Greater Posttraumatic Stress Disorder Symptoms Research Articles

Self-care status of veterans with combat-related post traumatic stress disorder: A review article

Background and Purpose: Post-traumatic stress disorder (PTSD) is identified as the risk factor for functional difficulties in most of the survivors. The aim of this study was to investigate the current evidence-based literature on the area of self-care and ADL status in the veterans with combat-related PTSD. Methods: This review was conducted on the studies published within 2005-2015. The search was performed using such databases as SID, Iran Medex, Magiran, Science Direct, ProQuest, and PubMed. The searches were initially carried out using single keywords, and then continued with using OR/AND for combining words such as “self-care activity, instrumental activities of daily living, physical functioning, post- traumatic stress disorder in war veterans, etc”. Finally, a total of 783 papers were retrieved, out of which only 15 publications were considered relevant to the subject under discussion and investigated in-depth. Results: According to the findings of the reviewed articles, there is a relationship between the self-care status and PTSD severity; as a result, greater PTSD symptoms are accompanied by poorer self-care practices and ADLs. Furthermore, in all the studies, the physical functioning (self-care or ADLs) was lower in the PTSD population in comparison to the non-PTSD population. Conclusion: As the findings of the retrieved articles indicated, it can be conclude that the self-care practices and ADLs were poor among the veterans suffering from PTSD. Therefore, it is necessary that nurses develop a comprehensive care planning for this population to facilitate their achievement of independence in ADLs.

Journal Digest

Journal Digest

Posttraumatic stress disorder symptoms, anxiety sensitivity, and alcohol-use motives in college students with a history of interpersonal trauma.

Posttraumatic stress disorder (PTSD) symptoms are associated with coping-motivated alcohol use in trauma-exposed samples. However, it is unclear which individuals experiencing PTSD symptoms are at greatest risk for alcohol-use problems following trauma exposure. Individuals endorsing high anxiety sensitivity, which is the fear of anxiety and related sensations, may be particularly motivated to use alcohol to cope with PTSD symptoms. In the current study, we examined the moderating role of anxiety sensitivity in the association between PTSD symptoms and coping motives in a sample of 295 young adults with a history of interpersonal trauma and current alcohol use. Participants completed measures of past 30-day alcohol consumption, trauma history, current PTSD symptoms, anxiety sensitivity, and alcohol-use motives. Results of hierarchical multiple regression analyses indicated that greater anxiety sensitivity was significantly associated with greater coping (β = .219) and conformity (β = .156) alcohol-use motives, and greater PTSD symptoms were associated with greater coping motives (β = .247), above and beyond the covariates of sex, alcohol consumption, trauma load, and noncriterion alcohol-use motives. The interaction of anxiety sensitivity and PTSD symptoms accounted for additional variance in coping motives above and beyond the main effects (β = .117), with greater PTSD symptoms being associated with greater coping motives among those high but not low in anxiety sensitivity. Assessment and treatment of PTSD symptoms and anxiety sensitivity in young adults with interpersonal trauma may be warranted as a means of decreasing alcohol-related risk in trauma-exposed young adults. (PsycINFO Database Record

Multimodal examination of distress tolerance and posttraumatic stress disorder symptoms in acute-care psychiatric inpatients

Distress tolerance (DT), the actual or perceived capacity to withstand negative internal states, has received increasing scholarly attention due to its theoretical and clinical relevance to posttraumatic stress disorder (PTSD). Past studies have indicated that lower self-reported – but not behaviorally observed – DT is associated with greater PTSD symptoms; however, studies in racially and socioeconomically diverse clinical samples are lacking. The current study evaluated associations between multiple measures of DT (self-report and behavioral) and PTSD symptoms in an urban, racially and socioeconomically diverse, acute-care psychiatric inpatient sample. It was hypothesized that lower self-reported DT (Distress Tolerance Scale [DTS]), but not behavioral DT (breath-holding task [BH]; mirror-tracing persistence task [MT]), would be associated with greater PTSD symptoms, above and beyond the variance contributed by trauma load, substance use, gender, race/ethnicity, and subjective social status. Participants were 103 (41.7% women, Mage=33.5) acute-care psychiatric inpatients who endorsed exposure to potentially traumatic events consistent with DSM-5 PTSD Criterion A. Results of hierarchical regression analyses indicated that DTS was negatively associated with PTSD symptom severity (PCL-5 Total) as well as with each of the four DSM-5 PTSD symptom clusters (p’s<0.001), contributing between 5.0%–11.1% of unique variance in PTSD symptoms across models. BH duration was positively associated with PTSD arousal symptom severity (p<0.05). Covariates contributed between 21.3%–40.0% of significant variance to the models. Associations between DT and PTSD in this sample of acute-care psychiatric inpatients are largely consistent with those observed in community samples.

