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Lee A, Thuras P, Baller J, Jiao C, Guo B, Erbes CR, Polusny MA, Liu C, Wu B, Lim KO, Bishop JR. Serotonin Transporter (SLC6A4) and FK506-Binding Protein 5 (FKBP5) Genotype and Methylation Relationships with Response to Meditation in Veterans with PTSD. Mol Neurobiol 2024:10.1007/s12035-024-04096-6. [PMID: 38671329 DOI: 10.1007/s12035-024-04096-6] [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] [Received: 11/21/2022] [Accepted: 03/04/2024] [Indexed: 04/28/2024]
Abstract
Meditation-based interventions are novel and effective non-pharmacologic treatments for veterans with PTSD. We examined relationships between treatment response, early life trauma exposure, DNA polymorphisms, and methylation in the serotonin transporter (SLC6A4) and FK506-binding protein 5 (FKBP5) genes. DNA samples and clinical outcomes were examined in 72 veterans with PTSD who received meditation-based therapy in two separate studies of mindfulness-based stress reduction (MBSR) and Transcendental Meditation (TM). The PTSD Checklist was administered to assess symptoms at baseline and after 9 weeks of meditation intervention. We examined the SLC6A4 promoter (5HTTLPR_L/S insertion/deletion + rs25531_A/G) polymorphisms according to previously defined gene expression groups, and the FKBP5 variant rs1360780 previously associated with PTSD disease risk. Methylation for CpG sites of SLC6A4 (28 sites) and FKBP5 (45 sites) genes was quantified in DNA samples collected before and after treatment. The 5HTTLPR LALA high expression genotype was associated with greater symptom improvement in participants exposed to early life trauma (p = 0.015). Separately, pre to post-treatment change of DNA methylation in a group of nine FKBP5 CpG sites was associated with greater symptom improvement (OR = 2.8, 95% CI 1.1-7.1, p = 0.027). These findings build on a wealth of existing knowledge regarding epigenetic and genetic relationships with PTSD disease risk to highlight the potential importance of SLC6A4 and FKBP5 for treatment mechanisms and as biomarkers of symptom improvement.
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Affiliation(s)
- Adam Lee
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Room 7-115 Weaver-Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55455, USA
| | - Paul Thuras
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Joshua Baller
- Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN, USA
| | - Chuan Jiao
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY, USA
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team Krebs, Université Paris Cité, 75014, Paris, France
| | - Bin Guo
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Christopher R Erbes
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Melissa A Polusny
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Chunyu Liu
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Baolin Wu
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California-Irvine, Irvine, CA, USA
| | - Kelvin O Lim
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Geriatric Research, Education, and Clinical Center, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Room 7-115 Weaver-Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55455, USA.
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA.
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Martin-Wagar CA, Marquardt CA, Liu Y, Arbisi PA, Erbes CR, Polusny MA. Inconsistent Reporting of Adverse Life Events Is Predicted by Current Internalizing Distress Among Military Service Members. Mil Med 2024; 189:337-344. [PMID: 35716127 PMCID: PMC10824483 DOI: 10.1093/milmed/usac167] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/15/2022] [Accepted: 05/27/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Accurate measurement of adverse life events is critical for understanding the effects of stressors on health outcomes. However, much of this research uses cross-sectional designs and self-report years after the events take place. The reliability of this retrospective reporting and the individual difference factors associated with inconsistent recall over time are not frequently addressed, especially among military service members. MATERIALS AND METHODS A longitudinal cohort of National Guard service members (n = 801) completed the Deployment Risk and Resilience Inventory-2 Prior Stressors scale and several measures of general well-being, including anxious depressive symptomatology, personal functioning, perceived social support, and overall health at two time points (before and after completion of basic combat training; median 11-month interval). RESULTS Consistency in reporting the life event items ranged from 69.5% to 99.7%, with an overall Cohen's kappa coefficient of 0.215 for the scale, indicating minimal agreement. Lower well-being scores at Time 1 independently predicted yes-to-no changes in responding, whereas lower well-being scores at Time 2 independently predicted no-to-yes changes in responding. Follow-up mediations were conducted using study measures available only at Time 2. For all study measures, Time 2 well-being independently predicted changes from no-to-yes responding by way of indirect effects through self-reported non-specific internalizing distress and arousal. CONCLUSIONS These findings highlight the confounding effects of fluctuations in current emotional distress on past stressor recall. There is a need for additional caution regarding the use of retrospective self-report of adverse life events in research and clinical practice and greater consideration of current psychological distress at the time of measurement completion.
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Affiliation(s)
- Caitlin A Martin-Wagar
- Department of Psychology, University of Montana, Missoula, MT 59812, USA
- Mental Health Integrated Care Community, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA
| | - Craig A Marquardt
- Mental Health Integrated Care Community, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 5454, USA
| | - Yuchen Liu
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Paul A Arbisi
- Mental Health Integrated Care Community, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 5454, USA
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Christopher R Erbes
- Mental Health Integrated Care Community, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 5454, USA
- Center for Care Delivery and Outcomes Research, Minneapolis, MN 55417, USA
| | - Melissa A Polusny
- Mental Health Integrated Care Community, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 5454, USA
- Center for Care Delivery and Outcomes Research, Minneapolis, MN 55417, USA
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Polusny MA, Erbes CR. A dynamic, multilevel approach to conceptualising and designing resilience research in the context of military stress. Stress Health 2023; 39:40-47. [PMID: 37248806 PMCID: PMC10528202 DOI: 10.1002/smi.3277] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Challenges in conceptualising resilience have impeded advancements in resilience science. In response, the National Institutes of Health (NIH) developed a general framework for harmonising the conceptualisation of resilience as a dynamic process determined by multiple systems and levels of analysis. Consistent with the NIH Resilience Framework, this paper presents a conceptual model of resilience applied to military service members. This model encompasses four core components necessary for resilience research: (1) the presence of significant challenge, (2) successful adaptation in response to the challenge, (3) the capacity for resilience (i.e., protective factors), and (4) the processes (i.e., mechanisms) by which protective factors exert positive effects on an individual's response. Guided by this conceptual model, we outline key methodological recommendations to advance resilience research and illustrate each using the Advancing Research on Mechanisms of Resilience study as an exemplar. We emphasise the need for future research to examine resilience as a dynamic process and apply a multilevel approach. We hope to provide a basic road map to those interested in improving the rigour of future research on resilience in a military context, the results of which can inform the development of interventions.
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Affiliation(s)
- Melissa A. Polusny
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
- Center for Care Delivery and Outcomes Research, Minneapolis, MN
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School
| | - Christopher R. Erbes
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
- Center for Care Delivery and Outcomes Research, Minneapolis, MN
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School
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Arbisi PA, Finn JA, Polusny MA, Erbes CR. The role of the MMPI-2-Restructured Form (MMPI-2-RF) in predicting and better understanding engagement in posttraumatic stress disorder treatment. Psychol Serv 2023; 20:453-464. [PMID: 35113621 DOI: 10.1037/ser0000597] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ability of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) scores to predict treatment engagement in veterans referred for empirically supported treatments for symptoms of Posttraumatic Stress Disorder (PTSD) was examined. Early withdrawal from treatment and process factors, such as adherence and therapy session attendance, were examined in 100 veterans seeking treatment for trauma-related symptoms who were referred to a Veterans Health Administration medical center's tertiary care clinic for Prolonged Exposure (PE) or Cognitive Processing Therapy (CPT). Veterans who scored higher on MMPI-2-RF scales associated with emotional/internalizing problems were more likely to be referred to PE or CPT, but individuals with the highest scores on those scales were also more likely to withdraw before completing treatment. These findings suggest Harkness and Lilienfeld's (1997) call to use personality assessment to guide treatment planning holds promise to better understand treatment engagement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Paul A Arbisi
- Minneapolis VA Health Care System, University of Minnesota
| | - Jacob A Finn
- Minneapolis VA Health Care System, University of Minnesota
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Meis LA, Polusny MA, Kehle-Forbes SM, Erbes CR, O’Dougherty M, Erickson EPG, Orazem R, Burmeister L, Spoont M. Making sense of poor adherence in PTSD treatment from the perspectives of veterans and their therapists. Psychol Trauma 2023; 15:715-725. [PMID: 35324228 PMCID: PMC10948176 DOI: 10.1037/tra0001199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/08/2022]
Abstract
OBJECTIVE Dropout rates from trauma-focused PTSD treatments (TFTs) in VA clinics are particularly high. We conducted in-depth qualitative interviews with 29 veterans and their therapists to better understand this phenomenon. METHOD Participants were part of a multisite, mixed-methods study of TFT adherence in VA clinics. Veterans were eligible for interviews if they exhibited poor TFT adherence and screened positive for PTSD in follow-up surveys. Interviews were analyzed using qualitative dyadic analysis approaches. RESULTS Therapists relied on stereotypes of poor adherence to understand veterans' experiences and were missing information critical to helping veterans succeed. Veterans misunderstood aspects of the therapy and struggled in ways they inadequately expressed to therapists. Therapist attempts at course corrections were poorly matched to veterans' needs. Many dyads reported difficulties in their therapeutic relationships. Veterans reported invalidating experiences that were not prominent in therapists' interviews. CONCLUSIONS Future work is needed to test hypotheses generated and find effective ways to help veterans fully engage in TFTs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Laura A. Meis
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, One Veterans Drive (152), Minneapolis, MN 55417
- University of Minnesota Medical School, Department of Medicine, 420 Delaware Street SE, MMC 194, Suite 14-110 Phillips-Wangensteen Building, Minneapolis, Minnesota 55455
| | - Melissa A. Polusny
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, One Veterans Drive (152), Minneapolis, MN 55417
- University of Minnesota Medical School, Department of Psychiatry, 420 Delaware Street SE, MMC 194, Suite 14-110 Phillips-Wangensteen Building, Minneapolis, Minnesota 55455
| | - Shannon M. Kehle-Forbes
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, One Veterans Drive (152), Minneapolis, MN 55417
- University of Minnesota Medical School, Department of Medicine, 420 Delaware Street SE, MMC 194, Suite 14-110 Phillips-Wangensteen Building, Minneapolis, Minnesota 55455
- Women’s Division, National Center for PTSD, Boston, MA
| | - Christopher R. Erbes
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, One Veterans Drive (152), Minneapolis, MN 55417
- University of Minnesota Medical School, Department of Psychiatry, 420 Delaware Street SE, MMC 194, Suite 14-110 Phillips-Wangensteen Building, Minneapolis, Minnesota 55455
| | - Maureen O’Dougherty
- Metropolitan State University, Department of Social Science, Saint John’s Hall, 700 7th Street E, St. Paul, Minnesota 55106
| | - Emily P. G. Erickson
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, One Veterans Drive (152), Minneapolis, MN 55417
| | - Robert Orazem
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, One Veterans Drive (152), Minneapolis, MN 55417
| | - Lori Burmeister
- School of Social and Behavioral Sciences, Arizona State University, Tempe, AZ, 85012
| | - Michele Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, One Veterans Drive (152), Minneapolis, MN 55417
- University of Minnesota Medical School, Department of Medicine, 420 Delaware Street SE, MMC 194, Suite 14-110 Phillips-Wangensteen Building, Minneapolis, Minnesota 55455
- University of Minnesota Medical School, Department of Psychiatry, 420 Delaware Street SE, MMC 194, Suite 14-110 Phillips-Wangensteen Building, Minneapolis, Minnesota 55455
- Pacific Islands Division, National Center for PTSD, Honolulu, Hawaii
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Marquardt CA, Hitz AC, Hill JE, Erbes CR, Polusny MA. Trait absorption predicts enhanced face emotion intensity discrimination among military recruits. Motiv Emot 2023. [DOI: 10.1007/s11031-023-10014-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Marquardt CA, Chu C, Hill JE, Venables NC, Kuzenski L, Davenport ND, Disner SG, Finn JA, Gilmore CS, Erbes CR, Urošević S. Evaluating resilience in response to COVID-19 pandemic stressors among veteran mental health outpatients. J Psychopathol Clin Sci 2023; 132:26-37. [PMID: 36455008 PMCID: PMC9870973 DOI: 10.1037/abn0000789] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/03/2022]
Abstract
There is a public health need to understand mental health vulnerabilities to COVID-19 pandemic-related stressors and promote resilience among high-risk populations with preexisting psychiatric conditions. Recent cross-sectional studies suggest increases in mental health distress (e.g., depression and anxiety) during the pandemic. The present study expands upon these emerging findings using longitudinal latent modeling and hierarchical linear regressions. Consistent with the developmental psychopathology literature on resilience, we distinguished between promotive or risk (i.e., main effect), and protective or vulnerability (i.e., moderation) effects on mental health during the pandemic. At a large medical center, 398 veterans receiving outpatient mental health care provided prepandemic (Time 1) and during pandemic (Time 2) assessments of mental and physical health-related distress. Additional Time 2 questionnaires assessed pandemic-related stressors and positive behavioral adaptations in the summer of 2020. As expected, total stressor scores predicted longitudinal worsening of self-reported mental (β = -.205) and physical health (β = -.217). Positive behavioral adaptations enacted during the pandemic moderated and protected against stressor effects on mental health (β = .160). In addition, the presence of substance use disorders moderated and conferred vulnerability to stressor effects on physical health (β = -.158). Thus, higher COVID-19 pandemic stressor exposure may have exacerbated mental and physical health distress among veterans with common forms of psychopathology. Nevertheless, behavioral activation, purposeful maintenance of social connections, and focused treatment for substance misuse may be important intervention targets for reducing the longitudinal impact of pandemic stressors and enhancing resilience among people with mental illness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Craig A. Marquardt
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Carol Chu
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Jessica E. Hill
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
| | - Noah C. Venables
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Laci Kuzenski
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
| | - Nicholas D. Davenport
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Seth G. Disner
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Jacob A. Finn
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Casey S. Gilmore
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
| | - Christopher R. Erbes
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Snežana Urošević
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
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Kuhn E, Sayers SL, Babusci C, Conroy C, Erbes CR. Internet-based family training with telephone coaching to promote mental health treatment initiation among veterans with posttraumatic stress disorder: A pilot study. J Trauma Stress 2022. [PMID: 36562921 DOI: 10.1002/jts.22900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/29/2022] [Revised: 10/05/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022]
Abstract
Posttraumatic stress disorder (PTSD) is common among military veterans, yet many affected veterans do not seek treatment. Family members of these veterans often experience compromised well-being and a desire for the veteran to receive mental health care. The Veterans Affairs (VA)-Community Reinforcement and Family Training (VA-CRAFT) for PTSD is an internet-based intervention intended to teach veterans' family members skills to encourage veterans to initiate mental health care. This study assessed the feasibility, acceptability, and potential efficacy of VA-CRAFT with telephone coaching in a sample of 12 spouses and intimate partners of veterans with PTSD. Participants completed the intervention over 12 weeks and were assessed pre- and posttreatment. For feasibility, 75.0% (n = 9) of participants completed the intervention and reported few difficulties and ease of use. Supporting acceptability, all nine completers had mostly favorable impressions of the intervention and perceived it as helpful. Finally, six (50.0%) participants got the PTSD-affected veteran to engage in mental health care; however, aside from potentially increasing treatment talk frequency, outcome expectancy, and self-efficacy, ds = 0.60-1.08, no apparent improvements were observed for any well-being outcomes, ds = 0.01-0.40. Although the findings are promising, given the study limitations, future research is required to evaluate this approach in a full-scale randomized controlled trial.
