Physical health burden of PTSD, depression, and their comorbidity in the U.S. veteran population: Morbidity, functioning, and disability

Nichter, Brandon; Norman, Sonya B.; Haller, Moira; Pietrzak, Robert H.

doi:10.1016/j.jpsychores.2019.109744

Cited by 78 publications

(47 citation statements)

References 52 publications

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“…Lastly, it is important to note that PTSD has been recognized as a heterogenous disorder, ranging from presentations with predominant states of hypervigilance to states of detachment (i.e., derealization, depersonalization), with the latter being more often associated to the recently formulated dissociative subtype (Fenster et al, ; Lanius et al, ). In addition, PTSD is often associated with several comorbidities, like, for example, major depressive disorder or substance use disorders (Driessen, Schulte et al, ; Nichter, Norman, Haller, & Pietrzak, ; Pietrzak, Goldstein, Southwick, & Grant, ). However, due to the limited number of identified studies, creating sufficiently sized subgroups for each of the possible combinations was not possible.…”

Section: Discussionmentioning

confidence: 99%

The neural correlates of trauma‐related autobiographical memory in posttraumatic stress disorder: A meta‐analysis

Thome

Terpou

McKinnon

et al. 2019

Depression and Anxiety

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Background Autobiographical memory (AM) refers to memories of events that are personally relevant and are remembered from one's own past. The AM network is a distributed brain network comprised largely by prefrontal medial and posteromedial cortical brain regions, which together facilitate AM. Autobiographical memories with high arousal and negatively valenced emotional states are thought to be retrieved more readily and re‐experienced more vividly. This is critical in the case of trauma‐related AMs, which are related to altered phenomenological experiences as well as aberrations to the underlying neural systems in posttraumatic stress disorder (PTSD). Critically, these alterations to the AM network have not been explored recently and have never been analyzed with consideration to the different processes of AM, them being retrieval and re‐experiencing. Methods We conducted a series of effect‐size signed differential mapping meta‐analyses across twenty‐eight studies investigating the neural correlates of trauma‐related AMs in participants with PTSD as compared with controls. Studies included either trauma‐related scripts or trauma‐related materials (i.e., sounds, images, pictures) implemented to evoke the recollection of a trauma‐related memory. Results The meta‐analyses revealed that control and PTSD participants displayed greater common brain activation of prefrontal medial and posteromedial cortices, respectively. Whereby the prefrontal medial cortices are suggested to facilitate retrieval monitoring, the posteromedial cortices are thought to enable the visual imagery processes of AM. Conclusions Taken together, reduced common activation of prefrontal cortices may be interpreted as a bias toward greater re‐experiencing, where the more salient elements of the traumatic memory are relived as opposed to retrieved in a controlled manner in PTSD.

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Section: Discussionmentioning

confidence: 99%

The neural correlates of trauma‐related autobiographical memory in posttraumatic stress disorder: A meta‐analysis

Thome

Terpou

McKinnon

et al. 2019

Depression and Anxiety

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“…Exposure to overwhelming conditions or traumatic events, under threatening circumstances, could trigger neurophysiological stress responses with symptoms of trauma, distress (suffering), and impair role functioning. The diagnosis of posttraumatic stress disorder (PTSD) requires trauma exposure with all three conditions, but circumstances, or context are not disregarded (Atwoli et al, 2015;Hoppen & Morina, 2019;Nichter et al, 2019;Spottswood et al, 2019). The health burden of PTSD includes the direct medical costs (e.g., medications and specialized therapies) and indirect costs of lost productivity due to absenteeism and presenteeism and the long-term risk of physiological, neuropsychiatric, and psychosocial disorders (McGowan, 2019).…”

