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Robert H Pietrzak - One of the best experts on this subject based on the ideXlab platform.

  • posttraumatic stress disorder in older u s Military Veterans prevalence characteristics and psychiatric and functional burden
    American Journal of Geriatric Psychiatry, 2021
    Co-Authors: Robert H Pietrzak, Joan M Cook, Jennifer Moye, Anica Pless Kaiser
    Abstract:

    Abstract Objectives To characterize the prevalence, characteristics, and comorbidities of subthreshold and full posttraumatic stress disorder (PTSD) in older U.S. Military Veterans. Design and Setting A nationally representative web-based survey of older U.S. Military Veterans who participated in the National Health and Resilience in Veterans Study (NHRVS) between 11/18/19 and 3/8/20. Participants U.S. Veterans aged 60 and older (n=3,001; mean age=73.2, SD=7.9, range=60-99). Measurements PTSD was assessed using the PTSD Checklist for DSM-5. Self-report measures assessed sociodemographic characteristics, trauma exposures, suicidal behaviors, psychiatric and substance use disorders, as well as mental, cognitive, and physical functioning. Multivariable analyses examined correlates of subthreshold and full PTSD. Results The vast majority of the sample (n=2,821; 92.7%) reported exposure to one or more potentially traumatic events. Of those exposed to such events, 262 (9.6%, 95% confidence interval [CI]=8.4-10.9%) and 68 (1.9%, 95%CI=1.3-2.6%) screened positive for subthreshold and full PTSD, respectively. The prevalence of subthreshold and full PTSD was significantly higher in female Veterans and Veterans who use VA as their primary healthcare. Subthreshold and full PTSD groups endorsed more adverse childhood experiences and total traumas than the no/minimal PTSD symptom group, the most common traumatic experiences endorsed were combat exposure, physical or sexual assault, and life-threatening illness or injury. Veterans with subthreshold and full PTSD were also more likely to screen positive for depression, substance use disorders, suicide attempts, non-suicidal self-injury, and suicidal ideation, and reported lower mental, cognitive, and physical functioning. Conclusions Subthreshold PTSD and full PTSD are prevalent and associated with substantial clinical burden in older U.S. Veterans. Results underscore the importance of assessing both subthreshold and full PTSD in this population.

  • risk and resilience factors associated with traumatic loss related ptsd in u s Military Veterans results from the national health and resilience in Veterans study
    Psychiatry Research-neuroimaging, 2021
    Co-Authors: Ruth H Asch, Irina Esterlis, Steven M Southwick, Robert H Pietrzak
    Abstract:

    Abstract Purpose Sudden death of a loved one is the most prevalent potentially traumatic event worldwide, yet little is known about risk and resilience factors associated with traumatic loss-related posttraumatic stress disorder (PTSD). Methods Data from a nationally representative sample of U.S. Military Veterans were analyzed to identify sociodemographic, Military, health and psychosocial correlates of traumatic loss-related PTSD. Results Loneliness, somatic symptoms, and attachment style were the strongest correlates of PTSD symptom severity and positive screens for traumatic loss-related PTSD. Conclusion Loneliness, somatic symptoms, and attachment style may represent therapeutic targets to help mitigate traumatic loss-related PTSD in U.S. Veterans.

  • comparative associations of problematic alcohol and cannabis use with suicidal behavior in u s Military Veterans a population based study
    Journal of Psychiatric Research, 2021
    Co-Authors: Melanie L Hill, Sonya B Norman, Brandon Nichter, Mallory Loflin, Robert H Pietrzak
    Abstract:

    Abstract Alcohol use disorder (AUD) and cannabis use disorder (CUD) are each associated with increased suicidal behavior, but it is unclear how their comorbidity relates to suicide risk. Understanding these associations in U.S. Military Veterans is especially important, given their heightened risk for suicide, high prevalence of AUD, and increasing access to cannabis. We compared associations of probable AUD, CUD, and AUD/CUD with suicide ideation, plan(s), and attempt(s) in a nationally representative sample of 4,069 Veterans surveyed in 2019–2020 as part of the National Health and Resilience in Veterans Study. Among Veterans who screened positive for current AUD, 8.7% also screened positive for current CUD. Among Veterans who screened positive for current CUD, 33.3% screened positive for current AUD. Current and lifetime positive screens for AUD, CUD, and AUD/CUD were each strongly and independently associated with past-year suicide ideation and lifetime suicide ideation, plan(s), and attempt(s) [odds ratios (ORs) = 1.6–8.7]. Relative to Veterans who screened positive for AUD only, Veterans who screened positive for AUD/CUD and CUD only had higher odds of past-year suicide ideation (AUD/CUD: OR = 3.3; CUD only: OR = 2.4), lifetime suicide ideation (AUD/CUD: OR = 1.9; CUD only: OR = 2.6) and lifetime suicide plan(s) (AUD/CUD: OR = 1.7; CUD only: OR = 6.1). Collectively, findings suggest that screening positive for CUD might be an especially strong indicator of suicide ideation and planning in Veterans with and without AUD, independent of sociodemographic, Military, trauma, and other psychiatric factors. These findings underscore the importance of routine screening for CUD in suicide prevention efforts, especially as cannabis becomes more widely available.

  • heterogeneity of posttraumatic stress symptomatology and social connectedness in treatment seeking Military Veterans a longitudinal examination
    European Journal of Psychotraumatology, 2019
    Co-Authors: Lauren M Sippel, Robert H Pietrzak, Rani A Hoff, Laura E Watkins, Ilan Harpazrotem
    Abstract:

    Elucidating whether PTSD symptoms predict poorer social connectedness over time (i.e. social erosion) and/or that poor social connectedness contributes to maintenance of PTSD (i.e. social causation) has implications for PTSD treatment and relapse prevention. Most extant research has been cross-sectional and examined overall PTSD symptoms. Evidence of longitudinal associations among heterogeneous PTSD symptom clusters and social connectedness could provide insight into more nuanced targets for intervention. Using data from 1,491 U.S. Military Veterans in residential treatment for PTSD at 35 Department of Veterans Affairs facilities, we evaluated a two-wave cross-lagged panel model including a five-factor model of PTSD and two aspects of social connectedness. PTSD, quality of connectedness (i.e. degree of distress related to interpersonal conflict), and structural social support (i.e. number of days of contact with supportive loved ones) in the past 30 days were assessed at baseline and 4 months after discharge. The largest effect was greater severity of PTSD dysphoric arousal symptoms (i.e. irritability/anger, poor concentration, and sleep problems) at baseline predicting more conflict-related distress at follow-up (β = 0.43). Post-hoc symptom-level analyses indicated that irritability/anger drove this association. In addition, conflict-related distress predicted greater PTSD symptom severity across all five clusters (β’s = 0.10 to 0.14, p’s < 0.01). More days of contact predicted lower severity of avoidance and numbing symptoms (β’s = −.05 and −.07, p’s < 0.01), along with individual symptoms within these clusters, plus flashbacks. Results support both social erosion and social causation models. Engaging loved ones in Veterans’ treatment and targeting dysphoric arousal symptoms, particularly anger and irritability, may improve long-term PTSD and relationship outcomes, respectively.

  • evaluating the stability of dsm 5 ptsd symptom network structure in a national sample of u s Military Veterans
    Journal of Affective Disorders, 2018
    Co-Authors: Robert H Pietrzak, Sophia H H Von Stockert, Eiko I Fried, Cherie Armour
    Abstract:

    Abstract Background Previous studies have used network models to investigate how PTSD symptoms associate with each other. However, analyses examining the degree to which these networks are stable over time, which are critical to identifying symptoms that may contribute to the chronicity of this disorder, are scarce. In the current study, we evaluated the temporal stability of DSM-5 PTSD symptom networks over a three-year period in a nationally representative sample of trauma-exposed U.S. Military Veterans. Methods Data were analyzed from 611 trauma-exposed U.S. Military Veterans who participated in the National Health and Resilience in Veterans Study (NHRVS). We estimated regularized partial correlation networks of DSM-5 PTSD symptoms at baseline (Time 1) and at three-year follow-up (Time 2), and examined their temporal stability. Results Evaluation of the network structure of PTSD symptoms at Time 1 and Time 2 using a formal network comparison indicated that the Time 1 network did not differ significantly from the Time 2 network with regard to network structure (p = 0.12) or global strength (sum of all absolute associations, i.e. connectivity; p = 0.25). Centrality estimates of both networks (r = 0.86) and adjacency matrices (r = 0.69) were highly correlated. In both networks, avoidance, intrusive, and negative cognition and mood symptoms were among the more central nodes. Limitations This study is limited by the use of a self-report instrument to assess PTSD symptoms and recruitment of a relatively homogeneous sample of predominantly older, Caucasian Veterans. Conclusion Results of this study demonstrate the three-year stability of DSM-5 PTSD symptom network structure in a nationally representative sample of trauma-exposed U.S. Military Veterans. They further suggest that trauma-related avoidance, intrusive, and dysphoric symptoms may contribute to the chronicity of PTSD symptoms in this population.

Brian P Marx - One of the best experts on this subject based on the ideXlab platform.

  • temporal sequences of suicidal and nonsuicidal self injurious thoughts and behaviors among inpatient and community residing Military Veterans
    Journal of Affective Disorders, 2021
    Co-Authors: Jaclyn C Kearns, Terence M Keane, Brian P Marx, Sarah L Brown, Ian Cero, Kaitlyn R Gorman, Matthew K Nock
    Abstract:

    Abstract Background Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) are major health concerns among Military Veterans yet little is known about the temporal relations among these outcomes. This study examined the temporal relations between suicidal and nonsuicidal SITBs among higher-risk Veterans. Specifically, we identified when SITBs emerged and evaluated the role of nonsuicidal self-injury (NSSI) in the medical lethality of suicide attempts (SA), relative risk, and survival time of suicidal SITBs (i.e., suicide ideation [SI], suicide plan, SA). Method Cross-sectional data were collected from two samples examining suicide risk among Veterans receiving inpatient psychiatric care (n = 157) and community-residing Veterans with current depression and/or past month SI (n = 200). Participants completed an interview to assess SITBs. Results SITBs emerged between ages 14-28 years with behaviors emerging, on average, earlier among inpatient Veterans. The time lag between SITBs was not significantly different between groups. Inpatient Veterans had a significantly shorter time lag from SI to SA. NSSI history predicted an increase in relative risk for all suicidal SITBs and shorter survival time. There was no association between NSSI history and medical lethality of the most serious SA for both groups. Limitations Limitations included use of cross-sectional, retrospective self-report with age-of-onset endorsed in years and not all SITBs were assessed (e.g., passive SI). Conclusions Veterans with a NSSI history are at high risk for suicidal SITBs and have a shorter survival time. Results showed thoughts (i.e., NSSI thoughts, SI) emerged before behavior (i.e., NSSI, SA) and NSSI emerged before SA.

  • the clinician administered ptsd scale for dsm 5 caps 5 development and initial psychometric evaluation in Military Veterans
    Psychological Assessment, 2017
    Co-Authors: Frank W Weathers, Michelle J Bovin, Daniel J Lee, Denise M Sloan, Paula P Schnurr, Danny G Kaloupek, Terence M Keane, Brian P Marx
    Abstract:

    The Clinician-Administered PTSD Scale (CAPS) is an extensively validated and widely used structured diagnostic interview for posttraumatic stress disorder (PTSD). The CAPS was recently revised to correspond with PTSD criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). This article describes the development of the CAPS for DSM-5 (CAPS-5) and presents the results of an initial psychometric evaluation of CAPS-5 scores in 2 samples of Military Veterans (Ns = 165 and 207). CAPS-5 diagnosis demonstrated strong interrater reliability (к = .78 to 1.00, depending on the scoring rule) and test-retest reliability (к = .83), as well as strong correspondence with a diagnosis based on the CAPS for DSM-IV (CAPS-IV; к = .84 when optimally calibrated). CAPS-5 total severity score demonstrated high internal consistency (α = .88) and interrater reliability (ICC = .91) and good test-retest reliability (ICC = .78). It also demonstrated good convergent validity with total severity score on the CAPS-IV (r = .83) and PTSD Checklist for DSM-5 (r = .66) and good discriminant validity with measures of anxiety, depression, somatization, functional impairment, psychopathy, and alcohol abuse (rs = .02 to .54). Overall, these results indicate that the CAPS-5 is a psychometrically sound measure of DSM-5 PTSD diagnosis and symptom severity. Importantly, the CAPS-5 strongly corresponds with the CAPS-IV, which suggests that backward compatibility with the CAPS-IV was maintained and that the CAPS-5 provides continuity in evidence-based assessment of PTSD in the transition from DSM-IV to DSM-5 criteria. (PsycINFO Database Record

  • the clinician administered ptsd scale for dsm 5 caps 5 development and initial psychometric evaluation in Military Veterans
    Psychological Assessment, 2017
    Co-Authors: Frank W Weathers, Michelle J Bovin, Daniel J Lee, Denise M Sloan, Paula P Schnurr, Danny G Kaloupek, Terence M Keane, Brian P Marx
    Abstract:

    The Clinician-Administered PTSD Scale (CAPS) is an extensively validated and widely used structured diagnostic interview for posttraumatic stress disorder (PTSD). The CAPS was recently revised to correspond with PTSD criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5; American Psychiatric Association, 2013). This article describes the development of the CAPS for DSM–5 (CAPS-5) and presents the results of an initial psychometric evaluation of CAPS-5 scores in 2 samples of Military Veterans (Ns = 165 and 207). CAPS-5 diagnosis demonstrated strong interrater reliability (κ = .78 to 1.00, depending on the scoring rule) and test–retest reliability (κ = .83), as well as strong correspondence with a diagnosis based on the CAPS for DSM–IV (CAPS-IV; κ = .84 when optimally calibrated). CAPS-5 total severity score demonstrated high internal consistency (α = .88) and interrater reliability (ICC = .91) and good test–retest reliability (ICC = .78). It also demonstrated good convergent validity with total severity score on the CAPS-IV (r = .83) and PTSD Checklist for DSM–5 (r = .66) and good discriminant validity with measures of anxiety, depression, somatization, functional impairment, psychopathy, and alcohol abuse (rs = .02 to .54). Overall, these results indicate that the CAPS-5 is a psychometrically sound measure of DSM–5 PTSD diagnosis and symptom severity. Importantly, the CAPS-5 strongly corresponds with the CAPS-IV, which suggests that backward compatibility with the CAPS-IV was maintained and that the CAPS-5 provides continuity in evidence-based assessment of PTSD in the transition from DSM–IV to DSM–5 criteria.

David W. Oslin - One of the best experts on this subject based on the ideXlab platform.

  • family problems among recently returned Military Veterans referred for a mental health evaluation
    The Journal of Clinical Psychiatry, 2009
    Co-Authors: Steven L Sayers, Victoria A Farrow, Jennifer L. Ross, David W. Oslin
    Abstract:

    CONTEXT: Existing evidence suggests that Military Veterans with mental health disorders have poorer family functioning, although little research has focused on this topic. OBJECTIVE: To test whether psychiatric symptoms are associated with family reintegration problems in recently returned Military Veterans. DESIGN: Cross-sectional survey of a clinical population. Respondents who were referred to behavioral health evaluation from April 2006 through August 2007 were considered for the survey. SETTING: Philadelphia Veterans Affairs Medical Center, Pa. PARTICIPANTS: 199 Military Veterans who served in Iraq or Afghanistan after 2001 and were referred for behavioral health evaluation from primary care (mean age = 32.7 years, SD = 9.1). MAIN OUTCOME MEASURES: Measures included the Mini-International Neuropsychiatric Interview for psychiatric diagnoses, the 9-item Patient Health Questionnaire for depression diagnosis and severity, and screening measures of alcohol abuse and illicit substance use. A measure of Military family readjustment problems and a screening measure of domestic abuse were developed for this study. RESULTS: Three fourths of the married/cohabiting Veterans reported some type of family problem in the past week, such as feeling like a guest in their household (40.7%), reporting their children acting afraid or not being warm toward them (25.0%), or being unsure about their family role (37.2%). Among Veterans with current or recently separated partners, 53.7% reported conflicts involving "shouting, pushing, or shoving," and 27.6% reported that this partner was "afraid of them." Depression and posttraumatic stress disorder symptoms were both associated with higher rates of family reintegration problems. CONCLUSIONS: Mental health problems may complicate Veterans' readjustment and reintegration into family life. The findings suggest an opportunity to improve the treatment of psychiatric disorders by addressing family problems. Language: en

  • family problems among recently returned Military Veterans referred for a mental health evaluation
    The Journal of Clinical Psychiatry, 2009
    Co-Authors: Steven L Sayers, Victoria A Farrow, Jennifer L. Ross, David W. Oslin
    Abstract:

    CONTEXT: Existing evidence suggests that Military Veterans with mental health disorders have poorer family functioning, although little research has focused on this topic. OBJECTIVE: To test whether psychiatric symptoms are associated with family reintegration problems in recently returned Military Veterans. DESIGN: Cross-sectional survey of a clinical population. Respondents who were referred to behavioral health evaluation from April 2006 through August 2007 were considered for the survey. SETTING: Philadelphia Veterans Affairs Medical Center, Pa. PARTICIPANTS: 199 Military Veterans who served in Iraq or Afghanistan after 2001 and were referred for behavioral health evaluation from primary care (mean age = 32.7 years, SD = 9.1). MAIN OUTCOME MEASURES: Measures included the Mini-International Neuropsychiatric Interview for psychiatric diagnoses, the 9-item Patient Health Questionnaire for depression diagnosis and severity, and screening measures of alcohol abuse and illicit substance use. A measure of Military family readjustment problems and a screening measure of domestic abuse were developed for this study. RESULTS: Three fourths of the married/cohabiting Veterans reported some type of family problem in the past week, such as feeling like a guest in their household (40.7%), reporting their children acting afraid or not being warm toward them (25.0%), or being unsure about their family role (37.2%). Among Veterans with current or recently separated partners, 53.7% reported conflicts involving "shouting, pushing, or shoving," and 27.6% reported that this partner was "afraid of them." Depression and posttraumatic stress disorder symptoms were both associated with higher rates of family reintegration problems. CONCLUSIONS: Mental health problems may complicate Veterans' readjustment and reintegration into family life. The findings suggest an opportunity to improve the treatment of psychiatric disorders by addressing family problems. Language: en

Lisa Delanowood - One of the best experts on this subject based on the ideXlab platform.

  • apoe e4 genotype is associated with elevated post concussion symptoms in Military Veterans with a remote history of mild traumatic brain injury
    Archives of Clinical Neuropsychology, 2019
    Co-Authors: Victoria C Merritt, Alexandra L Clark, Scott F Sorg, Madeleine L Werhane, Mark W Bondi, Dawn M Schiehser, Kristina M Lapira, Amy J Jak, Lisa Delanowood
    Abstract:

