Marijuana use and panic psychopathology among a representative sample of adults.

This study examined the relations between marijuana use and panic attacks and panic disorder using a large representative survey of adults (N = 5,672; 53% women; Mage = 45.05 years, SD = 17.9) conducted in the United States (Kessler et al., 2004). After adjusting for sociodemographic variables (age, marital status, income, education, race, and sex) and the presence of a lifetime substance use disorder, lifetime marijuana use was significantly associated with increased odds of a lifetime panic attack history. Lifetime marijuana use also was significantly associated with an increased risk of current (past-year) panic attacks; however, this relation was not significant when controlling for nicotine dependence. Lifetime marijuana use was significantly associated with increased odds of a lifetime diagnosis of panic disorder as well as a current (past-year) diagnosis of panic disorder. Current (past-year) marijuana use was significantly associated with both lifetime and current panic attacks, but not current or lifetime panic disorder. Results are discussed in relation to the novel information they offer in regard to understanding the putative marijuana use–panic psychopathology association(s). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Post-traumatic stress disorder and functioning and quality of life outcomes in female Vietnam veterans

OBJECTIVE: This investigation assessed whether current post-traumatic stress disorder (PTSD) was associated with impaired functioning in a nationally representative sample of female Vietnam veterans. METHODS: Logistic models were used to determine the association between PTSD and outcome while adjusting for demographic characteristics and medical and psychiatric co-morbidities. RESULTS: PTSD was associated with significantly elevated odds of poorer functioning in five of the six outcome domains; only the association between perpetration of violence in the past year and PTSD did not achieve statistical significance. After adjusting for demographics and medical and psychiatric co-morbidities, PTSD remained associated with significantly elevated odds of bed days, poorer physical health, and currently not working. CONCLUSIONS: Among female Vietnam veterans PTSD is associated with a broad profile of functional impairment. The significantly increased odds of impaired functioning and diminished quality of life suggest that PTSD may be the core problem of the set of problems afflicting female Vietnam veterans.     

A longitudinal investigation of interpersonal violence in relation to mental health and substance use.

The authors examined longitudinally the mental health status of women as a function of different types and combinations of exposure to interpersonal violence. A structured telephone interview was administered to a household probability sample of 4,008 women (18-89 years of age), who were then recontacted for 1- and 2-year follow-up interviews. Interviews assessed lifetime violence history (i.e., sexual assault, physical assault, witnessed serious injury or violent death), past-year mental health functioning (i.e., posttraumatic stress disorder [PTSD], depression, and substance use problems), and new instances of violence occurring after the baseline interview. Results indicate that (a) lifetime violence exposure was associated with increased risk of PTSD, depression, and substance use problems; (b) odds of PTSD, depression, and substance use problems increased incrementally with the number of different types of violence experienced; (c) relations were fairly stable over a 2-year period; and (d) new incidents of violence between the baseline and follow-up interviews were associated with heightened risk of PTSD and substance use problems. Greater understanding of the cumulative impact of violence exposure will inform service provision for individuals at high risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity and course of psychiatric disorders in a community sample of former prisoners of war

