat veterans frequently encounter challenges after returning from deployment, and these challenges may lead to difficulties in psychological and social functioning. Currently, research is limited on gender-related differences within this population, despite female veterans comprising a growing portion of the U.S. military with roles and exposures similar to their male counterparts. Using secondary analysis, we examined 283 returning combat veterans (female = 29.4%) for differences in psychopathology and trauma history. Female veterans were more likely to report a history of sexual trauma than their male counterparts, whereas male veterans were more likely to report greater frequency of gambling in the past year, impulsivity, and hypersexuality. No gender-related differences were identified for depression, anxiety, insomnia, or substance-use disorders, although both men and women veterans had higher rates than those found in the general population. While both male and female combat veterans report various mental health problems as they transition back into civilian life, gender-related differences relating to sexual trauma, hypersexuality, and impulsivity warrant additional investigations with respect to the potential impact they may have on veteran reintegration and treatment.
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Affiliation(s)
- Arielle A.J. Scoglio
- Social and Community Reintegration Research Program, Bedford, MA USA
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
| | - Steven D. Shirk
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
| | - Rani A. Hoff
- Northeast Program Evaluation Center; Director, Evaluation Division, National Center for PTSD, West Haven, CT USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Marc N. Potenza
- Connecticut Mental Health Center, Yale University School of Medicine, New Haven, CT USA
- Departments of Psychiatry, Child Study, Neuroscience, and the National Center on Addiction and Substance Abuse, Yale University School of Medicine, New Haven, CT USA
| | - Carolyn M. Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Crystal L. Park
- University of Connecticut, Department of Psychological Sciences, Storrs, CT USA
| | - Sherry A. McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Elizabeth A. Porter
- Northeast Program Evaluation Center; Evaluation Division, National Center for PTSD, West Haven, CT USA
| | - Shane W. Kraus
- Correspondence concerning this article should be addressed to Shane W. Kraus, Ph.D., VISN 1 MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, 200 Spring Road, Building 5, Room 135B, Bedford MA, 01730, United States. Telephone: 781-687-2000, Ext: 5001;
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19
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Abstract
In the midst of the current coronavirus pandemic, the United States continues to struggle with an ongoing opioid epidemic, initially fueled by widespread prescribing of opioid medications during the 1990s. The primary reason for prescribing opioids is to treat pain. Women have more acute and chronic pain and have been prescribed these drugs in significantly greater numbers than men. Comparison of women and men with chronic pain also shows that women receive the majority of prescription opioids, and the use of these prescribed medications became the major pathway to misuse and addiction for women. Yet, recognition of the extent of women's exposure to opioids and the attendant consequences has been limited. Attempts to stem the overall tide of the epidemic focused on reducing the availability of prescription opioids. However, as these medications became more difficult to obtain and treatment opportunities were limited, many turned to other synthetic opioids, such as heroin and fentanyl. Thus, the public health crisis of opioid addiction has endured. This paper highlights the importance of understanding differences among women and men in opioid use and its biological and psychosocial effects to advance the gender-based treatment approaches and effective public health policy.
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Affiliation(s)
- Teddy G Goetz
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jill B Becker
- Biopsychology Area Chair, University of Michigan, Ann Arbor, MI, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT, USA
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20
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Decker SE, Hoff R, Martino S, Mazure CM, Park CL, Porter E, Kraus SW. Is Emotion Dysregulation Associated With Suicidal Ideation in Post 9/11 Veterans? Arch Suicide Res 2021; 25:126-140. [PMID: 31556798 DOI: 10.1080/13811118.2019.1661895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Emotion dysregulation, a risk factor for suicide ideation and attempts, has not been studied in U.S. veterans of Operations Enduring and Iraqi Freedom and New Dawn (OEF/OIF/OND). Data were collected through standardized telephone interviews and computer-based surveys from 278 OEF/OIF/OND veterans (70.6% male, 29.4% female). Bivariate analyses indicated that emotion dysregulation was associated with suicidal ideation during the past-three-months (r = 0.30, p < 0.05) and lifetime suicide attempts (r = 0.21, p < 0.05). When PTSD and depression symptoms were added to a sequential logistic regression model, emotion dysregulation was no longer significantly associated with ideation or attempt. Emotion dysregulation was associated with suicidal ideation and attempt; however, current distress had greater associations. Dysregulation is one of several factors in veteran suicide risk.
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21
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Husky MM, Pietrzak RH, Marx BP, Mazure CM. Research on Posttraumatic Stress Disorder in the Context of the COVID-19 Pandemic: A Review of Methods and Implications in General Population Samples. Chronic Stress (Thousand Oaks) 2021; 5:24705470211051327. [PMID: 34765850 PMCID: PMC8576091 DOI: 10.1177/24705470211051327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022]
Abstract
Increasing concern about the mental health sequelae to the COVID-19 pandemic has prompted a surge in research and publications on the prevalence of posttraumatic stress disorder in general population samples in relation to the pandemic. We examined how posttraumatic stress disorder in the context of the COVID-19 pandemic has been studied to date and found three general themes: (1) assessment of posttraumatic stress disorder and posttraumatic stress disorder symptoms relied on self-report measures and often did not determine direct trauma exposure as required by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criterion A to diagnose posttraumatic stress disorder; (2) inadequate assessment of pre-existing mental disorders and co-occurring stress; and (3) the use of cross-sectional designs in most studies, often relying on snowball sampling strategies to conduct online surveys. Notwithstanding these methodological limitations, these studies have reported moderate to severe posttraumatic symptoms in 25.8% of the general population on average in relation to the pandemic (ranging from 4.6% to 55.3%). Opportunities for advancing future research that will inform public health planning are discussed.
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Affiliation(s)
| | - Robert H. Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West
Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Brian P. Marx
- National Center for PTSD, VA Boston
Healthcare System, and Boston University School of Medicine, Boston, MA, USA
| | - Carolyn M. Mazure
- Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Women's Health
Research at Yale, Yale School of Medicine, New Haven, CT, USA
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22
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Abstract
Szivak, TK, Thomas, MM, Pietrzak, RH, Nguyen, DR, Ryan, DM, and Mazure, CM. Obesity Risk Among West Point Graduates Later in Life. J Strength Cond Res XX(X): 000-000, 2020-The purpose of this investigation was to evaluate sex differences in health and fitness outcomes among United States Military Academy (USMA) graduates (class years 1980-2011). Subjects (n = 701 men, 641 women, age: 45.7 ± 9.3 years) were surveyed as a part of a larger investigation on risk and resiliency factors among USMA graduates. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short form and calculation of weekly metabolic equivalents (METs). Overweight and obesity status were assessed by body mass index (BMI). Significance for the study was set at p ≤ 0.05. Obesity rates for men (30.1%) were significantly higher than for women (16.6%). Men reported significantly higher (p = 0.01) vigorous METs·wk (1,214.6 ± 1,171.6) than women (1,046.8 ± 1,133.2) despite significantly higher (p = 0.00) BMI values (28.75 ± 4.53 kg·m) than women (25.90 ± 5.48 kg·m). Women were 89% more likely to have ever been on a diet and reported higher (15.2%) Army Body Composition Program enrollment rates than men (6.3%). Obesity rates among men reflect trends seen in the broader military, Veteran, and U.S. adult populations, whereas obesity rates among women were lower. Men may be at a greater risk for obesity later in life despite higher self-reported physical activity; however, lean body mass and self-report bias should be considered. Because lifetime obesity may be influenced by factors other than physical activity, health initiatives should use a comprehensive approach early in the career of military officers.