Consistency of Recall for Deployment-Related Traumatic Brain Injury.

To examine the temporal consistency of self-reported deployment-related traumatic brain injury (TBI) and its association with posttraumatic stress disorder (PTSD) symptom severity. In-person interviews at US Army installations (postdeployment); phone interviews (long-term follow-up). A total of 378 US Army soldiers and veterans deployed to Iraq; 14.3% (n = 54) reported TBI with loss of consciousness during an index deployment. Participants were evaluated after returning from deployment and again 5 to 9 years later. Temporal consistency of TBI endorsement based on TBI screening interviews; PTSD Checklist, Civilian Version. The concordance of deployment-related TBI endorsement from the postdeployment to long-term follow-up assessment was moderate (κ = 0.53). Of the 54 participants reporting (predominantly mild) TBI occurring during an index deployment, 32 endorsed TBI inconsistently over time. More severe PTSD symptoms at postdeployment assessment were independently associated with discordant reporting (P = .0004); each 10-point increase in PCL scores increasing odds of discordance by 69% (odds ratio = 1.69; 95% confidence interval, 1.26-2.26). Deployment-related TBI may not be reported reliably over time, particularly among war-zone veterans with greater PTSD symptoms. Results of screening evaluations for TBI history should be viewed with caution in the context of PTSD symptom history.

Mental health among older refugees: the role of trauma, discrimination, and religiousness

ABSTRACTObjectives: The aim of this study was to examine, first, how past traumatic stress and present acculturation indices, and discrimination are associated with mental health; and, second, whether religiousness can buffer the mental health from negative impacts of war trauma.Method: Participants were 128 older (50–80 years) Somali refugees living in Finland. They reported experiences of war trauma and childhood adversities, and filled-in questionnaires of perceived ethnic discrimination, religiousness (beliefs, attendance, and observance of Islamic faith), and symptoms of posttraumatic stress disorder (PTSD), depressive (BDI-21), psychological distress (GHQ-12), and somatization (SCL-90).Results: Symptom-specific regression models showed that newly arrived refugees with non-permanent legal status and severe exposures to war trauma, childhood adversity, and discrimination endorsed greater PTSD symptoms, while only war trauma and discrimination were associated with depressive symptoms. Results confirmed that high religiousness could play a buffering role among older Somalis, as exposure to severe war trauma was not associated with high levels of PTSD or somatization symptoms among highly religious refugees.Conclusion: Health care should consider both unique past and present vulnerabilities and resources when treating refugees, and everyday discrimination and racism should be regarded as health risks.

Higher Pretreatment Blood Pressure Is Associated With Greater Posttraumatic Stress Disorder Symptom Reduction in Soldiers Treated With Prazosin

In a previously reported positive randomized controlled trial of the α1-adrenoreceptor (α1AR) antagonist prazosin for combat posttraumatic stress disorder (PTSD) in 67 active duty soldiers, baseline symptoms did not predict therapeutic response. If increased brain α1AR activation in PTSD is the target of prazosin treatment action, higher brain α1AR activation should predict greater prazosin efficacy. Although brain α1AR activation is not measurable, coregulated peripheral α1AR activation could provide an estimate of brain α1AR activation. Standing blood pressure (BP) is an accessible biological parameter regulated by norepinephrine activation of α1ARs on peripheral arterioles. Effects of baseline standing systolic and other BP parameters on PTSD outcome measures from the previously reported randomized controlled trial were analyzed using linear mixed-effects models. Prazosin participants (n = 32) and placebo participants (n = 35) were analyzed separately. In prazosin participants, each 10-mm Hg higher baseline standing systolic BP increment resulted in an additional 14-point reduction (improvement) of Clinician-Administered PTSD Scale total score at end point (p = .002). All other combinations of baseline BP parameters and PTSD outcome measures were similarly significant or demonstrated trends in the predicted direction. In placebo participants, there was no signal for a baseline BP effect on PTSD outcome measures. These findings suggest that higher standing BP is a biomarker that helps identify persons with combat PTSD who are likely to benefit from prazosin. These results also are consistent with α1AR activation contributing to PTSD pathophysiology in a subgroup of patients.

