PTSD and depression severity are associated with cardiovascular disease symptoms in trauma-exposed women

Exploring the connections between traumatic experiences and subsequent health outcomes is vital for informing clinical practices and public health policies. The study aimed to investigate the relationship between lifetime trauma exposure and posttraumatic stress disorder (PTSD), depressive and cardiovascular disease (CVD) symptoms. A total of 171 patients who received treatment in a local heart centre were included in this study. Several questionnaires such as the Life Event Checklist-5, Posttraumatic Stress Disorder Checklist for DSM-5 and Patient Health Questionnaire-9 were used to measure their traumatic experiences and PTSD and depressive symptoms, respectively. Physiological measures were also examined. Data were analysed using SPSS. The chi-square test showed significant differences in the percentage of reported PTSD symptoms among the patients with CVD (24.0%), patients with kidney disease (4.3%) and patients with other health problems (7.1%). The patients with CVD reported having a significantly higher percentage of PTSD and depressive symptoms than the patients with other medical conditions. The patients with CVD who reported having PTSD symptoms had significant systolic blood pressure (SBP) and heart rate changes compared to the patients who did not. The patients who reported PTSD symptoms had a significantly shorter sleep duration than their counterparts. The SBP and diastolic blood pressure differed significantly between the patients with and without PTSD symptoms. Earlier detection, prevention and intervention related to trauma exposure and PTSD symptoms are suggested to reduce the CVD risk.

Individuals with post-traumatic stress disorder (PTSD) have an elevated risk of developing cardiovascular disease. Emerging research suggests that blood pressure variability (BPV) may serve as an early indicator for increased cardiovascular disease risk. However, the relationship between post-traumatic stress symptom severity and symptom clusters, and comorbid conditions such as depression, with BPV is unclear. Purpose: The primary objective of this study was to investigate the relationship between the severity of PTSD and depression symptoms, PTSD symptom clusters, and beat-to-beat blood pressure variability (BPV) in a sample of individuals diagnosed with PTSD. We hypothesized that participants with greater PTSD symptom severity would have increased BPV. Methods: Twenty participants (mean age = 46 ± 10 yr; 70% males; 75% African American) with diagnosed PTSD were enrolled. PTSD severity and symptom clusters were assessed via the PTSD Checklist (PCL-5) and depression symptoms were assessed via Beck's Depression Inventory (BDI). Beat-to-beat blood pressure was recorded via finger photoplethysmography for a five-minute duration. BPV indices were calculated as the coeffcient of variation (CV), standard deviation (SD), and average real variability (ARV) for systolic, diastolic, and mean blood pressure. Pearson correlations were conducted to evaluate the association between symptoms and BPV outcomes. Participants were also categorized into two groups based on symptom severity. Independent t-tests were used to compare those with mild to moderate symptoms (n = 7) relative to participants with severe and extreme PTSD symptoms (n = 13). Results: PTSD symptom severity was significantly correlated with depression symptoms (r = 0.83, p < 0.001). However, there were no significant correlations between BPV measures and either PTSD or depression symptoms. We did observe moderate non-significant correlations between the PTSD intrusive symptom cluster and diastolic and mean blood pressure CV (r = 0.33 and r = 0.29, p > 0.05). Similar moderate correlations were observed between depression symptoms and diastolic and mean blood pressure CV (r = 0.31 and r = 0.29, p > 0.05). No significant differences were observed between the two symptom severity groups in terms of systolic, diastolic, and mean blood pressure for CV, SD, and ARV (systolic CV 0.61 ± 0.17 vs. 0.62 ± 0.17 %, p > 0.05, diastolic CV, 0.70 ± 0.06 vs. 0.72 ± 0.16 %, p > 0.05, and mean blood pressure CV 0.63 ± 0.09 vs. 0.65 ± 0.15 %, p > 0.05 for mild to moderate and severe to extreme PTSD symptoms, respectively). Conclusions: Contrary to our hypothesis, those with greater PTSD symptom severity did not have significantly greater BPV. In summary, our data demonstrate that higher PTSD symptoms are not associated with beat-to-beat BPV; however, the moderate correlations suggest that larger studies are needed to determine if PTSD intrusive symptoms and depression symptoms, are related beat-to-beat BPV indices. VA Merit I01-CX001065, and DOD PR210574. M. McGranahan is supported by NIDDK training grant TL1DK129502 and U2CDK129501. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