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Affiliation(s)
- Tunde K Szivak
- Merrimack College, School of Health Sciences, North Andover, Massachusetts
| | | | - Robert H Pietrzak
- Yale University, School of Medicine, New Haven, Connecticut.,VA National Center for PTSD Research, NW Washington, DC
| | - Dana R Nguyen
- Tufts University, Tisch College, Medford, Massachusetts
| | - Diane M Ryan
- Uniformed Services University, Bethesda, Maryland
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23
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Lee SY, Finkelstein-Fox L, Park CL, Mazure CM, Huedo-Medina TB, Hoff R. Bidirectionality of Pain Interference and PTSD Symptoms in Military Veterans: Does Injury Status Moderate Effects? Pain Med 2020; 20:934-943. [PMID: 30016463 DOI: 10.1093/pm/pny133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Pain and post-traumatic stress disorder (PTSD) symptoms are strongly correlated in veteran populations. Arguments for which one condition predicts or worsens the other condition have gone in both directions. However, research addressing this issue has been primarily limited to cross-sectional studies rather than examinations of a potential bidirectional relationship between pain interference and PTSD symptoms over time. In addition, no studies have examined deployment injury status as potentially moderating this bidirectional effect in veterans. To address these gaps in the literature, the present longitudinal study examined whether there is a bidirectional relationship between pain interference and PTSD symptoms in a sample of male and female veterans returning from Operation Iraqi Freedom, Operation Enduring Freedom, or Operation New Dawn (N = 729) and whether deployment injury status moderates this relationship. METHODS Participants completed phone interviews regarding pain interference and PTSD symptoms at three time points, each three months apart. RESULTS Pain interference at Time 1 predicted worse PTSD symptoms at Time 2 for the subset of veterans who sustained injuries during deployment (n = 381) but not for veterans with pain interference who did not sustain injuries (n = 338). From Time 1 to Time 3, elevations in PTSD symptoms were mediated by pain interference for injured veterans; in contrast, PTSD symptoms did not appear to drive changes in pain interference in either group. CONCLUSIONS These results indicate that physical symptom management should be a crucial target of psychological intervention for returning veterans with PTSD symptoms and deployment-related injuries.
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Affiliation(s)
- Sharon Y Lee
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Lucy Finkelstein-Fox
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Women's Health Research at Yale, New Haven, CT, USA
| | | | - Rani Hoff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Women's Health Research at Yale, New Haven, CT, USA.,VISN1 MIRECC, VA Connecticut Healthcare System, New Haven, CT, USA
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24
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Schmaal L, van Harmelen AL, Chatzi V, Lippard ETC, Toenders YJ, Averill LA, Mazure CM, Blumberg HP. Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies. Mol Psychiatry 2020; 25:408-427. [PMID: 31787757 PMCID: PMC6974434 DOI: 10.1038/s41380-019-0587-x] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 10/21/2019] [Accepted: 10/29/2019] [Indexed: 01/06/2023]
Abstract
Identifying brain alterations that contribute to suicidal thoughts and behaviors (STBs) are important to develop more targeted and effective strategies to prevent suicide. In the last decade, and especially in the last 5 years, there has been exponential growth in the number of neuroimaging studies reporting structural and functional brain circuitry correlates of STBs. Within this narrative review, we conducted a comprehensive review of neuroimaging studies of STBs published to date and summarize the progress achieved on elucidating neurobiological substrates of STBs, with a focus on converging findings across studies. We review neuroimaging evidence across differing mental disorders for structural, functional, and molecular alterations in association with STBs, which converges particularly in regions of brain systems that subserve emotion and impulse regulation including the ventral prefrontal cortex (VPFC) and dorsal PFC (DPFC), insula and their mesial temporal, striatal and posterior connection sites, as well as in the connections between these brain areas. The reviewed literature suggests that impairments in medial and lateral VPFC regions and their connections may be important in the excessive negative and blunted positive internal states that can stimulate suicidal ideation, and that impairments in a DPFC and inferior frontal gyrus (IFG) system may be important in suicide attempt behaviors. A combination of VPFC and DPFC system disturbances may lead to very high risk circumstances in which suicidal ideation is converted to lethal actions via decreased top-down inhibition of behavior and/or maladaptive, inflexible decision-making and planning. The dorsal anterior cingulate cortex and insula may play important roles in switching between these VPFC and DPFC systems, which may contribute to the transition from suicide thoughts to behaviors. Future neuroimaging research of larger sample sizes, including global efforts, longitudinal designs, and careful consideration of developmental stages, and sex and gender, will facilitate more effectively targeted preventions and interventions to reduce loss of life to suicide.
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Affiliation(s)
- Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Vasiliki Chatzi
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Yara J Toenders
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Lynnette A Averill
- Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, West Haven, CT, USA
| | - Carolyn M Mazure
- Psychiatry and Women's Health Research at Yale, Yale School of Medicine, New Haven, CT, USA
| | - Hilary P Blumberg
- Psychiatry, Radiology and Biomedical Imaging, Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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25
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Zakiniaeiz Y, Hillmer AT, Matuskey D, Nabulsi N, Ropchan J, Mazure CM, Picciotto MR, Huang Y, McKee SA, Morris ED, Cosgrove KP. Sex differences in amphetamine-induced dopamine release in the dorsolateral prefrontal cortex of tobacco smokers. Neuropsychopharmacology 2019; 44:2205-2211. [PMID: 31269510 PMCID: PMC6897943 DOI: 10.1038/s41386-019-0456-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/31/2019] [Accepted: 06/19/2019] [Indexed: 12/18/2022]
Abstract
Sex differences exist in the neurochemical mechanisms underlying tobacco smoking and smoking-related behaviors. Men tend to smoke for the reinforcing effects of nicotine, whereas women tend to smoke for stress and mood regulation, and have a harder time maintaining long-term abstinence. The mesolimbic dopamine (DA) system drives the reinforcing effects of tobacco smoking, whereas the mesocortical DA system-including the dorsolateral prefrontal cortex (dlPFC)-is critical for stress-related cognitive functioning and inhibitory control. This study is the first to investigate dlPFC D2/3-type receptor (D2R) availability and amphetamine-induced cortical DA release in smokers and nonsmokers. Forty-nine subjects (24 tobacco smokers (12 females) and 25 sex- and age-matched nonsmokers) participated in two same-day [11C]FLB457 positron emission tomography (PET) scans before and 3-hours after amphetamine administration (0.4-0.5 mg/kg, PO). D2R availability (non-displaceable binding potential; BPND) was measured pre- and post-amphetamine. The percent fractional change in BPND (%ΔBPND) between pre- and post-amphetamine, an index of DA release, was compared between male and female smokers and nonsmokers. Smokers showed significantly lower dlPFC D2R availability (BPND = 0.77 ± 0.05) than nonsmokers (BPND = 0.92 ± 0.04), p = 0.016, driven by males. Female smokers showed significantly less amphetamine-induced DA release in dlPFC (%ΔBPND = 1.9 ± 3.0%) than male smokers (%ΔBPND = 14.0 ± 4.3%), p < 0.005, and female nonsmokers (%ΔBPND = 9.3 ± 3.3%), p < 0.005. This study shows that in the prefrontal cortex, smokers have lower D2R availability than nonsmokers and that female vs. male smokers have a blunted amphetamine-induced DA release. These findings demonstrate that tobacco smoking differentially affects the mesocortical DA system in men vs. women, suggesting a potential target for gender-specific treatments.
