Hypertension in relation to posttraumatic stress disorder and depression in the US National Comorbidity Survey

The clinical literature increasingly indicates that cardiovascular risk factors and cardiovascular disease (CVD) are more common among individuals with posttraumatic stress disorder (PTSD). Depression also poses a risk for CVD and is often comorbid with PTSD. Research to date has not established whether PTSD is associated with additional CVD risk beyond the risks associated with comorbid depression. The authors examined relationships of lifetime PTSD and depression with high blood pressure in data from the US National Comorbidity Survey. They divided participants into 4 mutually exclusive diagnostic groups: (1) PTSD history and no depression history, (2) PTSD and depression history, (3) depression history and no PTSD history, and (4) no history of mental disorder. Hypertension prevalence was higher for the PTSD, no depression and PTSD plus depression groups compared with the depression only and no mental disorder groups. PTSD appears to be related to hypertension independent of depression. This may partially explain elevated rates of CVD in PTSD patients.

Depressive symptoms and cardiovascular reactivity to laboratory behavioral stress

Although a growing literature associates depressive symptoms with cardiovascular disease (CVD), the mechanisms underlying this association have not been clearly determined. The cardiovascular reactivity (CVR) hypothesis suggests that chronically elevated CVR during psychological distress can confer disease risk via vascular alterations. This investigation is a quantitative review of studies that evaluated the association of depressive symptoms with CVR. A total of 60 hypotheses were tested: 21 tests involved systolic blood pressure (SBP), 21 involved diastolic blood pressure (DBP), and 18 involved heart rate (HR). The aggregate effect size for the relation between depressive symptoms and HR reactivity was moderate (d = 0.37); aggregate effect sizes were small for SBP reactivity (d = 0.13) and DBP reactivity (d = 0.17). Effect sizes involving SBP reactivity were homogenous, whereas effect sizes involving DBP and HR reactivity were higher for studies that examined participants with CVD. These findings provide partial support for the associations of depressive symptoms with CVR.

Neuropsychological Findings in Gulf War Illness: A Review

This review paper summarizes the accumulation of research investigating neuropsychological outcomes in veterans with Gulf War illness (GWI). Earlier research focused on Gulf War veterans (GW) who were deployed versus non-deployed, as well as those who were symptomatic versus asymptomatic, or compared neuropsychological test results to published norms. Further research became more sophisticated, investigating specific GWI criteria, as well as the result of neurotoxicant exposure and the relationship to possible neurocognitive outcomes. As the early research supported both psychological and physiological effects on GWI; current research as summarized in this literature review supports the presence of neuropsychological deficits, particularly in the domains of attention, executive functioning, memory, and motor functioning related to chemical exposures that can be exacerbated by comorbid mood-related conditions. The same test battery has not been used consistently making it difficult to compare results among studies. Therefore, researchers created a resource to provide recommendations for the recently listed Neuropsychological Tests for Common Data Elements (CDEs) for use in all future GWI studies. Future research is necessary to further understand patterns of neuropsychological test data and how these decrements may relate to immunological or other biological markers, and the impact of trauma from physical and psychological stressors. In conclusion, there is consistent evidence that GWI is characterized by neuropsychological decrements - with future research these findings may aid in the diagnosis and assessment of treatment trial efficacy of GW veterans.

Metabolic, autonomic and immune markers for cardiovascular disease in posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) has been associated with significantly greater incidence of heart disease. Numerous studies have indicated that health problems for individuals with PTSD occur earlier in life than in the general population. Multiple mechanistic pathways have been suggested to explain cardiovascular disese (CVD) risk in PTSD, including neurochemical, behavioral, and immunological changes. The present paper is a review of recent research that examines cardiovascular and immune risk profiles of individuals with PTSD. First, we address the relatively new evidence that the constellation of risk factors commonly experienced in PTSD fits the profile of metabolic syndrome. Next we examine the findings concerning hypertension/blood pressure in particular. The literature on sympathetic and parasympathetic responsivity in PTSD is reviewed. Last, we discuss recent findings concerning immune functioning in PTSD that may have a bearing on the high rates of CVD and other illnesses. Our primary goal is to synthesize the existing literature by examining factors that overlap mechanistically to increase the risk of developing CVD in PTSD.

