Sex Differences in Antihypertensive Medications and PTSD Incidence

PTSD and Combat-Related Injuries: Functional Neuroanatomy

BackgroundWe aimed to investigate the annual incidence of trauma and stress-related mental disorder including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) using the National Health Insurance Service Database. In addition, we estimated direct medical cost of ASD and PTSD in Korea.MethodsTo examine the incidence, we selected patients who had at least one medical claim containing a 10th revision of the International Statistical Classification of Diseases and Related Health Problems code for ASD (F43.0) and PTSD (F43.1) and had not been diagnosed in the previous 360 days, from 2010 to 2017. We estimated annual incidence and the number of newly diagnosed patients of ASD and PTSD. Annual prevalence and direct medical cost of ASD and PTSD were also estimated.ResultsThe number of newly diagnosed cases of ASD and PTSD from 2011 to 2017 totaled 38,298 and 21,402, respectively. The mean annual incidence of ASD ranged from 8.4 to 13.7 per 100,000 population and that of PTSD ranged from 4.2 to 8.3 per 100,000 population, respectively. The incidence of ASD was found more in females and was highest among the 70–79 years of age group and the self-employed individuals group. The incidence of PTSD was also more common in the female group. However, the incidence of PTSD was highest in the 60–69 years of age group and in the medical aid beneficiaries group. The annual estimated medical cost per person of ASD ranged from 104 to 149 US dollars (USD). In addition, that of PTSD ranged from 310 to 426 USD.ConclusionFrom 2011 to 2017, the annual incidence and direct medical cost of ASD and PTSD in Korea were increased. Proper information on ASD and PTSD will not only allows us to accumulate more knowledge about these disorders themselves but also lead to more appropriate therapeutic interventions by improving the ability to cope with these trauma related psychiatric sequelae.

The associations between injury severity, posttraumatic stress disorder (PTSD), and development of chronic diseases, such as hypertension, among military service members are not understood. We sought to (1) estimate the prevalence and incidence of PTSD within a severely injured military cohort, (2) assess the association between the presence and chronicity of PTSD and hypertension, and (3) determine whether or not initial injury severity score and PTSD are independent risk factors for hypertension. Administrative and clinical databases were used to conduct a retrospective cohort study of 3846 US military casualties injured in the Iraq and Afghanistan conflicts between February 1, 2002, and February 1, 2011. Development of PTSD and hypertension after combat injury were determined using the International Classification of Diseases, Ninth Revision codes. Multivariable competing risk regression models were used to assess associations between injury severity score, PTSD, and hypertension, while controlling for covariates. Overall prevalence of PTSD was 42.4%, and prevalence of hypertension was 14.3%. Unadjusted risk of hypertension increased significantly with chronicity of PTSD (1-15 diagnoses: hazard ratio, 1.77; 95% confidence interval, 1.46-2.14; P<0.001; >15 diagnoses: hazard ratio, 2.29; 95% confidence interval, 1.85-2.84; P<0.001) compared with patients never diagnosed with PTSD. The association between injury severity score (hazard ratio, 1.06 per 5-U increment; 95% confidence interval, 1.03-1.10; P<0.001) and hypertension was significant, with little change in effect in the multivariable model (hazard ratio, 1.05 per 5-U increment; 95% confidence interval, 1.01-1.09; P=0.03). In a cohort of service members injured in combat, we found that chronicity of PTSD diagnoses and injury severity were independent risk factors for hypertension.

Treatment of traumatic birth experience with postpartum early eye movement desensitization and reprocessing therapy: a randomized clinical trial.

