Chronic Stress最新文献

Background: Trauma exposure, posttraumatic stress disorder (PTSD), and substance use commonly co-occur among youth. Identifying specific subgroups of youth based on unique constellations across these domains may provide a novel way to identify and target youth at prospective risk for specific types of negative clinical outcomes.

Methods: Trauma exposed youth completed structured clinical assessments as part of a longitudinal study (N = 1826; ages 13-21). Latent class analyses identified distinct subgroups of youth based on lifetime trauma histories and current PTSD symptom and substance use inventories collected at the baseline study visit. Logistic regression analyses determined if the latent classes were associated with elevated risk for PTSD or substance use disorder (SUD) diagnoses as the 12-month follow-up study visit (n = 1029). Logistic regression models controlled for baseline clinical characteristics and demographic factors in a stepwise fashion to elucidate if latent classes carried conferred risk beyond established risk factors. Sensitivity analyses included latent profile analyses and predictive modeling with an alternative number of latent classes.

Results: Four latent classes were identified which differentiated participants based on the type of trauma exposure, the number of PTSD symptoms endorsed, and the propensity to be engaged in polysubstance use. Latent classes which were characterized by exposure to interpersonal violence at the baseline study visit had an elevated risk of PTSD 12 months later, relative to the latent class which was principally exposed to incidental trauma (odds ratios ranged from 4.11-5.88). Likewise, a distinct latent class which was characterized by poly-substance use at the baseline study visit had an elevated risk of SUD diagnoses at the 12-month follow-up (odds ratio = 2.48). The findings were robust to sensitivity analyses.

Conclusion: These results highlight nuanced patterns of co-occurrences between trauma exposure, PTSD symptomatology, and substance use that differentiate unique sub-groups of youth at varying degrees of risk for negative clinical outcomes one year later. Evaluating the co-expression of trauma and psychopathology inventories, as opposed to only assessing the summative epidemiological indices of these constructs, may help identify adolescents who are most at risk for sustaining deleterious health outcomes.

Background: Numerous man-made and naturally occurring incidents cause human suffering, both psychologically and mentally. Such circumstances endanger people's emotional, physical, and social well-being if left untreated or if appropriate intervention is delayed. This trial examines the effectiveness of an Eye Movement Desensitization and Reprocessing (EMDR) intervention on improving the subjective well-being of patients with post-traumatic stress disorder (PTSD) in Jordan.

Methods: The current trial employed the quasi-experimental, interrupted time series design. This includes measuring the subjective well-being (SWB) three times: once before intervention (pre-test) and twice after the intervention (post-tests), including immediately and one-month follow-ups for both the intervention and control group. 70 patients (35 patients for each group) were recruited from a specialized psychiatric trauma healing center in Jordan. The primary outcome variable was measured using the World Health Organization- Five Well-Being Index (WHO-5).

Results: The statistical analysis of repeated measures using ANCOVA revealed significant differences across all time points within subjects [F ( _{1, 56)} = 5.18, p = .027]. The covariate effect was not controlled and showed statistically significant differences in the SWB across all time points in both interventional and control groups (between subjects) (F _1,56 = 12.41,p = .001). There were no statistical differences in the total mean score of SWB correlated with sociodemographics and health-related factors.

Conclusion: The results suggest that EMDR may be an effective, pragmatic, and acceptable intervention for increasing SWB in patients with PTSD in Jordan. Findings support the continued investment in and adoption of EMDR among participants affected by trauma in the Arab World.

Background: Up to 25% of stroke survivors develop post-traumatic stress disorder (PTSD) symptoms, yet the predisposing factors remain largely unknown. The C-C-Chemokine receptor-5 gene (CCR5) loss-of-function mutation (LOFM, CCR5-Δ32) has been identified as a protective factor against post-stroke depression. This study investigates whether CCR5-Δ32 also confers protection against post-stroke PTSD, in conjunction with two additional polymorphisms: the 5-HTTLPR in the serotonin transporter gene and the BDNF Val66Met variant.

Methods: We conducted a prospective analysis of 432 survivors of first-ever mild-to-moderate ischemic stroke, assessing PTSD symptomatology at 6, 12, and 24 months post-stroke. Genetic screening for CCR5-Δ32 status and PTSD symptom data were available for these participants.

Results: PTSD was diagnosed in 48 participants (11%) within the first year post-stroke. CCR5-Δ32 carriers exhibited significantly fewer PTSD symptoms at 6, 12, and 24 months compared to non-carriers (P < .001, P < .001, P = .02, respectively), with sustained improvement over time. Multivariate analysis confirmed that CCR5-Δ32 status was independently associated with lower PTSD risk after adjusting for relevant confounders. Furthermore, individuals with a maladaptive coping style who were non-carriers of CCR5-Δ32 exhibited a higher risk of PTSD development (HR = 4.03; 95% CI, 1.95-6.32, P < .001). Carriers of both 5-HTTLPR-L and CCR5-Δ32 had significantly lower PTSD symptoms at 6 and 12 months post-stroke (P = .026, P = .05), as did carriers of both the BDNF Val allele and CCR5-Δ32 at 6 months (P = .022).