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Affiliation(s)
- Yasmin Zakiniaeiz
- 0000000419368710grid.47100.32Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT USA ,0000000419368710grid.47100.32Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT USA
| | - Ansel T. Hillmer
- 0000000419368710grid.47100.32Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT USA ,0000000419368710grid.47100.32Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT USA ,0000000419368710grid.47100.32Department of Psychiatry, Yale University, New Haven, CT USA
| | - David Matuskey
- 0000000419368710grid.47100.32Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT USA ,0000000419368710grid.47100.32Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT USA ,0000000419368710grid.47100.32Department of Psychiatry, Yale University, New Haven, CT USA
| | - Nabeel Nabulsi
- 0000000419368710grid.47100.32Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT USA
| | - Jim Ropchan
- 0000000419368710grid.47100.32Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT USA
| | - Carolyn M. Mazure
- 0000000419368710grid.47100.32Department of Psychiatry, Yale University, New Haven, CT USA ,0000000419368710grid.47100.32Women’s Health Research at Yale, Yale University, New Haven, CT USA
| | - Marina R. Picciotto
- 0000000419368710grid.47100.32Department of Psychiatry, Yale University, New Haven, CT USA
| | - Yiyun Huang
- 0000000419368710grid.47100.32Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT USA
| | - Sherry A. McKee
- 0000000419368710grid.47100.32Department of Psychiatry, Yale University, New Haven, CT USA
| | - Evan D. Morris
- 0000000419368710grid.47100.32Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT USA ,0000000419368710grid.47100.32Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT USA ,0000000419368710grid.47100.32Department of Psychiatry, Yale University, New Haven, CT USA ,0000000419368710grid.47100.32Department of Biomedical Engineering, Yale University, New Haven, CT USA
| | - Kelly P. Cosgrove
- 0000000419368710grid.47100.32Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT USA ,0000000419368710grid.47100.32Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT USA ,0000000419368710grid.47100.32Department of Psychiatry, Yale University, New Haven, CT USA
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26
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Thande NK, Wang M, Curlin K, Dalvie N, Mazure CM. The Influence of Sex and Gender on Health: How Much Is Being Taught in Medical School Curricula? J Womens Health (Larchmt) 2019; 28:1748-1754. [PMID: 30864888 DOI: 10.1089/jwh.2018.7229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Sex is a biological variable linked to our chromosomal complement, while gender refers to one's personal identification as influenced by social, cultural, and personal experience. Both sex and gender and their interactions influence health outcomes. Although this is increasingly clear, we have not yet ensured that the next generation of physicians and physician-scientists is being taught the empirical findings necessary to understand these relationships. We assert that medical schools must incorporate these data into didactics throughout an integrated curriculum. Materials and Methods: This study evaluates a medical curriculum for sex- and gender-based content and provides recommendations for establishing and integrating pertinent sex and gender medicine didactics. Trained first-and second-year medical students audited 548 lectures and workshops to determine sex- and gender-based content. Results: Less than 25% of all sessions raised the topic of sex or gender influences on physiology and pathophysiology or the experience of the patient in the health care environment. Only 8.1% of all sessions included an in-depth discussion of sex or gender differences, and these discussions predominantly focused on basic physiology and prevalence and/or incidence of disease, and not on available data on sex- and gender-specific influences on diagnosis, treatment, prognosis, and drug effects. The didactics that included data on sex or gender influences were largely in lectures rather than small group sessions, which are important for the development of critical clinical reasoning skills. Conclusions: A survey-based audit of medical school curricula can inform recommendations for improving the inclusion of data on sex- and gender-based content.
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Affiliation(s)
- Njeri K Thande
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | | | | | - Carolyn M Mazure
- Department of Psychiatry, Women's Health Research at Yale, Yale School of Medicine, New Haven, Connecticut
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Becker JB, Mazure CM. The federal plan for health science and technology's response to the opioid crisis: understanding sex and gender differences as part of the solution is overlooked. Biol Sex Differ 2019; 10:3. [PMID: 30616693 PMCID: PMC6322277 DOI: 10.1186/s13293-018-0215-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/10/2018] [Indexed: 01/22/2023] Open
Abstract
The Fast-Track Action Committee on (the) Health Science and Technology Response to the Opioid Crisis recently released their draft report for public comment. This report provides the "roadmap" for a coordinated federal research and development response to the opioid crisis. Other than noting the important concerns regarding maternal and neonatal exposure to opioids, the report overlooks the laboratory, clinical, and epidemiological data that inform the need for further research on sex and gender differences in opioid addiction that have critical gender-based treatment and prevention implications. As we embark on research and development, investigations into the neurobiology of pain, opioid use, and addiction must include both females and males in model systems and, similarly, psychological and sociocultural investigations must study women and men. All data should be reported by sex and gender so that gender-specific treatment and prevention strategies derived from this research are provided to practitioners and the public. We encourage biomedical researchers and clinical care providers, as well as the public, to insist that a successful response to the opioid crisis should highlight the importance of understanding sex and gender differences in the current opioid epidemic.
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Affiliation(s)
- Jill B Becker
- Department of Psychology and the Molecular & Behavioral Neuroscience Institute, University of Michigan, 205 Zina Pitcher Place, Ann Arbor, MI, 48109, USA.
| | - Carolyn M Mazure
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine, 135 College Street, Suite, New Haven, CT, 220, USA
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28
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Monteith LL, Hoffmire CA, Holliday R, Park CL, Mazure CM, Hoff RA. Do unit and post-deployment social support influence the association between deployment sexual trauma and suicidal ideation? Psychiatry Res 2018; 270:673-681. [PMID: 30384288 DOI: 10.1016/j.psychres.2018.10.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 11/15/2022]
Abstract
Deployment sexual trauma is associated with post-deployment suicidal ideation. No studies have examined the role of social support in this association. The present study examined if perceived unit support and post-deployment support influenced the association between deployment sexual trauma and suicidal ideation. 824 post-9/11 veterans (480 men, 344 women) from the Survey of Experiences of Returning Veterans completed the Deployment Risk and Resilience Inventory-2 and Columbia-Suicide Severity Rating Scale. Age, possible depression, posttraumatic stress disorder symptoms, and lifetime suicide attempt were covaried. Among men, post-deployment support moderated the association between deployment sexual trauma and suicidal ideation; deployment sexual trauma predicted suicidal ideation only for men reporting low post-deployment support. Among women, post-deployment support mediated the association between deployment sexual trauma and suicidal ideation. Unit support neither moderated nor mediated the association between deployment sexual trauma and suicidal ideation. Among men who experience deployment sexual trauma, those with low perceived post-deployment support may be at particularly elevated risk for suicidal ideation and may benefit from more intensive monitoring and interventions that bolster social support. Increasing perceived post-deployment support for women who experience deployment sexual trauma is also warranted. Determining optimal ways to strengthen post-deployment support for sexual trauma survivors is essential.