Nature disasters and terrorist attacks have occurred globally in recent years. Posttraumatic stress disorder (PTSD) has gained increasing attention, but its incidence and comorbidities in the general population are different from those inside the disaster areas. The present study estimated incident PTSD and comorbid diseases for over a decade in a cohort from a community-based integrated screening program. Factors associated with the incidence of PTSD were analyzed using Cox regression models. PTSD incidence was estimated as 81 per 105 person-years. Incidence was higher in females than in males and one-year increments in age lowered the risk for PTSD by 3%. Adjusting for other factors, cardiovascular heart disease (adjusted hazard ratio (aHR) = 1.45, 95% confidence interval (CI): 1.03–2.04), bipolar disorder (aHR = 1.86, 95% CI: 1.07–3.24) and major depressive disorder (aHR = 7.03, 95% CI: 5.02–9.85) all significantly increased 45%, 86% and 603%, respectively, the risk of developing PTSD. The low rate of people with incident PTSD receiving treatment in this community health screening population implies there is room for improvement in terms of early detection and intervention. Clinical preventive efforts may be made for patients seeking general medical help, especially those with cardiovascular disorders or mood disorders.

Alcohol withdrawal patients have increased risk of PTSD after ICU discharge. The aim of this study was to determine the PTSD incidence in AWS patients after ICU discharge and to investigate the stress marker dynamics – plasma cortisol during the course of treatment, depending on the chosen sedation method. To the prospective controlled study were admitted 200 AWS patients in 4 groups – dexmedetomidine (gr. 1.1), propofol (gr. 1.2) dexmedetomidine and propofol (hr.1.3) and control (gr. 1.4). PTSD incidence 1 month after discharge was as follows: in groups 1.1-1.3 in 3-7% patients, in group 1.4 – 15 (35%) patients had PTSD (p = 0.003). PTSD incidence 6 months after discharge was lower in groups 1.1-1.3 – 4-7% patients; in group 1.4 – 39% of patients had PTSD (p = 0.006). 48 hours after inclusion in the study cortisol level significantly decreased in groups 1.1-1.3 and increased in group 1.4 (rd”0,001). 72 hours after inclusion in the study cortisol level also significantly decreased in group 1.1-1.3 and remained high in the control group 1.4 (rd”0,001). Dexmedetomidine, propofol and their combination use for AWS patients sedation reduces the level of stress hormones and PTSD incidence.

The impact of sleep quality on the incidence of PTSD: Results from a 7-Year, Nationally Representative, Prospective Cohort of U.S. Military Veterans

Impact on new onset stress and post-traumatic stress disorder (PTSD) in relatives of patients admitted to an intensive care unit evaluated by diaries study

Meta-analysis of post-traumatic stress disorder and COVID-19 in patients discharged

To determine the incidence and severity of Post-Traumatic Stress Disorder (PTSD) in maxillofacial trauma patients and to assess the predisposing factors. Post-Traumatic Stress Disorder (PTSD) was assessed as per the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. The PTSD checklist for DSM-5 (PCL-5), was used initially to screen patients for PTSD for a provisional diagnosis. These provisionally diagnosed patients were then subjected to a structured interview by a Clinician Administered PTSD Scale for DSM-5 (CAPS-5). The PTSD status outcome of PCL-5 and CAPS-5 were correlated. PTSD was compared among patients with different types of facial fractures/injuries and also compared based on their anatomic location. The reliability of PCL-5 scale in relation to the structured CAPS-5 was assessed and the specificity was found to be 71.4%. Patients with both aesthetic and functional deformity exhibited greater severity of injury and showed higher incidence of PTSD with higher conversion rate from the 1st month to 3rd month. The frequency of PTSD in deformities with higher severity like zygomaticomaxillary complex injuries was found to be statistically significant. A high incidence of PTSD is associated with maxillofacial trauma and early detection is essential.