OBJECTIVE: The authors assessed DSM-III-R disorders among American former prisoners of war. Comorbidity, time of onset, and the relationship of trauma severity to complicated versus uncomplicated posttraumatic stress disorder (PTSD) were examined. METHOD: A community sample (N=262) of men exposed to combat and imprisonment was assessed by clinicians using the Structured Clinical Interview for DSM-III-R. RESULTS: The rates of comorbidity among the men with PTSD were lower than rates from community samples assessed by lay interviewers. Over one-third of the cases of lifetime PTSD were uncomplicated by another axis I disorder; over one-half of the cases of current PTSD were uncomplicated. PTSD almost always emerged soon after exposure to trauma. Lifetime PTSD was associated with increased risk of lifetime panic disorder, major depression, alcohol abuse/dependence, and social phobia. Current PTSD was associated with increased risk of current panic disorder, dysthymia, social phobia, major depression, and generalized anxiety disorder. Relative to PTSD, the onset of the comorbid disorders was as follows: major depression, predominantly secondary; alcohol abuse/dependence and agoraphobia, predominantly concurrent (same year); social phobia, equal proportions primary and concurrent; and panic disorder, equal proportions concurrent and secondary. Trauma exposure was comparable in the subjects with complicated and uncomplicated PTSD. CONCLUSIONS: The types of comorbid diagnoses and their patterns of onset were comparable to the diagnoses and patterns observed in other community samples. The findings support the validity of the PTSD construct; PTSD can be distinguished from comorbid disorders. Uncomplicated PTSD may be more common than previous studies suggest, particularly in clinician-assessed subjects exposed to severe trauma.     

Current and lifetime psychiatric disorders among veterans with war zone-related posttraumatic stress disorder

Previous research has found high rates of psychiatric disorders among veterans with war zone-related posttraumatic stress disorder (PTSD). However, many studies in this area are methodologically limited in ways that preclude unambiguous interpretation of their results. The purpose of this study was to address some of these limitations to clarify the relationship between war zone-related PTSD and other disorders. Participants were 311 male Vietnam theater veterans assessed at the National Center for PTSD at the Boston Veterans Affairs Medical Center. The Clinician-Administered PTSD Scale and the Structured Clinical Interview for DSM-III-R were used to derive current and lifetime diagnoses of PTSD, other axis I disorders (mood, anxiety, substance use, psychotic, and somatoform disorders), and two axis II disorders (borderline and antisocial personality disorders only). Participants also completed several self-report measures of PTSD and general psychopathology. Relative to veterans without PTSD, veterans with PTSD had significantly higher rates of current major depression, bipolar disorder, panic disorder, and social phobia, as well as significantly higher rates of lifetime major depression, panic disorder, social phobia, and obsessive-compulsive disorder. In addition, veterans with PTSD scored significantly higher on all self-report measures of PTSD and general psychopathology. These results provide further evidence that PTSD is associated with high rates of additional psychiatric disorders, particularly mood disorders and other anxiety disorders. The implications of these findings and suggestions about the direction of future research in this area are discussed.     

Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.

The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV:Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A clinical profile of women with posttraumatic stress disorder and substance dependence.

To assess the clinical characteristics of women with posttraumatic stress disorder (PTSD) and substance dependence, 28 women with both disorders were compared with 29 women with PTSD alone on a wide battery of lifetime and current clinical measures. The dual-diagnosis women consistently had a more severe clinical profile, including worse life conditions (e.g., physical appearance, opportunities in life), both as children and as adults; greater criminal behavior; a higher number of lifetime suicide attempts; a greater number having a sibling with a drug problem; and fewer outpatient psychiatric treatments. One discrepant finding, however, was their lower rate of major depression. Interestingly, the 2 groups did not differ in number or type of lifetime traumas, PTSD onset or severity, family history of substance use; coping style, functioning level, psychiatric symptoms, or sociodemographic characteristics. Treatment implications and methodological limitations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder in a community group of former prisoners of war: a normative response to severe trauma