Sexual revictimization, PTSD, and problem drinking in sexual assault survivors

Posttraumatic stress disorder (PTSD) and problem drinking are common and often co-occurring sequelae experienced by women survivors of adult sexual assault, yet revictimization may mediate risk of symptoms over time. Structural equation modeling was used to examine data from a 3-wave panel design with a large (N=1012), ethnically diverse sample of women assault survivors to examine whether repeated sexual victimization related to greater PTSD and problem drinking. Structural equation modeling revealed that child sexual abuse was associated with greater symptoms of PTSD and problem drinking and intervening sexual victimization was associated with greater symptoms of PTSD and problem drinking at both 1 and 2year follow-ups. We found no evidence, however, that PTSD directly influenced problem drinking over the long term or vice versa, although they were correlated at each timepoint. Revictimization during the study predicted survivors' prospective PTSD and problem drinking symptoms inconsistently. Implications and recommendations for future research are discussed.

Posttraumatic Stress Disorder Symptom Severity and Socioeconomic Factors Associated with Veterans Health Administration Use among Women Veterans

BackgroundThe Veterans Health Administration (VA) has historically focused on treating men. Although women veterans' VA use is increasing, they remain more likely than male veterans to receive their care in non-VA settings. To date, there is limited research on factors associated with VA use among women. We examined the relationship between demographic, civilian, military, and health-related variables with past-year VA use among women veterans. MethodsWomen veterans were recruited over the internet to participate in an anonymous national survey (n = 617) in 2013. An empirically derived decision tree was computed using signal detection software for iterative receiver operator characteristics (ROC) to identify variables with the best sensitivity/specificity balance associated with past-year VA use. ResultsROC analysis indicated that 85% of participants with high posttraumatic stress disorder (PTSD) and depressive symptoms and who were younger than 54 years of age used VA in the past year. Of those who were 54 years of age or older and had very high PTSD symptoms, 94% used the VA in the last year. By contrast, only 40% of participants with relatively lower PTSD symptoms had VA past-year use, although among these individuals, VA past-year use increased to 65% for those with a relatively lower income. ConclusionsFindings suggest that greater PTSD symptoms, depressive symptoms, and low income correlate with VA use, with very high PTSD symptoms in older groups, high PTSD symptoms coupled with high depressive symptoms in younger groups, and low income in those with lower PTSD symptoms each associated with greater past-year VA use. Ensuring PTSD assessment and treatment, and addressing socioeconomic factors, may be key strategies for health care delivered directly or through contract with VA facilities.

Posttraumatic Stress Disorder Symptoms, Emotion Dysregulation, and Aggressive Behavior Among Incarcerated Methamphetamine Users