RATIONALE: Post Traumatic Stress Disorder (PTSD) is characterized by intense, disturbing thoughts and flashbacks to traumatic events that can significantly reduce quality of life. An estimated 25-44% of survivors of critical illness develop clinically significant PTSD. Trauma leads to decreased glucocorticoid levels and upregulation of the cortisol receptor sensitivity, which may explain the hyper-arousal and avoidance seen in PTSD. Exogenous steroids may help attenuate this change. Previously published studies demonstrate steroids' efficacy in preventing PTSD when given during hospitalization. Data on PTSD specifically in patients hospitalized with Coronavirus-19 (COVID-19) remains sparse whilst utilization of corticosteroid in these patients is growing. Here we describe the incidence of PTSD in critically ill survivors of COVID-19 and explore steroids' role in the prevention of PTSD. METHODS: This is a multicenter retrospective cohort study of patients admitted to the University of Maryland Medical System for critical illness due to COVID-19 between March-December, 2020 and seen for follow up in the post-COVID clinic. Patient's demographic data, underlying medical conditions, and therapies received during hospitalization were collected and manually extracted through retrospective chart review. Patients were screened for PTSD via PTSD Checklist 5 (PCL-5) in outpatient setting. Those with PCL-5 score of 33 or greater were considered to have probable PTSD. We calculated descriptive statistics of demographic and clinical characteristics and performed nonparametric comparisons between groups using the Fishers exact test for categorical variables and the Mann Whitney U test for discrete variables. RESULTS: Twenty-eight patients were included in the study. Age ranged from 29 to 75 years old. Half of patients were female, 50% were African American, 28.6% Caucasian, 10.7% were Hispanic or Latino, and 10.7% were Asian. Four patients (14.3%) required extracorporeal membrane oxygenation (ECMO), seventeen (60.7%) required mechanical ventilation. The majority (78.6%) of the patients received solumedrol, hydrocortisone, prednisone, or dexamethasone as therapy for Acute Respiratory Distress Syndrome (ARDS), shock, or COVID-19 pneumonia. Seven patients developed PTSD (25%). There was no difference in demographics, past medical history, or ECMO utilization when comparing patients with and without PTSD. There was no difference in the usage of steroids (dose or duration) when comparing patients with and without PTSD. CONCLUSION: The incidence of PTSD in COVID-19 survivors is in line with the historical rate of PTSD in the general population of critical illness survivors. The use of corticosteroids had no effect on reducing the incidence of PTSD or the PCL-5 scores in this cohort of patients.

Patients with severe burns typically undergo multiple surgeries, and ketamine is often used as part of the multimodal anesthetic regimen during such surgeries. The anesthetic ketamine is an N-methyl-D-aspartate receptor antagonist that also provides analgesia at subanesthetic doses, but the psychoactive side effects of ketamine have caused concern about its potential psychological effects on a combat-wounded population. Post-traumatic stress disorder (PTSD) affects approximately 30% of burned U.S. service members injured in Operation Iraqi Freedom/Operation Enduring Freedom. A preliminary analysis by our research group reported that patients who received perioperative ketamine had a significantly lower prevalence of PTSD than those injured service members who did not receive ketamine. We have now expanded this research to examine the relationship between ketamine and PTSD development in a much larger population. A retrospective analysis on data from service members being treated for burns at the San Antonio Military Medical Center was conducted. Collected data included drugs received, injury severity score (ISS), total body surface area (TBSA) burned, length of hospital stay (LOS), number of intensive care unit days, number of surgeries, and PTSD Checklist-Military (PCL-M) scores and administration dates. Subjects were grouped based on intraoperative receipt of ketamine, and the groups were compared. The groups were binary for ketamine (yes or no), and dose of ketamine administered was not included in data analyses. Propensity score matching based on ISS and TBSA was performed to control for individual differences in burn severity. Two hundred eighty-nine burned U.S. service members received the PCL-M at least 30 days after injury. Of these subjects, 189 received intraoperative ketamine, and 100 did not. Despite significantly greater injuries, as evidenced by significantly higher TBSA burned and ISS (p < 0.01), patients who received ketamine did not screen positive for PTSD at a different rate than those patients who did not (24% vs. 26.98%, p = 0.582). Patients receiving intraoperative ketamine also underwent a significantly greater number of surgeries, spent more time in the hospital, spent more days in the ICU, and received more morphine equivalent units (p < 0.0001). Propensity score matching based on ISS and TBSA resulted in a total subject number of 130. In the matched samples, subjects who received ketamine still underwent significantly more surgeries and experienced longer hospital stays (p < 0.0001). Again, there was no statistically significant difference in the incidence of a positive screen for PTSD based upon the receipt of ketamine (28% vs. 26.15%, p = 0.843). Ketamine is often used in burn patients to reduce opioid usage and decrease the hemodynamic and respiratory side effects. Although this study does not show a benefit of ketamine on PTSD development that was identified in previous work with a smaller sample number, it does support the conclusion that ketamine does not increase PTSD development in burned service members.

