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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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Price M, Hidalgo JE, Bird YM, Bloomfield LSP, Buck C, Cerutti J, Dodds PS, Fudolig MI, Gehman R, Hickok M, Kim J, Llorin J, Lovato J, McGinnis EW, McGinnis RS, Norton R, Ramirez V, Stanton K, Ricketts TH, Danforth CM. A large clinical trial to improve well-being during the transition to college using wearables: The lived experiences measured using rings study. Contemp Clin Trials 2023; 133:107338. [PMID: 37722484 PMCID: PMC10591842 DOI: 10.1016/j.cct.2023.107338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/12/2023] [Revised: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION The transition to college is a period of elevated risk for a range of mental health conditions. Although colleges and universities strive to provide mental health support to their students, the high demand for these services makes it difficult to provide scalable, cost-effective solutions. OBJECTIVE To address these issues, the present study aims to compare the efficacy of three different treatments using a large cohort of 600 students transitioning to college. Interventions were selected based on their potential for generalizability and cost-effectiveness on college campuses. METHODS The study is a Phase II parallel-group, four-arm, randomized controlled trial with 1:1 allocation that will assign 600 participants to one (n = 150 per condition) of four arms: 1) group-based therapy, 2) physical activity program, 3) nature experiences, or 4) weekly assessment condition as a control group. Physiological data will be collected from all participants using a wearable device to develop algorithmic mental and physical health functioning predictions. Once recruitment is complete, modeling strategies will be used to evaluate the outcomes and effectiveness of each intervention. DISCUSSION The findings of this study will provide evidence as to the benefits of implementing scalable and proactive interventions using technology with the goal of improving the well-being and success of new college students.
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Affiliation(s)
- Matthew Price
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA.
| | - Johanna E Hidalgo
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Yoshi M Bird
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA
| | - Laura S P Bloomfield
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA; Gund Institute for Environment, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; Rubenstein School of Environment and Natural Resources, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Casey Buck
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Janine Cerutti
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Peter Sheridan Dodds
- MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA; Department of Computer Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Mikaela Irene Fudolig
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA
| | - Rachel Gehman
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Marc Hickok
- UVM Athletics, 2 Colchester Ave, Burlington VT 05405, USA
| | - Julia Kim
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA
| | - Jordan Llorin
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA
| | - Juniper Lovato
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA
| | - Ellen W McGinnis
- Department of Psychiatry, University of Vermont College of Medicine, 2 Colchester Ave, Burlington VT 05405, USA
| | - Ryan S McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Richard Norton
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Vanessa Ramirez
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Kathryn Stanton
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA
| | - Taylor H Ricketts
- Gund Institute for Environment, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; Rubenstein School of Environment and Natural Resources, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
| | - Christopher M Danforth
- Vermont Complex Systems Center, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; MassMutual Center of Excellence in Complex Systems and Data Science, 2 Colchester Ave, Burlington VT 05405, USA; Gund Institute for Environment, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA; Department of Mathematics & Statistics, University of Vermont, 2 Colchester Ave, Burlington VT 05405, USA
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Brier ZMF, Hidalgo JE, Espeleta HC, Davidson T, Ruggiero KJ, Price M. Assessment of Traumatic Stress Symptoms During the Acute Posttrauma Period. Focus (Am Psychiatr Publ) 2023; 21:239-246. [PMID: 37404969 PMCID: PMC10316216 DOI: 10.1176/appi.focus.20230001] [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] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
A substantial majority of adults in the United States will experience a potentially traumatic event (PTE) in their lifetime. A considerable proportion of those individuals will go on to develop posttraumatic stress disorder (PTSD). Distinguishing between those who will develop PTSD and those who will recover, however, remains as a challenge to the field. Recent work has pointed to the increased potential of identifying individuals at greatest risk for PTSD through repeated assessment during the acute posttrauma period, the 30-day period after the PTE. Obtaining the necessary data during this period, however, has proven to be a challenge. Technological innovations such as personal mobile devices and wearable passive sensors have given the field new tools to capture nuanced in vivo changes indicative of recovery or nonrecovery. Despite their potential, there are numerous points for clinicians and research teams to consider when implementing these technologies into acute posttrauma care. The limitations of this work and considerations for future research in the use of technology during the acute posttrauma period are discussed.
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Affiliation(s)
- Zoe M F Brier
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Johanna E Hidalgo
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Hannah C Espeleta
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Tatiana Davidson
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Kenneth J Ruggiero
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Matthew Price
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
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Diestel AJ, Price M, Hidalgo JE, Contractor AA, Grasso DJ. Linkages Between Childhood Maltreatment, Intimate Partner Violence, and Posttraumatic Stress Disorder Symptoms in Pregnant Hispanic Women: A Network Analysis. Child Maltreat 2023; 28:243-253. [PMID: 35465753 DOI: 10.1177/10775595221092948] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pregnant Hispanic women are at increased risk for posttraumatic stress disorder (PTSD) in part due to greater risk of childhood maltreatment, intimate partner violence (IPV), and pregnancy-related vulnerabilities. However, PTSD, is a highly heterogenous diagnosis with numerous presentations. Individual PTSD symptoms may be differentially associated with specific types of maltreatment, IPV. Determining how IPV exposure across the lifespan is associated with specific symptoms of PTSD in pregnant Hispanic women is necessary to develop group-relevant models of this disorder and targeted interventions. The present study examined a network model of PTSD symptoms, childhood maltreatment, and adulthood IPV in a sample of pregnant Hispanic women (N = 198). Childhood emotional abuse and adulthood psychological distress had the highest bridge centrality. These types of exposures were most strongly associated with social isolation. Childhood emotional abuse was associated with more individual PTSD symptoms than any IPV type. These findings suggest that associations between PTSD symptoms and different types of IPV exposure vary. In addition, robust associations between childhood emotional abuse and PTSD symptoms suggest that this domain may be particularly important for the clinical assessment and intervention for pregnant women.