Posttraumatic stress and cardiovascular disease risk

A growing literature indicates that posttraumatic stress is associated with cardiovascular risk and cardiovascular disease (CVD). Research on specific CVD risk factors and their prevalence in posttraumatic stress disorder (PTSD) may improve understanding of CVD development in this population. The primary purpose of the present article is to outline the evidence relating posttraumatic stress to CVD risk, with an emphasis on behavioral factors. The evidence concerning potential elevations in traditional cardiovascular risk factors with behavioral components in PTSD is reviewed. Brief discussions of autonomic nervous system hyperarousal and immune dysfunction as potential mechanisms for CVD risk are also presented. Together, the available evidence suggests that multiple related risk factors and physiological systems may impact health in PTSD. Based on the literature to date, it is suggested that additional studies are needed on the synergistic effects of multiple interacting CVD risk factors and interventions aimed at primary and secondary prevention of cardiovascular risk.

Perceived coping ability mediates the relationship between PTSD severity and heart rate recovery in veterans

Most psychophysiological studies of PTSD have not assessed physiological recovery, correlational relationships between PTSD severity and physiological measures within clinical populations, or mediation by cognitive appraisal. Relationships of PTSD severity to psychophysiological reactivity (to acoustic startle), habituation, and recovery were assessed in 29 combat veterans, and mediation by cognitive appraisal (perceived threat and coping ability) was assessed in a subset (n = 16) of participants. Heart rate (HR) recovery was linearly related to PTSD severity. Perceived ability to cope with the lab task, but not perceived threat inherent in the task, mediated the HR recovery-PTSD association. Potential implications of delayed HR recovery for functioning, treatment outcome, and health-risk in PTSD are presented. Cognitive appraisal may represent an important target for treatments.

Cardiovascular Correlates of Misconduct in Children and Adolescents

Abstract: Prior literature reviews addressing cardiovascular correlates of misconduct have focused on resting heart rate (HR) and skin conductance (SC). The present paper is a quantitative review of studies that tested the relationship between child/adolescent misconduct and cardiovascular regulation. An additional selection criterion for the present review was that the study examined physiological variables beyond resting HR and SC (e.g., cardiovascular reactivity). Misconduct was related to low HR reactivity, low resting parasympathetic nervous system (PNS) control, and less withdrawal of PNS control during mental challenge. These findings expand on prior reviews that indicated resting sympathetic nervous system underarousal is associated with antisocial behavior/misconduct. Cardiovascular reactivity to stress and PNS control may also be important correlates of misconduct.

The feasibility of modified directly observed therapy for HIV-seropositive African American substance users

Recently, modified directly observed therapy (MDOT) has emerged as a promising intervention to address nonadherence for hard-to-reach populations infected with HIV. To date, there are no existing data on MDOT focusing exclusively on African Americans. The present study sought to determine the feasibility of MDOT among 31 HIV-seropositive African American substance users in the South. An outreach worker observed the participants' medication intake 5 days per week (once per day) for a period of 3 months (intensive phase). This phase was followed by a transition phase of 3 months during which the frequency of MDOT was gradually tapered from 5 days to once weekly. Assessments to gather demographic information, HIV risk behaviors, substance use, depression, and medication adherence were conducted at baseline, 3 months, and 6 months. Results indicated that more participants adhered to their medication regimen and had viral loads of less than 400 copies per milliliter at 3 and 6 months compared to baseline. Participants reported significantly less depressive symptoms at the 6-month assessment compared to baseline and 3 months. With regard to acceptability, 95% of participants indicated they liked having the outreach visits, 100% reported MDOT helped them take their medications, and only 5% felt MDOT was a violation of privacy. These results suggest MDOT is feasible among African American substance users in the South and a larger controlled study of MDOT with this population is warranted.