ABSTRACTBackground: Many studies have reported the comorbidity of posttraumatic stress disorder (PTSD) and depression in children. However, the underlying relationship between PTSD and depression remains unclear.Objective: This study examines the relationship between PTSD and depressive symptoms in children who survived the Wenchuan earthquake in China.Methods: In total, 301 children were assessed at four months and then followed up at 29, 40 and 52 months after the disaster. The ages of the children ranged from 9.6–14.6 years old, and the sample included 157 males and 144 females. The children were assessed by using the University of California at Los Angeles PTSD reaction index for DSM-IV for PTSD symptoms and the Children’s Depression Inventory for depressive symptoms.Results: Comorbid PTSD and depressive symptoms were prevalent in 4.0, 3.3, 3.7 and 5.1% of the participants at times 1, 2, 3 and 4, respectively. The cross-lagged analysis indicated that PTSD symptoms at time 1 predicted depressive symptoms at time 2; depressive symptoms at time 1 predicted PTSD symptoms at time 2; depressive symptoms at time 2 predicted PTSD symptoms at time 3; and depressive symptoms at time 3 predicted PTSD symptoms at time 4. The findings also showed that being female, poor parental relationships and trauma exposure were risk factors for PTSD or depressive symptoms.Conclusions: The results suggest that the causal relationship between PTSD and depressive symptoms changes over time; the effects of PTSD symptoms tend to decrease, while those of depressive symptoms tend to increase. Two stages of the relationship between PTSD and depressive symptoms were observed, namely, that PTSD and depressive symptoms first influenced each other and then that depressive symptoms predicted PTSD. The results of our study also suggest that females with poor parental relationships and a high degree of trauma exposure are more likely to require intervention.

A prospective examination of sex differences in posttraumatic autonomic functioning

