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Dimensional structure and prospective evolution of posttraumatic stress symptomatology in World Trade Center responders
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Abstracts / Comprehensive Psychiatry 54 (2013) e15–e40
selected from a stratified multistage clustered area probability sample of households within the 39 municipalities of São Paulo, Brazil. Analyses used weighted simple and multiple logistic regression models with childhood neglect, physical abuse, sexual abuse, and family violence as exposures and heart disease and hypertension as outcomes, adjusted for socio-demographic variables and early onset of major depressive disorder. Results: In models adjusted for socio-demographic factors and early onset of depression, physical abuse (OR = 1.64, 95% CI: 1.30–2.07) and family violence (OR = 1.37, 95% CI: 1.10–1.71) were associated with hypertension. Physical abuse was a significant risk factor for heart disease (OR = 1.74, 95% CI: 1.06–2.85) when controlling for socio-demographic variables, but this association lost significance when controlling for early onset of depression. When additionally controlling for other childhood adversities simultaneously, physical abuse remained associated with adult hypertension (OR = 1.68, 95% CI: 1.28–2.20; OR = 1.59, 95% CI: 1.22–2.07 with and without adjusting for depression, respectively). Physical abuse lost significance when also adjusting for the other childhood adversities simultaneously. Conclusions: Results suggest a positive association between childhood physical abuse and hypertension in adulthood, even when adjusting for other childhood adversities, onset of depression and socio-demographic risk factors. Efforts to curb child physical abuse could potentially reduce subsequent hypertension, and morbidity and mortality due to cardiovascular disease. http://dx.doi.org/10.1016/j.comppsych.2013.07.050
Social cognition in schizophrenia and comorbid antisocial personality disorder E. Payne a,b, T. Deliberto a,b, M. Serper a,b,c Hempstead, NY b Far Rockaway, NY c New York, NY
a
Prior research theorizes that individuals with schizophrenia (SZ) have difficulty relating to others, because of poor social cognitive functioning. Yet high comorbidity between schizophrenia and antisocial personality disorder (APD) confound these findings. It remains unclear as to whether social deficits found in SZ are inherent to the illness, or due to the presence of comorbid APD. Previous studies comparing individuals with APD traits and a schizophreniaspectrum disorder to patients having SZ alone have shown significant structural and functioning differences on neuroimaging tasks. Additionally, the two diagnostic groups differ in terms of neurocognitive ability, with comorbid APD + SZ patients demonstrating lower intellectual functioning and poorer memory skills than individuals with SZ without APD. The present study will examine differences in empathetic functioning in SZ patients with high vs. low antisocial traits. We hypothesize that individuals with SZ and high APD traits will have greater empathetic deficits than uncomplicated SZ. We also hypothesize that individuals with SZ that are high in APD traits will have lower IQ scores and demonstrate poorer working memory performance than SZ low in APD trait comorbidity. http://dx.doi.org/10.1016/j.comppsych.2013.07.051
Dimensional structure and prospective evolution of posttraumatic stress symptomatology in World Trade Center responders Robert H. Pietrzak a,b,c, Adriana Feder c, Ritika Singh c, Clyde B. Schechter d, Jill L. Barron b, Steven M. Southwick a,b,c a National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA b Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA c Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA d Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
Background: Posttraumatic stress disorder (PTSD) is an anxiety disorder characterized by heterogeneous clusters of re-experiencing, avoidance, numbing, and hyperarousal symptoms. A large body of confirmatory factor analytic (CFA) studies has demonstrated that four-factor dysphoria and emotional numbing models provide a better representation of PTSD symptom dimensionality compared to the three-factor DSM-IV model. Recently, CFA studies of various trauma-exposed samples have found that a novel five-factor model, which separates the DSM-IV hyperarousal symptom cluster into distinct dysphoric and anxious arousal clusters, provides a superior representation of PTSD symptom dimensionality. To date, however, no study of which we are aware has evaluated the best dimensional representation of PTSD symptoms in World Trade Center (WTC) responders, or how symptom clusters from this model are prospectively related. Methods: Confirmatory factor analyses (CFAs) were used to examine the factor structure of the PTSD Checklist in a cohort of 10,835 WTC responders, including 4,035 police responders and 6,800 non-traditional responders, who were evaluated an average of 3, 6, and 8 years after the WTC attacks. An autoregressive cross-lagged panel regression analysis was then conducted to evaluate interrelationships among PTSD symptom clusters over time. Results: CFAs revealed that a five-factor model comprised of intercorrelated clusters of re-experiencing, avoidance, emotional numbing, dysphoric arousal, and anxious arousal symptoms provided the best representation of PTSD symptoms in police and non-traditional WTC responders. In police responders, anxious arousal symptoms were most strongly prospectively linked to reexperiencing symptoms, and dysphoric arousal to numbing symptoms in the intermediate-term, while re-experiencing symptoms predominantly drove numbing symptoms in the long-term. In non-traditional responders, anxious arousal symptoms were most strongly prospectively linked to re-experiencing symptoms, while dysphoric arousal symptoms predominantly drove numbing symptoms over time. In both groups of responders, avoidance symptoms drove re-experiencing symptoms over time. Conclusions: A novel 5-factor model comprised of re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal symptoms best represented PTSD symptomatology in both traditional and non-traditional disaster responders. Prospective interrelationships among these symptom clusters suggest that targeting hyperarousal and avoidance symptoms early after disaster exposure may help reduce later symptoms of re-experiencing and numbing in disaster responders.