Latino cultural values as protective factors against sexual risks among adolescents

The study objective was to examine the associations between cultural values and sexual risk factors among Latino youth. A sample of 226 Latino adolescents ages 13-16 completed a survey on cultural and sexual variables. Results indicate higher levels of Latino cultural orientation were related to greater sexual self-efficacy and fewer sexual partners for female adolescents and greater condom use self-efficacy for both males and females. Greater endorsement of simpatia (belief in interpersonal relationship harmony) was associated with sexual abstinence and greater sexual self-efficacy for all adolescents, and with being older at sexual debut for females. Stronger endorsement of respeto (respect towards parents and other authority figures) was correlated with a lower intention to have sex during secondary school and greater condom use self-efficacy. American cultural orientation was associated with less condom use. Our findings indicate Latino cultural values may serve as protective factors against sexual risk behaviors among Latino youth.

Hormones, menstrual distress, and migraine across the phases of the menstrual cycle

OBJECTIVE

The primary objectives of the present study were to (1) contrast reproductive hormone levels and ratings of menstrual distress of female migraineurs with those of a control group in each menstrual cycle phase, (2) examine correlations between hormone levels and migraine frequency, severity, and migraine-related disability, and (3) examine correlations between menstrual distress and migraine frequency, severity, and migraine-related disability. A secondary objective was to evaluate the validity of a migraine disability measure modified to reflect 7-day recall.

BACKGROUND

Further controlled, prospective study is needed regarding the temporal relationships between reproductive hormones at each stage of the menstrual cycle and fluctuations in migraine activity across the cycle.

METHODS

Twenty-three women (17 with migraine, 6 control participants) completed laboratory hormone assays and measures of menstrual distress and disability at each phase of one menstrual cycle, and monitored their headache activity daily during the same cycle. Results.-The migraine group evidenced lower premenstrual luteinizing hormone and more menstrual distress symptoms at each phase of the menstrual cycle. Hormones were associated with migraine activity and disability within cycle phases, and across phases in a time-lagged manner. Menstrual distress was associated with ovulatory phase migraine activity and with migraine-related disability across the menstrual cycle. A retrospective 7-day migraine disability measure appeared to be a consistently valid index.

CONCLUSIONS

Both reproductive hormones and menstrually related distress appear to predict migraine activity and disability. These associations were evident not only for perimenstrual migraine, but also for migraine at each phase of the menstrual cycle.

The effects of priming on a public health campaign targeting cardiovascular risks

Public health interventions are cost-effective methods to reduce heart disease. The present study investigated the impact of a low-cost priming technique on a public health campaign targeting cardiovascular risk. Participants were 415 individuals (66% female) ages 18 and older recruited through clinics and churches. The study consisted of three phases. In Phase I, participants completed a brief survey to assess knowledge of the cardiovascular health indicators. The survey served as the prime (intervention) for the study. At Phase II, participants were provided with access to a public health campaign consisting of an education brochure on cardiovascular health. Following the educational campaign, all participants completed a post-campaign survey in Phase III of the study. Participants who completed the surveys in both Phase I and III were placed in the intervention condition (26%) and those who only completed the Phase III survey were placed in the control condition (74%). Participants who were primed reported greater awareness of the public health campaign. Additionally, more intervention participants reported they had knowledge of their own and the normal ranges for cholesterol, glucose, and body mass index. For participants who were aware of the health promotion campaign, more participants in the primed group indicated they had knowledge of their own cholesterol and glucose levels and had made positive lifestyle changes as a result of the campaign. Results suggest the presence of a priming effect. Public health campaigns may benefit from the inclusion of a low-cost prime prior to intervention.