First responders are at risk for developing symptoms of posttraumatic stress disorder (PTSD). Little is known about the risk factors for developing PTSD during a years-long period after complex mass disasters. To explore the long-term course of PTSD symptoms and to identify risk factors and their relative association with PTSD among first responders dispatched to the 2011 Japanese earthquake, tsunami, and nuclear disaster. This 6-year, large, prospective cohort study was part of a continuous longitudinal study of Japan Ground Self-Defense Force first responders. The data were collected at 1, 6, 12, 24, 36, 48, 60, and 72 months after mission completion from 2011 to 2017. Of approximately 70 000 eligible participants, 56 388 were enrolled in this study. Data were analyzed from 2017 to 2020. Stress exposures owing to personal or professional disaster experience (eg, duties with body recovery or radiation exposure risk) and working conditions (eg, deployment length, postdeployment overtime work). The Impact of Event Scale-Revised score assessed PTSD symptoms; scores of at least 25 were defined as probable PTSD. Cox proportional hazards regression models assessed the risk factors for incidence of probable PTSD. Among the 56 388 participants, 97.1% were men, and the median age at enrollment was 34 (range, 18-63) years. A probable PTSD rate was 2.7% at 1 month and showed a downward trend in the first year and a subsequent plateau. The cumulative incidence of probable PTSD was 6.75%. The severity of PTSD symptoms demonstrated a high degree of rank-order stability over time. Rather than professional disaster experience, sociodemographic factors and working conditions were independently associated with the incidence of probable PTSD: personal experience of the disaster (hazard ratio [HR], 1.96; 95% CI, 1.72-2.24), deployment length of at least 3 months (HR vs <1 month, 1.75; 95% CI, 1.52-2.02), increased age (HR for ≥46 vs ≤25 years, 2.28; 95% CI, 1.79-2.92), and postdeployment overtime work of at least 3 months (HR vs little to none, 1.61; 95% CI, 1.39-1.87). Given these findings, in the future, first responders' PTSD symptoms might be mitigated by shortening deployment length, avoiding postdeployment overtime work, and paying special attention to the needs of personnel with personal experience of the disaster or older age. Efforts to alleviate responders' initial symptoms will be required.

BackgroundThe impact of combat operations in Iraq and Afghanistan on the incidence of post-traumatic stress disorder (PTSD) in military service members has been poorly quantified. The purpose of this study was to examine trends in the incidence rate of physician-diagnosed PTSD in active-duty military personnel between 1999 and 2008.MethodsWe conducted a retrospective cohort study utilizing data extracted from the Defense Medical Surveillance System to identify incident cases of PTSD within the study population. The incidence rate of physician-diagnosed PTSD was the primary outcome of interest. Multivariable Poisson regression was used to analyze the data.ResultsThe overall incidence rate of PTSD among all active-duty US military personnel was 3.84 (95% CI: 3.81, 3.87) cases per 1000 person-years. The adjusted average annual percentage increase in the incidence rate of PTSD prior to the initiation of Operation Iraqi Freedom (OIF) was a modest 5.02% (95% CI: 1.85, 8.29%). Following the initiation of OIF, the average annual percentage increase in the rate of PTSD was 43.03% (95% CI: 40.55, 45.56%). Compared to the baseline period between 1999 and 2002, the incidence rate of PTSD in 2008 was nearly 7 times higher (RR = 6.85, 95% CI: 6.49, 7.24). Significant increases in the incidence rate of PTSD were observed following the initiation of OIF regardless of sex, age, race, marital status, military rank, or branch of military service. Notably, the rate of PTSD among females was 6–7 times higher prior to OIF, but there was no difference by gender by 2008.ConclusionsOverall, these data quantify the significant increase in the incidence rate of PTSD following the initiation of combat operations in Iraq and Afghanistan within the active-duty military population during the study period.

Long-Term Impact of Exposure to Suicide: A Three-Year Controlled Follow-up