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Affiliation(s)
- Eric Kuhn
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Steven L Sayers
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina Babusci
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Catherine Conroy
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Christopher R Erbes
- Center for Chronic Disease Outcomes Research, Minneapolis VA HealthCare System, Minneapolis, Minnesota, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Erbes CR, Ferguson J, Yang K, Koehler-McNicholas S, Polusny MA, Hafner BJ, Heinemann AW, Hill J, Rich T, Walker N, Weber M, Hansen A. Amputation-specific and generic correlates of participation among Veterans with lower limb amputation. PLoS One 2022; 17:e0270753. [PMID: 35797375 PMCID: PMC9262244 DOI: 10.1371/journal.pone.0270753] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Abstract
Participation in valued interpersonal and community activities is a key component of rehabilitation for Veterans with amputation. The purpose of this study was to identify specific factors that promote or inhibit participation to inform development of interventions that may facilitate participation in desired life activities. A convenience sample of 408 Veterans with at least one lower limb amputation and who had received outpatient care from the Regional Amputation Center (RAC) completed a mailed survey. Participation was measured using the Community Participation Indicators (CPI) Importance, Control, and Frequency scales and the Patient Reported Outcome Measurement Information System (PROMIS) Ability to Participate in Social Roles and Satisfaction with Social Participation scales. Multiple imputation procedures were used to address missing data. Correlates of participation were examined through multiple linear regression. A total of 235 participants completed the survey, a response rate of 58%. Levels of participation, measured with the PROMIS instruments, were 43.2 (SD = 8.1) for Ability and 46.4 (SD = 8.6) for Satisfaction. Regression analyses found robust amputation-specific correlates for participation, including body image and balance confidence. Generic (non-amputation specific) correlates for participation included depression and pain interference. Development of treatment approaches and devices that can address body image, balance confidence, pain, and mental health concerns such as depression have the potential to enhance the participation and rehabilitation of Veterans with lower limb amputation.
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Affiliation(s)
- Christopher R. Erbes
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
| | - John Ferguson
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Kalia Yang
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
| | - Sara Koehler-McNicholas
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Melissa A. Polusny
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Brian J. Hafner
- Departments of Rehabilitation Medicine and Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Allen W. Heinemann
- Departments of Physical Medicine and Rehabilitation, Emergency Medicine, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University and Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Jessica Hill
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Tonya Rich
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Nicole Walker
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Marilyn Weber
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
| | - Andrew Hansen
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
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Maihofer AX, Choi KW, Coleman JR, Daskalakis NP, Denckla CA, Ketema E, Morey RA, Polimanti R, Ratanatharathorn A, Torres K, Wingo AP, Zai CC, Aiello AE, Almli LM, Amstadter AB, Andersen SB, Andreassen OA, Arbisi PA, Ashley-Koch AE, Austin SB, Avdibegović E, Borglum AD, Babić D, Bækvad-Hansen M, Baker DG, Beckham JC, Bierut LJ, Bisson JI, Boks MP, Bolger EA, Bradley B, Brashear M, Breen G, Bryant RA, Bustamante AC, Bybjerg-Grauholm J, Calabrese JR, Caldas-de-Almeida JM, Chen CY, Dale AM, Dalvie S, Deckert J, Delahanty DL, Dennis MF, Disner SG, Domschke K, Duncan LE, Kulenović AD, Erbes CR, Evans A, Farrer LA, Feeny NC, Flory JD, Forbes D, Franz CE, Galea S, Garrett ME, Gautam A, Gelaye B, Gelernter J, Geuze E, Gillespie CF, Goçi A, Gordon SD, Guffanti G, Hammamieh R, Hauser MA, Heath AC, Hemmings SM, Hougaard DM, Jakovljević M, Jett M, Johnson EO, Jones I, Jovanovic T, Qin XJ, Karstoft KI, Kaufman ML, Kessler RC, Khan A, Kimbrel NA, King AP, Koen N, Kranzler HR, Kremen WS, Lawford BR, Lebois LA, Lewis C, Liberzon I, Linnstaedt SD, Logue MW, Lori A, Lugonja B, Luykx JJ, Lyons MJ, Maples-Keller JL, Marmar C, Martin NG, Maurer D, Mavissakalian MR, McFarlane A, McGlinchey RE, McLaughlin KA, McLean SA, Mehta D, Mellor R, Michopoulos V, Milberg W, Miller MW, Morris CP, Mors O, Mortensen PB, Nelson EC, Nordentoft M, Norman SB, O’Donnell M, Orcutt HK, Panizzon MS, Peters ES, Peterson AL, Peverill M, Pietrzak RH, Polusny MA, Rice JP, Risbrough VB, Roberts AL, Rothbaum AO, Rothbaum BO, Roy-Byrne P, Ruggiero KJ, Rung A, Rutten BP, Saccone NL, Sanchez SE, Schijven D, Seedat S, Seligowski AV, Seng JS, Sheerin CM, Silove D, Smith AK, Smoller JW, Sponheim SR, Stein DJ, Stevens JS, Teicher MH, Thompson WK, Trapido E, Uddin M, Ursano RJ, van den Heuvel LL, Van Hooff M, Vermetten E, Vinkers C, Voisey J, Wang Y, Wang Z, Werge T, Williams MA, Williamson DE, Winternitz S, Wolf C, Wolf EJ, Yehuda R, Young KA, Young RM, Zhao H, Zoellner LA, Haas M, Lasseter H, Provost AC, Salem RM, Sebat J, Shaffer RA, Wu T, Ripke S, Daly MJ, Ressler KJ, Koenen KC, Stein MB, Nievergelt CM. Enhancing Discovery of Genetic Variants for Posttraumatic Stress Disorder Through Integration of Quantitative Phenotypes and Trauma Exposure Information. Biol Psychiatry 2022; 91:626-636. [PMID: 34865855 PMCID: PMC8917986 DOI: 10.1016/j.biopsych.2021.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/25/2021] [Accepted: 09/21/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is heritable and a potential consequence of exposure to traumatic stress. Evidence suggests that a quantitative approach to PTSD phenotype measurement and incorporation of lifetime trauma exposure (LTE) information could enhance the discovery power of PTSD genome-wide association studies (GWASs). METHODS A GWAS on PTSD symptoms was performed in 51 cohorts followed by a fixed-effects meta-analysis (N = 182,199 European ancestry participants). A GWAS of LTE burden was performed in the UK Biobank cohort (N = 132,988). Genetic correlations were evaluated with linkage disequilibrium score regression. Multivariate analysis was performed using Multi-Trait Analysis of GWAS. Functional mapping and annotation of leading loci was performed with FUMA. Replication was evaluated using the Million Veteran Program GWAS of PTSD total symptoms. RESULTS GWASs of PTSD symptoms and LTE burden identified 5 and 6 independent genome-wide significant loci, respectively. There was a 72% genetic correlation between PTSD and LTE. PTSD and LTE showed largely similar patterns of genetic correlation with other traits, albeit with some distinctions. Adjusting PTSD for LTE reduced PTSD heritability by 31%. Multivariate analysis of PTSD and LTE increased the effective sample size of the PTSD GWAS by 20% and identified 4 additional loci. Four of these 9 PTSD loci were independently replicated in the Million Veteran Program. CONCLUSIONS Through using a quantitative trait measure of PTSD, we identified novel risk loci not previously identified using prior case-control analyses. PTSD and LTE have a high genetic overlap that can be leveraged to increase discovery power through multivariate methods.
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11
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Polusny MA, Marquardt CA, Campbell EH, Filetti CR, Noël VV, Disner SG, Schaefer JD, Davenport N, Lissek S, Noorbaloochi S, Sponheim SR, Erbes CR. Advancing Research on Mechanisms of Resilience (ARMOR) Longitudinal Cohort Study of New Military Recruits: Results from a Feasibility Pilot Study. Res Hum Dev 2021; 18:212-229. [PMID: 34887706 DOI: 10.1080/15427609.2021.1964898] [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: 10/20/2022]
Abstract
Psychological resilience as a longitudinal process is highly relevant for understanding the functioning outcomes of military populations. Here, we review the extant literature on resilience among military service members, focusing on National Guard Soldiers. Our specific project (Advancing Research on Mechanisms of Resilience, "ARMOR") aims to develop a comprehensive model of resilience using a multilevel perspective. We report results from our prospective pilot study (n = 103) conducted in preparation for our large-scale longitudinal cohort study of Basic Combat Training (BCT) and its impact on military recruits' wellbeing. Results support feasibility of the larger study, evidence for a new measure of BCT stressor exposure, and demonstrate preliminary associations with BCT-related stressors and longitudinal changes in adaptive functioning. Future directions for our larger study will utilize data from survey responses, structured clinical interviews, neurobehavioral tasks, and neurobiological measures (functional and structural MRI and electroencephalography [EEG]) to examine individual differences in self-regulation as a predictor of resilience-related processes. ARMOR is well positioned to elucidate mechanisms that could be targeted for promoting wellbeing, preventing psychopathology, and facilitating long-term recovery.
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Affiliation(s)
- Melissa A Polusny
- Minneapolis VA Health Care System, Minneapolis, MN.,Center for Care Delivery and Outcomes Research, Minneapolis, MN.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Craig A Marquardt
- Minneapolis VA Health Care System, Minneapolis, MN.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Emily Hagel Campbell
- Center for Care Delivery and Outcomes Research, Minneapolis, MN.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Clarissa R Filetti
- Minneapolis VA Health Care System, Minneapolis, MN.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Valentin V Noël
- Minneapolis VA Health Care System, Minneapolis, MN.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Seth G Disner
- Minneapolis VA Health Care System, Minneapolis, MN.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | | | - Nicholas Davenport
- Minneapolis VA Health Care System, Minneapolis, MN.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Shmuel Lissek
- Department of Psychology, University of Minnesota - Twin Cities
| | - Siamak Noorbaloochi
- Minneapolis VA Health Care System, Minneapolis, MN.,Center for Care Delivery and Outcomes Research, Minneapolis, MN.,Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Scott R Sponheim
- Minneapolis VA Health Care System, Minneapolis, MN.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Christopher R Erbes
- Minneapolis VA Health Care System, Minneapolis, MN.,Center for Care Delivery and Outcomes Research, Minneapolis, MN.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
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12
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Hammett PJ, Businelle MS, Taylor BC, Erbes CR, Bastian L, Doran N, Sherman SE, Rogers ES, Burgess DJ, Fu SS. The Association Between Smoking Abstinence and Pain Trajectory Among Veterans Engaged in U.S. Department of Veterans Affairs Mental Health Care. Pain Med 2021; 22:1793-1803. [PMID: 33502511 DOI: 10.1093/pm/pnab009] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To prospectively examine associations between smoking and nicotine abstinence and pain trajectory over 12 months among smokers with low, moderate, and severe pain and to assess whether these associations differ over time. DESIGN A secondary analysis of the "Proactive Outreach for Smokers in VA Mental Health" study, a randomized controlled trial of proactive outreach for veteran smokers engaged in U.S. Department of Veterans Affairs (VA) mental health care. METHODS Participants were categorized into "low" (n = 616), "moderate" (n = 479), and "severe" pain (n = 656) groups according to baseline pain score. Associations between self-reported abstinence from smoking and nicotine at 6 and 12 months and pain trajectory, measured via the PEG scale (Pain intensity, Enjoyment of life, General activity) composite score, were assessed through the use of general linear mixed models. Interaction tests assessed whether these associations differed at 6 and 12 months. Analyses were conducted within the overall sample and within the separate pain groups. RESULTS There were significant interactions in the overall sample and the low and moderate pain groups, such that 7-day point prevalence smoking abstinence was associated with lower pain scores at 6 but not 12 months. In the severe pain group, 7-day abstinence from both smoking and nicotine was associated with lower pain scores across both time points. Six-month prolonged abstinence was not associated with pain scores. CONCLUSIONS In this prospective analysis conducted among veteran smokers engaged in mental health services, 7-day abstinence from smoking and nicotine was associated with significantly lower levels of pain. Education efforts could help better inform smokers on the relationship between smoking and pain.
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Affiliation(s)
- Patrick J Hammett
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Michael S Businelle
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, Oklahoma
| | - Brent C Taylor
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Christopher R Erbes
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Psychiatry, University of Minnesota Medical School, Minnesota
| | - Lori Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut.,School of Medicine, Yale University, New Haven, Connecticut
| | - Neal Doran
- VA San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California, San Diego, California
| | - Scott E Sherman
- VA New York Harbor Healthcare System, New York.,Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Erin S Rogers
- VA New York Harbor Healthcare System, New York.,Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Diana J Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Steven S Fu
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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13
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Tolly B, Erbes CR, Apostolidou I. Posttraumatic stress disorder and anesthesia: Respect for the military veteran's mind. J Clin Anesth 2021; 71:110242. [PMID: 33774437 DOI: 10.1016/j.jclinane.2021.110242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Brian Tolly
- Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA; Department of Anesthesiology, University of Minnesota School of Medicine, B515 Mayo Memorial Building, 420 Delaware St SE, Minneapolis, MN 55455, USA.
| | - Christopher R Erbes
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, 1 Veterans Dr, Minneapolis, MN 55417, USA; Department of Psychiatry, University of Minnesota School of Medicine, 2312 S 6(th) St, Floor 2 Ste F-275, Minneapolis, MN 55455, USA.
| | - Ioanna Apostolidou
- Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA; Department of Anesthesiology, University of Minnesota School of Medicine, B515 Mayo Memorial Building, 420 Delaware St SE, Minneapolis, MN 55455, USA.