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Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, 1700N. Wheeling St., Aurora, CO 80045, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, 1700N. Wheeling St., Aurora, CO 80045, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, 1700N. Wheeling St., Aurora, CO 80045, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Carolyn M Mazure
- Women's Health Research at Yale, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rani A Hoff
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Northeast Program Evaluation Center, West Haven, CT, USA
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Affiliation(s)
| | - David A Fiellin
- Yale University School of Medicine, New Haven, CT 06510, USA; Yale School of Public Health, New Haven, CT 06510, USA
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30
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Holmes SE, Esterlis I, Mazure CM, Lim YY, Ames D, Rainey-Smith S, Fowler C, Ellis K, Martins RN, Salvado O, Doré V, Villemagne VL, Rowe CC, Laws SM, Masters CL, Pietrzak RH, Maruff P. Trajectories of depressive and anxiety symptoms in older adults: a 6-year prospective cohort study. Int J Geriatr Psychiatry 2018; 33:405-413. [PMID: 28736899 PMCID: PMC5773367 DOI: 10.1002/gps.4761] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/05/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Depressive and anxiety symptoms are common in older adults, significantly affect quality of life, and are risk factors for Alzheimer's disease. We sought to identify the determinants of predominant trajectories of depressive and anxiety symptoms in cognitively normal older adults. METHOD Four hundred twenty-three older adults recruited from the general community underwent Aβ positron emission tomography imaging, apolipoprotein and brain-derived neurotrophic factor genotyping, and cognitive testing at baseline and had follow-up assessments. All participants were cognitively normal and free of clinical depression at baseline. Latent growth mixture modeling was used to identify predominant trajectories of subthreshold depressive and anxiety symptoms over 6 years. Binary logistic regression analysis was used to identify baseline predictors of symptomatic depressive and anxiety trajectories. RESULTS Latent growth mixture modeling revealed two predominant trajectories of depressive and anxiety symptoms: a chronically elevated trajectory and a low, stable symptom trajectory, with almost one in five participants falling into the elevated trajectory groups. Male sex (relative risk ratio (RRR) = 3.23), lower attentional function (RRR = 1.90), and carriage of the brain-derived neurotrophic factor Val66Met allele in women (RRR = 2.70) were associated with increased risk for chronically elevated depressive symptom trajectory. Carriage of the apolipoprotein epsilon 4 allele (RRR = 1.92) and lower executive function in women (RRR = 1.74) were associated with chronically elevated anxiety symptom trajectory. CONCLUSION Our results indicate distinct and sex-specific risk factors linked to depressive and anxiety trajectories, which may help inform risk stratification and management of these symptoms in older adults at risk for Alzheimer's disease. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sophie E Holmes
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Irina Esterlis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Carolyn M. Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Yen Ying Lim
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - David Ames
- Academic Unit for Psychiatry of Old Age, St. Vincent’s Health, Department of Psychiatry, The University of Melbourne, Kew, Victoria, Australia,National Ageing Research Institute, Parkville, Victoria, Australia
| | - Stephanie Rainey-Smith
- Centre of Excellence for Alzheimer’s Disease Research and Care, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Chris Fowler
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Kathryn Ellis
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Ralph N. Martins
- Centre of Excellence for Alzheimer’s Disease Research and Care, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia,Sir James McCusker Alzheimer’s Disease Research Unit, Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Olivier Salvado
- The Commonwealth Scientific and Industrial Research Organization, Canberra, Australia
| | - Vincent Doré
- The Commonwealth Scientific and Industrial Research Organization, Canberra, Australia,Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, Victoria, Australia
| | - Victor L. Villemagne
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia,Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, Victoria, Australia
| | - Christopher C. Rowe
- Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, Victoria, Australia
| | - Simon M. Laws
- Centre of Excellence for Alzheimer’s Disease Research and Care, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia,Co-operative Research Centre for Mental Health,School of Biomedical Sciences, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University
| | - Colin L. Masters
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Paul Maruff
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia,Cogstate Ltd., Melbourne, Victoria, Australia
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Lippard ETC, Mazure CM, Johnston JAY, Spencer L, Weathers J, Pittman B, Wang F, Blumberg HP. Brain circuitry associated with the development of substance use in bipolar disorder and preliminary evidence for sexual dimorphism in adolescents. J Neurosci Res 2017; 95:777-791. [PMID: 27870392 DOI: 10.1002/jnr.23901] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/29/2016] [Accepted: 08/05/2016] [Indexed: 02/06/2023]
Abstract
Substance use disorders and mood disorders are highly comorbid and confer a high risk for adverse outcomes. However, data are limited on the neurodevelopmental basis of this comorbidity. Substance use initiation typically occurs during adolescence, and sex-specific developmental mechanisms are implicated. In this preliminary study, we review the literature and investigate regional gray matter volume (GMV) associated with subsequent substance use problems in adolescents with bipolar disorder (BD) and explore these associations for females and males. Thirty adolescents with DSM-IV-diagnosed BD and minimal alcohol/substance exposure completed baseline structural magnetic resonance imaging scans. At follow-up (on average 6 years post baseline), subjects were administered the CRAFFT interview and categorized into those scoring at high ( ≥ 2: CRAFFTHIGH ) vs. low ( < 2: CRAFFTLOW ) risk for alcohol/substance problems. Lower GMV in prefrontal, insular, and temporopolar cortices were observed at baseline among adolescents with BD reporting subsequent alcohol and cannabis use compared to adolescents with BD who did not (P < 0.005, clusters ≥ 20 voxels). Lower dorsolateral prefrontal GMV was associated with future substance use in both females and males. In females, lower orbitofrontal and insula GMV was associated with future substance use, while in males, lower rostral prefrontal GMV was associated with future use. Lower orbitofrontal, insular, and temporopolar GMV was observed in those who transitioned to smoking tobacco. Findings indicate that GMV development is associated with risk for future substance use problems in adolescents with BD, with results implicating GMV development in regions subserving emotional regulation in females and regions subserving executive processes and attention in males. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Elizabeth T C Lippard
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Carolyn M Mazure
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Women's Health Research at Yale, Yale School of Medicine, New Haven, Connecticut
| | | | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Judah Weathers
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.,Women's Health Research at Yale, Yale School of Medicine, New Haven, Connecticut.,Child Study Center, Yale School of Medicine, New Haven, Connecticut
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Brindis CD, Freund KM, Baecher-Lind L, Bairey Merz CN, Carnes M, Gulati M, Joffe H, Klein WS, Mazure CM, Pace LE, Regensteiner JG, Redberg RF, Wenger NK, Younger L. The Risk of Remaining Silent: Addressing the Current Threats to Women's Health. Womens Health Issues 2017; 27:621-624. [DOI: 10.1016/j.whi.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/17/2022]
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Smith PH, Weinberger AH, Zhang J, Emme E, Mazure CM, McKee SA. Sex Differences in Smoking Cessation Pharmacotherapy Comparative Efficacy: A Network Meta-analysis. Nicotine Tob Res 2017; 19:273-281. [PMID: 27613893 DOI: 10.1093/ntr/ntw144] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/04/2016] [Indexed: 01/08/2023]
Abstract
Introduction Converging clinical and biological evidence suggest sex is an important factor when selecting a pharmacological intervention for smoking cessation. The current investigation used network meta-analyses to estimate sex differences in the comparative efficacy of transdermal nicotine (TN), varenicline, and sustained release (SR) bupropion for smoking cessation. Methods Systematically searched previously published reviews and databases (Medline, PsycINFO, Embase) of randomized, double-blind, placebo-controlled trials of bupropion-SR, TN, and varenicline for cigarette smoking cessation in primary care/general community samples were included. Results Thirty-two studies met all criteria and 28 (88%) were included in the final analyses, representing 14 389 smokers (51% female). Results of the full sample (women and men combined) mirrored those from a Cochrane Tobacco Addiction Group network meta-analysis of smoking cessation pharmacotherapy, showing VAR>TN=BUP. All medications improved quit rates over placebo for both women and men. Relative to placebo, varenicline efficacy was similar for women and men. Significant sex differences were evident when comparing varenicline versus TN and varenicline versus bupropion. For women, varenicline was more efficacious than TN (RR = 1.41; 95% CI = 1.12,1.76) and bupropion (RR = 1.38; 95% CI = 1.08,1.77). For men, outcomes for those treated with TN and bupropion were similar to those treated with varenicline. There were no differences in efficacy when comparing bupropion versus TN. Conclusions The advantage of varenicline over bupropion SR and TN is greater for women than men. Clinicians should strongly consider varenicline as the first option treatment for women. Among men, the advantage of varenicline over TN or bupropion is less clear. Implications This study provides information for the sex-informed treatment of nicotine addiction among cigarette smokers. Relative to placebo, women and men achieved similar outcomes when treated with varenicline; however the advantages of varenicline over transdermal patch and bupropion were greater for women compared to men.