Conclusions: Our findings suggest that CCR5-Δ32 carriers are less likely to develop PTSD symptoms following stroke, including individuals with pre-existing maladaptive coping styles. These results highlight a potential genetic target for future intervention strategies, with CCR5 blockade emerging as a promising therapeutic avenue for post-stroke PTSD prevention.

Background: Low-income veterans are a group that are at high risk for suicidal behaviors and require clinical attention and research.

Methods: This brief report analyzed data from a nationally representative sample of 985 low-income veterans participating in the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study in 2021. The lifetime prevalence and correlates of three levels of suicidal behaviors were analyzed, including suicidal ideation (SI), having a suicidal plan (SP), and making a suicide attempt (SA).

Results: In the sample, 17.6% reported any SI, 7.0% reported any SP, and 4.5% reported any SA. Multivariable analyses revealed that compared to veterans who only reported SI, those who reported SP had overall lower mental health functioning scores (aOR = 0.97, 95% CI = 0.95-0.99). Compared to veterans who reported only SP, those who reported SA were two times more likely to be unmarried (aOR = 2.38, 95% = 1.09-5.30).

Conclusion: These findings suggest a few factors may be driving differences between veterans who engage in different levels of suicidal behaviors, and these factors may be important treatment targets.

Background: Unhelpful thoughts are associated with greater levels of pain intensity and incapability. Difficulty cultivating a healthier inner narrative regarding sensations is associated with lower tolerance of uncertainty and lower cognitive flexibility. Among people seeking musculoskeletal specialty care we analyzed associations between mindset factors and awareness of prior experiences adjusting unhelpful thinking and trust in the clinician.

Methods: In a cross-sectional study, 163 adults completed measures of mindsets (intolerance of uncertainty, cognitive flexibility, and distress and unhelpful thoughts regarding sensations), awareness of prior experiences adjusting unhelpful thinking, and trust and experiences with clinicians. We measured associations between mindsets (both individually and in statistical clusters) awareness of prior experiences and trust in the clinician.

Results: Both awareness of prior experiences adjusting thinking and trust in the clinician were modestly associated with greater cognitive flexibility in bivariate analysis, but neither were associated with statistical groupings with healthier mindsets identified in cluster analysis.

Conclusion: The modest associations with cognitive flexibility suggest that both the inability to describe a past experience rethinking one's interpretation of bodily sensations, as well as difficulty establishing trust with the clinician, might signal unhealthy fusion with unhelpful thoughts that are known correlates of greater levels of discomfort and incapability.

Background: In musculoskeletal health and care, visits, tests and treatments are often optional. There is some evidence that levels of utilization can be associated with subjective aspects of the illness, mindsets (thoughts and feelings about sensations) and stressful circumstances in particular. In a cross-sectional study of people seeking musculoskeletal specialty care, we addressed two questions: 1) Is there a difference in planned care utilization based on statistical groupings of measures of the subjective aspects of the illness? And 2) Are there any factors specifically associated with scheduling a return visit?

Methods: One hundred thirty-five patients seeking musculoskeletal specialty care completed measures of subjective patient factors including unhelpful thoughts and feelings of distress regarding symptoms, personal health agency, social health, and trust and experience with the clinician. Plans for a return visit, an injection, an imaging test, or referral to a physical therapist were documented. Cluster analysis was utilized to identify statistical groupings of scores on measures of subjective personal factors. Bivariate and logistic regression analyses evaluated factors associated with planned care utilization.

Results: We identified four statistical groupings of subjective factors through Cluster analysis: Group 1 had low trust, agency, and social health; Group 2 had low social health and high distress; Group 3 had healthy mindset and circumstances; and Group 4 had the highest social health and relatively healthy levels of the other subjective measures. Furthermore, no difference observed between statistical groups of the subjective regarding planned care utilization. Multivariable analysis revealed an association between scheduling a return visit and lower extremity clinicians (RC = 0.3; 95% CI 0.05 to 0.5; P-value, 0.02) but not with statistical groupings of measures of personal factors.

Conclusion: The finding that statistical groupings of patient personal factors were not associated with planned utilization of visits, tests, or treatments is inconsistent with other evidence linking mindsets actual utilization. A better understanding of sources of variation in planned and actual utilization is needed to help limit unwarranted variation and enhance effective use of resources.