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14
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Tolly B, Waly A, Peterson G, Erbes CR, Prielipp RC, Apostolidou I. Adult Emergence Agitation: A Veteran-Focused Narrative Review. Anesth Analg 2021; 132:353-364. [PMID: 33177329 DOI: 10.1213/ane.0000000000005211] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Emergence agitation (EA) is a self-limited state of psychomotor excitement during awakening from general anesthesia. EA is confined to the emergence period as consciousness is restored, which sharply distinguishes it from other postoperative delirium states. Sporadic episodes of EA may become violent with the potential for harm to both patients and caregivers, but the long-term consequences of such events are not fully understood. Current literature on EA in adults is limited to small-scale studies with inconsistent nomenclature, variable time periods that define emergence, a host of different surgical populations, and conflicting diagnostic criteria. Therefore, true incidence rates and risk factors are unknown. In adult noncardiac surgery, the incidence of EA is approximately 19%. Limited data suggest that young adults undergoing otolaryngology operations with volatile anesthetic maintenance may be at the highest risk for EA. Currently suggested EA mechanisms are theoretical but might reflect underblunted sympathetic activation in response to various internal (eg, flashbacks or anxiety) or external (eg, surgical pain) stimuli as consciousness returns. Supplemental dexmedetomidine and ketamine may be utilized for EA prevention. Compared to the civilian population, military veterans may be more vulnerable to EA due to high rates of posttraumatic stress disorder (PTSD) manifesting as violent flashbacks; however, confirmatory data are limited. Nonetheless, expert military medical providers suggest that use of patient-centered rapport tactics, PTSD trigger identification and avoidance, and grounding measures may alleviate hyperactive emergence phenomena. Future research is needed to better characterize EA in veterans and validate prophylactic measures to optimize care for these patients. This narrative review provides readers with an important framework to distinguish EA from delirium. Furthermore, we summarize current knowledge of EA risk factors, mechanisms, and adult management strategies and specifically revisit them in the context of veteran perioperative health. The anesthesiology care team is ideally positioned to further explore EA and develop effective prevention and treatment protocols.
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Affiliation(s)
- Brian Tolly
- From the Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,Department of Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Amr Waly
- From the Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Garrett Peterson
- From the Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Christopher R Erbes
- From the Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Richard C Prielipp
- Department of Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Ioanna Apostolidou
- From the Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,Department of Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota
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15
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Bishop JR, Lee AM, Mills LJ, Thuras PD, Eum S, Clancy D, Erbes CR, Polusny MA, Lamberty GJ, Lim KO. Corrigendum: Methylation of FKBP5 and SLC6A4 in Relation to Treatment Response to Mindfulness Based Stress Reduction for Posttraumatic Stress Disorder. Front Psychiatry 2021; 12:642245. [PMID: 33746798 PMCID: PMC7970629 DOI: 10.3389/fpsyt.2021.642245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/15/2020] [Accepted: 02/08/2021] [Indexed: 11/26/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyt.2018.00418.].
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Affiliation(s)
- Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Adam M Lee
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
| | - Lauren J Mills
- University of Minnesota Supercomputing Institute, Minneapolis, MN, United States
| | - Paul D Thuras
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States.,Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Seenae Eum
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
| | - Doris Clancy
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Christopher R Erbes
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States.,Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Melissa A Polusny
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States.,Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Gregory J Lamberty
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States.,Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States.,Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States.,Defense Veterans Brain Injury Center, Minneapolis, MN, United States
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16
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Khazem LR, Anestis JC, Erbes CR, Ferrier-Auerbach AG, Schumacher MM, Arbisi PA. Assessing the Clinical Utility of the MMPI-2-RF in Detecting Suicidal Ideation in a High Acuity, Partially-Hospitalized Veteran Sample. J Pers Assess 2020; 103:10-18. [PMID: 32208938 DOI: 10.1080/00223891.2020.1739057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) has demonstrated utility in suicide risk assessment. Limited research with the MMPI-2-RF in higher acuity populations exists, particularly regarding the impact of possible underreporting on prediction of suicide risk. The current study serves to extend previous findings of the utility of clinically indicated MMPI-2-RF scales and proxy indices in 293 veterans (83.62% White, 85.32% male, and 74.40% with past-week suicide ideation) enrolled in a Veterans Affairs Medical Center partial psychiatric hospitalization program. Differences in self-report indicators and MMPI-2-RF scales and proxy indices relevant in assessing suicide ideation between veterans indicated as possibly underreporting and those who were not and the ability of the scales and proxy indices to predict current suicide ideation were examined. These indicators, scales, and proxy indices, with the exception of SUI, were significantly impacted by underreporting, and none of the examined scales or proxy indices (or their interaction) were consistently associated with self-reported suicide ideation after accounting for SUI. However, SUI was consistently associated with suicide ideation and was less influenced by under-reporting. In acutely ill psychiatric patients, SUI may be the most robust indicator of current suicide ideation.
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Affiliation(s)
- Lauren R Khazem
- National Center for Veterans Studies, University of Utah, Salt Lake City, Utah
| | - Joye C Anestis
- Department of Psychology, Univeristy of Southern Mississippi, Hattiesburg, Mississippi
| | - Christopher R Erbes
- Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Psychology, University of Minnesota, Minneapolis, Minnesota.,Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota
| | - Amanda G Ferrier-Auerbach
- Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | | | - Paul A Arbisi
- Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
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17
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Erbes CR, Kuhn E, Polusny MA, Ruzek JI, Spoont M, Meis LA, Gifford E, Weingardt KR, Campbell EH, Oleson H, Taylor BC. A Pilot Trial of Online Training for Family Well-Being and Veteran Treatment Initiation for PTSD. Mil Med 2020; 185:401-408. [PMID: 31621884 DOI: 10.1093/milmed/usz326] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/27/2019] [Accepted: 08/13/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Family members are important supports for veterans with Posttrauamtic Stress Disroder (PTSD), but they often struggle with their own distress and challenges. The Veterans Affairs-Community Reinforcement and Family Training (VA-CRAFT) website was designed to teach family members of veterans with PTSD effective ways to interact with their veterans to encourage initiation of mental health services as well as to care for themselves and improve their relationships. This article presents a pilot investigation of VA-CRAFT. MATERIALS AND METHOD Spouse/partners of veterans who had screened positive for PTSD but were not in mental health treatment were randomized to either use the VA-CRAFT website (n = 22) or to a waitlist control condition (n = 19) for 3 months. Veteran mental health service initiation was assessed posttreatment. Spouse/partner distress, caregiver burden, quality of life, and relationship quality were assessed pre and posttreatment. The study was approved by the Minneapolis VA Health Care System Institutional Review Board (IRB). RESULTS Differences between groups on veteran treatment initiation were small (Phi = 0.17) and not statistically significant. VA-CRAFT participants reported large and statistically significantly greater decreases in overall caregiver burden (η2 = 0.10) and objective caregiver burden (η2 = 0.14) than control participants. Effects were larger for those with greater initial distress. Effects sizes for other partner outcomes were negligible (η2 = 0.01) to medium (η2 = 0.09) and not statistically significant. Postintervention interviews suggested that only 33% of the VA-CRAFT participants talked with their veterans about starting treatment for PTSD during the trial. CONCLUSION Results from this pilot trial suggest that VA-CRAFT holds initial promise in reducing caregiver burden and as such it could be a useful resource for family members of veterans with PTSD. However, VA-CRAFT does not enhance veteran treatment initiation. It may benefit from enhancements to increase effectiveness and caregiver engagement.
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Affiliation(s)
- Christopher R Erbes
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
| | - Eric Kuhn
- Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
- National Center for PTSD, 795 Willow Road Menlo Park, CA 94025
| | - Melissa A Polusny
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
| | - Josef I Ruzek
- Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
- National Center for PTSD, 795 Willow Road Menlo Park, CA 94025
| | - Michele Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
- National Center for PTSD, 795 Willow Road Menlo Park, CA 94025
| | - Laura A Meis
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
| | - Elizabeth Gifford
- Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025
| | | | - Emily Hagel Campbell
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
| | - Heather Oleson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
| | - Brent C Taylor
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
- University of Minnesota School of Public Health, 420 Delaware St., Minneapolis, MN 55455
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18
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Nievergelt CM, Maihofer AX, Klengel T, Atkinson EG, Chen CY, Choi KW, Coleman JRI, Dalvie S, Duncan LE, Gelernter J, Levey DF, Logue MW, Polimanti R, Provost AC, Ratanatharathorn A, Stein MB, Torres K, Aiello AE, Almli LM, Amstadter AB, Andersen SB, Andreassen OA, Arbisi PA, Ashley-Koch AE, Austin SB, Avdibegovic E, Babić D, Bækvad-Hansen M, Baker DG, Beckham JC, Bierut LJ, Bisson JI, Boks MP, Bolger EA, Børglum AD, Bradley B, Brashear M, Breen G, Bryant RA, Bustamante AC, Bybjerg-Grauholm J, Calabrese JR, Caldas-de-Almeida JM, Dale AM, Daly MJ, Daskalakis NP, Deckert J, Delahanty DL, Dennis MF, Disner SG, Domschke K, Dzubur-Kulenovic A, Erbes CR, Evans A, Farrer LA, Feeny NC, Flory JD, Forbes D, Franz CE, Galea S, Garrett ME, Gelaye B, Geuze E, Gillespie C, Uka AG, Gordon SD, Guffanti G, Hammamieh R, Harnal S, Hauser MA, Heath AC, Hemmings SMJ, Hougaard DM, Jakovljevic M, Jett M, Johnson EO, Jones I, Jovanovic T, Qin XJ, Junglen AG, Karstoft KI, Kaufman ML, Kessler RC, Khan A, Kimbrel NA, King AP, Koen N, Kranzler HR, Kremen WS, Lawford BR, Lebois LAM, Lewis CE, Linnstaedt SD, Lori A, Lugonja B, Luykx JJ, Lyons MJ, Maples-Keller J, Marmar C, Martin AR, Martin NG, Maurer D, Mavissakalian MR, McFarlane A, McGlinchey RE, McLaughlin KA, McLean SA, McLeay S, Mehta D, Milberg WP, Miller MW, Morey RA, Morris CP, Mors O, Mortensen PB, Neale BM, Nelson EC, Nordentoft M, Norman SB, O'Donnell M, Orcutt HK, Panizzon MS, Peters ES, Peterson AL, Peverill M, Pietrzak RH, Polusny MA, Rice JP, Ripke S, Risbrough VB, Roberts AL, Rothbaum AO, Rothbaum BO, Roy-Byrne P, Ruggiero K, Rung A, Rutten BPF, Saccone NL, Sanchez SE, Schijven D, Seedat S, Seligowski AV, Seng JS, Sheerin CM, Silove D, Smith AK, Smoller JW, Sponheim SR, Stein DJ, Stevens JS, Sumner JA, Teicher MH, Thompson WK, Trapido E, Uddin M, Ursano RJ, van den Heuvel LL, Van Hooff M, Vermetten E, Vinkers CH, Voisey J, Wang Y, Wang Z, Werge T, Williams MA, Williamson DE, Winternitz S, Wolf C, Wolf EJ, Wolff JD, Yehuda R, Young RM, Young KA, Zhao H, Zoellner LA, Liberzon I, Ressler KJ, Haas M, Koenen KC. International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci. Nat Commun 2019; 10:4558. [PMID: 31594949 PMCID: PMC6783435 DOI: 10.1038/s41467-019-12576-w] [Citation(s) in RCA: 277] [Impact Index Per Article: 55.4] [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] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/18/2019] [Indexed: 12/14/2022] Open
Abstract
The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5-20%, varying by sex. Three genome-wide significant loci are identified, 2 in European and 1 in African-ancestry analyses. Analyses stratified by sex implicate 3 additional loci in men. Along with other novel genes and non-coding RNAs, a Parkinson's disease gene involved in dopamine regulation, PARK2, is associated with PTSD. Finally, we demonstrate that polygenic risk for PTSD is significantly predictive of re-experiencing symptoms in the Million Veteran Program dataset, although specific loci did not replicate. These results demonstrate the role of genetic variation in the biology of risk for PTSD and highlight the necessity of conducting sex-stratified analyses and expanding GWAS beyond European ancestry populations.
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Affiliation(s)
- Caroline M Nievergelt
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA.
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA.