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Affiliation(s)
- Philip H Smith
- Community Health and Social Medicine, Sophie Davis School of Biomedical Education/CUNY School of Medicine, New York, NY.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT.,Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Ju Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT
| | - Erin Emme
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT.,Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT
| | - Sherry A McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT.,Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT
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34
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Zhang S, Hu S, Fucito LM, Luo X, Mazure CM, Zaborszky L, Li CSR. Resting-State Functional Connectivity of the Basal Nucleus of Meynert in Cigarette Smokers: Dependence Level and Gender Differences. Nicotine Tob Res 2017; 19:452-459. [PMID: 27613921 DOI: 10.1093/ntr/ntw209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/06/2016] [Indexed: 12/13/2022]
Abstract
Introduction Numerous studies have characterized impaired cerebral functioning in nicotine-addicted individuals. Whereas nicotine interacts with multiple neurotransmitters in cortical and subcortical circuits, it directly targets the cholinergic system, sourced primarily from the basal nucleus of Meynert (BNM). However, no studies have examined how this cholinergic system is influenced by cigarette smoking. Here, we addressed this gap of research. Methods Using a dataset from the Functional Connectome Projects, we investigated this issue by contrasting seed-based BNM connectivity of 40 current smokers and 170 age- and gender-matched nonsmokers. We followed our data analytic routines in recent work and examined differences between smokers and nonsmokers in men and women combined as well as separately. Results Compared to nonsmokers, female but not male smokers demonstrated greater positive BNM connectivity to the supplementary motor area, bilateral anterior insula, and right superior temporal/supramarginal gyri as well as greater negative connectivity to the posterior cingulate cortex and precuneus. Further, BNM connectivity to the supplementary motor area is negatively correlated to the Fagerström Test for Nicotine Dependence score in male but not female smokers. Conclusions Along with a previous report of upregulated nicotinic acetylcholine receptor in male but not female smokers, these new findings highlight functional changes of the cholinergic systems in cigarette smokers. The results suggest sex-specific differences in cholinergic dysregulation and a need for multiple imaging modalities to capture the neural markers of nicotine addiction. Implications Nicotine influences cognition via cholinergic projections of the basal forebrain to the cerebral cortex. This study examined changes in resting-state whole-brain functional connectivity of the BNM in cigarette smokers. The new findings elucidate for the first time sex differences in BNM-cerebral connectivity in cigarette smoking.
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Affiliation(s)
- Sheng Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Sien Hu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Lisa M Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- Women's Health Research, Yale University School of Medicine, New Haven, CT
| | | | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT
- Interdepartmental Neuroscience Program, Yale University, New Haven, CT
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35
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Zakiniaeiz Y, Cosgrove KP, Mazure CM, Potenza MN. Does Telescoping Exist in Male and Female Gamblers? Does It Matter? Front Psychol 2017; 8:1510. [PMID: 28928697 PMCID: PMC5591942 DOI: 10.3389/fpsyg.2017.01510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/21/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yasmin Zakiniaeiz
- Interdepartmental Neuroscience Program, Yale University School of MedicineNew Haven, CT, United States
| | - Kelly P Cosgrove
- Interdepartmental Neuroscience Program, Yale University School of MedicineNew Haven, CT, United States.,Department of Radiology and Biomedical Imaging, Yale University School of MedicineNew Haven, CT, United States.,Department of Psychiatry, Yale University School of MedicineNew Haven, CT, United States.,Department of Neuroscience, Yale University School of MedicineNew Haven, CT, United States
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of MedicineNew Haven, CT, United States.,Women's Health Research at YaleNew Haven, CT, United States
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of MedicineNew Haven, CT, United States.,Department of Neuroscience, Yale University School of MedicineNew Haven, CT, United States.,Women's Health Research at YaleNew Haven, CT, United States.,Child Study Center, Yale University School of MedicineNew Haven, CT, United States.,National Center on Addiction and Substance Abuse, Yale University School of MedicineNew Haven, CT, United States.,Connecticut Mental Health CenterNew Haven, CT, United States
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Smith PH, Zhang J, Weinberger AH, Mazure CM, McKee SA. Gender differences in the real-world effectiveness of smoking cessation medications: Findings from the 2010-2011 Tobacco Use Supplement to the Current Population Survey. Drug Alcohol Depend 2017; 178:485-491. [PMID: 28715776 PMCID: PMC6779031 DOI: 10.1016/j.drugalcdep.2017.05.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/18/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Meta-analyses of clinical trial data have identified clinically relevant gender differences in the efficacy of smoking cessation pharmacotherapy. It is unclear whether these findings are generalizable to smokers quitting in real-world contexts. METHODS Using Tobacco Use Supplement to the Current Population Survey (TUS-CPS) 2010-2011 cross-sectional data, we generated propensity score matched samples of smokers who quit either unassisted by medication, using only varenicline, or using only transdermal nicotine patch (TNP). We used generalized estimating equations to estimate gender differences in the comparative effectiveness of these cessation options for achieving 30-days of abstinence, adjusting for potential confounders. RESULTS When stratified by gender, TNP was significantly more effective than unassisted quit attempts for men (OR=1.37; 95%CI=1.02,1.83; p=0.03), but not for women (OR=0.96; 95%CI=0.71,1.31; p=0.82). Varenicline was significantly more effective than unassisted quit attempts for women (OR=1.63; 95%CI=1.16, 2.31; p=0.005), but not men (OR=1.35; 95%CI=0.94,1.96; p=0.11). Varenicline was also more effective than TNP for women (OR=1.51; 95%CI=0.12,2.05; p=0.007) but not men (OR=0.92; 95%CI=0.65,1.31; p=0.64). A significant gender by medication interaction was found only for the comparison of varenicline to TNP (OR=1.64; 95%CI=1.04,2.61; p=0.04). CONCLUSIONS Findings for varenicline vs. TNP were consistent with clinical trial data, showing greater differences in effectiveness for women compared to men. Results lend support to the generalizability of clinical trial findings, highlighting the importance of considering gender when offering treatment for smoking cessation.
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Affiliation(s)
- Philip H. Smith
- Community Health and Social Medicine, CUNY School of Medicine
| | - Ju Zhang
- Yale University School of Public Health
| | - Andrea H. Weinberger
- Epidemiology and Population Health, Albert Einstein College of Medicine,Ferkauf Graduate School of Psychology, Yeshiva University
| | - Carolyn M. Mazure
- Psychiatry, Yale University School of Medicine,Women’s Health Research at Yale
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Dhruva SS, Mazure CM, Ross JS, Redberg RF. Inclusion of Demographic-Specific Information in Studies Supporting US Food & Drug Administration Approval of High-Risk Medical Devices. JAMA Intern Med 2017; 177:1390-1391. [PMID: 28738116 PMCID: PMC5818834 DOI: 10.1001/jamainternmed.2017.3148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This analysis characterizes the studies used to support US Food & Drug Administration 2015 premarket approval of devices, particularly findings of device safety and effectiveness for women, the elderly, and minorities.