Objective: Methamphetamine use remains a prevalent problem in the United States and is linked to numerous deleterious outcomes, including aggressive behavior, criminal activity, and incarceration. Given these associations, a greater understanding of factors that contribute to aggression among users of methamphetamine is needed, particularly within criminal justice settings, where users of this drug are overrepresented. Methods: The present study examined the relationships between posttraumatic stress disorder (PTSD) symptoms and emotion dysregulation and in-prison physical aggression among incarcerated males who identified as methamphetamine users (N = 60). Results: Participants’ average age was 34.4 years (SD = 7.9), and they were predominantly European American (n = 48, 80%), had spent an average of 6.53 years incarcerated (SD = 4.64), and perpetrated about 1.54 acts of aggression (SD = 6.74) during the past three months. Bivariate correlations found that greater PTSD symptoms (p <.001), greater impulse control difficulties (p <.001), and limited access to emotion regulation strategies (p <.05) were associated with aggression perpetrated in prison. However, results from multiple regression analyses indicated that only PTSD symptoms (p <.001) and nonacceptance of emotional responses (p <.03) were predictive of aggression. Regression analyses also suggested that impulse control difficulties (p <.001), limited access to emotion regulation strategies (p <.04), and nonacceptance of emotional responses (p <.001) interacted with PTSD symptoms to predict increased aggressive behavior. The first interaction ran counter to study hypotheses: At greater levels of PTSD symptoms, those with greater acceptance of emotional responses reported greater aggression perpetration than those with lesser acceptance of emotional responses. The other two interactions were in line with hypotheses, showing that at greater levels of PTSD symptoms, those with greater impulse control difficulties (or lesser access to emotion regulation strategies) reported more aggressive behaviors. Conclusions: Consistent with theories of aggression, study findings suggest that PTSD symptoms bolster the risk of aggression via various forms emotion dysregulation. Results shed light on potential mechanisms that promote in-prison aggression and violent recidivism among this population.

Longitudinal Relationships of Social Reactions, PTSD, and Revictimization in Sexual Assault Survivors.

Sexual assault survivors receive various positive and negative social reactions to assault disclosures, yet little is known about the directionality of associations of social reactions to posttraumatic stress disorder (PTSD) symptoms over time. Data from a large, diverse sample of women who had experienced adult sexual assault was analyzed with hierarchical linear modeling (HLM) to examine how negative and positive reactions relate to PTSD symptoms over 3 years and to test the hypothesis that the relationship between negative social reactions and PTSD symptoms is reciprocal. We found that, as predicted, social reactions predicted subsequent PTSD symptoms, and in turn PTSD symptoms predicted subsequent social reactions. We also investigated the role of sexual revictimization by comparing women who suffered (vs. not) additional sexual victimization during the course of our study. Revictimized women had greater PTSD symptoms and more negative social reactions, but associations of social reactions with PTSD symptoms did not vary according to revictimization status. Implications for practice and suggestions for future research are discussed.

PT175 Role of novel noninvasive herbal procedure Sampurna Hriday Shudhikaran (SHS) in reducing angina &amp; improving effort tolerance in Ischemic Heart Disease

The Veterans Health Administration (VA) has historically focused on treating men. Although women veterans' VA use is increasing, they remain more likely than male veterans to receive their care in non-VA settings. To date, there is limited research on factors associated with VA use among women. We examined the relationship between demographic, civilian, military, and health-related variables with past-year VA use among women veterans.Women veterans were recruited over the internet to participate in an anonymous national survey (n = 617) in 2013. An empirically derived decision tree was computed using signal detection software for iterative receiver operator characteristics (ROC) to identify variables with the best sensitivity/specificity balance associated with past-year VA use.ROC analysis indicated that 85% of participants with high posttraumatic stress disorder (PTSD) and depressive symptoms and who were younger than 54 years of age used VA in the past year. Of those who were 54 years of age or older and had very high PTSD symptoms, 94% used the VA in the last year. By contrast, only 40% of participants with relatively lower PTSD symptoms had VA past-year use, although among these individuals, VA past-year use increased to 65% for those with a relatively lower income.Findings suggest that greater PTSD symptoms, depressive symptoms, and low income correlate with VA use, with very high PTSD symptoms in older groups, high PTSD symptoms coupled with high depressive symptoms in younger groups, and low income in those with lower PTSD symptoms each associated with greater past-year VA use. Ensuring PTSD assessment and treatment, and addressing socioeconomic factors, may be key strategies for health care delivered directly or through contract with VA facilities.