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, USA.
| | - Adam X Maihofer
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, USA
| | - Torsten Klengel
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
- University Medical Center Goettingen, Department of Psychiatry, Göttingen, DE, Germany
| | - Elizabeth G Atkinson
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, USA
- Massachusetts General Hospital, Analytic and Translational Genetics Unit, Boston, MA, USA
| | - Chia-Yen Chen
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, USA
- Massachusetts General Hospital, Analytic and Translational Genetics Unit, Boston, MA, USA
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA, USA
| | - Karmel W Choi
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, USA
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Jonathan R I Coleman
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, GB, USA
- King's College London, NIHR BRC at the Maudsley, London, GB, USA
| | - Shareefa Dalvie
- University of Cape Town, SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Cape Town, Western Cape, ZA, USA
| | - Laramie E Duncan
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
| | - Joel Gelernter
- US Department of Veterans Affairs, Department of Psychiatry, West Haven, CT, USA
- Yale University School of Medicine, Department of Genetics and Neuroscience, New Haven, CT, USA
- VA Connecticut Healthcare Center, West Haven, CT, USA
| | - Daniel F Levey
- VA Connecticut Healthcare Center, West Haven, CT, USA
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Mark W Logue
- VA Boston Healthcare System, National Center for PTSD, Boston, MA, USA
| | - Renato Polimanti
- VA Connecticut Healthcare Center, West Haven, CT, USA
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | | | | | - Murray B Stein
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Million Veteran Program, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Psychiatry Service, San Diego, CA, USA
| | - Katy Torres
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, USA
| | - Allison E Aiello
- Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA
| | - Lynn M Almli
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Richmond, VA, USA
| | - Søren B Andersen
- The Danish Veteran Centre, Research and Knowledge Centre, Ringsted, Sjaelland, Denmark
| | - Ole A Andreassen
- University of Oslo, Institute of Clinical Medicine, Oslo, NO, Norway
| | - Paul A Arbisi
- Minneapolis VA Health Care System, Mental Health Service Line, Minneapolis, MN, USA
| | | | - S Bryn Austin
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
- Boston Children's Hospital, Division of Adolescent and Young Adult Medicine, Boston, MA, USA
- Brigham and Women's Hospital, Channing Division of Network Medicine, Boston, MA, USA
- Harvard School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
| | - Esmina Avdibegovic
- University Clinical Center of Tuzla, Department of Psychiatry, Tuzla, BA, Bosnia and Herzegovina
| | - Dragan Babić
- University Clinical Center of Mostar, Department of Psychiatry, Mostar, BA, Bosnia and Herzegovina
| | - Marie Bækvad-Hansen
- Statens Serum Institut, Department for Congenital Disorders, Copenhagen, DK, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, DK, Denmark
| | - Dewleen G Baker
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Psychiatry Service, San Diego, CA, USA
| | - Jean C Beckham
- Durham VA Medical Center, Research, Durham, NC, USA
- Duke University, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Genetics Research Laboratory, Durham, NC, USA
| | - Laura J Bierut
- Washington University in Saint Louis School of Medicine, Department of Psychiatry, Saint Louis, MO, USA
| | - Jonathan I Bisson
- Cardiff University, National Centre for Mental Health, MRC Centre for Psychiatric Genetics and Genomics, Cardiff, UK
| | - Marco P Boks
- UMC Utrecht Brain Center Rudolf Magnus, Department of Translational Neuroscience, Utrecht, Utrecht, NL, Netherlands
| | - Elizabeth A Bolger
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Anders D Børglum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, DK, Denmark
- Aarhus University, Centre for Integrative Sequencing, iSEQ, Aarhus, DK, Denmark
- Aarhus University, Department of Biomedicine - Human Genetics, Aarhus, DK, Denmark
| | - Bekh Bradley
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
- Atlanta VA Health Care System, Mental Health Service Line, Decatur, GA, USA
| | - Megan Brashear
- Louisiana State University Health Sciences Center, School of Public Health and Department of Epidemiology, New Orleans, LA, USA
| | - Gerome Breen
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, GB, USA
- King's College London, NIHR BRC at the Maudsley, London, GB, USA
| | - Richard A Bryant
- University of New South Wales, Department of Psychology, Sydney, NSW, Australia
| | - Angela C Bustamante
- University of Michigan Medical School, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI, USA
| | - Jonas Bybjerg-Grauholm
- Statens Serum Institut, Department for Congenital Disorders, Copenhagen, DK, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, DK, Denmark
| | | | - José M Caldas-de-Almeida
- CEDOC -Chronic Diseases Research Centre, Lisbon Institute of Global Mental Health, Lisbon, PT, Portugal
| | - Anders M Dale
- University of California San Diego, Department of Radiology, Department of Neurosciences, La Jolla, CA, USA
| | - Mark J Daly
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA, USA
| | - Nikolaos P Daskalakis
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
- Cohen Veterans Bioscience, Cambridge, MA, USA
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Jürgen Deckert
- University Hospital of Würzburg, Center of Mental Health, Psychiatry, Psychosomatics and Psychotherapy, Würzburg, DE, Germany
| | - Douglas L Delahanty
- Kent State University, Department of Psychological Sciences, Kent, OH, USA
- Kent State University, Research and Sponsored Programs, Kent, OH, USA
| | - Michelle F Dennis
- Durham VA Medical Center, Research, Durham, NC, USA
- Duke University, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Genetics Research Laboratory, Durham, NC, USA
| | - Seth G Disner
- Minneapolis VA Health Care System, Research Service Line, Minneapolis, MN, USA
| | - Katharina Domschke
- Medical Center-University of Freiburg, Faculty of Medicine, Department of Psychiatry and Psychotherapy, Freiburg, DE, Germany
- University of Freiburg, Faculty of Medicine, Centre for Basics in Neuromodulation, Freiburg, DE, Germany
| | - Alma Dzubur-Kulenovic
- University Clinical Center of Sarajevo, Department of Psychiatry, Sarajevo, BA, Bosnia and Herzegovina
| | - Christopher R Erbes
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA
- Minneapolis VA Health Care System, Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis, MN, USA
| | - Alexandra Evans
- Cardiff University, National Centre for Mental Health, MRC Centre for Psychiatric Genetics and Genomics, Cardiff, South Glamorgan, GB, USA
| | - Lindsay A Farrer
- Boston University School of Medicine, Department of Medicine, Boston, MA, USA
| | - Norah C Feeny
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
| | - Janine D Flory
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - David Forbes
- University of Melbourne, Department of Psychiatry, Melbourne, VIC, AU, USA
| | - Carol E Franz
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Sandro Galea
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, USA
| | - Melanie E Garrett
- Duke University, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
| | - Bizu Gelaye
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Elbert Geuze
- Netherlands Ministry of Defence, Brain Research and Innovation Centre, Utrecht, Utrecht, NL, Netherlands
- UMC Utrecht Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht, Utrecht, NL, Netherlands
| | - Charles Gillespie
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Aferdita Goci Uka
- University Clinical Centre of Kosovo, Department of Psychiatry, Prishtina, Kosovo, XK, USA
| | - Scott D Gordon
- QIMR Berghofer Medical Research Institute, Department of Genetics and Computational Biology, Brisbane, Queensland, Australia
| | - Guia Guffanti
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Rasha Hammamieh
- US Army Medical Research and Materiel Command, USACEHR, Fort Detrick, MD, USA
| | - Supriya Harnal
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, USA
| | - Michael A Hauser
- Duke University, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
| | - Andrew C Heath
- Washington University in Saint Louis School of Medicine, Department of Genetics, Saint Louis, MO, USA
| | - Sian M J Hemmings
- Stellenbosch University Faculty of Medicine and Health Sciences, Department of Psychiatry, Cape Town, Western Cape, ZA, South Africa
| | - David Michael Hougaard
- Statens Serum Institut, Department for Congenital Disorders, Copenhagen, DK, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, DK, Denmark
| | - Miro Jakovljevic
- University Hospital Center of Zagreb, Department of Psychiatry, Zagreb, HR, USA
| | - Marti Jett
- US Army Medical Research and Materiel Command, USACEHR, Fort Detrick, MD, USA
| | - Eric Otto Johnson
- RTI International, Behavioral Health and Criminal Justice Division, Research Triangle Park, NC, USA
| | - Ian Jones
- Cardiff University, National Centre for Mental Health, MRC Centre for Psychiatric Genetics and Genomics, Cardiff, South Glamorgan, GB, USA
| | - Tanja Jovanovic
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Xue-Jun Qin
- Duke University, Duke Molecular Physiology Institute, Durham, NC, USA
| | - Angela G Junglen
- Kent State University, Department of Psychological Sciences, Kent, OH, USA
| | - Karen-Inge Karstoft
- The Danish Veteran Centre, Research and Knowledge Centre, Ringsted, Sjaelland, Denmark
- University of Copenhagen, Department of Psychology, Copenhagen, DK, Denmark
| | - Milissa L Kaufman
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Ronald C Kessler
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Alaptagin Khan
- McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Department of Health Care Policy, Boston, MA, USA
| | - Nathan A Kimbrel
- Duke University, Duke Molecular Physiology Institute, Durham, NC, USA
- Durham VA Medical Center, Research, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Genetics Research Laboratory, Durham, NC, USA
| | - Anthony P King
- University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, USA
| | - Nastassja Koen
- University of Cape Town, SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Cape Town, Western Cape, ZA, USA
| | - Henry R Kranzler
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA
- Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, PA, USA
| | - William S Kremen
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Bruce R Lawford
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, AU, Australia
- Queensland University of Technology, School of Biomedical Sciences, Kelvin Grove, QLD, AU, Australia
| | - Lauren A M Lebois
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Catrin E Lewis
- Cardiff University, National Centre for Mental Health, MRC Centre for Psychiatric Genetics and Genomics, Cardiff, South Glamorgan, GB, USA
| | - Sarah D Linnstaedt
- UNC Institute for Trauma Recovery, Department of Anesthesiology, Chapel Hill, NC, USA
| | - Adriana Lori
- Emory University, Department of Gynecology and Obstetrics, Atlanta, GA, USA
| | - Bozo Lugonja
- Cardiff University, National Centre for Mental Health, MRC Centre for Psychiatric Genetics and Genomics, Cardiff, South Glamorgan, GB, USA
| | - Jurjen J Luykx
- UMC Utrecht Brain Center Rudolf Magnus, Department of Translational Neuroscience, Utrecht, Utrecht, NL, Netherlands
- UMC Utrecht Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht, Utrecht, NL, Netherlands
| | | | - Jessica Maples-Keller
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Charles Marmar
- New York University School of Medicine, Department of Psychiatry, New York, NY, USA
| | - Alicia R Martin
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, USA
- Massachusetts General Hospital, Analytic and Translational Genetics Unit, Boston, MA, USA
| | - Nicholas G Martin
- QIMR Berghofer Medical Research Institute, Department of Genetics and Computational Biology, Brisbane, Queensland, Australia
| | | | | | - Alexander McFarlane
- University of Adelaide, Department of Psychiatry, Adelaide, South Australia, AU, Australia
| | | | | | - Samuel A McLean
- UNC Institute for Trauma Recovery, Department of Anesthesiology, Chapel Hill, NC, USA
- UNC Institute for Trauma Recovery, Department of Emergency Medicine, Chapel Hill, NC, USA
| | - Sarah McLeay
- Gallipoli Medical Research Institute, PTSD Initiative, Greenslopes, Queensland, AU, Australia
| | - Divya Mehta
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, AU, Australia
- Queensland University of Technology, School of Psychology and Counseling, Faculty of Health, Kelvin Grove, QLD, AU, Australia
| | | | - Mark W Miller
- VA Boston Healthcare System, National Center for PTSD, Boston, MA, USA
| | - Rajendra A Morey
- Duke University, Duke Molecular Physiology Institute, Durham, NC, USA
| | - Charles Phillip Morris
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, AU, Australia
- Queensland University of Technology, School of Biomedical Sciences, Kelvin Grove, QLD, AU, Australia
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, DK, Denmark
- Aarhus University Hospital, Psychosis Research Unit, Risskov, DK, Denmark
| | - Preben B Mortensen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, DK, Denmark
- Aarhus University, Centre for Integrative Sequencing, iSEQ, Aarhus, DK, Denmark
- Aarhus University, Centre for Integrated Register-based Research, Aarhus, DK, Denmark
- Aarhus University, National Centre for Register-Based Research, Aarhus, DK, Denmark
| | - Benjamin M Neale
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, USA
- Massachusetts General Hospital, Analytic and Translational Genetics Unit, Boston, MA, USA
| | - Elliot C Nelson
- Washington University in Saint Louis School of Medicine, Department of Psychiatry, Saint Louis, MO, USA
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, DK, Denmark
- University of Copenhagen, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Copenhagen, DK, Denmark
| | - Sonya B Norman
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Department of Research and Psychiatry, San Diego, CA, USA
- National Center for Post Traumatic Stress Disorder, Executive Division, White River Junction, San Diego, VT, USA
| | - Meaghan O'Donnell
- University of Melbourne, Department of Psychiatry, Melbourne, VIC, AU, USA
| | - Holly K Orcutt
- Northern Illinois University, Department of Psychology, DeKalb, IL, USA
| | - Matthew S Panizzon
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Edward S Peters
- Louisiana State University Health Sciences Center, School of Public Health and Department of Epidemiology, New Orleans, LA, USA
| | - Alan L Peterson
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, San Antonio, TX, USA
| | - Matthew Peverill
- University of Washington, Department of Psychology, Seattle, WA, USA
| | - Robert H Pietrzak
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, West Haven, CT, USA
| | - Melissa A Polusny
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA
- Minneapolis VA Health Care System, Department of Mental Health, Minneapolis, MN, USA
- Minneapolis VA Health Care System, Department of Psychology, Minneapolis, MN, USA
| | - John P Rice
- Washington University in Saint Louis School of Medicine, Department of Psychiatry, Saint Louis, MO, USA
| | - Stephan Ripke
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, USA
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA, USA
- Charité - Universitätsmedizin, Department of Psychiatry and Psychotherapy, Berlin, GE, Germany
| | - Victoria B Risbrough
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, USA
| | - Andrea L Roberts
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, USA
| | - Alex O Rothbaum
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
| | - Barbara O Rothbaum
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Peter Roy-Byrne
- University of Washington, Department of Psychology, Seattle, WA, USA
| | - Ken Ruggiero
- Medical University of South Carolina, Department of Nursing and Department of Psychiatry, Charleston, SC, USA
| | - Ariane Rung
- Louisiana State University Health Sciences Center, School of Public Health and Department of Epidemiology, New Orleans, LA, USA
| | - Bart P F Rutten
- Maastricht Universitair Medisch Centrum, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht, Limburg, NL, Netherlands
| | - Nancy L Saccone
- Washington University in Saint Louis School of Medicine, Department of Psychiatry, Saint Louis, MO, USA
| | - Sixto E Sanchez
- Universidad Peruana de Ciencias Aplicadas Facultad de Ciencias de la Salud, Department of Medicine, Lima, Lima, PE, USA
| | - Dick Schijven
- UMC Utrecht Brain Center Rudolf Magnus, Department of Translational Neuroscience, Utrecht, Utrecht, NL, Netherlands