OBJECTIVE: The goal of this study was to assess and describe the long-term impact of traumatic prisoner of war (POW) experiences within the context of posttraumatic psychopathology. Specifically, the authors attempted to investigate the relative degree of normative response represented by posttraumatic stress disorder (PTSD) in comparison to other DSM axis I disorders often found to be present, either alone or concomitant with other disorders, in survivors of trauma. METHOD: A community group of 262 U.S. World War II and Korean War former POWs was recruited. These men had been exposed to the multiple traumas of combat, capture, and imprisonment, yet few had ever sought mental health treatment. They were assessed for psychopathology with diagnostic interviews and psychodiagnostic testing. Regression analyses were used to assess the contributions of age at capture, war trauma, and postwar social support to PTSD and the other diagnosed disorders. RESULTS: More than half of the men (53%) met criteria for lifetime PTSD, and 29% met criteria for current PTSD. The most severely traumatized group (POWs held by the Japanese) had PTSD lifetime rates of 84% and current rates of 59%. Fifty-five percent of those with current PTSD were free from the other current axis I disorders (uncomplicated PTSD). In addition, 34% of those with lifetime PTSD had PTSD as their only lifetime axis I diagnosis. Regression analyses indicated that age at capture, severity of exposure to trauma, and postmilitary social support were moderately predictive of PTSD and only weakly predictive of other disorders. CONCLUSIONS: These findings indicate that PTSD is a persistent, normative, and primary consequence of exposure to severe trauma.     

Posttraumatic stress disorder, exposure to combat, and lower plasma cortisol among Vietnam veterans: Findings and clinical implications.

Several clinical studies suggest that individuals with posttraumatic stress disorder (PTSD) experience neuroendocrine system alterations, resulting in significantly lower plasma cortisol. To test this hypothesis, morning serum cortisol was compared among a national sample of Vietnam "theater" veterans (n?=?2,490) and a sample of Vietnam "era" veterans (n?=?1,972) without service in Vietnam. Analysis of covariance was used to compare cortisol concentrations after adjusting for 9 covariates (education, income, race, age, smoking status, alcohol use, illicit drug use, medication use, and body mass index ). Adjusted cortisol was lower among theater veterans with current PTSD but not era or theater veterans with lifetime PTSD. Among theater veterans, cortisol was inversely related to combat exposure, with veterans exposed to heavy combat having the lowest concentrations. Analysis of plasma cortisol, together with other clinical data, may be instrumental in the future diagnosis and treatment of stress disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance use after residential treatment among individuals with co-occurring disorders: The role of anxiety/depressive symptoms and trauma exposure.

This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure, and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were not associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vulnerability to posttraumatic stress disorder in adult offspring of Holocaust survivors

OBJECTIVE: There has been considerable controversy regarding the impact of the Holocaust on the second generation, but few empirical data are available that systematically document trauma exposure and psychiatric disorder in these individuals. To obtain such data, the authors examined the prevalence of stress and exposure to trauma, current and lifetime posttraumatic stress disorder (PTSD), and other psychiatric diagnoses in a group of adult offspring of Holocaust survivors (N=100) and a demographically similar comparison group (N=44). METHOD: Subjects were recruited from both community and clinical populations and were evaluated with the use of structured clinical instruments. Stress and trauma history were evaluated with the Antonovsky Life Crises Scale and the Trauma History Questionnaire, PTSD was diagnosed with the Clinician Administered PTSD Scale, and other psychiatric disorders were evaluated according to the Structured Clinical Interview for DSM-IV. RESULTS: The data show that although adult offspring of Holocaust survivors did not experience more traumatic events, they had a greater prevalence of current and lifetime PTSD and other psychiatric diagnoses than the demographically similar comparison subjects. This was true in both community and clinical subjects. CONCLUSIONS: The findings demonstrate an increased vulnerability to PTSD and other psychiatric disorders among offspring of Holocaust survivors, thus identifying adult offspring as a possible high-risk group within which to explore the individual differences that constitute risk factors for PTSD.     

The impact of PTSD, depression, and substance use disorders on disease burden and health care utilization among OEF/OIF veterans.

Growing evidence suggests that posttraumatic stress disorder (PTSD) is associated with poorer health status (e.g., more medical disease, physical symptoms, and sick visits to health care professionals) among veterans who served in Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq. We investigated whether PTSD, depression, and substance use disorders independently predicted health status over time among OEF/OIF veterans. Information regarding psychiatric and medical conditions and health care utilization was culled for 4,463 OEF/OIF veterans enrolled in Veterans Administration primary care for a period of 6 years. Data were analyzed using multilevel modeling and generalized estimating equations. Results suggest that PTSD, depression, and substance use disorders are independently associated with increased medical disease burden and mental health care utilization but not increased medical health care utilization. The association between PTSD and medical disease burden strengthened over time. These data suggest that OEF/OIF veterans with PTSD may be at risk for increasingly poorer physical health in terms of medical disease burden over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trajectories of PTSD and substance use disorders in a longitudinal study of personality disorders.