Cardiovascular risks in relation to posttraumatic stress severity among young trauma-exposed women

BACKGROUND

Posttraumatic stress is associated with elevated risk for cardiovascular disease (CVD). Relatively little research, particularly among women, has documented mechanisms by which PTSD might confer CVD risk during early adulthood. The purpose of the present study was to examine whether the number and relative levels of CVD risk factors are associated with posttraumatic stress symptom severity among young, trauma-exposed women.

METHODS

Participants were premenopausal women ages 19-49 with varying levels of posttraumatic stress and no history of chronic medical illness (n = 54), and were recruited from mental health clinics and the general community. Posttraumatic stress severity was assessed with a structured clinical interview (Clinician-Administered PTSD Scale). The CVD risk factors assessed were lipids (total cholesterol, triglycerides, high- and low-density lipoproteins), resting blood pressure (BP), body mass index (BMI), no exercise in typical week, and cigarette smoking.

RESULTS

Posttraumatic stress severity was associated with lower high-density lipoprotein levels and higher triglycerides, greater systolic and diastolic BP, greater BMI, and a greater number of total CVD risk factors.

LIMITATIONS

The main limitation is the limited number of participants who displayed clinical levels on some of the CVD risk factors (e.g., BP). Nonetheless, most participants exhibited more than one CVD risk factor, indicating the potential for many of the women in this relatively young sample to progress toward greater risk later in life.

CONCLUSIONS

The present results support the contention that, in the absence of medical illness, posttraumatic stress symptom severity among young women is associated with several CVD risk factors early in life.

The relationship of character strengths to sexual behaviors and related risks among African American adolescents

BACKGROUND

Relatively few studies have examined positive character traits that are associated with lower HIV/STD risks.

PURPOSE

In the present study, the relationships of character strengths with sexual behaviors and attitudes were assessed among 383 African-American adolescents.

METHOD

Character strengths were measured using the Values in Action Inventory of Strengths. Because the strengths were highly inter-correlated, stepwise discriminant function analyses were utilized to assess their independent associations with sexual behaviors and attitudes.

RESULTS

Greater Love of Learning was related to self-reported abstinence from sexual intercourse for boys and self-reported abstinence from drug use for boys and girls. Greater Love of Learning and Curiosity were related to the belief in no premarital sex for boys, whereas only Curiosity was significant for girls. Prudence was related to reported abstinence from sexual intimacy (e.g., touching or kissing). Judgment was related to sexual initiation efficacy for girls and boys, whereas Leadership was only significant for girls.

CONCLUSIONS

The findings suggest that character strengths may be associated with lower levels of sexual behaviors and sex-related beliefs among a sample of African-American adolescents.

Correlates of willingness to participate in microbicide research among African Americans

The objective of the present article is to identify predictors of willingness to participate (WTP) in microbicide trials among African Americans. A total of 595 participants completed a survey on WTP in microbicide trials and predictors of WTP. Significant associations were observed for relationships of greater WTP with female gender, greater HIV risk, lower mistrust of research, and knowing someone with HIV/AIDS. An interaction revealed HIV risk was positively associated with WTP for women only. Accurate knowledge of the Tuskegee Syphilis Study was associated with greater WTP. These predictors may be employed in microbicide trials to enhance African American participation.

Sympathoimmune anomalies underlying the response to stressful challenge in human immunodeficiency virus spectrum disease

OBJECTIVE

This study examined immune, endocrine, and cardiovascular reactivity during stressful behavioral challenge in human immunodeficiency virus (HIV) seropositive (HIV+) and seronegative (HIV-) men and women and assessed whether immunocellular reactivity was differentially associated with concomitant alterations in sympathetic response.

METHODS

The 133 HIV+ [84 asymptomatic, 49 symptomatic] and 92 HIV- subjects completed a speech stress reactivity protocol.

