Posttraumatic Stress Disorder Depression Research Articles

Exercise training effects on sleep quality and symptoms of anxiety and depression in post-traumatic stress disorder: A systematic review and meta-analysis of randomized control trials

IntroductionSleep problems are common in post-traumatic stress disorder (PTSD). Exercise can improve sleep quality, but whether this occurs among those with PTSD is unclear. We conducted a systematic review and meta-analysis to estimate the magnitude of the effect of exercise training on overall sleep quality in patients with PTSD. Secondarily, the impact of exercise training on symptoms of PTSD, anxiety, and depression were evaluated. MethodsArticles published before April 1, 2020, were located through PubMed, Web of Science, PsycINFO, and Google Scholar. Exercise training interventions that measured sleep quality in patients with PTSD were evaluated for inclusion. In total, 1,948 articles were screened, 40 were further appraised, and four were analyzed. Hedges’ d effect sizes were calculated for sleep quality. Due to the relationship between poor sleep and symptoms of PTSD, anxiety, and depression, symptom changes with exercise training were analyzed. ResultsThe four studies involved a total of 149 participants (61% males) with a mean (SD) age of 44.7 (16.3) years. The exercise intervention duration ranged from 3 to 12 weeks. All 5 effect sizes for overall sleep quality supported a favorable effect of exercise training; the mean Hedges'd (95% CI) was −0.47 (−0.18, −0.75), p < 0.05. Exercise training was consistently associated with small or moderate improvements in PTSD, anxiety, and depression symptoms. ConclusionsThe small body of evidence suggests that exercise training has promise for improving overall sleep quality and PTSD, anxiety, and depression symptoms among those with PTSD.

Depression in post-traumatic stress disorder.

Major depressive disorder (MDD) symptoms commonly occur after trauma-exposure, both alone and in combination with post-traumatic stress disorder (PTSD). This article reviews recent research on comorbidity between these disorders, including its implications for symptom severity and response to treatment. Despite considerable symptom overlap, the two disorders represent distinct constructs and depend, at least in part, on separate biological mechanisms. Both, however, are also clearly related to stress psychopathology. We recommend that more research focus specifically on the study of individual differences in symptom expression in order to identify distinct subgroups of individuals and develop targeted treatments. However, a barrier to this line of inquiry is the trend of excluding particular patients from clinical trials of new interventions based on symptom severity or comorbidity. Another obstacle is the overreliance on self-report measures in human research. We argue that developing computer-based behavioral measures in order to supplement self-report can help address this challenge. Furthermore, we propose that these measures can help tie findings from human and non-human animal research. A number of paradigms have been used to model MDD-and PTSD-like behavior in animals. These models remain valuable for understanding the biological basis of these disorders in humans and for identifying potential interventions, but they have been underused for the study of comorbidity. Although the interpretation of animal behavior remains a concern, we propose that this can also be overcome through the development of close human analogs to animal paradigms.

The influence of depression-PTSD comorbidity on health-related quality of life in treatment-seeking veterans

ABSTRACT Objective Posttraumatic stress disorder (PTSD) and depression substantially impair health-related quality of life (HRQOL) for many Canadian Armed Forces (CAF) veterans. Although PTSD and depression are highly comorbid, little is known about whether the disorders may interact in their association with HRQOL. We sought to investigate whether depressive symptoms modify the relation between PTSD and HRQOL in treatment-seeking veterans. Method We accessed the clinical data of 545 CAF veterans aged 18 to 65 years who were seeking treatment at a specialized clinic in London, Ontario. We used hierarchical linear regression to assess the additive and multiplicative relations between depression and PTSD symptoms on HRQOL, controlling for age and alcohol/substance abuse. Simple slopes were examined to probe significant interactions. Results Probable PTSD and major depression were present in 77.4% and 85.3% of the sample, respectively, and 73.0% of the sample presented with probable PTSD-depression comorbidity. Depression symptoms significantly modified the relation between PTSD symptoms and overall mental HRQOL (β = 0.12, p <0.001, ∆R2 = 0.014), and role impairment due to emotional difficulties (β = 0.20, p <0.001, ∆R2 = 0.035). Simple slope analyses revealed the impact of PTSD was greater among those with lower depression symptoms and became weaker with greater depression symptom severity. In adjusted models, only depression was significantly associated with all mental and physical HRQOL domains; PTSD was not associated with physical HRQOL, role emotional impairment, or vitality. Conclusions For those with severe comorbid depression, PTSD symptoms were no longer associated with mental HRQOL, particularly in areas related to emotional functioning. Findings suggest the importance of targeting depression in patients presenting with PTSD-depression comorbidity.

The Meaning Behind the Scar: Anonymous Live Liver Donors' Perceptions of Their Surgical Scars.