http://dx.doi.org/10.1016/j.comppsych.2013.07.052
Early life adversity is associated with anxiety and depressive disorders in young adulthood: a prospective longitudinal investigation over 25 years D.T. Plant, S. Pawlby, C.M. Pariante Institute of Psychiatry, King's College London, United Kingdom Background: The etiological pathways for anxiety and depressive disorders are not fully understood. Adverse childhood experiences such as exposure to maltreatment and maternal depression have been found to predict later depression and anxiety. In this study, we investigate the impact of very early life adversity (exposure to maternal depression in utero) on young adulthood psychopathology. Method: The sample comprised a subgroup (n = 50) of participants from the South London Child Development Study. A prospective longitudinal design was employed. Data on offspring exposure to depression in utero (20 and 36 weeks gestation), exposure to childhood maltreatment (11 years) and adulthood depression and anxiety (25 years) were obtained from parents and offspring through clinical interview. Results: At 25 years, 26% (13) of offspring met criterion for an anxiety disorder diagnosis (panic disorder/posttraumatic stress disorder/social phobia) and 26% (13) of offspring had experienced at least one depressive episode as an adult. Offspring exposed to depression in utero were significantly more likely to have an anxiety disorder or major depressive
Abstracts / Comprehensive Psychiatry 54 (2013) e15–e40
selected from a stratified multistage clustered area probability sample of households within the 39 municipalities of São Paulo, Brazil. Analyses used weighted simple and multiple logistic regression models with childhood neglect, physical abuse, sexual abuse, and family violence as exposures and heart disease and hypertension as outcomes, adjusted for socio-demographic variables and early onset of major depressive disorder. Results: In models adjusted for socio-demographic factors and early onset of depression, physical abuse (OR = 1.64, 95% CI: 1.30–2.07) and family violence (OR = 1.37, 95% CI: 1.10–1.71) were associated with hypertension. Physical abuse was a significant risk factor for heart disease (OR = 1.74, 95% CI: 1.06–2.85) when controlling for socio-demographic variables, but this association lost significance when controlling for early onset of depression. When additionally controlling for other childhood adversities simultaneously, physical abuse remained associated with adult hypertension (OR = 1.68, 95% CI: 1.28–2.20; OR = 1.59, 95% CI: 1.22–2.07 with and without adjusting for depression, respectively). Physical abuse lost significance when also adjusting for the other childhood adversities simultaneously. Conclusions: Results suggest a positive association between childhood physical abuse and hypertension in adulthood, even when adjusting for other childhood adversities, onset of depression and socio-demographic risk factors. Efforts to curb child physical abuse could potentially reduce subsequent hypertension, and morbidity and mortality due to cardiovascular disease. http://dx.doi.org/10.1016/j.comppsych.2013.07.050
Social cognition in schizophrenia and comorbid antisocial personality disorder E. Payne a,b, T. Deliberto a,b, M. Serper a,b,c Hempstead, NY b Far Rockaway, NY c New York, NY
a
Prior research theorizes that individuals with schizophrenia (SZ) have difficulty relating to others, because of poor social cognitive functioning. Yet high comorbidity between schizophrenia and antisocial personality disorder (APD) confound these findings. It remains unclear as to whether social deficits found in SZ are inherent to the illness, or due to the presence of comorbid APD. Previous studies comparing individuals with APD traits and a schizophreniaspectrum disorder to patients having SZ alone have shown significant structural and functioning differences on neuroimaging tasks. Additionally, the two diagnostic groups differ in terms of neurocognitive ability, with comorbid APD + SZ patients demonstrating lower intellectual functioning and poorer memory skills than individuals with SZ without APD. The present study will examine differences in empathetic functioning in SZ patients with high vs. low antisocial traits. We hypothesize that individuals with SZ and high APD traits will have greater empathetic deficits than uncomplicated SZ. We also hypothesize that individuals with SZ that are high in APD traits will have lower IQ scores and demonstrate poorer working memory performance than SZ low in APD trait comorbidity. http://dx.doi.org/10.1016/j.comppsych.2013.07.051