- UMC Utrecht Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht, Utrecht, NL, Netherlands
| | - Soraya Seedat
- Stellenbosch University Faculty of Medicine and Health Sciences, Department of Psychiatry, Cape Town, Western Cape, ZA, South Africa
| | - Antonia V Seligowski
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Julia S Seng
- University of Michigan, School of Nursing, Ann Arbor, MI, USA
| | - Christina M Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Richmond, VA, USA
| | - Derrick Silove
- University of New South Wales, Department of Psychiatry, Sydney, NSW, AU, USA
| | - Alicia K Smith
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
- Emory University, Department of Gynecology and Obstetrics, Atlanta, GA, USA
| | - Jordan W Smoller
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, USA
- Massachusetts General Hospital, Analytic and Translational Genetics Unit, Boston, MA, USA
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
| | - Scott R Sponheim
- Minneapolis VA Health Care System, Mental Health Service Line, Minneapolis, MN, USA
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA
| | - Dan J Stein
- University of Cape Town, SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Cape Town, Western Cape, ZA, USA
| | - Jennifer S Stevens
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Jennifer A Sumner
- Columbia University Medical Center, Department of Medicine, New York, NY, USA
| | - Martin H Teicher
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Wesley K Thompson
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, DK, Denmark
- Mental Health Centre Sct. Hans, Institute of Biological Psychiatry, Roskilde, DK, Denmark
- Oslo University Hospital, KG Jebsen Centre for Psychosis Research, Norway Division of Mental Health and Addiction, Oslo, NO, USA
| | - Edward Trapido
- Louisiana State University Health Sciences Center, School of Public Health and Department of Epidemiology, New Orleans, LA, USA
| | - Monica Uddin
- University of South Florida College of Public Health, Genomics Program, Tampa, FL, USA
| | - Robert J Ursano
- Uniformed Services University, Department of Psychiatry, Bethesda, Maryland, USA
| | - Leigh Luella van den Heuvel
- Stellenbosch University Faculty of Medicine and Health Sciences, Department of Psychiatry, Cape Town, Western Cape, ZA, South Africa
| | - Miranda Van Hooff
- University of Adelaide, Department of Psychiatry, Adelaide, South Australia, AU, Australia
| | - Eric Vermetten
- New York University School of Medicine, Department of Psychiatry, New York, NY, USA
- Arq, Psychotrauma Reseach Expert Group, Diemen, NH, Netherlands
- Leiden University Medical Center, Department of Psychiatry, Leiden, ZH, NL, Netherlands
- Netherlands Defense Department, Research Center, Utrecht, UT, Netherlands
| | - Christiaan H Vinkers
- Amsterdam UMC (location VUmc), Department of Anatomy and Neurosciences, Amsterdam, Holland, NL, Netherlands
- Amsterdam UMC (location VUmc), Department of Psychiatry, Amsterdam, Holland, NL, Netherlands
| | - Joanne Voisey
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, AU, Australia
- Queensland University of Technology, School of Biomedical Sciences, Kelvin Grove, QLD, AU, Australia
| | - Yunpeng Wang
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, DK, Denmark
- Mental Health Centre Sct. Hans, Institute of Biological Psychiatry, Roskilde, DK, Denmark
- Oslo University Hospital, KG Jebsen Centre for Psychosis Research, Norway Division of Mental Health and Addiction, Oslo, NO, USA
| | - Zhewu Wang
- Ralph H Johnson VA Medical Center, Department of Mental Health, Charleston, SC, USA
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston, SC, USA
| | - Thomas Werge
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, DK, Denmark
- Mental Health Centre Sct. Hans, Institute of Biological Psychiatry, Roskilde, DK, Denmark
- University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark
| | - Michelle A Williams
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Douglas E Williamson
- Durham VA Medical Center, Research, Durham, NC, USA
- Duke University, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
| | - Sherry Winternitz
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Christiane Wolf
- University Hospital of Würzburg, Center of Mental Health, Psychiatry, Psychosomatics and Psychotherapy, Würzburg, DE, Germany
| | - Erika J Wolf
- VA Boston Healthcare System, National Center for PTSD, Boston, MA, USA
| | | | - Rachel Yehuda
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
- James J Peters VA Medical Center, Department of Mental Health, Bronx, NY, USA
| | - Ross McD Young
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, AU, Australia
- Queensland University of Technology, School of Psychology and Counseling, Faculty of Health, Kelvin Grove, QLD, AU, Australia
| | - Keith A Young
- Baylor Scott and White Central Texas, Department of Psychiatry, Temple, TX, USA
- CTVHCS, COE for Research on Returning War Veterans, Waco, TX, USA
| | - Hongyu Zhao
- Yale University, Department of Biostatistics, New Haven, CT, USA
| | - Lori A Zoellner
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
| | - Israel Liberzon
- University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, USA
| | - Kerry J Ressler
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Magali Haas
- Cohen Veterans Bioscience, Cambridge, MA, USA
| | - Karestan C Koenen
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, USA
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA, USA
- Harvard School of Public Health, Department of Epidemiology, Boston, MA, USA
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19
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Abstract
BACKGROUND PTSD is associated with high levels of vocational difficulty, and research on relationships between PTSD and vocational adjustment may be relevant to vocational rehabilitation services to achieve optimal outcomes. Veteran perception of ability to cope with stressors in the workplace setting may play a role in rehabilitation outcome. OBJECTIVE This article outlines preliminary steps in the development of the Vocational Efficacy in Trauma Survivors Scale (VETSS), to measure perceived efficacy in managing PTSD symptoms in the workplace. This has potential to expand future options for research in vocational rehabilitation for veterans with PTSD. METHODS Veterans in outpatient treatment for PTSD at a large, mid-western Veterans Affairs Health Care System facility responded to items on the proposed instrument and items on other measures of vocational and psychological functioning to assess the potential validity of items for an instrument to measure vocational self-efficacy among veterans managing PTSD. RESULTS In a sample of 63 working veterans who receive outpatient care for PTSD, exploratory factor analysis identified two viable subscales, one tapping Workplace Coping, and another tapping Self-Disclosure. CONCLUSIONS Preliminary findings indicate that the measure demonstrated acceptable indications of reliability and validity, suggesting promise for future use in vocational rehabilitation research.
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Affiliation(s)
- J Irene Harris
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA
| | - Thad Q Strom
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA
| | - Christopher R Erbes
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA.,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Josef Ruzek
- U.S. Department of Veterans Affairs National Center for PTSD, Menlo Park, CA, USA.,Stanford University, Stanford, CA, USA.,Palo Alto University, Palo Alto, CA, USA
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20
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Davis LL, Resnick SG, Maieritsch KP, Weber KC, Erbes CR, Strom TQ, McCall KP, Kyriakides TC. Employment outcomes from VA vocational services involving transitional work for veterans with a diagnosis of posttraumatic stress disorder. Psychiatr Rehabil J 2019; 42:257-267. [PMID: 30945920 PMCID: PMC6910199 DOI: 10.1037/prj0000357] [Citation(s) in RCA: 5] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Transitional work (TW) for veterans with psychiatric disabilities is the predominant model of vocational rehabilitation in the Veterans Health Administration (VA). Although, on average, TW employment outcomes have been demonstrated to be inferior to supported employment, little is known about the potential subgroup of veterans for which TW may be most effective. This study of veterans with posttraumatic stress disorder (PTSD) examines differences in competitive employment outcomes and identifies characteristics of veterans who chose to engage in TW compared with those who did not. METHOD A post hoc comparative subgroup analysis of veterans with PTSD randomly assigned to TW as part of a randomized controlled trial was conducted. Veterans were divided into 2 subgroups: those who engaged in TW (n = 141) and nonengagers (n = 129). Differences in baseline characteristics were examined and 18-month employment outcomes were compared. RESULTS There were no differences in 18-month employment outcomes between TW engagers and nonengagers. Compared with TW engagers, those that did not engage in TW were 2.5 times more likely to get a competitive job within the first 6 months and were less likely to obtain lower skilled jobs. Younger age, adequate housing, personal means of transportation, and recent work history factor into the odds of gaining and maintaining competitive work. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Consistent with past research, engagement in TW did not result in improved long-term competitive employment outcomes for veterans with PTSD. Those who did not engage in TW were more likely to gain a competitive job within the first 6 months. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Lori L Davis
- Research and Development Service, Tuscaloosa VA Medical Center
| | | | | | | | | | - Thad Q Strom
- Department of Psychiatry, University of Minnesota Medical School
| | | | - Tassos C Kyriakides
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System
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21
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Meis LA, Noorbaloochi S, Campbell EMH, Erbes CR, Polusny MA, Velasquez TL, Bangerter A, Cutting A, Eftekhari A, Rosen C, Tuerk PW, Burmeister LB, Spoont MR. Sticking it out in trauma-focused treatment for PTSD: It takes a village. J Consult Clin Psychol 2019; 87:246-256. [PMID: 30777776 PMCID: PMC6548182 DOI: 10.1037/ccp0000386] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE One in 3 veterans will dropout from trauma-focused treatments for posttraumatic stress disorder (PTSD). Social environments may be particularly important to influencing treatment retention. We examined the role of 2 support system factors in predicting treatment dropout: social control (direct efforts by loved ones to encourage veterans to participate in treatment and face distress) and symptom accommodation (changes in loved ones' behavior to reduce veterans' PTSD-related distress). METHOD Veterans and a loved one were surveyed across 4 VA hospitals. All veterans were initiating prolonged exposure therapy or cognitive processing therapy (n = 272 dyads). Dropout was coded through review of VA hospital records. RESULTS Regression analyses controlled for traditional, individual-focused factors likely to influence treatment dropout. We found that, even after accounting for these factors, veterans who reported their loved ones encouraged them to face distress were twice as likely to remain in PTSD treatment than veterans who denied such encouragement. CONCLUSIONS Clinicians initiating trauma-focused treatments with veterans should routinely assess how open veterans' support systems are to encouraging veterans to face their distress. Outreach to support networks is warranted to ensure loved ones back the underlying philosophy of trauma-focused treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Laura A. Meis
- Minneapolis Veterans Affairs Health Care System, Center for Care Delivery & Outcomes Research
- University of Minnesota, Medical School, Department of Medicine
| | - Siamak Noorbaloochi
- Minneapolis Veterans Affairs Health Care System, Center for Care Delivery & Outcomes Research
- University of Minnesota, Medical School, Department of Medicine
| | - Emily M. Hagel Campbell
- Minneapolis Veterans Affairs Health Care System, Center for Care Delivery & Outcomes Research
| | - Christopher R. Erbes
- Minneapolis Veterans Affairs Health Care System, Center for Care Delivery & Outcomes Research
- University of Minnesota, Medical School, Department of Psychiatry
| | - Melissa A. Polusny
- Minneapolis Veterans Affairs Health Care System, Center for Care Delivery & Outcomes Research
- University of Minnesota, Medical School, Department of Psychiatry
| | - Tina L. Velasquez
- Minneapolis Veterans Affairs Health Care System, Center for Care Delivery & Outcomes Research
| | - Ann Bangerter
- Minneapolis Veterans Affairs Health Care System, Center for Care Delivery & Outcomes Research
| | - Andrea Cutting
- Minneapolis Veterans Affairs Health Care System, Center for Care Delivery & Outcomes Research
| | - Afsoon Eftekhari
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System
| | - Craig Rosen
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System
| | - Peter W. Tuerk
- University of Virginia, Sheila C Johnson Center for Human Services
| | | | - Michele R. Spoont
- Minneapolis Veterans Affairs Health Care System, Center for Care Delivery & Outcomes Research
- University of Minnesota, Medical School, Department of Medicine
- University of Minnesota, Medical School, Department of Psychiatry
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22
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Hansen LP, Kinskey C, Koffel E, Polusny M, Ferguson J, Schmer-Galunder S, Erbes CR. Sleep Patterns and Problems Among Army National Guard Soldiers. Mil Med 2018; 183:e396-e401. [PMID: 29788128 DOI: 10.1093/milmed/usy107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/26/2018] [Indexed: 11/12/2022] Open
Abstract
Introduction Adequate sleep plays an integral role in the physical and mental health of individuals, while simultaneously influencing their cognitive and work performance. Having recognized this, the U.S. Army has focused efforts on improving soldiers' healthy sleep behaviors. This study examines the extent to which mental health, alcohol use, and certain sleep hygiene behaviors predict sleep problems within an Army National Guard sample (N = 438). Materials and Methods This manuscript is part of a larger study approved through the Minneapolis Veterans Affairs Medical Center Institutional Review Board. Mailed surveys were sent to Minnesota Army National Guard soldiers collecting data on sleep hygiene behaviors, mental health symptoms (post-traumatic stress disorder and depression), and alcohol use. Predictors of sleep problems were evaluated with ordinary least squares multiple linear regression analyses, regressing Insomnia Severity Index total scores on demographic variables, post-traumatic stress disorder (PTSD), depression, alcohol use, sleep hygiene factors (routine and consumption activity; both derived from exploratory factor analysis), and technology use (multiple device use and use before bed). Results Overall, the majority of participants did not endorse high levels of sleep impairment, while 16.4% screened positive for moderate or even severe levels of clinical insomnia. Bivariate correlations demonstrated that sleep problems were correlated with PTSD symptoms (r = 0.41, p < 0.001), depression (r = 0.49, p < 0.001), Sleep Hygiene Routine (r = -0.34, p < 0.001), and more frequent use of multiple devices before bed (r = 0.15, p = 0.002). The overall regression model predicting sleep problems was significant (R2 = 0.35, adj R2 = 0.34, F[8,408] = 27.58, p < 0.001). Independent predictors of sleep problems included gender (B = 0.99, β = 0.09, t = 2.10, p = 0.036), PTSD (B = 0.89, β = 0.22, t = 4.86, p < 0.001), depression (B = 1.53, β = 0.20, t = 7.56, p < 0.001), and Sleep Hygiene Routine (B = -0.88, β = -0.23, t = -5.473, p < 0.001). Alcohol use, Sleep Hygiene Consumption, and technology use did not emerge as independent predictors. Conclusion Although most soldiers denied sleep problems, a sizeable minority met screening criteria for clinical insomnia. Greater numbers of sleep-related complaints were related to psychological distress including depressive and PTSD symptoms, while adherence to a bedtime routine (Sleep Hygiene Routine) showed an inverse relationship. Alcohol use and sleep hygiene consumption activities were not predictive of sleep problems, suggesting that different sleep hygiene behaviors have differential relationships with sleep problems. Screening and intervention for specific sleep problems may be helpful even very early in Army National Guard service members' careers. Particular focus may be needed for those showing signs of emotional distress, such as PTSD or depression. Future research examining the impact of individual sleep hygiene components is warranted.