RESULTS

Immunocellular reactivity to the speech stressor did not differ among asymptomatic and symptomatic HIV+ groups; however, relative to seronegatives, reactivity differences were present. Specifically, HIV+ subjects exhibited greater increases in total number of T cells, as well as in cytotoxic/suppressor T cells, activated T cells, and activated cytotoxic/suppressor T cells, and less increase in natural killer (NK) cell numbers. In addition, less stress-induced increase in NK cell cytotoxicity was observed along with greater suppression of the lymphoproliferative response to mitogen stimulation in the HIV+ group. Although no group differences in catecholamine reactivity were observed, the association of immunoreactivity with catecholamine responsiveness differed between serostatus groups. Specifically, the HIV+ subjects compared with HIV- subjects displayed greater lymphocytosis per unit change in norepinephrine; whereas NK cell reactivity was positively related to epinephrine responsiveness, but only in the HIV- group. These findings were present even after controlling for age and body mass, as well as other potential influences on immunocellular migration, such as cortisol levels and prevailing cardiac output.

CONCLUSION

Early in HIV spectrum disease, functional abnormalities in the stress-induced migratory ability of specific immunocellular subsets are present that may reflect an underlying pathophysiological alteration in sympathoimmune communication.

An Extension of the Perseverative Cognition Hypothesis to Posttraumatic Stress Disorder Symptomatology: Cardiovascular Recovery in Relation to Posttraumatic Stress Disorder Severity and Cognitive Appraisals of Stress

Beyond the construct of cardiovascular reactivity, the measurement of cardiovascular recovery from stress represents an important index of exaggerated physiological arousal and disease risk. Cardiovascular recovery in posttraumatic stress disorder (PTSD) has not received adequate attention. The present study examined whether cardiovascular recovery following an oral speaking stressor was associated with the severity of PTSD symptoms, and whether cognitive stress appraisals of threat and challenge were significantly associated with PTSD severity and recovery. The sample consisted of 50 trauma-exposed civilian women ranging from 19 to 49 years of age (M = 30.9, SD = 7.8). The PTSD severity indices were quantified based on structured interview. Cardiovascular recovery was assessed at two posttask time points as percentage return to baseline; the recovery measures consisted of impedance cardiography-derived cardiac output (CO) and total peripheral resistance (TPR), heart rate and blood pressure. Total PTSD severity was associated with less CO recovery, r = -.39, p = .006; this effect was similar across PTSD symptom categories, with significant correlations ranging from r = -.30 to r = -.44. However, only PTSD severity in the avoidance cluster was associated with less TPR recovery, r = -.29, p = .047. Total PTSD severity was associated with greater threat appraisal, r = .30, p = .035, and greater threat appraisal was associated with less CO recovery, r = -.33, p = .019. Results partially support the theory that greater PTSD severity and cognitive appraisals of threat contribute to less cardiovascular recovery when confronted with a stress-inducing situation.

Illness Intrusiveness Mediates the Relationship Between Heart Failure Severity and Depression in Older Adults

Depression frequently co-occurs in heart failure (HF) patients, causing significant interference and negative health outcomes. This case-controlled study explored the construct of illness intrusiveness and examined its relationship to HF severity and depression. Older veterans ( n = 104) with an HF diagnosis completed a one-time assessment that included demographics, depressive symptoms (Geriatric Depression Scale), the Illness Intrusiveness Rating Scale (IIRS), and HF quality of life and functional abilities (Kansas City Cardiomyopathy Questionnaire [KCCQ]). Analyses included exploratory correlations between IIRS and KCCQ items, a confirmatory factor analysis (IIRS), and formal mediational analyses. Results indicated that the IIRS had adequate internal consistency and concurrent validity, with support for its established three-factor model. Regression analyses indicated that illness intrusiveness mediated HF illness severity and depression. In conclusion, illness intrusiveness may be a better indicator of depression than illness severity (HF symptoms); thus research methods and interventions targeted at reducing illness intrusiveness merit further investigation.