    OBJECTIVE We evaluated the influence of the APOE-e4 allele on post-concussive symptoms in Military Veterans with a remote history of mild traumatic brain injury (mTBI). METHOD Participants (N = 77) were administered neuropsychiatric measures, on average, approximately 5 years following their most recent mTBI and provided a DNA sample for APOE genotyping. Veterans were divided into two groups based on their e4 status (n = 14 e4+, n = 63 e4-). The Neurobehavioral Symptom Inventory (NSI) was the primary outcome measure, from which a total score was derived, as well as three symptom clusters (somatic, cognitive, and affective). RESULTS ANCOVAs showed a significant main effect of e4 genotype on the NSI total score and somatic symptom cluster after adjusting for posttraumatic stress symptoms and mTBI history (p = .019-.028, ηp2 = .064-.073), such that e4+ Veterans endorsed significantly greater symptoms than e4- Veterans. CONCLUSIONS Our findings suggest that genetic risk may help to explain the poorer long-term outcomes often observed in this population.

  • apolipoprotein e apoe e4 genotype is associated with reduced neuropsychological performance in Military Veterans with a history of mild traumatic brain injury
    Journal of Clinical and Experimental Neuropsychology, 2018
    Co-Authors: Victoria C Merritt, Alexandra L Clark, Scott F Sorg, Nicole D Evangelista, Madeleine L Werhane, Mark W Bondi, Dawn M Schiehser, Lisa Delanowood
    Abstract:

    Introduction: The purpose of this study was to investigate the effect of the apolipoprotein E (APOE) e4 allele on neuropsychological functioning in Military Veterans with a remote history of mild t...

Lee E Goldstein - One of the best experts on this subject based on the ideXlab platform.

  • response to comment on chronic traumatic encephalopathy in blast exposed Military Veterans and a blast neurotrauma mouse model
    Science Translational Medicine, 2012
    Co-Authors: Lee E Goldstein, Ann C Mckee
    Abstract:

    Goldstein and McKee respond to points raised in two letters about their study of tau neuropathology in postmortem brain tissue samples from blast-exposed Military Veterans with traumatic brain injury.

  • chronic traumatic encephalopathy in blast exposed Military Veterans and a blast neurotrauma mouse model
    Science Translational Medicine, 2012
    Co-Authors: Lee E Goldstein, Andrew Fisher, Chad Tagge, Xiaolei Zhang, Libor Velisek, John A Sullivan, Chirag Upreti, Jonathan M Kracht, Maria Ericsson, Mark W Wojnarowicz
    Abstract:

    Blast exposure is associated with traumatic brain injury (TBI), neuropsychiatric symptoms, and long-term cognitive disability. We examined a case series of postmortem brains from U.S. Military Veterans exposed to blast and/or concussive injury. We found evidence of chronic traumatic encephalopathy (CTE), a tau protein–linked neurodegenerative disease, that was similar to the CTE neuropathology observed in young amateur American football players and a professional wrestler with histories of concussive injuries. We developed a blast neurotrauma mouse model that recapitulated CTE-linked neuropathology in wild-type C57BL/6 mice 2 weeks after exposure to a single blast. Blast-exposed mice demonstrated phosphorylated tauopathy, myelinated axonopathy, microvasculopathy, chronic neuroinflammation, and neurodegeneration in the absence of macroscopic tissue damage or hemorrhage. Blast exposure induced persistent hippocampal-dependent learning and memory deficits that persisted for at least 1 month and correlated with impaired axonal conduction and defective activity-dependent long-term potentiation of synaptic transmission. Intracerebral pressure recordings demonstrated that shock waves traversed the mouse brain with minimal change and without thoracic contributions. Kinematic analysis revealed blast-induced head oscillation at accelerations sufficient to cause brain injury. Head immobilization during blast exposure prevented blast-induced learning and memory deficits. The contribution of blast wind to injurious head acceleration may be a primary injury mechanism leading to blast-related TBI and CTE. These results identify common pathogenic determinants leading to CTE in blast-exposed Military Veterans and head-injured athletes and additionally provide mechanistic evidence linking blast exposure to persistent impairments in neurophysiological function, learning, and memory.