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Affiliation(s)
- Annabel J Diestel
- Department of Psychological Science, Center for Research on Emotion, Stress, and Technology, 2092University of Vermont, Burlington, VT, USA
| | - Matthew Price
- Department of Psychological Science, Center for Research on Emotion, Stress, and Technology, 2092University of Vermont, Burlington, VT, USA
| | - Johanna E Hidalgo
- Department of Psychological Science, Center for Research on Emotion, Stress, and Technology, 2092University of Vermont, Burlington, VT, USA
| | - Ateka A Contractor
- Department of Psychology, 3404University of North Texas, Denton, TX, USA
| | - Damion J Grasso
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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Dahne J, Player MS, Strange C, Carpenter MJ, Ford DW, King K, Miller S, Kruis R, Hawes E, Hidalgo JE, Diaz VA. Proactive Electronic Visits for Smoking Cessation and Chronic Obstructive Pulmonary Disease Screening in Primary Care: Randomized Controlled Trial of Feasibility, Acceptability, and Efficacy. J Med Internet Res 2022; 24:e38663. [PMID: 36040766 PMCID: PMC9472044 DOI: 10.2196/38663] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/08/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most smokers with chronic obstructive pulmonary disease (COPD) have not yet been diagnosed, a statistic that has remained unchanged for over two decades. A dual-focused telehealth intervention that promotes smoking cessation, while also facilitating COPD screening, could help address national priorities to improve the diagnosis, prevention, treatment, and management of COPD. The purpose of this study was to preliminarily evaluate an integrated asynchronous smoking cessation and COPD screening e-visit (electronic visit) that could be delivered proactively to adult smokers at risk for COPD, who are treated within primary care. OBJECTIVE The aims of this study were (1) to examine e-visit feasibility and acceptability, particularly as compared to in-lab diagnostic pulmonary function testing (PFT), and (2) to examine the efficacy of smoking cessation e-visits relative to treatment as usual (TAU), all within primary care. METHODS In a randomized clinical trial, 125 primary care patients who smoke were randomized 2:1 to receive either proactive e-visits or TAU. Participants randomized to the e-visit condition were screened for COPD symptoms via the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE). Those with scores ≥2 were invited to complete both home spirometry and in-lab PFTs, in addition to two smoking cessation e-visits. Smoking cessation e-visits assessed smoking history and motivation to quit and included completion of an algorithm to determine the best Food and Drug Administration-approved cessation medication to prescribe. Primary outcomes included measures related to (1) e-visit acceptability, feasibility, and treatment metrics; (2) smoking cessation outcomes (cessation medication use, 24-hour quit attempts, smoking reduction ≥50%, self-reported abstinence, and biochemically confirmed abstinence); and (3) COPD screening outcomes. RESULTS Of 85 participants assigned to the e-visits, 64 (75.3%) were invited to complete home spirometry and in-lab PFTs based on CAPTURE. Among those eligible for spirometry, 76.6% (49/64) completed home spirometry, and 35.9% (23/64) completed in-lab PFTs. At 1 month, all cessation outcomes favored the e-visit, with a significant effect for cessation medication use (odds ratio [OR]=3.22). At 3 months, all cessation outcomes except for 24-hour quit attempts favored the e-visit, with significant effects for cessation medication use (OR=3.96) and smoking reduction (OR=3.09). CONCLUSIONS A proactive, asynchronous e-visit for smoking cessation and COPD screening may offer a feasible, efficacious approach for broad interventions within primary care. TRIAL REGISTRATION ClinicalTrials.gov NCT04155073; https://clinicaltrials.gov/ct2/show/NCT04155073.
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Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Marty S Player
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Charlie Strange
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Dee W Ford
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Kathryn King
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Sarah Miller
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Ryan Kruis
- Center for Telehealth, Medical University of South Carolina, Charleston, SC, United States
| | - Elizabeth Hawes
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Johanna E Hidalgo
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Vanessa A Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, United States
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Abstract
A case report of a congenital scalp defect with distal limb anomalies is presented. Etiology, associated anomalies, treatment, complications, and mortality are reviewed. The presence of prominent scalp veins may be an indication to defer rotation flaps and to obtain immediate coverage with a split-thickness skin graft after excision of the eschar.
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Huang TT, Hidalgo JE, Lewis SR. A circumareolar approach in surgical management of gynecomastia. Plast Reconstr Surg 1982; 69:35-40. [PMID: 7053509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Gynecomastia is a common deformity encountered among male patients. Surgery is primarily aimed at reducing the size of the breast mound and therefore should be considered aesthetic in nature. In an attempt to minimize the problems of hematoma formation, nipple necrosis, and unsightly scarring around the upper torso after the surgery, we have had the opportunity to utilize a circumareolar approach for breast tissue removal in 33 breasts (24 patients). This method, when compared with other techniques, has the advantage of leaving minimal scarring around the areolar margin while obliterating the dead space by imbricating the tissue stalk to minimize hematoma formation.
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