Introduction: Cardiovascular disease (CVD) remains the leading cause of death among women in the United States. Although premenopausal women are thought to be protected from CVD, trauma exposure increases their CVD risk. Poor sleep – a CVD risk factor – is common after trauma exposure. Further, accumulating evidence suggests that vascular dysfunction is independently associated with CVD. However, the link between sleep and vascular function in otherwise healthy, trauma-exposed young women is not known. Therefore, the purpose of the present study was to investigate the individual and combined effects of sleep quality and post-traumatic stress disorder (PTSD) symptom severity on endothelial function and arterial stiffness. Methods: We recruited 42 otherwise healthy women (18 –­ 40 years) from diverse backgrounds who had been exposed to trauma. We successfully collected data on sleep, vascular function, depression and PTSD symptom severity in 35 women, across two visits. Sleep efficiency (SE) was objectively measured as the relative time (%) spent asleep while in bed, using wrist actigraphy. Participants wore the ActiWatch for seven days between visits. During visit one, PTSD symptom severity was assessed using the PTSD checklist for DSM 5 (PCL5) and depressive symptom severity with the Beck Depression Inventory (BDI). At visit two, we assessed endothelial function via reactive hyperemia index (RHI) using peripheral arterial tone and arterial stiffness via pulse wave velocity (PWV) using applanation tonometry. Results: Participants’ mean age and body mass index (BMI) were 27±7 years and 27±6 kg/m2 respectively. Mean systolic and diastolic blood pressures were 103±9 and 67±8 mmHg respectively, and heart rate was 74±12 bpm. SE was positively correlated with RHI (r=0.35, p=0.019), and negatively correlated with PWV (r=-0.46, p=0.004). PCL5 score was negatively correlated with RHI (r=-0.52, p<0.001), and not PWV (r=0.12, p=0.253). Additionally, a positive association was observed between age and PWV (r=0.50, p=0.001). BDI score was only correlated with PCL5 (r=0.60, p<0.001). Next, to explore the predictive value of SE and PCL5 on RHI and PWV, we conducted separate multiple linear regression models with SE, PCL5 scores and age as predictors. The model predicting RHI was significant (R2=0.48, p<0.001), with PCL5 emerging as the strongest predictor (β=-0.56, p<0.001). Similarly, the model predicting PWV was significant (R2=0.45, p<0.001), with both SE and age as the strongest predictors (β=-0.44, p=0.004 and β=0.49, p=0.001, respectively). Conclusion: Our results suggest that poor sleep may contribute to increased arterial stiffness after trauma exposure, while endothelial dysfunction could be driven by PTSD symptom severity. These findings could serve to distinguish trauma-exposed women at risk of CVD and identify specific interventions (i.e., targeting sleep efficiency or PTSD symptoms) to prevent or delay vascular dysfunction. UL1TR002494, NIH K01HL161027 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are associated with functional impairments, yet little is known about their influence on HIV pre-exposure prophylaxis (PrEP) motivation among women survivors of intimate partner violence (IPV). Understanding how PTSD and MDD symptoms influence PrEP motivation is particularly important given survivors of IPV have an increased risk for HIV acquisition. The present study assessed the association between PrEP motivation with latent profiles of PTSD and MDD symptoms among women survivors of IPV. Data were collected from a sample of 285 women from Baltimore, MD, and New Haven, CT. Latent profile analysis (LPA) was performed to identify distinct patterns of depressive and PTSD symptoms among women survivors of IPV. Binary logistic regression was performed to examine the association of profile membership on PrEP motivation. A six-profile solution was determined to best fit the data. Profiles were characterized by: Profile 1, very low depressive and very low PTSD symptoms (28.07%); Profile 2, average depressive symptoms and low (below the mean) PTSD symptoms (21.05%); Profile 3, high depressive symptoms and low (below the mean) PTSD symptoms (9.8%); Profile 4, moderate depressive symptoms and high PTSD symptoms (15.78%); Profile 5, high PTSD avoidance and average depressive symptoms (17.1%); Profile 6, high depressive and high PTSD symptoms (8%). We found that, the odds of being in Stage 3 of the PrEP Motivational Cascade (PrEParation; defined by having access to a medical provider to prescribe PrEP, be willing to take PrEP, and self-identifying as an appropriate candidate for PrEP) compared to Stage 1 of the PrEP Motivational Cascade (Precontemplation; defined by being eligible for PrEP, but not willing to take PrEP and/or not self-identifying as an appropriate candidate for PrEP) were lower for women assigned to the low depressive symptoms and low PTSD symptoms profile (Profile 1 of the LPA) compared to women in the high depressive symptoms and High PTSD symptoms profile (Profile 6 of the LPA, OR = 0.22, 95% CI = 0.06-0.76, p = 0.02). Women assigned to the low PTSD symptoms and average depressive symptoms profile (Profile 2 of the LPA) had lower odds of being in Stage 3 (PrEParation) compared to Stage 1 (Precontemplation) compared to women assigned to the high depressive symptoms and High PTSD symptoms profile (Profile 6 of the LPA, OR = 0.25, 95% CI = 0.07-0.92, p = 0.037). Women survivors of IPV with higher PTSD and MDD symptoms expressed greater motivation to engage in PrEP compared to women survivors with low PTSD and low MDD symptoms. Findings support the CDC's clinical PrEP recommendations to integrate depression screening into PrEP services, but there is a critical need to also include PTSD screening. Further, MDD and PTSD symptoms may present differential barriers to PrEP motivation among women survivors of IPV. Precision care could synchronize trauma-informed practices and mental health treatment to engage survivors in PrEP services.

Psychological stress is a proposed risk factor for cardiovascular disease (CVD), and posttraumatic stress disorder (PTSD), the sentinel stress-related mental disorder, occurs twice as frequently in women as men. However, whether PTSD contributes to CVD risk in women is not established. We examined trauma exposure and PTSD symptoms in relation to incident CVD over a 20-year period in 49 978 women in the Nurses' Health Study II. Proportional hazards models estimated hazard ratios and 95% confidence intervals for CVD events confirmed by additional information or medical record review (n=548, including myocardial infarction [n=277] and stroke [n=271]). Trauma exposure and PTSD symptoms were assessed by using the Brief Trauma Questionnaire and a PTSD screen. In comparison with no trauma exposure, endorsing ≥4 PTSD symptoms was associated with increased CVD risk after adjusting for age, family history, and childhood factors (hazard ratio,1.60; 95% confidence interval, 1.20-2.13). Being trauma-exposed and endorsing no PTSD symptoms was associated with elevated CVD risk (hazard ratio, 1.45; 95% confidence interval, 1.15-1.83), although being trauma-exposed and endorsing 1 to 3 PTSD symptoms was not. After adjusting for adult health behaviors and medical risk factors, this pattern of findings was maintained. Health behaviors and medical risk factors accounted for 14% of the trauma/no symptoms-CVD association and 47% of the trauma/4+ symptoms-CVD association. Trauma exposure and elevated PTSD symptoms may increase the risk of CVD in this population of women. These findings suggest that screening for CVD risk and reducing health risk behaviors in trauma-exposed women may be promising avenues for prevention and intervention.