Background: The populations of middle- and low-income countries are exposed to many stressors, and these are associated with worse mental health. The ICD-11 includes a section "Disorders specifically associated with stress" and there are many validated measures for the assessment of stress-related disorders. However, there is no self-reported measure of ICD-11 adjustment disorder available for use in Arabic-speaking populations. This study aimed to translate and validate the Arabic version of the self-reported International Adjustment Disorder Questionnaire.

Methods: Data was collected from Iraqi patients with physical illness and their families from October 6 to October 14, 2024, through a cross-sectional study conducted at Baghdad's Teaching Hospital and the Oncology Teaching Hospital. The R Environment for Statistical Programming was utilized for analysis.

Results: Findings from confirmatory factor analysis were consistent with previous studies by identifying two strongly correlated factors (r = 0.72), representing the 'preoccupation' and 'failure to adapt' symptom clusters. These factors showed reliable scores (α = 0.695 and 0.814) and significant relations to depression and anxiety. To avoid multicollinearity, a total symptom scale can be used, based on similarly positive relations to psychological states and high reliability (α = 0.798).

Conclusion: The Arabic translation demonstrates good psychometric properties and can be utilized in clinical and research settings.

Background: Armed conflicts severely impact survivors psychologically, with effects tied to the trauma's intensity and widespread displacement. From October 2023 to January 2025, the Gaza Strip faced violent conflict, leading to major displacement and suffering. This study examines anxiety, PTSD, and depression among displaced adults from Gaza Strip.

Methods: This cross-sectional study, conducted in November 2024, surveyed 952 displaced adults using the GAD-7, PCL-5, and PHQ-9 instruments and a convenience sampling method. A PTSD diagnosis required having a PCL-5 score ≥ 23 and fulfilling the DSM-5 criteria. The rates and severity of probable anxiety, PTSD, and depression were reported. Then, using SPSS, logistic regression models identified factors associated with each disorder, while multinomial regression models explored associations with the number of comorbidities.

Results: The majority were unemployed (73.7%). Over half of the participants were displaced in camps (55.6%), while 40.4% lived in shelters. Nearly a fifth (20.3%) had lost a first-degree relative, 12.7% were injured, and 4.8% were detained by the military. Moderate or higher levels of anxiety and depression were reported by 79.3% and 84.5%, respectively. The rate of symptomatic PTSD was 67.8% when defined as meeting the DSM-5 criteria for PTSD and having a PCL-5 score ≥ 23, and 88.2% based on the latter criterion alone, while subthreshold PTSD was encountered in 18.1%. Also, 63.1% suffered significant symptoms of all three comorbidities. Significant predictors of anxiety included being female and having PTSD or depression. Significant predictors of PTSD included experiencing more frequent migrations, unemployment or working in the private sector, military detention, or having anxiety or depression. Significant predictors of depression included the death of a first-degree relative, military detention, torture, and having anxiety or PTSD. Additionally, having a higher number of migrations was significantly associated with having one, two, or three disorders compared to having "no disorders," while those experiencing more forms of harm were significantly more likely to have all three disorders.

Conclusions: The study found very high rates of psychiatric disorders among IDPs in Gaza and identified several risk factors contributing to those rates. Interventions must be prioritized to support society's long-term recovery.

Background: Depression, posttraumatic stress disorder (PTSD), and suicidality are more prevalent among people with seizures, but few studies exist in low-resourced minoritized populations. Existing knowledge of the overlapping neurocircuitry between seizure activity in limbic regions (eg, medial temporal lobe epilepsy) and PTSD also suggests that people with seizure histories may exhibit PTSD-like alterations in their fear-potentiated startle (FPS) responses. However, this hypothesis has yet to be systematically tested. Here, we leveraged a large study on stress and trauma to evaluate the prevalence of psychiatric conditions and FPS responses in a low-resourced minoritized population of individuals with a history of seizures.

Methods: Prevalence of self-reported PTSD symptoms, depression symptoms, suicidality, and history of suicide attempt were compared between people with and without self-reported seizures among a sample of 3012 predominantly racially marginalized and low-resourced civilians. We compared FPS responses in 13 people with a history of seizures to 13 rigorously matched seizure-free controls. FPS responses were measured using eyeblink data collected during a fear conditioning acoustic startle task.

Results: Participants with a history of seizures showed significantly higher prevalence of depression symptoms, suicidality, history of suicide attempt, PTSD symptoms, and probable PTSD diagnosis than seizure-free controls, even after controlling for trauma load. Those with a history of seizures displayed heightened FPS responses and impaired fear discrimination which mimics that of PTSD.

Conclusion: These data concur with prior literature on people with a history of seizure activity being at higher risk for psychiatric symptomatology. Additionally, this study provides novel insights on the psychophysiological fear response in trauma-exposed people with a history of seizures, which could inform the identification and treatment of psychiatric vulnerability in these individuals.