Section: Introductionmentioning

confidence: 99%

Meta-Analysis of Cultural Influences in Trauma Exposure and PTSD Prevalence Rates

et al. 2021

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Introduction: The global prevalence of posttraumatic stress disorder (PTSD) continues to rise, the influence of culture and resilience remains unclear. This review and meta-analysis aimed to (a) examine the prevalence of PTSD among studies addressing culture and resilience, and (b) compare the PTSD prevalence rates across different trauma exposures and cultural contexts. Methodology: PubMed, CINAHL, and PsycINFO were searched for articles published between 01/01/2000 to 12/01/019 that defined PTSD, reported PTSD prevalence rates, and addressed culture and resilience. Meta-analysis of PTSD prevalence rates was performed using generalized linear mixed models. Results: Thirty articles met all search criteria. In the pooled sample of 20,138 participants, 3,403 met defined PTSD diagnostic criteria. The random-effects model showed PTSD cultural effects. Refugees displaced in similar cultures (0.44) had higher rates of PTSD. Discussion: Findings indicate that trauma-informed, practical assessments of health protective cultural determinants may promote individual resilience and reduce the risk of PTSD in displaced refugees.

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“…Compared to veterans with PTSD only and MDD only, those with comorbid PTSD/MDD were significantly more likely to screen positive for current SI, lifetime suicide attempts, and anxiety disorders, and they scored substantially lower on measures of mental health and cognitive functioning, and QOL. Furthermore, a follow-up study (85) found that veterans with comorbid PTSD/MDD had a substantially greater burden of physical illness than veterans with either disorder alone. Specifically, veterans with comorbid PTSD/MDD had higher rates of heart disease, migraine, fibromyalgia, and rheumatoid arthritis compared to veterans with MDD alone, and higher rates of hypercholesterolemia and hypertension compare to veterans with PTSD alone (85).…”

Section: Major Depressive Disordermentioning

confidence: 99%

“…Furthermore, a follow-up study (85) found that veterans with comorbid PTSD/MDD had a substantially greater burden of physical illness than veterans with either disorder alone. Specifically, veterans with comorbid PTSD/MDD had higher rates of heart disease, migraine, fibromyalgia, and rheumatoid arthritis compared to veterans with MDD alone, and higher rates of hypercholesterolemia and hypertension compare to veterans with PTSD alone (85). Taken together, these findings highlight the importance of screening, monitoring, and treatment comorbid PTSD/MDD in veterans.…”

Section: Major Depressive Disordermentioning

confidence: 99%

The National Health and Resilience in Veterans Study: A Narrative Review and Future Directions

et al. 2020

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United States (U.S.) veterans are substantially older than their non-veteran counterparts. However, nationally representative, population-based data on the unique health needs of this population are lacking. Such data are critical to informing the design of large-scale outreach initiatives, and to ensure the effectiveness of service care delivery both within and outside of the Veterans Affairs healthcare system. The National Health and Resilience in Veterans Study (NHRVS) is a contemporary, nationally representative, prospective study of two independent cohorts (n = 3,157 and n = 1,484) of U.S. veterans, which is examining longitudinal changes, and key risk and protective factors for several health outcomes. In this narrative review, we summarize the main findings of all NHRVS studies (n = 82) published as of June 2020, and discuss the clinical implications, limitations, and future directions of this study. Review of these articles was organized into six major topic areas: post-traumatic stress disorder, suicidality, aging, resilience and post-traumatic growth, special topics relevant to veterans, and genetics and epigenetics. Collectively, results of these studies suggest that while a significant minority of veterans screen positive for mental disorders, the majority are psychologically resilient. They further suggest that prevention and treatment efforts designed to promote protective psychosocial characteristics (i.e., resilience, gratitude, purpose in life), and social connectedness (i.e., secure attachment, community integration, social engagement) help mitigate risk for mental disorders, and promote psychological resilience and post-traumatic growth in this population.

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Physical health burden of PTSD, depression, and their comorbidity in the U.S. veteran population: Morbidity, functioning, and disability

Cited by 78 publications

References 52 publications

The neural correlates of trauma‐related autobiographical memory in posttraumatic stress disorder: A meta‐analysis

The neural correlates of trauma‐related autobiographical memory in posttraumatic stress disorder: A meta‐analysis

Meta-Analysis of Cultural Influences in Trauma Exposure and PTSD Prevalence Rates

The National Health and Resilience in Veterans Study: A Narrative Review and Future Directions

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