Ethnic Identity, Family Cohesion, and Symptoms of Post-traumatic Stress Disorder in Maltreated Youth

Post-traumatic stress disorder (PTSD) is prevalent among maltreated youth, but little empirical work exists regarding the role of ethnic identity and family cohesion as influential factors among different ethnic groups. This study included an ethnically diverse sample of adolescents affiliated with a state-administered residential facility for maltreated youth. Variables included ethnic identity and family cohesion, as well as symptoms of PTSD, depression, dissociation, and post-traumatic cognitions. The most prominent finding was that low family cohesion predicted greater PTSD symptoms, depression, dissociation, and post-traumatic cognitions. This finding was especially pronounced for multiracial youth. Results are discussed within the context of developmental pathways regarding ethnic identity development in multiracial youth.

Posttraumatic stress disorder symptoms, depressive symptoms, exercise, and health in college students.

Posttraumatic stress disorder (PTSD) symptoms have consistently been associated with poorer health in highly traumatized samples. However, less is known about the relationship between PTSD symptoms, depressive symptoms, and health in nonclinical groups. Because exercise contributes to health, we hypothesized that PTSD symptoms and depressive symptoms would be related to poorer health status, in part, through their association with lower exercise. We examined this in a sample of 200 undergraduates. Health status variables included functional health and negative health symptoms. Results indicated that greater PTSD symptoms and depressive symptoms were associated with poorer health status, and exercise mediated these relationships, in most cases. This study has implications for future research examining the effects of PTSD and depressive symptoms on health.

Posttraumatic Stress Symptoms in Children of Mothers Diagnosed with Breast Cancer

There are inconsistent findings regarding whether a mother's diagnosis of cancer affects her child's psychological health. The aim of this study was to compare maternally perceived symptoms of posttraumatic stress disorder (PTSD) in children of women with and without breast cancer. Forty mothers with breast cancer (assessed within 8 weeks of diagnosis) and 39 mothers without breast cancer were administered the Child Behavior Checklist (CBCL/6-18), UCLA Post Traumatic Stress Disorder (PTSD) Index, and Patient Health Questionnaire (PHQ-9). Descriptive discriminant analysis revealed that mothers with cancer perceived their children to have significantly greater symptoms of PTSD and internalizing distress than the mothers without cancer. No significant difference was found in maternal perception of externalizing symptoms in their children. Results revealed the importance of the assessment of PTSD in children whose mothers have cancer and the discussion includes implications for future research and clinical interventions.

The Neurobiological Role of the Dorsolateral Prefrontal Cortex in Recovery From Trauma

A multiwave longitudinal neuroimaging study in a cohort of direct survivors of a South Korean subway disaster, most of whom recovered from posttraumatic stress disorder 5 years after trauma, provided a unique opportunity to investigate the brain correlates of recovery from a severe psychological trauma. To investigate region-specific brain mobilization during successful recovery from posttraumatic stress disorder by assessing cortical thickness multiple times from early after trauma to recovery, and to examine whether a brain-derived neurotrophic factor gene polymorphism was associated with this brain mobilization. Five-year follow-up case-control study conducted from 2003-2007. Seoul National University and Hospital. Thirty psychologically traumatized disaster survivors and 36 age- and sex-matched control group members recruited from the disaster registry and local community, respectively, who contributed 156 high-resolution brain magnetic resonance images during 3 waves of assessments. Cerebral cortical thickness measured in high-resolution anatomic magnetic resonance images using a validated cortical thickness analysis tool and its prospective changes from early after trauma to recovery in trauma-exposed individuals and controls. Trauma-exposed individuals had greater dorsolateral prefrontal cortical (DLPFC) thickness 1.42 years after trauma (right DLPFC, 5.4%; left superior frontal cortex, 5.8%; and left inferior frontal cortex, 5.3% [all clusters, P≤.01]) relative to controls. Thicknesses gradually normalized over time during recovery. We found a positive linear trend, with trauma-exposed individuals with a valine/valine genotype having the greatest DLPFC cortical thickness, followed by those with a methionine genotype and controls (P<.001 for trend). Greater DLPFC thickness was associated with greater posttraumatic stress disorder symptom reductions and better recovery. The DLPFC region might play an important role in psychological recovery from a severely traumatic event in humans.

