Examination of the PC-PTSD in previously deployed Air Force Medical Service personnel

This study assessed the performance of the PC-PTSD in diagnosing postdeployment posttraumatic stress disorder (PTSD) in a cohort of Air Force Medical Services personnel (N = 18,530). The prevalence of PTSD in the cohort was 5.18% based on medical record data. The area under the receiver operating characteristic curve was 0.69, indicating poor classification accuracy. Sensitivity was 47.55%, specificity was 90.68%, positive predictive value was 21.79%, and negative predictive value was 96.94%. The positive and negative likelihood ratios were 5.10 and 0.58, respectively. Several risk factors were found to be associated with a diagnosis of postdeployment PTSD: being a nurse, being enlisted in the medical service career field, being enlisted in the mental health service career field, those over age 30, being a member of the Active Duty service component, and having one’s first deployment be to Iraq. Being an officer was found to be a protective characteristic. These factors could potentially improve screening for PTSD among Air Force healthcare personnel.     

PTSD,comorbid depression,and the cortisol waking response in victims of intimate partner violence: preliminary evidence

Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two highly comorbid and debilitating disorders experienced by more than half of intimate partner violence victims (IPV). Hypothalamic–pituitary–adrenal (HPA) abnormalities are common in both disorders, though the direction of abnormalities often differs. The present study examined the relationship between comorbid PTSD and MDD, and the (salivary) cortisol waking response in 104 recently abused IPV victims. Waking cortisol levels, area under the waking curve with respect to ground (AUCg), and AUC with respect to increase (AUCi) were examined to determine the relation of HPA dynamics to comorbidity for basal versus more dynamic measures. Prior to accounting for comorbidity, women with PTSD or MDD showed significantly greater AUCi than women without the respective disorder. Accounting for comorbidity, PTSD only did not differ from other groups, while MDD only and PTSD + MDD showed greater AUCi than women with neither disorder. Results were nonsignificant for waking cortisol levels or AUCg. Results suggest that MDD drives elevated waking cortisol response, but not basal cortisol activity in recently abused IPV victims. Results demonstrate the importance of examining comorbid diagnoses and HPA activity from a dynamic perspective. Therapeutic implications are discussed.     

The impact of sport and physical activity on the well-being of combat veterans: A systematic review

ObjectivesThis review examined the potential impact of sport and physical activity upon the subjective and psychological well-being of combat veterans in the aftermath of physical or psychological combat trauma.DesignA systematic review was conducted. The question guiding this review was ‘what is the impact of sport and physical activity on the well-being of combat veterans?’MethodsKey databases were searched for articles relating to the use of sport and/or physical activity in supporting combat veterans. 11 studies were identified as relevant for inclusion. Data from these studies were extracted by means of a directed content analysis, the results of which were reported in a narrative synthesis.ResultsSport and physical activity enhances subjective well-being in veterans through active coping and doing things again, PTSD symptom reduction, positive affective experience, activity in nature/ecotherapy, and quality of life. Impact on psychological well-being includes determination and inner strength, focus on ability and broadening of horizons, identity and self-concept, activity in nature/ecotherapy, sense of achievement/accomplishment, and social well-being. Participating in sport and/or physical activity can also enhance motivation for living.ConclusionsThe review advances knowledge by producing a synthesis of evidence that highlights the value of sport and physical activity for supporting the well-being and rehabilitation of disabled combat veterans and combat veterans diagnosed with Post-Traumatic Stress Disorder. It also develops knowledge by identifying the type of sports and physical activities used to promote well-being, offering the first definition of combat veterans in the sport literature, taking a critical approach, and highlighting the under researched role of nature-based physical activity.     

An Initial Investigation of the Factor-Analytic Structure of the Impact of Event Scale-Revised With a Volunteer Firefighter Sample

We provide an initial evaluation of the factor structure of the Impact of Event Scale-Revised (IES-R) when used with a volunteer firefighter and a similar community participant sample. A volunteer firefighter sample (n = 65) and a sample of similar community respondents (n = 103) completed a questionnaire study, including responses to the IES-R. The IES-R data from both groups were entered into a three-factor principal components analysis with direct oblimin rotation. We found further support for the validity of the IES-R when used with a community sample. However, our data suggested that when using the IES-R with a community sample, the choice between a two- and a three-factor model may depend on the composition of the participants. For volunteer firefighters, the factor-analytic structure of the IES-R appeared to be similar to that of the community sample, with more scatter in terms of item loadings. To our knowledge, there is no previous research considering the use of the IES-R with a strictly volunteer firefighter sample. In addition, despite adequate research on the factor-analytic structure of the original IES, little research has considered the factor-analytic structure of the more recent IES-R, even with community samples.     

A Multimodal Study of Childhood Trauma and Distress Tolerance in Young Adulthood

Individuals with a history of childhood trauma experience deficits in emotion regulation. However, few studies have investigated childhood trauma and both perceived (i.e., self-report) and behavioral measures of distress tolerance. The current study evaluated associations between childhood trauma (i.e., physical abuse, sexual abuse, and witnessing family violence) and measures of perceived (Distress Tolerance Scale) and behavioral distress tolerance (i.e., Paced Auditory Serial Addition Test, breath-holding). Participants were 320 undergraduate students with a history of interpersonal trauma (e.g., sexual/physical assault). Structural equation modeling was used to evaluate associations between frequency of childhood trauma type and distress tolerance. Greater childhood physical abuse was associated with higher perceived distress tolerance. Greater levels of witnessing family violence were associated with lower behavioral distress tolerance on the breath-holding task. No significant effects were found for Paced Auditory Serial Addition Test performance. Associations between childhood trauma and emotion regulation likely are complex and warrant further study.     