Scarring can greatly impact quality of life for individuals (ie, causing depression posttraumatic stress disorder and body image issues). Those who wish to be anonymous live liver donors are warned of the potential negative psychological impacts associated with the large scar left from liver donation surgery. Given the unique degree of autonomy that these patients have over their surgery, we explore whether a sample of 26 anonymous live liver donors experience a unique relationship with their scar. Anonymous donors participated in a semistructured qualitative interview examining their experience with donation. Interviews were audio-recorded, transcribed, and analyzed using the constant comparison method for themes pertaining, to participants' perception of their scar. Five main themes were identified-a marker of satisfaction about the donation experience, a physical reminder of donation, a trigger for recipient-related thoughts, an awareness tool, and a potential threat to anonymity. Donors did not voice any body image or cosmetic concerns due to their scars. Instead, discussions about the negative aspects of scarring centered around the identifying nature of their scar. These findings help underscore the distinctiveness of anonymous living liver donors as a patient population. Preparing anonymous living liver donors for different types of cosmetic issues relating to their scar (ie, as a possible threat to their desired anonymity) may be more appropriate than preparing them in the same way as other donor populations.

Understanding Depression as It Occurs in the Context of Post-Traumatic Stress Disorder

The aim of the current special issue is to gain a better understanding of depression as it occurs in the context of posttraumatic stress disorder (PTSD). Depression and major depressive disorder (MDD) are often present in the context of PTSD, but it is not clear whether the high prevalence of depressive disorders in PTSD should be best understood as true comorbid conditions, with a separate underlying cause and pathophysiology or rather, whether it should best be considered an artifact of overlapping symptoms. Indeed, when individuals with PTSD also meet criteria for depression, this may signal the presence of a single depressive subtype of PTSD rather than two separate syndromes. Epidemiologic data support the idea that a depressive diathesis can be a risk factor for the development of PTSD following trauma exposure. However, the question of childhood trauma as an even earlier antecedent of depression suggests that the depression that contributes to PTSD risk may relate to earlier forms of trauma exposure rather than genetic diatheses per se. Prospective studies assessing the development of major depressive disorder (MDD) show that, although the prevalence of PTSD is higher shortly after exposure, later on approximately the same prevalences of PTSD and MDD are seen after exposure to traumatic events. Severe depressive symptoms in the early aftermath of trauma exposure can be considered more relevant in predicting an unfavorable course of mental health than severity of PTSD symptoms, underlining the relevance of broad mental health assessment after trauma exposure. Whether depression in PTSD represents a phenomenological expression of the same underlying pathophysiology becomes interesting to consider in the context of the rather distinct biological alterations that have been observed in PTSD and major depressive disorder, particularly in the context of neuroendocrine, neurochemical, and brain metabolic factors. Beside clinical characteristics, biological markers may help to further improve identification of biologically distinct endophenotypes and, ultimately, to devise more specific treatment strategies. Although antidepressants are among the only FDA-approved pharmacological treatments for PTSD, these medications have only limited utility in PTSD, and it is not clear whether the efficacy of these agents results from the treatment of comorbid depression or PTSD per se.

Age at first trauma is associated with serotonin 1B receptor reductions and comorbid depression in posttraumatic stress disorder

ACKNOWLEDGMENTS Data presented in mean ± standard deviation, unless otherwise indicated. P values determined by independent sample t-tests or ANOVA followed by Tukey’s post-hoc test for continuous variables, or by chi-square for dichotomous variables. 1Post-hoc PTSD > HC, p=0.002. 2Physical assault includes sexual assault, domestic violence and other non-combat related physical violence. 3Traumatic experiences included meet DSM-IV-TR criteria A for PTSD. 4Post-hoc PTSD > HC, p TC, p<0.001. AA, African-American; AS, Asian-American; BMI, body mass index; C, Caucasian; F, female; H, Hispanic; M, male; MDD, major depressive disorder; MDE, major depressive episode; N, nonsmoker; S, smoker. Significant group differences in [11C]P943 BPND within a cortico-striatal-limbic circuit initially established by multivariate analysis of variance including the 5 a priori ROIs (Wilks' Lambda F[10,178]=2.18, p=0.021). F-statistic and P values in table determined by subsequent one-way ANOVA for each ROI. Data presented in mean ± standard deviation, unless otherwise indicated. Tukey’s HSD Post-hoc t-tests and % differences as follows: Anterior Cingulate Cortex: PTSD < Healthy Control (9.1%, p=0.048)*, Trauma Control = Healthy Control (p=0.095), PTSD = Trauma Control (p=0.98) Amygdala: PTSD < Healthy Control (10.9%, p=0.047)*, Trauma Control < Healthy Control (14.7%, p=0.027)*, PTSD = Trauma Control (p=0.74) Caudate: PTSD < Healthy Control (18.8%, p=0.006)*, Trauma Control < Healthy Control (25.8%, p=0.002)*, PTSD = Trauma Control (p=0.56)