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Affiliation(s)
- Sanket S Dhruva
- Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Veterans Affairs Connecticut Healthcare System, West Haven
| | - Carolyn M Mazure
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Women's Health Research at Yale, Yale School of Medicine, New Haven, Connecticut
| | - Joseph S Ross
- Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut.,Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.,Associate Editor
| | - Rita F Redberg
- Division of Cardiology, Department of Medicine, University of California-San Francisco School of Medicine, San Francisco, California.,Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco School of Medicine, San Francisco, California.,Editor
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38
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Husky MM, Mazure CM, Ruffault A, Flahault C, Kovess-Masfety V. Differential Associations Between Excess Body Weight and Psychiatric Disorders in Men and Women. J Womens Health (Larchmt) 2017; 27:183-190. [PMID: 28686068 DOI: 10.1089/jwh.2016.6248] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The current investigation is the first large-scale population-based study from France that documents the association between excess body weight and common psychiatric disorders, and examines the influence of gender on the association between excess body weight and these disorders. A recent plan has been implemented in France to treat the rising rate of those who are overweight or obese, and we seek to demonstrate whether integrated treatment of excess weight and psychiatric conditions appears as indicated. MATERIALS AND METHODS Data were drawn from a cross-sectional general population survey of 17,237 adults. Past-year psychiatric disorders were assessed using the Composite International Diagnostic Interview-Short Form. Body mass index was used to determine excess weight status. RESULTS Overall, 3.7% of the sample were underweight, 57% were normal weight, 28% were overweight (35% of men, 22% of women), and 11% were obese (11% of men, 11% of women). Being overweight was more common in men than women, although obesity did not differ by gender. Sociodemographic variables significantly associated with weight status included, age, marital status, education, employment status, income level, and population density. Adjusting for these variables, being overweight was associated with major depression and other disorders among women and inversely associated with drug abuse and dependence among men. Obesity was associated with major depression, panic disorder, agoraphobia, social phobia, specific phobia, and obsessive-compulsive disorder among women. Only generalized anxiety was associated with obesity among men. CONCLUSION Past year, mental disorders were more likely associated with being overweight or obese among women as compared with men. The prevalence of these co-occurring psychiatric disorders in the context of the rising rate of obesity in France indicates a clear need for psychiatric assessment and treatment in caring for those with excess weight, especially women. Preliminary reports suggest this need is unmet within the otherwise progressive move in France to assist those struggling with excess weight.
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Affiliation(s)
- Mathilde M Husky
- 1 Laboratoire de Psychologie EA 4139, Institut Universitaire de France , Université de Bordeaux, Bordeaux, France
| | - Carolyn M Mazure
- 2 Department of Psychiatry, Women's Health Research at Yale, Yale School of Medicine , New Haven, Connecticut
| | - Alexis Ruffault
- 3 Laboratoire de Psychopathologie et Processus de Santé EA 4057, Université Paris Descartes , Sorbonne Paris Cité, Paris, France
| | - Cécile Flahault
- 3 Laboratoire de Psychopathologie et Processus de Santé EA 4057, Université Paris Descartes , Sorbonne Paris Cité, Paris, France
| | - Viviane Kovess-Masfety
- 3 Laboratoire de Psychopathologie et Processus de Santé EA 4057, Université Paris Descartes , Sorbonne Paris Cité, Paris, France .,4 Ecole des Hautes Etudes en Santé Publique, Paris, France
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Park CL, Smith PH, Lee SY, Mazure CM, McKee SA, Hoff R. Positive and Negative Religious/Spiritual Coping and Combat Exposure as Predictors of Posttraumatic Stress and Perceived Growth in Iraq and Afghanistan Veterans. Psycholog Relig Spiritual 2017; 9:13-20. [PMID: 28217246 PMCID: PMC5310632 DOI: 10.1037/rel0000086] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We examined religious/spiritual (RS) coping from the Survey of Experiences of Returning Veterans (SERV) Study, 630 participants who reported on their demographics, combat exposure, use of positive and negative RS coping, posttraumatic stress disorder (PTSD) symptoms and perceived posttraumatic growth (PPTG). PTSD symptoms and PPTG were inversely correlated. As hypothesized, negative RS coping was inversely associated with PPTG and positively with PTSD, while positive RS coping was related only to PPTG. Although we expected that RS coping would buffer relations between combat exposure and both PTSD and PPTG, we found only one moderator effect and it was opposite our hypothesized direction: Those with high combat exposure and high positive RS coping had the highest PTSD symptomatology. These results suggest, among veterans with combat exposure, negative RS coping is associated with higher PTSD symptomatology, while positive RS coping is generally associated with higher PPTG as well as higher PTSD for those with high combat exposure.
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Affiliation(s)
| | - Philip H Smith
- Yale University School of Medicine, Department of Psychiatry; Women's Health Research at Yale
| | - Sharon Y Lee
- University of Connecticut, Department of Psychology
| | - Carolyn M Mazure
- Yale University School of Medicine, Department of Psychiatry; Women's Health Research at Yale
| | - Sherry A McKee
- Yale University School of Medicine, Department of Psychiatry; Women's Health Research at Yale
| | - Rani Hoff
- Yale University School of Medicine, Department of Psychiatry; Women's Health Research at Yale ; VISN1 MIRECC, VA Connecticut Healthcare System
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Holmes SE, Esterlis I, Mazure CM, Lim YY, Ames D, Rainey-Smith S, Martins RN, Salvado O, Dore V, Villemagne VL, Rowe CC, Laws SM, Masters CL, Maruff P, Pietrzak RH. β-Amyloid, APOE and BDNF Genotype, and Depressive and Anxiety Symptoms in Cognitively Normal Older Women and Men. Am J Geriatr Psychiatry 2016; 24:1191-1195. [PMID: 27742526 DOI: 10.1016/j.jagp.2016.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/22/2016] [Accepted: 08/09/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine how β-amyloid (Aβ), APOE and BDNF genotypes, and cortisol relate to depressive and anxiety symptoms in cognitively normal older women and men. METHODS Cross-sectional data were analyzed from 423 older adults from the Australian Imaging Biomarkers and Lifestyle study. Analyses of covariance evaluated associations between Aβ, APOE and BDNF genotype, and cortisol in relation to severity of depressive and anxiety symptoms. RESULTS Among Aβ+ older adults, APOE ε4 carriage was associated with greater severity of anxiety symptoms (d = 0.55); and in the full sample, APOE ε4 carriage was linked to greater severity of depressive (d = 0.26) and anxiety (d = 0.21) symptoms. Among Aβ+ women, ε4 carriers reported greater anxiety symptoms than non-ε4 carriers (d = 0.83), and female BDNF rs6265 Val66 Met allele carriers reported greater depressive symptoms (d = 0.29). CONCLUSION Sex moderated the relationship between Aβ, APOE genotype, and BDNF genotype in predicting severity of anxiety and depressive symptoms in cognitively normal older adults.
