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Baker LD, Ponder WN, Carbajal J, Galusha JM, Hidalgo JE, Price M. Mapping PTSD, depression, and anxiety: A network analysis of co-occurring symptoms in treatment-seeking first responders. J Psychiatr Res 2023; 168:176-183. [PMID: 37913744 DOI: 10.1016/j.jpsychires.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
First responders are at high risk for a range of co-occurring mental health conditions due to their repeated exposure to traumatic events. When first responders present for treatment, their complex presentation of symptoms including posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) can prove challenging to differentiate for clinical purposes. Network analysis provides a means to identify the nuanced associations between the symptoms of these conditions and to identify groups of related symptoms. In this study, a treatment-seeking sample of first responders (N = 432) completed self-report measures of PTSD, depression, and GAD. Network analysis was used to identify symptom clusters within the sample. Our cross-sectional data yielded six empirically distinct communities: depression symptoms, GAD symptoms, and four communities comprising PTSD symptoms - intrusion and avoidance; irritability and aggression; negative affect; and arousal and sleep. Network associations underscore the heterogeneity of PTSD and also highlight overlapping and diverging symptoms of depression and GAD. These findings are discussed within the context of existing research on first responders, and recommendations for further study and treatment interventions are provided.
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Affiliation(s)
- Lucas D Baker
- Department of Mental Health Service, George E. Wahlen VA Medical Center, Salt Lake City, Utah, United States
| | | | - Jose Carbajal
- Stephen F. Austin State University, Nacogdoches, Texas, United States
| | | | - Johanna E Hidalgo
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States
| | - Matthew Price
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States
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Beattie E, Thomas K, Ponder WN, Meyer EC, Kimbrel NA, Cammarata C, Coe E, Pennington ML, Sacco A, Nee B, Leto F, Ostiguy W, Yockey RA, Carbajal J, Schuman DL, Gulliver SB. Network analysis of posttraumatic stress disorder in a treatment-seeking sample of US firefighters and emergency medical technicians. J Affect Disord 2023; 340:686-693. [PMID: 37595896 DOI: 10.1016/j.jad.2023.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND First responders, including firefighters and emergency medical technicians (EMTs), are under extreme stress from repeated exposure to potentially traumatic events. To optimize treatment for this population, it is critical to understand how the various posttraumatic stress disorder (PTSD) symptom factors are associated with one another so these relations may be targeted in treatment. METHOD Using a sample of treatment-seeking firefighters/EMTs (N = 342), we conducted a partial correlation network analysis of the eight-factor model. A Bayesian directed acyclic graph (DAG) was used to estimate causal associations between clusters. RESULTS Approximately 37 % of the sample screened positive for probable PTSD. Internal re-experiencing and external re-experiencing had the strongest edges. In the DAG, internal re-experiencing was the parent node and was potentially predictive of external re-experiencing, negative affect, dysphoric arousal, and avoidance. LIMITATIONS Data were drawn from a treatment-seeking sample that may not generalize to all firefighters/EMTs. CONCLUSIONS The current findings are consistent with prior research suggesting re-experiencing plays a critical role in developing and maintaining PTSD symptoms. Future research should investigate non-treatment-seeking first responders, as well as EMTs and firefighters as individual populations.
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Affiliation(s)
- Emily Beattie
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA.
| | - Katharine Thomas
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA
| | | | - Eric C Meyer
- Department of Counseling and Behavioral Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Claire Cammarata
- New York City Office of Labor Relations Employee Assistance Program, USA
| | - Elizabeth Coe
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA
| | | | - Angelo Sacco
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA
| | - Brian Nee
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA
| | - Frank Leto
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA
| | - William Ostiguy
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA
| | - R Andrew Yockey
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Jose Carbajal
- Stephen F. Austin State University, Nacogdoches, TX, USA
| | | | - Suzy B Gulliver
- Trauma Research Consortium at Baylor Scott & White Health, Waco, TX, USA; Texas A&M University Health Science Center, College of Medicine, College Station, TX, USA
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Ahmadi A, Ponder WN, Carbajal J, Schuman DL, Whitworth J, Yockey RA, Galusha JM. Validation of the PCL-5, PHQ-9, and GAD-7 in a Sample of Veterans. J Occup Environ Med 2023; 65:643-654. [PMID: 37264532 DOI: 10.1097/jom.0000000000002898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Veterans can present at nongovernment (Department of Defense, Department of Veterans Affairs) mental health agencies with complex symptom constellations that frequently include posttraumatic stress disorder, depression, and generalized anxiety. To date, no veteran study has validated these measures on a treatment-seeking sample of veterans outside the DoD and VA. METHODS We used a treatment-seeking sample of veterans ( N = 493) to validate measures that assess these constructs (PTSD Checklist 5, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7). RESULTS The seven-factor posttraumatic stress disorder hybrid configuration was the best fit. The best fitting model of the depression measure was a two-factor structure, cognitive-affective, and somatic depression. The measure of generalized anxiety was a unidimensional model. LIMITATIONS Follow-up studies should validate these measures on nontreatment-seeking discharged veterans. CONCLUSIONS We interpret these findings within the veteran scholarship and explore clinical implications for providers.
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Affiliation(s)
- Aazi Ahmadi
- From the Pennsylvania State University, State College, PA (A.A.); One Tribe Foundation, Fort Worth, Texas (W.N.P.); Stephen F. Austin State University, Nacogdoches, Texas (J.C.); University of Texas at Arlington, Arlington, Texas (D.L.S.); University of Central Florida, Orlando, Florida (J.W.); University of North Texas Health Science Center, Fort Worth, Texas (R.A.Y.); and Private Practice, Dallas, Texas (J.M.G.)