Maintaining Effective Psychosocial Treatment Strategies for Children With HIV/AIDS in Africa: An Ongoing Challenge

In this article we provide a brief summary of some of the challenges that are faced by communities in developing countries with high numbers of HIV/AIDS victims. Although an increasing number of those countries’ governments now provide retroviral medication to their infected citizens few have been able to tackle the psychological consequences of this disease. As seen in the case of the Sparrow Ministries an outstanding institution in terms of resources and professional competence for this part of the world a significant number of children now face the consequences of long-term institutionalization with their associated high incidence of depression post traumatic stress disorder (PTSD) attachment problems and externalizing disorders.8 In addition the stigma against AIDS victims among the population remains extremely high compromising the reintegration of medically treated individuals into their communities from Sparrow and other treatment facilities and raising the threat of victims becoming victimizers. What seems clear is that HIV/AIDS is a chronic disorder that affects both the medical and psychological health of its victims and their families often for life. Although comprehensive medical treatment is essential for survival affected individuals and here especially children need support for their overall emotional cognitive and academic development from the day of their diagnosis onward to deal with the condition’s profound psychosocial consequences. In the absence of capable biological or adoptive families group rearing arrangements must be structured to facilitate the development of solid attachments between the children and their caretakers. The additional present day costs of such arrangements may be substantial but can possibly prevent a future multigenerational collapse of significant social structures in the developing world. (authors)

Relationship between depression and arousal symptom in trauma survivors

Depression is highly comorbid with post-traumatic stress disorder (PTSD). However, there have been few studies investigating the risk factors for depression in PTSD patients. The aim of this study was to evaluate the prevalence of depression in PTSD and relationship between depressive symptoms, PTSD symptom clusters, and anxiety. Participants were 24 survivors from the disaster of the Taegu subway fire (29.4±9.3 years, 9 men) who had diagnosis of PTSD by the Structured Clinical Interview for DSM-IV (SCID-IV) and 39 healthy comparison subjects (30.5 ± 7.2 years, 20 men). Depressed mood and anxiety were examined by Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in all subjects. In PTSD subjects, the severity of PTSD symptoms including arousal, avoidance, and re-experience were assessed by the Clinician-Administered PTSD Scale for DSMIV (CAPS). The mean HAMD score of PTSD subjects was significantly higher than that of control subjects (13.4±4.8 vs 3.5±3.9, t=8.8, pb0.001). When applying standard HAMD cut-off score of 11 or higher, 15 PTSD subjects (62.5%) and 2 control subjects (5.1%) had significant depressive symptoms (χ = 24.8, pb0.001). The mean HAMA score was also significantly higher in PTSD subjects than control subjects (15.5±4.7 vs 1.3±1.6, t=12.1, pb0.001). HAMD scores were positively correlated with arousal (r=0.78) and avoidance (r=0.65) scores, intensity/ frequency of PTSD symptoms (r=0.69; r=0.69), and HAMA scores (r=0.49). However, multiple linear regression analysis controlling for sex and age indicated that only arousal score was a significant predictor of HAMD score in PTSD subjects (regression coefficient=0.53, pb0.01). This study showed that survivors from trauma had significant depressive symptoms and that arousal symptoms appeared to be a salient factor contributing to depressive symptoms observed in the survivors. Further prospective study should be necessary to clarify the role of arousal symptoms to development of depression in PTSD patients.

Repetitive Transcranial Magnetic Stimulation Treatment of Comorbid Posttraumatic Stress Disorder and Major Depression

Twelve patients with comorbid posttraumatic stress disorder (PTSD) and major depression underwent repetitive transcranial magnetic stimulation (rTMS) to left frontal cortex as an open-label adjunct to current antidepressant medications. rTMS parameters were as follows: 90% of motor threshold, 1 Hz or 5 Hz, 6,000 stimuli over 10 days. Seventy-five percent of the patients had a clinically significant antidepressant response after rTMS, and 50% had sustained response at 2-month follow-up. Comparable improvements were seen in anxiety, hostility, and insomnia, but only minimal improvement in PTSD symptoms. Left frontal cortical rTMS may have promise for treating depression in PTSD, but there may be a dissociation between treating mood and treating core PTSD symptoms.

Self-Critical Depressive Experience in Posttraumatic Stress Disorder

Consistent with prior research, 73 hospitalized male Vietnam veterans with combat-related Posttraumatic Stress Disorder (PTSD) reported high scores on Self-criticism as measured by the Depressive Experiences Questionnaire. Self-criticism scores predicted greater severity of PTSD (Mississippi scale) after controlling for symptomatic depression (MMPI-D scale), suggesting that the nature of depression in Posttraumatic Stress Disorder differs from that in major depressive disorder.