This study investigated the co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) in a sample (N = 668) recruited for personality disorders and followed longitudinally as part of the Collaborative Longitudinal Personality Disorders Study. The study both examined rates of co-occurring disorders at baseline and temporal relationships between PTSD and substance use disorders over 4 years. Subjects with a lifetime history of PTSD at baseline had significantly higher rates of SUDs (both alcohol and drug) than subjects without PTSD. Latent class growth analysis, a relatively novel approach used to analyze trajectories and identify homogeneous subgroups of participant on the basis of probabilities of PTSD and SUD over time, identified 6 classes, which were compared with respect to a set of functioning and personality variables. The most consistent differences were observed between the group that displayed low probabilities of both SUD and PTSD and the group that displayed high probabilities of both. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hitting home: Relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for Army couples.

Using a sample of 434 couples consisting of active duty Army husbands married to civilian wives, relationships between recent deployment, current posttraumatic stress disorder (PTSD) symptoms, and a range of marital outcomes were investigated. Self-reports from both husbands and wives regarding relationship functioning did not differ between couples who were and were not separated due to deployment in the prior year. However, deployment in the past year was related to higher levels of current PTSD symptoms for husbands, and husbands' current PTSD symptoms were associated with lower marital satisfaction, confidence in the relationship, positive bonding between the spouses, parenting alliance, and dedication to the relationship for both husbands and wives. In addition, husbands' current PTSD symptoms were associated with higher levels of negative communication for both husbands and wives, and lower satisfaction with sacrifice for the relationship for husbands. Once positive bonding, negative communication, and parenting alliance were controlled, husband PTSD symptoms no longer significantly predicted marital satisfaction for wives. Husband PTSD symptoms continued to exert a significant, but reduced, unique effect on husband marital satisfaction once these variables were accounted for. The results provide greater understanding of the relationship of deployment/PTSD symptoms and marital functioning and suggest areas for intervention with military couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spontaneous remission from PTSD depends on the number of traumatic event types experienced.

As exposure to different types of traumatic stressors increases, the prevalence of PTSD increases. However, little is known about the effects of cumulative exposure to traumatic stress on the maintenance and remission from PTSD. In 2006/2007, we investigated 444 refugees from the 1994 Rwandan genocide, assessing exposure to traumatic events, current and lifetime PTSD, and PTSD symptom severity. Higher trauma exposure was associated with higher prevalence of current and lifetime PTSD, with lower probability of spontaneous remission from PTSD, and with higher current and lifetime PTSD symptom severity in clear dose-response effects. The results suggest traumatic load as a root cause of both PTSD chronicity and symptom severity and support the hypothesis of a neural fear network in the etiology of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of PTSD and other mental disorders in World War II and Korean Conflict POW survivors and combat veterans.

Mental disorders were assessed in 326 prisoners of war (POWs) of the World War II (WWII) European theater, WWII Pacific theater, and Korean Conflict (KC) and in combat veterans of both wars. Diagnoses were identified using a structured diagnostic interview including a posttraumatic stress disorder (PTSD) module. POW trauma severity was measured by a trauma events index, captivity weight loss, and captivity duration. KC and WWII Pacific former POWs reported the most extreme trauma and, as hypothesized, showed highest prevalences of lifetime and current mental disorders and PTSD. POW subgroups exhibited greater psychopathology than combat veterans. PTSD was frequently associated with other mental disorders and found in high prevalences in all subgroups, pointing to the persistent, far-reaching impact of combat and POW experiences on mental health. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Patterns of current and lifetime substance use in schizophrenia