Dimensional structure and prospective evolution of posttraumatic stress symptomatology in World Trade Center responders Robert H. Pietrzak a,b,c, Adriana Feder c, Ritika Singh c, Clyde B. Schechter d, Jill L. Barron b, Steven M. Southwick a,b,c a National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA b Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA c Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA d Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
Background: Posttraumatic stress disorder (PTSD) is an anxiety disorder characterized by heterogeneous clusters of re-experiencing, avoidance, numbing, and hyperarousal symptoms. A large body of confirmatory factor analytic (CFA) studies has demonstrated that four-factor dysphoria and emotional numbing models provide a better representation of PTSD symptom dimensionality compared to the three-factor DSM-IV model. Recently, CFA studies of various trauma-exposed samples have found that a novel five-factor model, which separates the DSM-IV hyperarousal symptom cluster into distinct dysphoric and anxious arousal clusters, provides a superior representation of PTSD symptom dimensionality. To date, however, no study of which we are aware has evaluated the best dimensional representation of PTSD symptoms in World Trade Center (WTC) responders, or how symptom clusters from this model are prospectively related. Methods: Confirmatory factor analyses (CFAs) were used to examine the factor structure of the PTSD Checklist in a cohort of 10,835 WTC responders, including 4,035 police responders and 6,800 non-traditional responders, who were evaluated an average of 3, 6, and 8 years after the WTC attacks. An autoregressive cross-lagged panel regression analysis was then conducted to evaluate interrelationships among PTSD symptom clusters over time. Results: CFAs revealed that a five-factor model comprised of intercorrelated clusters of re-experiencing, avoidance, emotional numbing, dysphoric arousal, and anxious arousal symptoms provided the best representation of PTSD symptoms in police and non-traditional WTC responders. In police responders, anxious arousal symptoms were most strongly prospectively linked to reexperiencing symptoms, and dysphoric arousal to numbing symptoms in the intermediate-term, while re-experiencing symptoms predominantly drove numbing symptoms in the long-term. In non-traditional responders, anxious arousal symptoms were most strongly prospectively linked to re-experiencing symptoms, while dysphoric arousal symptoms predominantly drove numbing symptoms over time. In both groups of responders, avoidance symptoms drove re-experiencing symptoms over time. Conclusions: A novel 5-factor model comprised of re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal symptoms best represented PTSD symptomatology in both traditional and non-traditional disaster responders. Prospective interrelationships among these symptom clusters suggest that targeting hyperarousal and avoidance symptoms early after disaster exposure may help reduce later symptoms of re-experiencing and numbing in disaster responders.
http://dx.doi.org/10.1016/j.comppsych.2013.07.052
Early life adversity is associated with anxiety and depressive disorders in young adulthood: a prospective longitudinal investigation over 25 years D.T. Plant, S. Pawlby, C.M. Pariante Institute of Psychiatry, King's College London, United Kingdom Background: The etiological pathways for anxiety and depressive disorders are not fully understood. Adverse childhood experiences such as exposure to maltreatment and maternal depression have been found to predict later depression and anxiety. In this study, we investigate the impact of very early life adversity (exposure to maternal depression in utero) on young adulthood psychopathology. Method: The sample comprised a subgroup (n = 50) of participants from the South London Child Development Study. A prospective longitudinal design was employed. Data on offspring exposure to depression in utero (20 and 36 weeks gestation), exposure to childhood maltreatment (11 years) and adulthood depression and anxiety (25 years) were obtained from parents and offspring through clinical interview. Results: At 25 years, 26% (13) of offspring met criterion for an anxiety disorder diagnosis (panic disorder/posttraumatic stress disorder/social phobia) and 26% (13) of offspring had experienced at least one depressive episode as an adult. Offspring exposed to depression in utero were significantly more likely to have an anxiety disorder or major depressive