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Ponder WN, Carbajal J, Whitworth J, Schuman DL, Galusha JM, Yockey RA. Predictors of Suicide and Differences in Attachment Styles and Resilience Among Treatment-Seeking First-Responder Subtypes. J Occup Environ Med 2023; 65:321-329. [PMID: 36730737 DOI: 10.1097/jom.0000000000002750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To identify the predictors of suicide for firefighters (FFs), emergency medical technicians (EMTs), and law enforcement officers (LEOs). METHODS We used baseline data from FFs/EMTs (n = 69) and LEOs (n = 81) to investigate the unique predictors for both first-responder subtypes. We conducted confirmatory factor analysis on validated assessments of posttraumatic stress disorder (PTSD) and depression. Measures of attachment, resilience, PTSD, depression, generalized anxiety, trauma history, and substance use were the independent variables in two backward stepwise regressions predicting suicide. RESULTS Substance use and somatic depression were significant predictors for LEOs, whereas affective depression, anhedonia, externalizing behaviors, trauma history, and generalized anxiety were significant predictors for FFs/EMTs. LIMITATIONS These data are cross-sectional and should be modeled longitudinally over the course of treatment. CONCLUSION Separate constructs influence suicide for LEOs and FFs/EMTs.
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Affiliation(s)
- Warren N Ponder
- From the One Tribe Foundation, Fort Worth, Texas (W.N.P.); Stephen F. Austin State University (J.C.); University of Central Florida (J.W.); University of Texas at Arlington (D.L.S.); Private Practice, Dallas Texas (J.M.G.); and University of North Texas Health Science Center (A.Y.)
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Mallory JB, Ponder WN, Sherrill T, Carbajal J, Schuman DL, Jetelina KK, Stafford J. The Impact of COVID-19 on Veterans’ Resilience, Attachment, and Negative Affect. Journal of Veterans Studies 2022. [DOI: 10.21061/jvs.v8i3.324] [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: 11/23/2022] Open
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Carbajal J, Ponder WN. Does Attachment Mediate PTSD and Suicidality in a Sample of Global War on Terrorism (GWOT) Combat Veterans? Journal of Veterans Studies 2022. [DOI: 10.21061/jvs.v8i1.287] [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: 11/03/2022] Open
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Gacto-Sanchez P, Pereyra-Rodriguez JJ, Carbajal J, Gomez-Cía T, Conejo-Mir J. Toxic epidermal necrolysis treatment without immunosuppressive therapy in a Burn Centre: a series of 10 cases. J Eur Acad Dermatol Venereol 2017; 32:e66-e68. [PMID: 28776776 DOI: 10.1111/jdv.14509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P Gacto-Sanchez
- Department of Plastic and Reconstructive Surgery, Virgen del Rocío University Hospitals, Sevilla, Spain
| | | | - J Carbajal
- Department of Intensive Care, Virgen del Rocío University Hospitals, Sevilla, Spain
| | - T Gomez-Cía
- Department of Plastic and Reconstructive Surgery, Virgen del Rocío University Hospitals, Sevilla, Spain
| | - J Conejo-Mir
- Department of Dermatology, Virgen del Rocío University Hospitals, Sevilla, Spain
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Genebat M, Moniche F, González A, Marín A, Carbajal J, Muñoz-Sánchez MÁ. [Bilateral carotid dissection secondary to low-energy craniocervical trauma, with an excellent response following early endovascular treatment]. Med Intensiva 2013; 38:399-401. [PMID: 24296335 DOI: 10.1016/j.medin.2013.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/05/2013] [Indexed: 11/19/2022]
Affiliation(s)
- M Genebat
- Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España; Laboratorio de Inmunovirología, Instituto de Biomedicina de Sevilla (IBiS), Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - F Moniche
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A González
- Servicio de Radiodiagnóstico, Unidad de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Marín
- Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J Carbajal
- Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Á Muñoz-Sánchez
- Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
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Jiménez M, Fuster C, Raya C, Díaz A, Carbajal J. [Outbreak of Shigella boydii dysentery in the county of El Bierzo]. Enferm Infecc Microbiol Clin 1996; 14:155-9. [PMID: 8695684] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Investigation of an outbreak of bacillar dysentery of possible transmission by water produced by Shigella boydii. METHODS The strains were isolated in the stools and studies of identification, serotyping, susceptibility to antibiotics and plasmid profile were carried out according to standard methods. The epidemiological investigation was carried out retrospectively. RESULTS 51 strains were isolated from 48 patients. All were identified as S. boydii serotype 4. The pattern of susceptibility was variable, all of them showed resistance to ampicillin, tetracycline and chloramphenicol. The plasmid profile was homogeneous. Of the 41 patients who completed the questionnaire all were living in the same town or nearby localities. CONCLUSIONS The serotype 4 of S. boydii, infrequent in Spain, the homogeneous plasmid profile and the relationship between time and place of the cases, suggest that we find ourselves faced with an outbreak epidemiologically relationed. The localisation of the cases and the network of the drinking water supply represented on the plan of the town, support the hypothesis of the origin of hte outbreak as being in the lack of chlorination of one of the tanks of the network of supply.
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Affiliation(s)
- M Jiménez
- Servicio de Medicina Preventiva, Hospital de El Bierzo, Ponferrada
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