Body mass index in relation to cardiovascular recovery from psychological stress among trauma-exposed women

Delayed cardiovascular recovery has been associated with greater heart disease risks. However, relative to stress reactivity, cardiovascular recovery has been understudied. Further, few studies have examined associations of recovery with modifiable factors that might inform efforts to enhance recovery. The focus of the present study was whether body mass index (BMI) was associated with recovery following two stress tasks (speech and mental arithmetic). Based on the conceptualization that obesity may lead to impaired post-stress recovery, we also examined whether higher BMI accounted for previously reported associations between elevated PTSD symptoms and delayed recovery. The sample consisted of 50 trauma-exposed civilian women ages 19-49 (M±SD = 30 ± 8). The stress tasks were followed by 15-min post-task rest periods. Cardiovascular recovery was assessed as percentage return to baseline; the recovery measures consisted of heart rate (HR), cardiac output (CO), systolic blood pressure (SBP) and diastolic blood pressure (DBP). PTSD severity was based on structured interview. Higher BMI was associated with significantly less CO recovery from the speech task and less HR recovery from mental arithmetic. Higher BMI was associated with more SBP recovery from the math task, but was not associated with DBP recovery. The indirect effects of BMI in the PTSD/CO recovery relationship based on the Sobel test of mediation were significant. These results partially support the hypotheses that BMI is associated with cardiovascular recovery and that associations of PTSD with recovery may be mediated by BMI.

Evaluation of a brief questionnaire for assessing Barriers to Research Participation

Racial minority groups are often underrepresented in biobehavioral research. Mistrust stemming from historic abuses of minority research participants is one explanation for this problem. Although mistrust and other variables affect dispositions toward research, brief, quantitative measures of these factors have not been available to researchers in assessing potential recruitment barriers. The present paper is a description and psychometric examination of the Barriers to Research Participation Questionnaire (BRPQ), a new survey designed to assess five factors that affect research participation (religious beliefs, mistrust, health-related fears/beliefs, role overload/ time demands, and perceived personal and community benefits). Good model-fit for the proposed five-factor structure and good test-retest reliability were observed among African American undergraduate men and women at an urban, primarily African American university. The BRPQ appears to be a reliable and valid tool for researchers to use in identifying barriers to recruiting African American participants.

Psychophysiological Reactivity and PTSD Symptom Severity among Young Women

Mixed findings with regard to cardiovascular reactivity (CVR) and posttraumatic stress disorder (PTSD) have suggested a need to further explore the nature of this relationship and factors that might explain differences in reactivity across and within samples. In the present study, the severity of PTSD symptoms was investigated in relation to CVR among young women. In addition, we examined whether severity within PTSD symptom clusters and level of dissociative symptoms were related to CVR. Heart rate, systolic and diastolic blood pressure, cardiac output (CO) and total peripheral resistance (TPR) reactivity in response to an oral speaking task were assessed for 58 young trauma-exposed civilian women with varying levels of PTSD symptomatology (from no symptoms to high severity of PTSD). The PTSD severity sub-scores for the DSM-V symptom clusters and total PTSD severity were based on structured interview (Clinician Administered PTSD Scale), and dissociative symptoms were assessed using the Dissociative Experiences Scale. Severity of total PTSD symptoms was associated with greater CO reactivity (r = .48, p < .01) and lower TPR reactivity (r = -.50, p < .01). Significant associations were not observed for heart rate or blood pressure. Results did not vary according to severity of symptoms within PTSD symptom cluster, with correlations for CO reactivity ranging from .40 to .49 and correlations for TPR reactivity ranging from -.40 to -.50 within symptom clusters. Dissociative symptoms were not significantly correlated with the CVR measures. Results partially supported the expectation that PTSD severity is one factor that would be associated with CVR, and suggest that reactivity for the underlying components of blood pressure (CO and TPR) provide additional information in probing stress reactivity in PTSD.