A structured interview and standardized rating scales were used to assess a sample of 194 outpatients with schizophrenia in a regional Australian mental health service for substance use, abuse, and dependence. Case manager assessments and urine drug screens were also used to determine substance use. Additional measurements included demographic information, history of criminal charges, symptom self-reports, personal hopefulness, and social support. The sample was predominantly male and showed relative instability in accommodations, and almost half had a history of criminal offenses, most frequently drug or alcohol related. The 6-month and lifetime prevalence of substance abuse or dependence was 26.8 and 59.8 percent, respectively, with alcohol, cannabis, and amphetamines being the most commonly abused substances. Current users of alcohol comprised 77.3 percent and current users of other nonprescribed substances (excluding tobacco and caffeine) comprised 29.9 percent of the sample. Rates of tobacco and caffeine consumption were high. There was a moderate degree of concordance between case manager determinations of a substance-use problem and research diagnoses. Subjects with current or lifetime diagnoses of substance abuse/dependence were predominantly young, single males with higher rates of criminal charges; however, there was no evidence of increased rates of suicide attempts, hospital admissions, or daily doses of antipsychotic drugs in these groups compared with subjects with no past or current diagnosis of substance abuse or dependence. Subjects with a current diagnosis of substance use were younger at first treatment and currently more symptomatic than those with no past or current substance use diagnosis. The picture emerging from this study replicates the high rate of substance abuse in persons with schizophrenia reported in North American studies but differs from the latter in finding a slightly different pattern of substances abused (i.e., absence of cocaine), reflecting relative differences in the availability of certain drugs.     

Axis I comorbidity of borderline personality disorder

OBJECTIVE: The purpose of this study was to assess the lifetime rates of occurrence of a full range of DSM-III-R axis I disorders in a group of patients with criteria-defined borderline personality disorder and comparison subjects with other personality disorders. METHOD: The axis I comorbidity of 504 inpatients with personality disorders was assessed by interviewers who were blind to clinical diagnosis and who used a semistructured research interview of demonstrated reliability. RESULTS: Four new findings emerged from this study. First, anxiety disorders were found to be almost as common among borderline patients (N=379) as mood disorders but far more discriminating from axis II comparison subjects (N=125). Second, posttraumatic stress disorder (PTSD) was found to be a common but not universal comorbid disorder among borderline patients, a finding inconsistent with the view that borderline personality disorder is actually a form of chronic PTSD. Third, male and female borderline patients were found to differ in the type of disorder of impulse in which they "specialized." More specifically, substance use disorders were significantly more common among male borderline patients, while eating disorders were significantly more common among female borderline patients. Fourth, a lifetime pattern of complex comorbidity (i.e., met DSM-III-R criteria for both a disorder of affect and a disorder of impulse at some point before the patients' index admission) was found to have strong positive predictive power for the borderline diagnosis as well as a high degree of sensitivity and specificity. CONCLUSIONS: These results suggest that the lifetime pattern of axis I comorbidity characteristic of borderline patients and distinguishing for the disorder is a particularly good marker for borderline personality disorder.     

Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans.

The association between physician-diagnosed medical disorders and combat-related posttraumatic stress disorder (PTSD) symptoms was examined in 605 male combat veterans of World War II and the Korean conflict. Physician exams were performed at periodic intervals beginning in the 1960s. PTSD symptoms were assessed in 1990. Cox regression was used to examine the onset of each of 12 disorder categories as a function of PTSD symptoms, controlling for age, smoking, alcohol use, and body weight at study entry. Even with control for these factors, PTSD symptoms were associated with increased onset of arterial, lower gastrointestinal, dermatologic, and musculoskeletal disorders. There was only weak evidence that PTSD mediated the effects of combat exposure on morbidity. Possible mediators of the relationship between combat exposure, PTSD, and physical morbidity are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)