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Affiliation(s)
- Lucas P Hansen
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN
| | - Caroline Kinskey
- Minnesota State University, Mankato, 103 Armstrong Hall, Mankato, MN
| | - Erin Koffel
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN.,Center for Chronic Disease Outcomes Research, 1 Veterans Drive, Minneapolis, MN.,Department of Psychiatry, University of Minnesota Medical School, 2450 Riverside Ave South, Minneapolis, MN
| | - Melissa Polusny
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN.,Center for Chronic Disease Outcomes Research, 1 Veterans Drive, Minneapolis, MN.,Department of Psychiatry, University of Minnesota Medical School, 2450 Riverside Ave South, Minneapolis, MN
| | - John Ferguson
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN.,Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, 420 Delaware St. SE, MMC 297, Minneapolis, MN
| | | | - Christopher R Erbes
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN.,Center for Chronic Disease Outcomes Research, 1 Veterans Drive, Minneapolis, MN.,Department of Psychiatry, University of Minnesota Medical School, 2450 Riverside Ave South, Minneapolis, MN
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23
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Kang SS, Erbes CR, Lamberty GJ, Thuras P, Sponheim SR, Polusny MA, Moran AC, Van Voorhis AC, Lim KO. Transcendental meditation for veterans with post-traumatic stress disorder. Psychol Trauma 2018; 10:675-680. [PMID: 30024219 DOI: 10.1037/tra0000346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Transcendental Meditation (TM) is a mental technique using a mantra to facilitate meditation. TM has a potential for treating symptoms of posttraumatic stress disorder (PTSD), but its clinical efficacy remains to be clarified. This pilot study evaluated the acceptability, preliminary effectiveness, and neurophysiology of TM for veterans with PTSD. METHOD Twenty-nine veterans (20.7% female) were recruited from a major medical center and enrolled in the study. TM instruction was provided by certified TM teachers from the Maharishi Foundation and consisted of 8 weeks of individual and group-based meditation instruction and practice. Outcomes were assessed at baseline, during treatment, posttreatment, and at 2-month follow-up, and included clinical interviews, self-report questionnaires, and electroencephalography (EEG) recorded during resting and meditation states. RESULTS From baseline to posttreatment, participants reported reductions in PTSD symptoms, experiential avoidance, and depressive and somatic symptoms, as well as increases on measures of mindfulness and quality of life. Gains were either maintained or continued to improve through the 2-month follow-up. Compared to baseline, EEG spectral power increased in low-frequency bands (1-7 Hz) at posttreatment and follow-up and only during meditation states suggesting TM-specific changes in brain state associated with the intervention. CONCLUSIONS TM appears to be an acceptable and effective treatment for veterans with PTSD that warrants further study regarding specific outcomes and beneficial changes in brain function. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Seung Suk Kang
- Department of Psychiatry, University of Missouri- Kansas City
| | | | | | - Paul Thuras
- Minneapolis Veterans Affairs Health Care System
| | | | | | | | | | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Twin Cities
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24
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Bishop JR, Lee AM, Mills LJ, Thuras PD, Eum S, Clancy D, Erbes CR, Polusny MA, Lamberty GJ, Lim KO. Methylation of FKBP5 and SLC6A4 in Relation to Treatment Response to Mindfulness Based Stress Reduction for Posttraumatic Stress Disorder. Front Psychiatry 2018; 9:418. [PMID: 30279666 PMCID: PMC6153325 DOI: 10.3389/fpsyt.2018.00418] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 12/12/2017] [Accepted: 08/15/2018] [Indexed: 01/18/2023] Open
Abstract
Mindfulness Based Stress Reduction (MBSR) is an effective non-pharmacologic treatment for veterans with PTSD. Extensive work has identified epigenetic factors related to PTSD disease risk and pathophysiology, but how these factors influence treatment response is unclear. Serotonin signaling and hypothalamic-pituitary-adrenal (HPA) axis functioning may be perturbed in PTSD and are molecular pathways targeted by PTSD treatments. To identify potential biomarkers for treatment response, we utilized genomic DNA isolated from peripheral blood samples from veterans with PTSD who were responders (n = 11) or non-responders (n = 11) to MBSR as part of a clinical trial. We assessed methylation levels at CpG sites in regions of the serotonin transporter (SLC6A4) previously associated with expression and depression outcomes, as well as the Intron 7 region of the FK506 binding protein 5 (FKBP5) containing known glucocorticoid response elements suggested to regulate this gene. Selected subjects were matched across MBSR responder status by baseline symptoms, age, sex, current smoking status, and current antidepressant use. Percent methylation was compared between responders and non-responders at baseline (pre-MBSR treatment). Additionally, percent change in methylation from baseline to post-treatment was compared between responders and non-responders. There was a significant time x responder group interaction for methylation in FKBP5 intron 7 bin 2 [F (1, 19) = 7.492, p = 0.013] whereby responders had a decrease in methylation and non-responders had an increase in methylation from before to after treatment in this region. Analyses of the three CpG sites within bin 2 revealed a significant time x responder group interaction for CpG_35558513 [F (1, 19) = 5.551, p = 0.029] which resides in a known glucocorticoid response element (GRE). Decreases in FKBP5 methylation after treatment in responders as compared to increases in non-responders suggest that effective meditation intervention may be associated with stress-related pathways at the molecular level. These preliminary findings suggest that DNA methylation signatures within FKBP5 are potential indicators of response to meditation treatment in PTSD and require validation in larger cohorts.
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Affiliation(s)
- Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Adam M Lee
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
| | - Lauren J Mills
- University of Minnesota Supercomputing Institute, Minneapolis, MN, United States
| | - Paul D Thuras
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States.,Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Seenae Eum
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
| | - Doris Clancy
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Christopher R Erbes
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States.,Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Melissa A Polusny
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States.,Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Gregory J Lamberty
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States.,Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States.,Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States.,Defense Veterans Brain Injury Center, Minneapolis, MN, United States
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25
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26
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Harris JI, Strom TQ, Ferrier-Auerbach AG, Kaler ME, Hansen LP, Erbes CR. Workplace social support in job satisfaction among veterans with posttraumatic stress symptoms: A preliminary correlational study. PLoS One 2017; 12:e0181344. [PMID: 28777812 PMCID: PMC5544179 DOI: 10.1371/journal.pone.0181344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 06/29/2017] [Indexed: 11/18/2022] Open
Abstract
For Veterans managing PTSD symptoms, returning to vocational functioning is often challenging; identifying modifiable variables that can contribute to positive vocational adjustment is critical to improved vocational rehabilitation services. Workplace social support has proven to be important in vocational adjustment in both general population and vocational rehabilitation samples, but this area of inquiry has received little attention among Veterans with PTSD symptoms. In this small correlational study, employed Veterans (N = 63) presenting for outpatient PTSD treatment at a VA Health Care System completed surveys assessing demographic variables, PTSD symptoms, workplace social support, and job satisfaction. Workplace social support contributed to the prediction of job satisfaction. It is of note that workplace social support predicted a larger proportion of the variance in employment satisfaction than PTSD symptoms. Further research on workplace social support as a vocational rehabilitation resource for Veterans with PTSD is indicated.
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Affiliation(s)
- J. I. Harris
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
- University of Minnesota Department of Psychiatry, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Thad Q. Strom
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
- University of Minnesota Department of Psychiatry, Minneapolis, Minnesota, United States of America
| | | | - Matthew E. Kaler
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Lucas P. Hansen
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Christopher R. Erbes
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
- University of Minnesota Department of Psychiatry, Minneapolis, Minnesota, United States of America
- Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, United States of America
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27
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Polusny MA, Erbes CR, Kramer MD, Thuras P, DeGarmo D, Koffel E, Litz B, Arbisi PA. Resilience and Posttraumatic Stress Disorder Symptoms in National Guard Soldiers Deployed to Iraq: A Prospective Study of Latent Class Trajectories and Their Predictors. J Trauma Stress 2017; 30:351-361. [PMID: 28763565 DOI: 10.1002/jts.22199] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 08/02/2016] [Revised: 04/03/2017] [Accepted: 04/13/2017] [Indexed: 11/10/2022]
Abstract
This study examined the prospective course of posttraumatic stress disorder (PTSD) symptoms in a cohort of National Guard soldiers (N = 522) deployed to combat operations in Iraq. Participants were assessed 4 times: 1 month before deployment, 2-3 months after returning from deployment, 1 year later, and 2 years postdeployment. Growth mixture modeling revealed 3 distinct trajectories: low-stable symptoms, resilient, 76.4%; new-onset symptoms, 14.2%; and chronic distress, 9.4%. Relative to the resilient class, membership in both the new-onset symptoms and chronic distress trajectory classes was predicted by negative emotionality/neuroticism, odds ratios (ORs) = 1.09, 95% CI [1.02, 1.17], and OR = 1.22, 95% CI [1.09,1.35], respectively; and combat exposure, OR = 1.07, 95% CI [1.02, 1.12], and OR = 1.12, 95% CI [1.02, 1.24], respectively. Membership in the new-onset trajectory class was predicted by predeployment military preparedness, OR = 0.95, 95% CI [0.91, 0.98], perceived threat during deployment, OR = 1.07, 95% CI [1.03, 1.10], and stressful life events following deployment, OR = 1.44, 95% CI [1.05, 1.96]. Prior deployment to Iraq or Afghanistan, OR = 3.85, 95% CI [1.72, 8.69], predeployment depression, OR = 1.27, 95% CI [1.20, 1.36], and predeployment concerns about a deployment's impact on civilian/family life, OR = 1.09, 95% CI [1.02, 1.16], distinguished the chronic distress group relative to the resilient group. Identifying predeployment vulnerability and postdeployment contextual factors provides insight for future efforts to bolster resilience, prevent, and treat posttraumatic symptoms.
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Affiliation(s)
- Melissa A Polusny
- Minneapolis VA Medical Center, Minneapolis, Minnesota, USA.,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Christopher R Erbes
- Minneapolis VA Medical Center, Minneapolis, Minnesota, USA.,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mark D Kramer
- Minneapolis VA Medical Center, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Paul Thuras
- Minneapolis VA Medical Center, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Dave DeGarmo
- Prevention Science Institute, and the Department of Educational Methodology, Policy, and Leadership, University of Oregon, Eugene, Oregon, USA
| | - Erin Koffel
- Minneapolis VA Medical Center, Minneapolis, Minnesota, USA.,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Brett Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychological and Brain Sciences and Department of Psychiatry, Boston University, Boston, Massachusetts, USA
| | - Paul A Arbisi
- Minneapolis VA Medical Center, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA.,Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
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28
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Erbes CR, Kramer M, Arbisi PA, DeGarmo D, Polusny MA. Characterizing spouse/partner depression and alcohol problems over the course of military deployment. J Consult Clin Psychol 2017; 85:297-308. [PMID: 28333532 DOI: 10.1037/ccp0000190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Mark Kramer
- Department of Psychiatry, University of Minnesota
| | | | - David DeGarmo
- Department of Educational Methodology, Policy, & Leadership, University of Oregon
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29
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Meis LA, Erbes CR, Kramer MD, Arbisi PA, Kehle-Forbes SM, DeGarmo DS, Shallcross SL, Polusny MA. Using reinforcement sensitivity to understand longitudinal links between PTSD and relationship adjustment. J Fam Psychol 2017; 31:71-81. [PMID: 27077237 PMCID: PMC6791525 DOI: 10.1037/fam0000195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/05/2023]
Abstract
There is limited research testing longitudinal models of how posttraumatic stress disorder (PTSD) severity leads to impaired relationship adjustment. The present study evaluated 2 potential mechanisms among a longitudinal sample of National Guard soldiers deployed to the Iraq War: (1) sensitivity to cues associated with punishment within intimate relationships and (2) sensitivity to cues associated with incentives in intimate relationships. Participants were surveyed by mail 1 year after an extended 16-month combat deployment and again 2 years later. Using a cross-lagged panel analysis with 2 mediators (relationship-specific threat and incentive sensitivity), findings indicated Time 1 PTSD symptom severity significantly eroded relationship adjustment over time through greater sensitivity to cues of relationship-related punishment, but not through incentive sensitivity. Additionally, findings indicated sensitivity to cues of relationship-related threats maintains symptoms of PTSD while sensitivity to cues of relationship-related incentives maintains relationship adjustment. Finally, PTSD symptoms significantly predicted erosion of relationship adjustment over time; however, associations from relationship adjustment to changes in PTSD severity over time were nonsignificant. Findings are discussed within the context of reinforcement sensitivity theory and emotional processing theory of PTSD. (PsycINFO Database Record
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Affiliation(s)
- Laura A Meis
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs (VA) Health Care System
| | - Christopher R Erbes
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System
| | | | | | | | | | | | - Melissa A Polusny
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System
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Erbes CR, Thuras P, Lim KO, Polusny MA. Letter in response to Drs Lee and Hoge's commentary. Evid Based Ment Health 2017; 20:31. [PMID: 28108598 PMCID: PMC10688415 DOI: 10.1136/eb-2016-102595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Christopher R Erbes
- Minneapolis VA Health Care System, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
- Department of Psychiatry, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
- Department of Mental and Behavioral Health PSL, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Paul Thuras
- Department of Psychiatry, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
- Department of Mental and Behavioral Health PSL, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
- Minneapolis VA Health Care System, Geriatric Education Research and Clinical Center, Minneapolis, Minnesota, USA
| | - Melissa A Polusny
- Minneapolis VA Health Care System, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
- Department of Psychiatry, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
- Department of Mental and Behavioral Health PSL, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Vogt D, Erbes CR, Polusny MA. Role of social context in posttraumatic stress disorder (PTSD). Curr Opin Psychol 2017; 14:138-142. [PMID: 28813313 DOI: 10.1016/j.copsyc.2017.01.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/11/2017] [Accepted: 01/18/2017] [Indexed: 11/25/2022]
Abstract
Research has increasingly focused on the role that social circumstances before, during, and after trauma exposure play in risk for posttraumatic stress disorder (PTSD). In this article, we provide an overview of conceptual and methodological challenges to the study of social context's role in PTSD and propose strategies that can mitigate these challenges. Throughout the article, we draw from the current literature to illustrate how attention to these issues can lead to advances in our knowledge of the role of social context in PTSD.
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Affiliation(s)
- Dawne Vogt
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Boston University School of Medicine,72 East Concord Street, Boston, MA 02118, USA.
| | - Christopher R Erbes
- Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive (68-2), Minneapolis, MN 55417, USA; Department of Psychiatry, University of Minnesota Medical School, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
| | - Melissa A Polusny
- Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive (68-2), Minneapolis, MN 55417, USA; Department of Psychiatry, University of Minnesota Medical School, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
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Koffel E, Kuhn E, Petsoulis N, Erbes CR, Anders S, Hoffman JE, Ruzek JI, Polusny MA. A randomized controlled pilot study of CBT-I Coach: Feasibility, acceptability, and potential impact of a mobile phone application for patients in cognitive behavioral therapy for insomnia. Health Informatics J 2016; 24:3-13. [PMID: 27354394 DOI: 10.1177/1460458216656472] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There has been growing interest in utilizing mobile phone applications (apps) to enhance traditional psychotherapy. Previous research has suggested that apps may facilitate patients' completion of cognitive behavioral therapy for insomnia (CBT-I) tasks and potentially increase adherence. This randomized clinical trial pilot study ( n = 18) sought to examine the feasibility, acceptability, and potential impact on adherence and sleep outcomes related to CBT-I Coach use. All participants were engaged in CBT-I, with one group receiving the app as a supplement and one non-app group. We found that patients consistently used the app as intended, particularly the sleep diary and reminder functions. They reported that it was highly acceptable to use. Importantly, the app did not compromise or undermine benefits of cognitive behavioral therapy for insomnia and patients in both groups had significantly improved sleep outcomes following treatment.