Background: Studies on mental health rates among primary school children are still limited, particularly related to psychological trauma and its relationship to other mental health challenges. Objective: The objective of this study was to 1) examine the prevalence of PTSD, depression, and anxiety symptoms in primary school children before the Covid-19 pandemic; 2) identify the relationship between PTSD, depression and anxiety symptoms; and 3) investigate potential gender differences in PTSD symptoms. Methods: This is the first cross-sectional study examining the rates of trauma exposure, posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in primary school children before the covid-19 pandemic in Malaysia. Two hundred and twenty-one students participated in this study. They were recruited from four primary schools that volunteered to participate in this study. PTSD Checklist for DSM-5 (PCL-5), Child PTSD Symptoms Scale-5 (CPSS-5), The Center for Epidemiologic Studies Depression Scale version (CESD), and the Spence Children's Anxiety Scale (SCAS) were used to survey psychological symptoms. Results: Most of the students, or 54.3% of them, have experienced at least one traumatic event. Of 221 students, 39.4% reported having PTSD symptoms, 38% reported having depressive symptoms, and 19% reported having anxiety symptoms. Female students were more likely to report PTSD symptoms compared to male students. The first regression analysis model indicated that depressive symptoms were the only significant predictors of PTSD. In the second model, religion, family income, anxiety, and PTSD symptoms were significant predictors of depressive symptoms. In the third model, depressive symptoms were the sole significant predictors of anxiety. Conclusion: The study reveals that primary school children experience high levels of trauma, PTSD, depression, and anxiety, especially before the COVID-19 pandemic. During the early phases of the pandemic, these mental health issues have been largely neglected in Malaysia, with limited preventative and therapeutic interventions available. Future research should focus on documenting the prevalence of these issues in relation to the COVID-19 pandemic.

Consistent evidence has found associations between posttraumatic stress disorder (PTSD) and increased risk of chronic disease and greater prevalence of health risk factors. However, the association between PTSD and all-cause mortality has not been thoroughly investigated in civilians. To investigate the association between PTSD symptoms, with or without comorbid depressive symptoms, and risk of death. This prospective cohort study was conducted using data on female US nurses in the Nurses' Health Study II followed up from 2008 to 2017. Women who responded to a 2008 questionnaire querying PTSD and depressive symptoms were included. Data were analyzed from September 2018 to November 2020. Symptoms of PTSD, measured using the short screening scale for Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) PTSD, and depression symptoms, measured using the Center for Epidemiologic Studies Depression Scale-10 in 2008. All-cause mortality was determined via National Death Index, US Postal Service, or report of participant's family. The hypothesis being tested was formulated after data collection. Trauma exposure and PTSD symptoms were jointly coded as no trauma exposure (reference), trauma and no PTSD symptoms, 1 to 3 PTSD symptoms (subclinical), 4 to 5 PTSD symptoms (moderate), and 6 to 7 PTSD symptoms (high). Among 51 602 women (50 137 [97.2%] White individuals), the mean (range) age was 53.3 (43-64) years at study baseline in 2008. PTSD and probable depression were comorbid; of 4019 women with high PTSD symptoms, 2093 women (52.1%) had probable depression, while of 10 105 women with no trauma exposure, 1215 women (12.0%) had probable depression. Women with high PTSD symptoms and probable depression were at nearly 4-fold greater risk of death compared with women with no trauma exposure and no depression (hazard ratio [HR], 3.80; 95% CI, 2.65-5.45; P < .001). After adjustment for health factors, women with these conditions had a more than 3-fold increased risk (HR, 3.11; 95% CI, 2.16-4.47, P < .001). Women with subclinical PTSD symptoms without probable depression had increased risk of death compared with women with no trauma exposure and no depression (HR, 1.43; 95% CI, 1.06-1.93; P = .02). Among 7565 women with PTSD symptoms and probable depression, 109 deaths (1.4%) occurred for which we obtained cause of death information, compared with 124 such deaths (0.6% ) among 22 215 women with no depression or PTSD symptoms. Women with PTSD symptoms and probable depression, compared with women with no PTSD or depression, had higher rates of death from cardiovascular disease (17 women [0.22%] vs 11 women [0.05%]; P < .001), diabetes (4 women [0.05%] vs 0 women; P < .001), unintentional injury (7 women [0.09%] vs 7 women [0.03%]; P = .03), suicide (9 women [0.12%] vs 1 woman [<0.01%]; P < .001), and other causes of death (14 women [0.19%] vs 17 women [0.08%]; P = .01). These findings suggest that at midlife, women with high PTSD symptoms and co-occurring probable depression are at increased risk of death compared with women without these disorders. Treatment of PTSD and depression in women with symptoms of both disorders and efforts to improve their health behaviors may reduce their increased risk of mortality.