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Affiliation(s)
- Sophie E Holmes
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT.
| | - Irina Esterlis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Yen Ying Lim
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - David Ames
- Academic Unit for Psychiatry of Old Age, St. Vincent's Health, Department of Psychiatry, The University of Melbourne, Kew, Victoria, Australia; National Ageing Research Institute, Parkville, Victoria, Australia
| | - Stephanie Rainey-Smith
- Centre of Excellence for Alzheimer's Disease Research and Care, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Ralph N Martins
- Centre of Excellence for Alzheimer's Disease Research and Care, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; Sir James McCusker Alzheimer's Disease Research Unit, Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Olivier Salvado
- The Commonwealth Scientific and Industrial Research Organization, Canberra, Australia
| | - Vincent Dore
- The Commonwealth Scientific and Industrial Research Organization, Canberra, Australia; Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, Victoria, Australia
| | - Victor L Villemagne
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia; Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, Victoria, Australia
| | - Christopher C Rowe
- Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, Victoria, Australia
| | - Simon M Laws
- Centre of Excellence for Alzheimer's Disease Research and Care, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; School of Biomedical Sciences, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Colin L Masters
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Paul Maruff
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia; Cogstate Ltd., Melbourne, Victoria, Australia
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT
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Park CL, Finkelstein-Fox L, Barnes DM, Mazure CM, Hoff R. CAM use in recently-returned OEF/OIF/OND US veterans: Demographic and psychosocial predictors. Complement Ther Med 2016; 28:50-6. [PMID: 27670870 DOI: 10.1016/j.ctim.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/03/2016] [Accepted: 08/16/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Because the use of complementary and alternative medicine (CAM) is increasing among veterans, understanding more about the characteristics of veterans who use CAM is increasingly important. Studies reporting on predictors of use almost always discuss CAM in the aggregate, yet each CAM modality represents a unique approach to healthcare, and each may have different correlates as well as different effectiveness. Very little information is available about veterans' use of each distinct modality, and about psychosocial correlates of various forms of CAM use. DESIGN We analyzed data from wave 1 of the Survey of the Experiences of Returning Veterans (SERV) Study, which included 729 veterans returning from Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND). SETTING Data were collected by telephone interviews. MAIN MEASURES We examined a range of potentially important correlates of CAM use, including demographics, military experiences, and current mental and physical health. RESULTS Each predictor related to a unique constellation of CAM modalities; not one of the predictors examined was associated with more than half of the 12 modalities. For example, women were more likely to use acupuncture, massage, yoga, meditation and spiritual healing, and age related only to greater use of homeopathy, while deployment injuries related positively to use of chiropractic, nutrition and meditation. CONCLUSIONS Results suggest that in order to understand CAM use, CAM modalities should be considered unique and separate practices. This greater understanding should be useful for future health service provision for veterans.
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Affiliation(s)
- Crystal L Park
- University of Connecticut, Department of Psychological Sciences, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
| | - Lucy Finkelstein-Fox
- University of Connecticut, Department of Psychological Sciences, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
| | - David M Barnes
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, 39 Broadway, Suite 530, New York, NY 10006, USA.
| | - Carolyn M Mazure
- Yale University School of Medicine, Department of Psychiatry and Women's Health Research at Yale, 135 College Street, Suite 220, New Haven, CT 06510, USA.
| | - Rani Hoff
- Yale University School of Medicine, Department of Psychiatry and Women's Health Research at Yale and VISN1 MIRECC, VA Connecticut Healthcare System, NEPC/182, 950 Campbell Avenue, West Haven, CT 06416, USA.
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Laws H, Mazure CM, McKee SA, Park CL, Hoff R. Within-unit relationship quality mediates the association between military sexual trauma and posttraumatic stress symptoms in veterans separating from military service. ACTA ACUST UNITED AC 2016; 8:649-56. [DOI: 10.1037/tra0000118] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Carolyn M Mazure
- Yale University School of Medicine, 135 College Street, New Haven, CT 06510, USA.
| | - Joel Swendsen
- University of Bordeaux, PSL Research University, Bordeaux, France
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Raghavan C, Swan SC, Snow DL, Mazure CM. The Mediational Role of Relationship Efficacy and Resource Utilization in the Link Between Physical and Psychological Abuse and Relationship Termination. Violence Against Women 2016; 11:65-88. [PMID: 16043541 DOI: 10.1177/1077801204271514] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines the roles of physical and emotional abuse and resource utilization, relationship efficacy, and childhood abuse on relationship status (together or separated) in a sample of 69 low-income, nonsheltered battered women. Separate path models were conducted for physical and psychological abuse. Increased physical abuse was related to separated status, increased resource utilization, and decreased efficacy. The effect of physical abuse on status was mediated by resource utilization and efficacy, whereas the effect of psychological abuse on status was partially mediated only by utilization. Increased childhood abuse was associated with together status. Baseline psychological but not physical abuse predicted a longer term separated status thereby suggesting that the effects of psychological abuse may be enduring.
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Affiliation(s)
- Chitra Raghavan
- John Jay College of Criminal Justice, City University of New York, USA
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Zakiniaeiz Y, Cosgrove KP, Potenza MN, Mazure CM. Balance of the Sexes: Addressing Sex Differences in Preclinical Research. Yale J Biol Med 2016; 89:255-9. [PMID: 27354851 PMCID: PMC4918870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Preclinical research is fundamental for the advancement of biomedical sciences and enhancing healthcare. Considering sex differences in all studies throughout the entire biomedical research pipeline is necessary to adequately inform clinical research and improve health outcomes. However, there is a paucity of information to date on sex differences in preclinical work. As of 2009, most (about 80 percent) rodent studies across 10 fields of biology were still conducted with only male animals. In 2016, the National Institutes of Health implemented a policy aimed to address this concern by requiring the consideration of sex as a biological variable in preclinical research grant applications. This perspective piece aims to (1) provide a brief history of female inclusion in biomedical research, (2) describe the importance of studying sex differences, (3) explain possible reasons for opposition of female inclusion, and (4) present potential additional solutions to reduce sex bias in preclinical research.
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Affiliation(s)
- Yasmin Zakiniaeiz
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT,To whom all correspondence should be addressed: Yasmin Zakiniaeiz, 1 Church Street, Suite 721, New Haven, CT 06510; Tel: 203-737-3448;
| | - Kelly P. Cosgrove
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT,Department of Radiology and Bioimaging, Yale University, New Haven, CT,Department of Psychiatry, Yale University, New Haven, CT,Department of Neuroscience, Yale University School of Medicine, New Haven, CT
| | - Marc N. Potenza
- Department of Psychiatry, Yale University, New Haven, CT,Department of Neuroscience, Yale University School of Medicine, New Haven, CT,Child Study Center, Yale University School of Medicine, New Haven, CT,CASAColumbia, Yale University School of Medicine, New Haven, CT,Connecticut Mental Health Center, New Haven, CT,Women’s Health Research at Yale, New Haven, CT
| | - Carolyn M. Mazure
- Department of Psychiatry, Yale University, New Haven, CT,Women’s Health Research at Yale, New Haven, CT
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Verplaetse TL, Smith PH, Pittman BP, Mazure CM, McKee SA. Associations of Gender, Smoking, and Stress with Transitions in Major Depression Diagnoses. Yale J Biol Med 2016; 89:123-9. [PMID: 27354839 PMCID: PMC4918874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Using data from the newly available U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 3; n = 36,309), we evaluated relationships among gender, cigarette smoking status (current, former, non-smoker), life event stress (0-1 vs. 2+ events), and their impact on transitions in major depression diagnosis (MDD; new vs. absent cases; ongoing vs. remit cases). Women who were both current and former cigarette smokers with more than two stressful events had higher rates of new MDD diagnosis compared to men who were current or former smokers with two or more stressful events. Current smoking and experiencing two or more stressful events increased the odds of having an ongoing MDD diagnosis, while being a former smoker decreased these odds. Results suggest that smoking and stress are markers for depression risk in women and should help guide clinical assessment as well as gender-difference research on the biological underpinnings of these conditions.