The role of protective self‐cognitions in the relationship between childhood trauma and later resource loss

The authors examined a prospective model investigating posttraumatic stress disorder (PTSD) symptoms and protective self-cognitions (self-esteem and self-efficacy) with later resource loss among 402 inner-city women who experienced childhood abuse. They predicted that women with PTSD may fail to develop or sustain protective self-cognitions that could protect against future stress. Results from the hypothesized model suggest that child abuse was associated with greater PTSD symptoms and later resource loss. PTSD symptoms were also related to protective self-cognitions, which, in turn, were associated with less resource loss. The authors also examined an alternative model exploring the relationship between resource loss and later PTSD symptoms. Findings allude to the relationship of risk and resiliency variables among women with childhood trauma histories.

Posttraumatic stress among mothers of very low birthweight infants at 6 months after discharge from the neonatal intensive care unit

This correlational study examined how mother's posttraumatic stress disorder (PTSD) symptoms are related to characteristics of the mother and her infant, as well as to mother–infant interaction and infant development, in 21 mothers of very low birthweight infants. Twenty-three percent of mothers scored in the clinical range on a measure of PTSD. How ill the infant was during the NICU hospitalization was related to mothers' PTSD symptoms. Mothers with greater PTSD symptoms were less sensitive and effective at structuring interaction with their infant.

Association of Time Since Deployment, Combat Intensity, and Posttraumatic Stress Symptoms With Neuropsychological Outcomes Following Iraq War Deployment

Previous research has demonstrated neuropsychological changes following Iraq deployment. It is unknown whether these changes endure without subsequent war-zone exposure or chronic stress symptoms. To determine the associations of time since deployment, combat intensity, and posttraumatic stress disorder (PTSD) and depression symptoms with longer-term neuropsychological outcomes in war-deployed soldiers. Prospective cohort study involving (1) soldiers assessed at baseline (median, 42 days prior to deployment) and following return from Iraq (median, 404 days after return and 885 days since baseline), and (2) soldiers more recently returned from deployment assessed at baseline (median, 378 days prior to deployment) and following return from Iraq (median, 122 days after return and 854 days since baseline assessment). Active-duty military installations. Two hundred sixty-eight male and female regular active-duty soldiers (164 with 1-year follow-up; 104 recently returned). Neuropsychological performances (verbal learning, visual memory, attention, and reaction time). There was a significant interaction between time and PTSD symptom severity (B= -0.01 [unstandardized], P = .04). Greater PTSD symptoms were associated with poorer attention in soldiers tested at 1-year follow-up (B = 0.01, P = .03) but not in recently returned soldiers. At 1-year follow-up, mean adjusted attention error scores increased by 0.10 points for every 10 points on the PTSD scale. Greater combat intensity was associated with more efficient postdeployment reaction-time performances, regardless of time since deployment (B = 0.48, P = .004), with mean adjusted reaction efficiency scores increasing by 4.8 points for every 10 points on the combat experiences scale. Neither depression nor contextual variables (alcohol use and deployment head injury) were significantly related to neuropsychological outcomes. In this study of army soldiers deployed to the Iraq war, only PTSD symptoms (among soldiers back from deployment for 1 year) were associated with a neuropsychological deficit (reduced attention). Greater combat intensity was associated with enhanced reaction time, irrespective of time since return.

Prospective effects of sexual victimization on PTSD and problem drinking

Posttraumatic stress disorder (PTSD) and problem drinking are common and often co-occurring sequelae experienced by women survivors of adult sexual assault, yet it remains unclear whether survivors drink to cope with PTSD symptoms or whether PTSD symptoms are exacerbated by drinking. Thus, we used a cross-lagged panel design with a large ( N = 555), ethnically diverse sample of women assault survivors to determine whether PTSD prospectively led to problem drinking or vice versa. We also examined whether cumulative sexual victimization experiences related to greater PTSD and problem drinking. Structural equation modeling revealed that child sexual abuse was associated with greater symptoms of PTSD and problem drinking and intervening sexual victimization was associated with greater symptoms of PTSD and problem drinking 1 year later. We found no evidence, however, that PTSD directly influenced problem drinking over the long term, or vice versa. Rather, experiencing revictimization during the study predicted survivors' prospective PTSD and problem drinking symptoms. Implications and recommendations for future research are discussed.