Augmenting treatment efficiency in exposure therapy for PTSD: a randomized double-blind placebo-controlled trial of yohimbine HCl

The alpha-2 adrenergic receptor antagonist, yohimbine, can facilitate fear extinction in animals and humans. One potential mechanism is increased noradrenergic activity and associated arousal in the presence of conditioned stimuli. Accordingly, yohimbine might augment prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD), where heightened exposure-oriented arousal is a theorized driver and empirical predictor of treatment success. A double-blind placebo-controlled randomized trial (NCT 01031979) piloted yohimbine augmentation in 26 males with combat-related PTSD. Participants were given one-time dose of yohimbine or placebo prior to the first imaginal exposure. Subsequently, both arms completed standard PE. The primary outcome was trauma-cued heart-rate reactivity a week after the drug/exposure visit, a highly specified, objective measure sensitive to incremental change. Secondary outcomes included arousal during the drug/exposure visit and slope of distress, PTSD, and depression over the course of PE. Consistent with hypothesis, yohimbine led to higher objective and subjective arousal during the drug/exposure visit and to lower trauma-cued heart-rate reactivity one-week later. One dose of yohimbine also led to greater between-session habituation and more rapid improvement on depression, but not PTSD, over the course of care. Results of this controlled pilot indicate support for continued investigation of yohimbine-augmented exposure therapy for PTSD.     

Engagement in community activities and trust in local leaders as concomitants of psychological distress among Israeli civilians exposed to prolonged rocket attacks

Background and objectives: Present study, conducted in the aftermath of the 2014 Israel–Gaza conflict, investigated psychological toll of exposure to rockets attacks in a sample of residents of central and southern Israel. Analyses focused on the distress-protective functions of collectively grounded resources: engagement in community activities and trust in local leadership.

Design: This cross-sectional study was conducted between 2 and 3 months after the hostilities.

Method: Participants (N?=?764) were recruited by an online survey company that distributed a questionnaire assessing, in addition to focal predictors, sociodemographic factors and prior exposure to trauma. The outcome variables were post-traumatic stress disorder (PTSD) and nonspecific distress symptoms.

Results: Conservative regression analyses revealed that greater exposure to rocket attacks was predictive of higher levels of posttraumatic stress symptoms. Higher engagement in community activities exhibited a partial trauma-buffering function. However, higher levels of trust in local leaders appeared to exacerbate, rather than diminish, negative impact of rocket exposure on PTSD. Symptoms of psychological distress were not influenced neither by trauma exposure nor by stressor interactions with resources. Trust in local leadership exerted a beneficial main effect on distress.

Conclusions: Collectively based resources are important for coping in times of community-wide stressors, yet their role is complex.     

Serotonin transporter 5-HTTLPR genotype is associated with intrusion and avoidance symptoms of DSM-5 posttraumatic stress disorder (PTSD) in Chinese earthquake survivors

Background and Objectives: Prior studies have found that the serotonin transporter gene-linked polymorphic region (5-HTTLPR) interacts with trauma exposure to increase general risk for Posttraumatic Stress Disorder (PTSD). However, there is little knowledge about the effects of the interaction on distinct symptom clusters of PTSD. This study aimed to investigate the relation between the interaction of 5-HTTLPR and earthquake-related exposures and a contemporary phenotypic model of DSM-5 PTSD symptoms in a traumatised adult sample from China.

Design: A cross-sectional design with gene-environment interaction (G?×?E) approach was adopted. Methods: Participants were 1131 survivors who experienced 2008 Wenchuan earthquake. PTSD symptoms were assessed with the PTSD Checklist for DSM-5 (PCL-5). The 5-HTTLPR polymorphism was genotyped with capillary electrophoresis (CE) in ABI 3730xl genetic Analyzer.

Results: Although there was no significant interaction between 5-HTTLPR and traumatic exposure on total PTSD symptoms, respondents with the LL genotype of 5-HTTLPR who were highly exposed to the earthquake experienced lower intrusion and avoidance symptoms than those with the S-allele carriers.

Conclusions: The findings suggest that the 5-HTTLPR may have an important impact on the development of PTSD and add to the extant knowledge on understanding and treating of posttraumatic psychopathology.     

A Cross-Lagged Panel Approach to Understanding Social Support and Chronic Posttraumatic Stress Disorder Symptoms in Veterans: Assessment Modality Matters

Although there is a strong and consistent association between social support and posttraumatic stress disorder (PTSD), the directionality of this association has been debated, with some research indicating that social support protects against PTSD symptoms, whereas other research suggests that PTSD symptoms erode social support. The majority of studies in the literature have been cross-sectional, rendering directionality impossible to determine. Cross-lagged panel models overcome many previous limitations; however, findings from the few studies employing these designs have been mixed, possibly due to methodological differences including self-report versus clinician-administered assessment. The current study used a cross-lagged panel structural equation model to explore the relationship between social support and chronic PTSD symptoms over a 1-year period in a sample of 264 Iraq and Afghanistan veterans assessed several years after trauma exposure. Approximately a third of the sample met criteria for PTSD at the baseline assessment, with veterans’ trauma occurring an average of 6 years prior to baseline. Two separate models were run, with one using PTSD symptoms assessed via self-report and the other using clinician-assessed PTSD symptoms. Excellent model fit was found for both models. Results indicated that the relationship between social support and PTSD symptoms was affected by assessment modality. Whereas the self-report model indicated a bidirectional relationship between social support and PTSD symptoms over time, the clinician-assessed model indicated only that baseline PTSD symptoms predicted social support 1 year later. Results highlight that assessment modality is one factor that likely impacts disparate findings across previous studies. Theoretical and clinical implications of these findings are discussed, with suggestions for the growing body of literature utilizing these designs to dismantle this complex association.