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Affiliation(s)
- Terril L. Verplaetse
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine,To whom all correspondence should be addressed: Terril L. Verplaetse, PhD, 2 Church Street South, Suite 201, Yale University School of Medicine, New Haven, CT 06519; Fax: 203.737.4243
| | - Philip H. Smith
- Department of Community Health and Social Medicine, CUNY School of Medicine
| | - Brian P. Pittman
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine
| | - Carolyn M. Mazure
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine
| | - Sherry A. McKee
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine
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Sullivan TP, Meese KJ, Swan SC, Mazure CM, Snow DL. Precursors and Correlates of Women's Violence: Child Abuse Traumatization, Victimization of Women, Avoidance Coping, and Psychological Symptoms. Psychology of Women Quarterly 2016. [DOI: 10.1111/j.1471-6402.2005.00223.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Path modeling assessed (a) the influence of child abuse traumatization on women's use of violence and their experiences of being victimized, (b) the association of these three variables to depressive and posttraumatic stress symptoms, and (c) the indirect pathways from women using violence and their being victimized to psychological symptoms through avoidance coping. Among 108 primarily African American women recruited from the community who used violence with a male partner, women's use of violence, but not their experiences of being victimized, was predicted by child abuse traumatization. Women's use of violence did not directly or indirectly predict symptomatology. In contrast, child abuse traumatization and women's experiences of being victimized were predictive of both depressive and posttraumatic stress symptoms, and being victimized also was related indirectly to depressive symptoms through avoidance coping.
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Affiliation(s)
| | | | - Suzanne C. Swan
- Department of Psychiatry, Yale University School of Medicine
| | | | - David L. Snow
- Department of Psychiatry, Yale University School of Medicine
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Whiting SW, Potenza MN, Park CL, McKee SA, Mazure CM, Hoff RA. Investigating Veterans' Pre-, Peri-, and Post-Deployment Experiences as Potential Risk Factors for Problem Gambling. J Behav Addict 2016; 5:213-20. [PMID: 27156377 PMCID: PMC5387772 DOI: 10.1556/2006.5.2016.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and aims Gambling disorder and its comorbid diagnoses are observed at higher rates in military veterans than in the general population. A significant research gap exists regarding the relationships of veterans' life and service experiences to problematic gambling. The present study explored pre-, peri-, and post-deployment factors associated with problem gambling in veterans. Methods Veterans of Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn (n = 738; 463 males, and 275 females) completed questionnaires via structured telephone interview. We conducted bivariate and multinomial logistic regression analyses exploring associations among problem-gambling severity and socio-demographic variables, psychiatric comorbidities, and 10 scales of the Deployment Risk and Resilience Inventory measuring experiences pre-, peri-, and post-deployment. Results Approximately 4.2% of veterans indicated at-risk or probable pathological gambling (ARPG) post-deployment (two or more DSM-IV criteria for pathological gambling). Bivariate analyses found more severe gambling in males, higher frequencies of post-traumatic stress disorder, substance dependence, traumatic brain injury, panic disorder, and depression in veterans with ARPG, and higher general harassment during deployment, and lower social support and more stressful life events post-deployment in those with ARPG. In multivariable models, both post-deployment factors remained significantly associated with ARPG. Discussion The study suggests that problem gambling among veterans is related to service experiences, and particularly to life experiences post-deployment. Conclusions Adverse service and life experiences and lack of social support may contribute to the risk of problem gambling in military veterans. Investigation of how Veterans Affairs clinical settings may serve veterans following deployment to prevent behavioral addictions is warranted.
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Affiliation(s)
- Seth W. Whiting
- Department of Veterans Affairs, VISN 1 Mental Illness Research Education and Clinical Center (MIRECC), West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA,Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Crystal L. Park
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Sherry A. McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Carolyn M. Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rani A. Hoff
- Department of Veterans Affairs, VISN 1 Mental Illness Research Education and Clinical Center (MIRECC), West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Corresponding author: Rani A. Hoff; NEPEC/182, 950 Campbell Ave., West Haven, CT 06416, USA; Phone: +1 203 937 3850; Fax: +1 203 937 3433; E-mail:
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McKee SA, Smith PH, Kaufman M, Mazure CM, Weinberger AH. Sex Differences in Varenicline Efficacy for Smoking Cessation: A Meta-Analysis. Nicotine Tob Res 2016; 18:1002-11. [PMID: 26446070 PMCID: PMC5942618 DOI: 10.1093/ntr/ntv207] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/03/2015] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Women have lower rates of quitting than men with both bupropion and nicotine replacement. It is unknown whether varenicline demonstrates differential efficacy for men and women. The purpose of this study was to conduct the first comprehensive meta-analysis of clinical trial data examining sex differences in the efficacy of varenicline for smoking cessation. METHODS Searching MEDLINE, EMBASE, and PsychINFO, 17 of 43 clinical trials of varenicline for smoking cessation published through December 31, 2014 were low-bias randomized double-blind placebo-controlled trials. Data (n = 6710 smokers, 34% female, n = 16 studies, 96% of available data) was analyzed with Metafor program in R. Outcome endpoints were 7-day point-prevalence (PP) and continuous-abstinence (CA) at week 12 (end of treatment), week 24 (6-month follow-up), and week 52 (12-month follow-up). RESULTS Using placebo, women were less likely than men to quit (PP-12, CA-24; P < .05 for sex). Using varenicline, similar rates of abstinence for men and women were demonstrated for all six outcomes (eg, PP-12 abstinence rates were 53% in both women and men). Varenicline versus placebo outcomes demonstrated that varenicline was more effective for women for short and intermediate outcomes (PP-12, CA-12, CA-24; P < .05 sex × medication interaction). For end-of-treatment PP, varenicline was 46% more effective for women. For continuous abstinence, varenicline was 34% (CA-12) and 31% (CA-24) more effective for women. CONCLUSIONS Unlike other smoking cessation medications, varenicline demonstrated greater efficacy among women smokers for short and immediate-term outcomes and equal efficacy for 1-year outcomes. Varenicline may be particularly useful for reducing the sex disparity typically seen in rates of smoking cessation. IMPLICATIONS Varenicline is currently the most effective FDA-approved smoking cessation medication and this is the first demonstration that women compared with men have a preferred therapeutic response for a smoking cessation medication when considering short-term outcomes. Importantly, this is also the first demonstration that women have similar rates of quitting to men when considering longer-term, 1-year outcomes.
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Affiliation(s)
- Sherry A McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT; Cancer Prevention and Control Research Program, Yale Cancer Center, New Haven, CT;
| | - Philip H Smith
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Mira Kaufman
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT
| | - Andrea H Weinberger
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT; Cancer Prevention and Control Research Program, Yale Cancer Center, New Haven, CT; Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
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Abstract
The policy announcement by the National Institutes of Health that sex should be considered as a relevant variable in preclinical research has sparked considerable debate. This debate has largely centered on specific concerns regarding how the policy will be implemented. However, others have reacted to the new policy by calling into question the capacity of preclinical science to generate data that can be useful to human health. This commentary examines the basis for this contention and maintains that it is essential to expand our scientific efforts to include the influence of sex on the biology and behavior that is studied in preclinical investigations.
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Affiliation(s)
- Carolyn M Mazure
- Department of Psychiatry, Women's Health Research at Yale, Yale University School of Medicine, 135 College Street, Suite 220, New Haven, CT 06510 USA
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