Exploring the relationship between posttraumatic stress disorder symptoms and momentary heart rate variability

Toward the Predeployment Detection of Risk for PTSD

ObjectivesOur objective was to determine if symptoms of depression and posttraumatic stress disorder (PTSD) are associated with peritraumatic dissociation, and if this association is modified by trauma prior to police...

Posttraumatic Stress Disorder Symptoms During the First Six Months After Traumatic Brain Injury

In this study, we evaluated whether peritraumatic dissociation (PD) was associated with symptoms of depression and posttraumatic stress disorder (PTSD), and whether this association was modified by trauma prior to police work. Symptoms of depression, PTSD, peritraumatic dissociative experience (PDE), and trauma prior to police work were measured using the Center for Epidemiologic Studies Depression scale, PTSD Checklist-Civilian, PDE questionnaire, and the Brief Trauma questionnaire, respectively, in 328 police officers. Separate regression models were used to assess if either symptoms of depression or PTSD were associated with PD stratified by prior trauma. Means were adjusted for race, number of drinks per week, and smoking. PD was associated with symptoms of PTSD and depression (β = 0.65, p < .001 and β = 0.27, p < .001, respectively). PD was positively associated with symptoms of PTSD regardless of prior trauma (β = 0.61, p < .001(without prior trauma), 0.75, p < .001 (with prior trauma). In contrast to PTSD, depression symptoms were significantly associated with PD scores in individuals with prior trauma (β = 0.47, p < .001), but not in individuals without prior trauma (β = 0.13, p = .165). This is a cross-sectional study. Outcomes were obtained via self-report and were not clinically diagnosed. Aspects of both the trauma event as well as the symptoms and severity of PD may have introduced recall bias. These results add to the literature indicating that PD plays a role in symptoms of PTSD and depression and how prior trauma may modify this relationship. (PsycINFO Database Record

Post-trauma patients are at risk of developing symptoms of post-traumatic stress disorder (PTSD) and major depression. The primary goal of this study is to estimate the prevalence of PTSD and depression symptoms in patients who have been hospitalised for the treatment of physical trauma. Additionally, we wanted to compare the prevalence of PTSD or depression symptoms alone versus PTSD associated with depression symptoms, in orthopaedic post-trauma patients. This study had involved orthopaedic post-trauma patients in the orthopaedic ward and clinic of Hospital Tuanku Jaafar (HTJ), Seremban, Malaysia, using an online questionnaire, which consist of English and Malay language. We then determined the prevalence of depression and PTSD symptoms in orthopaedic post-trauma patients and compared this prevalence to the severity of the injuries sustained and any association between PTSD and depression symptoms. Only 12.9% of the participants are likely to have post-traumatic stress disorder (PTSD) symptoms and 43.3% of participants have depression symptoms. There is no significant association between patient demographics and severity of the injuries with the prevalence of post-traumatic stress disorder (PTSD) and depression symptoms. However, of those deemed likely to have PTSD, 93.5% of them had both post-traumatic stress disorder (PTSD) symptoms as well as depressive symptoms. Only a few of the participants are likely to develop post-traumatic stress disorder (PTSD) while almost half of the participants are likely to have developed depression. Physicians caring for trauma patients should screen them for early symptoms of PTSD and depression and treat them accordingly.