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Affiliation(s)
- Erin Koffel
- Minneapolis Veteran Affairs Health Care System, USA; University of Minnesota Medical School, USA
| | - Eric Kuhn
- National Center for PTSD (NCPTSD), Dissemination and Training (D&T) Division, USA; Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS), USA
| | | | - Christopher R Erbes
- Minneapolis Veteran Affairs Health Care System, USA; University of Minnesota Medical School, USA
| | | | - Julia E Hoffman
- National Center for PTSD (NCPTSD), Dissemination and Training (D&T) Division, USA; Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS), USA
| | - Josef I Ruzek
- National Center for PTSD (NCPTSD), Dissemination and Training (D&T) Division, USA; Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS), USA
| | - Melissa A Polusny
- Minneapolis Veteran Affairs Health Care System, USA; University of Minnesota Medical School, USA
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Shallcross SL, Arbisi PA, Polusny MA, Kramer MD, Erbes CR. Social Causation Versus Social Erosion: Comparisons of Causal Models for Relations Between Support and PTSD Symptoms. J Trauma Stress 2016; 29:167-75. [PMID: 27077494 DOI: 10.1002/jts.22086] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 11/06/2022]
Abstract
Social support is a robust correlate of posttraumatic stress disorder (PTSD) symptoms and of general psychological distress (Ozer, Best, Lipsey, & Weiss, 2003). The nature of the causal relationship between support and PTSD remains the subject of debate, with 2 models, social erosion and social causation, often used to explain findings. Despite extensive research using these models, no studies of which we are aware have included tests of both models within the same series of analyses, across more than 2 time points, in veterans. These competing models were tested in a sample of National Guard soldiers (N = 521) who completed measures of perceived social support and the PTSD Checklist-Military version (Weathers, Litz, Herman, Huska, & Keane, 1993) at 3 months, 15 months, and 27 months following a combat deployment to Iraq. Analyses were run separately for overall PTSD symptoms and the PTSD components of intrusion, trauma-avoidance, dysphoria, and hyperarousal. Both the social erosion (βs ranging from -.10 to -.19) and social causation (βs ranging from -.08 to -.13) hypotheses were supported. Results suggested PTSD-specific symptom dimensions may both erode and be influenced by social support, whereas general psychological distress erodes social support. Implications for clinical intervention and research are discussed.
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Affiliation(s)
- Sandra L Shallcross
- Psychology Department, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Paul A Arbisi
- Psychology Department, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,University of Minnesota, Medical School, Minneapolis, Minnesota, USA
| | - Melissa A Polusny
- Psychology Department, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,University of Minnesota, Medical School, Minneapolis, Minnesota, USA.,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Mark D Kramer
- University of Minnesota, Medical School, Minneapolis, Minnesota, USA.,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Christopher R Erbes
- University of Minnesota, Medical School, Minneapolis, Minnesota, USA.,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Kramer MD, Arbisi PA, Thuras PD, Krueger RF, Erbes CR, Polusny MA. The class-dimensional structure of PTSD before and after deployment to Iraq: Evidence from direct comparison of dimensional, categorical, and hybrid models. J Anxiety Disord 2016; 39:1-9. [PMID: 26896605 DOI: 10.1016/j.janxdis.2016.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/13/2015] [Revised: 12/16/2015] [Accepted: 02/06/2016] [Indexed: 10/22/2022]
Abstract
The assumption of specific etiology in posttraumatic stress disorder (PTSD) differentiates the disorder from most other psychiatric conditions. A 'risky test' of the assumption of specific etiology and resultant trauma-related symptom dimensions was conducted through structural modeling of PTSD symptoms in soldiers before (N=522) and after (n=423) a combat deployment to Iraq. If PTSD represents a discrete diagnostic entity that emerges after trauma exposure, we hypothesized either the number of latent classes should increase from pre- to post-deployment or symptom dimensions should qualitatively distinguish affected from unaffected classes following trauma exposure. Comparison of latent structural models revealed best fitting hybrid models for PTSD and depression with strong invariance of symptom dimensions across classes both before and after deployment and only quantitative (i.e., severity) differences between classes. These findings suggest PTSD is generally well-conceptualized as a dimensional syndrome worsened but not necessarily elicited by trauma exposure.
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Affiliation(s)
- Mark D Kramer
- Center for Chronic Disease Outcome Research, Minneapolis VA Healthcare System, B9-152, One Veterans Drive, Minneapolis, MN 55417, USA; Minneapolis VA Healthcare System, B68-2, One Veterans Drive, Minneapolis, MN 55417, USA; University of Minnesota-Department of Psychiatry, F282/2A West, 2450 Riverside Ave S, Minneapolis, MN 55454, USA.
| | - Paul A Arbisi
- Minneapolis VA Healthcare System, B68-2, One Veterans Drive, Minneapolis, MN 55417, USA; University of Minnesota-Department of Psychiatry, F282/2A West, 2450 Riverside Ave S, Minneapolis, MN 55454, USA; University of Minnesota-Department of Psychology, N218 Elliott Hall, 75 E River Rd, Minneapolis, MN 55417, USA.
| | - Paul D Thuras
- Minneapolis VA Healthcare System, B68-2, One Veterans Drive, Minneapolis, MN 55417, USA; University of Minnesota-Department of Psychiatry, F282/2A West, 2450 Riverside Ave S, Minneapolis, MN 55454, USA.
| | - Robert F Krueger
- University of Minnesota-Department of Psychology, N218 Elliott Hall, 75 E River Rd, Minneapolis, MN 55417, USA.
| | - Christopher R Erbes
- Center for Chronic Disease Outcome Research, Minneapolis VA Healthcare System, B9-152, One Veterans Drive, Minneapolis, MN 55417, USA; Minneapolis VA Healthcare System, B68-2, One Veterans Drive, Minneapolis, MN 55417, USA; University of Minnesota-Department of Psychiatry, F282/2A West, 2450 Riverside Ave S, Minneapolis, MN 55454, USA.
| | - Melissa A Polusny
- Center for Chronic Disease Outcome Research, Minneapolis VA Healthcare System, B9-152, One Veterans Drive, Minneapolis, MN 55417, USA; Minneapolis VA Healthcare System, B68-2, One Veterans Drive, Minneapolis, MN 55417, USA; University of Minnesota-Department of Psychiatry, F282/2A West, 2450 Riverside Ave S, Minneapolis, MN 55454, USA.
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Abstract
There is limited understanding of the etiology and temporal relations of chronic pain, sleep complaints, and depression/anxiety. Several models have been proposed by which sleep disruption represents a common mechanism for the comorbidity of these symptoms. The goals of this study were to 1) clarify the boundaries of these domains and to 2) examine the relations of these symptoms over time following exposure to stressful and potentially traumatic experiences during a combat deployment. We found support for three distinct domains of sleep complaints, internalizing symptoms, and physical complaints. We tested two competing models that have been proposed in the literature, controlling for negative and positive emotionality. Internalizing symptoms strongly mediated the relation between sleep complaints and pain (total effect = .15, direct effect = -.05). The study suggests that increases in sleep complaints immediately following deployment increase the risk of internalizing symptoms and pain several years after deployment.
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Affiliation(s)
- Erin Koffel
- Center for Chronic Disease Outcomes Research, Minneapolis Veteran Affairs Health Care System, Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Erin E Krebs
- Center for Chronic Disease Outcomes Research, Minneapolis Veteran Affairs Health Care System, University of Minnesota Medical School, Minneapolis, MN
| | - Paul A Arbisi
- Minneapolis Veteran Affairs Health Care System, Departments of Psychology and Psychiatry, University of Minnesota, Minneapolis, MN
| | - Christopher R Erbes
- Center for Chronic Disease Outcomes Research, Minneapolis Veteran Affairs Health Care System, Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Melissa A Polusny
- Center for Chronic Disease Outcomes Research, Minneapolis Veteran Affairs Health Care System, Department of Psychiatry, University of Minnesota, Minneapolis, MN
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Abstract
BACKGROUND Research suggests that personality traits have both direct and indirect effects on the development of psychological symptoms, with indirect effects mediated by stressful or traumatic events. This study models the direct influence of personality traits on residualized changes in internalizing and externalizing symptoms following a stressful and potentially traumatic deployment, as well as the indirect influence of personality on symptom levels mediated by combat exposure. METHOD We utilized structural equation modeling with a longitudinal prospective study of 522 US National Guard soldiers deployed to Iraq. Analyses were based on self-report measures of personality, combat exposure, and internalizing and externalizing symptoms. RESULTS Both pre-deployment Disconstraint and externalizing symptoms predicted combat exposure, which in turn predicted internalizing and externalizing symptoms. There was a significant indirect effect for pre-deployment externalizing symptoms on post-deployment externalizing via combat exposure (p < 0.01). Negative Emotionality and pre-deployment internalizing symptoms directly predicted post-deployment internalizing symptoms, but both were unrelated to combat exposure. No direct effects of personality on residualized changes in externalizing symptoms were found. CONCLUSIONS Baseline symptom dimensions had significant direct and indirect effects on post-deployment symptoms. Controlling for both pre-exposure personality and symptoms, combat experiences remained positively related to both internalizing and externalizing symptoms. Implications for diagnostic classification are discussed.
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Affiliation(s)
- Erin Koffel
- Center for Chronic Disease Outcomes Research
- Minneapolis VA Healthcare System
- University of Minnesota—Department of Psychiatry
| | - Mark D. Kramer
- Minneapolis VA Healthcare System
- University of Minnesota—Department of Psychiatry
| | - Paul A. Arbisi
- Minneapolis VA Healthcare System
- University of Minnesota—Department of Psychiatry
- University of Minnesota—Department of Psychology
| | - Christopher R. Erbes
- Center for Chronic Disease Outcomes Research
- Minneapolis VA Healthcare System
- University of Minnesota—Department of Psychiatry
| | | | - Melissa A. Polusny
- Center for Chronic Disease Outcomes Research
- Minneapolis VA Healthcare System
- University of Minnesota—Department of Psychiatry
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Polusny MA, Erbes CR, Thuras P, Moran A, Lamberty GJ, Collins RC, Rodman JL, Lim KO. Mindfulness-Based Stress Reduction for Posttraumatic Stress Disorder Among Veterans: A Randomized Clinical Trial. JAMA 2015; 314:456-65. [PMID: 26241597 DOI: 10.1001/jama.2015.8361] [Citation(s) in RCA: 193] [Impact Index Per Article: 21.4] [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: 11/14/2022]
Abstract
IMPORTANCE Mindfulness-based interventions may be acceptable to veterans who have poor adherence to existing evidence-based treatments for posttraumatic stress disorder (PTSD). OBJECTIVE To compare mindfulness-based stress reduction with present-centered group therapy for treatment of PTSD. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 116 veterans with PTSD recruited at the Minneapolis Veterans Affairs Medical Center from March 2012 to December 2013. Outcomes were assessed before, during, and after treatment and at 2-month follow-up. Data collection was completed on April 22, 2014. INTERVENTIONS Participants were randomly assigned to receive mindfulness-based stress reduction therapy (n = 58), consisting of 9 sessions (8 weekly 2.5-hour group sessions and a daylong retreat) focused on teaching patients to attend to the present moment in a nonjudgmental, accepting manner; or present-centered group therapy (n = 58), an active-control condition consisting of 9 weekly 1.5-hour group sessions focused on current life problems. MAIN OUTCOMES AND MEASURES The primary outcome, change in PTSD symptom severity over time, was assessed using the PTSD Checklist (range, 17-85; higher scores indicate greater severity; reduction of 10 or more considered a minimal clinically important difference) at baseline and weeks 3, 6, 9, and 17. Secondary outcomes included PTSD diagnosis and symptom severity assessed by independent evaluators using the Clinician-Administered PTSD Scale along with improvements in depressive symptoms, quality of life, and mindfulness. RESULTS Participants in the mindfulness-based stress reduction group demonstrated greater improvement in self-reported PTSD symptom severity during treatment (change in mean PTSD Checklist scores from 63.6 to 55.7 vs 58.8 to 55.8 with present-centered group therapy; between-group difference, 4.95; 95% CI, 1.92-7.99; P=.002) and at 2-month follow-up (change in mean scores from 63.6 to 54.4 vs 58.8 to 56.0, respectively; difference, 6.44; 95% CI, 3.34-9.53, P < .001). Although participants in the mindfulness-based stress reduction group were more likely to show clinically significant improvement in self-reported PTSD symptom severity (48.9% vs 28.1% with present-centered group therapy; difference, 20.9%; 95% CI, 2.2%-39.5%; P = .03) at 2-month follow-up, they were no more likely to have loss of PTSD diagnosis (53.3% vs 47.3%, respectively; difference, 6.0%; 95% CI, -14.1% to 26.2%; P = .55). CONCLUSIONS AND RELEVANCE Among veterans with PTSD, mindfulness-based stress reduction therapy, compared with present-centered group therapy, resulted in a greater decrease in PTSD symptom severity. However, the magnitude of the average improvement suggests a modest effect. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01548742.
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Affiliation(s)
- Melissa A Polusny
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota2Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota3Department of Psychiatry, University of Minnesota, Minneapolis
| | - Christopher R Erbes
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota2Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota3Department of Psychiatry, University of Minnesota, Minneapolis
| | - Paul Thuras
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota3Department of Psychiatry, University of Minnesota, Minneapolis
| | - Amy Moran
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Greg J Lamberty
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota3Department of Psychiatry, University of Minnesota, Minneapolis
| | - Rose C Collins
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - John L Rodman
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Kelvin O Lim
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota3Department of Psychiatry, University of Minnesota, Minneapolis
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McCallum EB, Murdoch M, Erbes CR, Arbisi P, Polusny MA. Impact of Deployment-Related Sexual Stressors on Psychiatric Symptoms After Accounting for Predeployment Stressors: Findings From a U.S. National Guard Cohort. J Trauma Stress 2015; 28:307-13. [PMID: 26184776 DOI: 10.1002/jts.22019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/10/2022]
Abstract
This study used a longitudinal research design to examine the impact of predeployment stressors and deployment-related sexual stressors on self-reported psychiatric symptoms of U.S. National Guard soldiers returning from deployments to Iraq or Afghanistan. Prior to deployment, participants completed measures of depression and posttraumatic stress symptoms, along with an inventory of predeployment stressor experiences. At 3-months postdeployment, participants (468 men, 60 women) again completed self-report measures of psychiatric symptoms, along with an inventory of sexual stressors experienced during deployment. We compared a cross-sectional model of sexual stressors' impact on psychiatric symptoms, in which only postdeployment reports were considered, to a longitudinal model in which we adjusted for participants' predeployment stressors and psychiatric symptoms. No participants reported sexual assault during deployment, though sexual harassment was common. The cross-sectional model suggested that deployment-related sexual stressors were significantly associated with postdeployment depression (R(2) = .11) and posttraumatic stress symptoms (R(2) = .10). Once predeployment factors were taken into consideration, however, sexual stressors were no longer significant. The results did not support the notion of lasting negative impact for low-level sexual stressors (e.g., sexual harassment) during deployment after predeployment stressors are accounted for. Future studies of sexual stressors should consider longitudinal designs.
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Affiliation(s)
- Ethan B McCallum
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Maureen Murdoch
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Christopher R Erbes
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Paul Arbisi
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Melissa A Polusny
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Nelson NW, Anderson CR, Thuras P, Kehle-Forbes SM, Arbisi PA, Erbes CR, Polusny MA. Factors associated with inconsistency in self-reported mild traumatic brain injury over time among military personnel in Iraq. Br J Psychiatry 2015; 206:237-44. [PMID: 25614533 DOI: 10.1192/bjp.bp.114.149096] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 11/23/2022]
Abstract
BACKGROUND Estimates of the prevalence of mild traumatic brain injury (mTBI) among military personnel and combat veterans rely almost exclusively on retrospective self-reports; however, reliability of these reports has received little attention. AIMS To examine the consistency of reporting of mTBI over time and identify factors associated with inconsistent reporting. METHOD A longitudinal cohort of 948 US National Guard Soldiers deployed to Iraq completed self-report questionnaire screening for mTBI and psychological symptoms while in-theatre 1 month before returning home (time 1, T1) and 1 year later (time 2, T2). RESULTS Most respondents (n = 811, 85.5%) were consistent in their reporting of mTBI across time. Among those who were inconsistent in their reports (n = 137, 14.5%), the majority denied mTBI at T1 and affirmed mTBI at T2 (n = 123, 89.8%). Respondents rarely endorsed mTBI in-theatre and later denied mTBI (n = 14, 10.2% of those with inconsistent reports). Post-deployment post-traumatic stress symptoms and non-specific physical complaints were significantly associated with inconsistent report of mTBI. CONCLUSIONS Military service members' self-reports of mTBI are generally consistent over time; however, inconsistency in retrospective self-reporting of mTBI status is associated with current post-traumatic stress symptoms and non-specific physical health complaints.
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Affiliation(s)
- Nathaniel W Nelson
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Carolyn R Anderson
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Paul Thuras
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Shannon M Kehle-Forbes
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Paul A Arbisi
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Christopher R Erbes
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - Melissa A Polusny
- Nathaniel W. Nelson, PhD, Graduate School of Professional Psychology, University of St. Thomas and Minneapolis VA Health Care System, Minneapolis, Minnesota; Carolyn R. Anderson, PhD, Minneapolis VA Health Care System, Minneapolis, Minnesota; Paul Thuras, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Shannon M. Kehle-Forbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Paul A. Arbisi, PhD, Christopher R. Erbes, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota; Melissa A. Polusny, PhD, Minneapolis VA Health Care System, and Department of Psychiatry, University of Minnesota Medical School, and Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
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Abstract
Narrative therapy is a postmodern, collaborative therapy approach based on the elaboration of personal narratives for lived experiences. Many aspects of narrative therapy suggest it may have great potential for helping people who are negatively affected by traumatic experiences, including those diagnosed with posttraumatic stress disorder (PTSD). The potential notwithstanding, narrative therapy is relatively untested in any population, and has yet to receive empirical support for treatment among survivors of trauma. A pilot investigation of the use of narrative therapy with 14 veterans with a diagnosis of PTSD (11 treatment completers) is described. Participants completed structured diagnostic interviews and self-report assessments of symptoms prior to and following 11 to 12 sessions of narrative therapy. After treatment, 3 of 11 treatment completers no longer met criteria for PTSD and 7 of 11 had clinically significant decreases in PTSD symptoms as measured by the Clinician Administered PTSD Scale. Pre- to posttreatment effect sizes on outcomes ranged from 0.57 to 0.88. These preliminary results, in conjunction with low rates of treatment dropout (21.4%) and a high level of reported satisfaction with the treatment, suggest that further study of narrative therapy is warranted as a potential alternative to existing treatments for PTSD.
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Affiliation(s)
- Christopher R Erbes
- Mental Health Service Line, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA; Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
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Erbes CR, Stinson R, Kuhn E, Polusny M, Urban J, Hoffman J, Ruzek JI, Stepnowsky C, Thorp SR. Access, Utilization, and Interest in mHealth Applications Among Veterans Receiving Outpatient Care for PTSD. Mil Med 2014; 179:1218-22. [DOI: 10.7205/milmed-d-14-00014] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kehle-Forbes SM, Polusny MA, Erbes CR, Gerould H. Acceptability of prolonged exposure therapy among U.S. Iraq war veterans with PTSD symptomology. J Trauma Stress 2014; 27:483-7. [PMID: 25158642 DOI: 10.1002/jts.21935] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 11/10/2022]
Abstract
Despite efforts to increase the availability of prolonged exposure therapy (PE) within the Department of Veterans Affairs, little is known about the acceptability of PE among veteran populations. We queried a sample of 58 U.S. National Guard Iraq War veterans previously deployed to combat who screened positive for posttraumatic stress disorder (PTSD) as to whether they would prefer PE, treatment with an antidepressant, or no treatment. We also gathered open-ended responses regarding the veterans' reasons for their choice and potential barriers to engaging in that treatment. A majority (53.4%) of veterans who completed the interview said they would choose to participate in PE, 36.2% preferred antidepressant treatment, 8.6% chose no treatment, and 1.8% were unable to choose among the options. Credibility of the treatment rationale and beliefs about the treatment's efficacy were the most frequently given reasons for choosing PE (45.2%); past treatment experience was the most common reason for choosing antidepressant treatment (47.6%). The most commonly cited barrier for those who chose both antidepressant treatment and PE was time to participate (52.4% and 77.4%, respectively). The findings suggest that PE is a credible and acceptable treatment option for veterans with PTSD symptomology.
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Affiliation(s)
- Shannon M Kehle-Forbes
- Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA; Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Polusny MA, Kumpula MJ, Meis LA, Erbes CR, Arbisi PA, Murdoch M, Thuras P, Kehle-Forbes SM, Johnson AK. Gender differences in the effects of deployment-related stressors and pre-deployment risk factors on the development of PTSD symptoms in National Guard Soldiers deployed to Iraq and Afghanistan. J Psychiatr Res 2014; 49:1-9. [PMID: 24290487 DOI: 10.1016/j.jpsychires.2013.09.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [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: 04/23/2013] [Revised: 07/23/2013] [Accepted: 09/26/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although women in the military are exposed to combat and its aftermath, little is known about whether combat as well as pre-deployment risk/protective factors differentially predict post-deployment PTSD symptoms among women compared to men. The current study assesses the influence of combat-related stressors and pre-deployment risk/protective factors on women's risk of developing PTSD symptoms following deployment relative to men's risk. METHOD Participants were 801 US National Guard Soldiers (712 men, 89 women) deployed to Iraq or Afghanistan who completed measures of potential risk/protective factors and PTSD symptoms one month before deployment (Time 1) and measures of deployment-related stressors and PTSD symptoms about 2-3 months after returning from deployment (Time 2). RESULTS Men reported greater exposure to combat situations than women, while women reported greater sexual stressors during deployment than men. Exposure to the aftermath of combat (e.g., witnessing injured/dying people) did not differ by gender. At Time 2, women reported more severe PTSD symptoms and higher rates of probable PTSD than did men. Gender remained a predictor of higher PTSD symptoms after accounting for pre-deployment symptoms, prior interpersonal victimization, and combat related stressors. Gender moderated the association between several risk factors (combat-related stressors, prior interpersonal victimization, lack of unit support and pre-deployment concerns about life/family disruptions) and post-deployment PTSD symptoms. CONCLUSIONS Elevated PTSD symptoms among female service members were not explained simply by gender differences in pre-deployment or deployment-related risk factors. Combat related stressors, prior interpersonal victimization, and pre-deployment concerns about life and family disruptions during deployment were differentially associated with greater post-deployment PTSD symptoms for women than men.
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Affiliation(s)
- Melissa A Polusny
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Mandy J Kumpula
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Laura A Meis
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA; Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Christopher R Erbes
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Paul A Arbisi
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA; Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Maureen Murdoch
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA; Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Paul Thuras
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Shannon M Kehle-Forbes
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA; Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Alexandria K Johnson
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA
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Finn JA, Arbisi PA, Erbes CR, Polusny MA, Thuras P. The MMPI–2 Restructured Form Personality Psychopathology Five Scales: BridgingDSM–5Section 2 Personality Disorders andDSM–5Section 3 Personality Trait Dimensions. J Pers Assess 2013; 96:173-84. [DOI: 10.1080/00223891.2013.866569] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Clark R, DeYoung CG, Sponheim SR, Bender TL, Polusny MA, Erbes CR, Arbisi PA. Predicting post-traumatic stress disorder in veterans: interaction of traumatic load with COMT gene variation. J Psychiatr Res 2013; 47:1849-56. [PMID: 24074515 DOI: 10.1016/j.jpsychires.2013.08.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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: 01/28/2013] [Revised: 08/20/2013] [Accepted: 08/20/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Because post-traumatic stress disorder (PTSD) by definition can occur only after exposure to a traumatic event, military veterans who are at high risk for trauma exposure are a particularly relevant population for studying the interaction of trauma with genetic factors that may predispose for the disorder. A number of studies have implicated specific genes as possible risk factors in developing PTSD, including the catechol-O-methyltransferase gene (COMT). METHODS Data from Iraq War veterans (n = 236) were used to examine the interaction between COMT and traumatic experiences in predicting later development of PTSD symptoms. Subjects were assessed for exposure to traumatic events both before and during deployment. RESULTS The interaction between trauma load and COMT was a significant predictor of PTSD symptoms. Those with the heterozygous genotype (Val/Met) showed fewer symptoms associated with trauma exposure compared to those with either homozygous genotype. This interaction remained significant after controlling for other risk factors for PTSD, including personality dimensions of Internalizing and Externalizing. CONCLUSIONS COMT genotype affects risk for development of PTSD symptoms following exposure to trauma.
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Affiliation(s)
- Rachel Clark
- University of Minnesota Psychology Department, USA
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Vrieze SI, Docherty A, Thuras P, Arbisi P, Iacono WG, Sponheim S, Erbes CR, Siegel W, Leskela J. Best practices: The electronic medical record is an invaluable clinical tool: let's start using it. Psychiatr Serv 2013; 64:946-9. [PMID: 23946012 PMCID: PMC5770979 DOI: 10.1176/appi.ps.201300272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This column describes the potential of an enhanced electronic medical record (EMR) to advance best practices by displaying patient history, measuring progress, and facilitating clinical research. To create a graphical, single-page display of patient history, the authors examined data in the Minneapolis Department of Veterans Affairs EMR system, including 1.8 million encounters for 50,000 mental health patients. The prototype dashboard presents information on a patient's current and past providers, diagnoses, therapeutic interventions, prescriptions, dosages, and outcomes. To provide needed outcome data to monitor patient progress, the authors tested two questions with 212 patients. Patient and clinician responses to the questions provide reliable and clinically useful data that can be used in the EMR to track patient change over time. Use of EMRs can bridge gaps between science and practice to inform diagnosis and treatment decisions and permit more accurate prognoses.
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Koffel E, Polusny MA, Arbisi PA, Erbes CR. Pre-deployment daytime and nighttime sleep complaints as predictors of post-deployment PTSD and depression in National Guard troops. J Anxiety Disord 2013; 27:512-9. [PMID: 23939336 DOI: 10.1016/j.janxdis.2013.07.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [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: 10/20/2012] [Revised: 06/26/2013] [Accepted: 07/05/2013] [Indexed: 11/17/2022]
Abstract
There is growing evidence that disturbed sleep is a risk factor for the development of a number of psychiatric diagnoses including depression, PTSD and substance use. The goal of this study was to use a subset of participants from a larger prospective longitudinal study to examine whether preexisting daytime and nighttime sleep disturbances predict depression, PTSD and substance use in US National Guard Soldiers deployed to Iraq. Data on daytime and nighttime sleep complaints, baseline symptoms and personality variables were gathered prior to deployment to Iraq. Measures of psychopathology were collected at three time points post-deployment over the course of two years using both questionnaires and interviews. Multiple regressions were used to predict diagnoses and symptoms of depression, PTSD and substance use. Pre-deployment daytime and nighttime sleep complaints contributed significantly to the prediction of PTSD and depression up to two years after deployment, but not substance use. This study suggests that daytime and nighttime sleep complaints are a risk factor for internalizing disorders including PTSD and depression.
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Affiliation(s)
- Erin Koffel
- Minneapolis Veteran Affairs Health Care System, Minneapolis, MN 55417, USA
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Lancaster SL, Erbes CR, Kumpula MJ, Ferrier-Auerbach A, Arbisi PA, Polusny MA. Longitudinal Predictors of Desire to Re-enlist in the Military Among Male and Female National Guard Soldiers. Mil Med 2013; 178:267-73. [DOI: 10.7205/milmed-d-12-00147] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Meis LA, Schaaf KW, Erbes CR, Polusny MA, Miron LR, Schmitz TM, Nugent SM. Interest in partner-involved services among veterans seeking mental health care from a VA PTSD clinic. ACTA ACUST UNITED AC 2013. [DOI: 10.1037/a0028366] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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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Arbisi PA, Kaler ME, Kehle-Forbes SM, Erbes CR, Polusny MA, Thuras P. The predictive validity of the PTSD Checklist in a nonclinical sample of combat-exposed National Guard troops. Psychol Assess 2012; 24:1034-40. [DOI: 10.1037/a0028014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [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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