Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults

OBJECTIVE: Few studies have focused on the natural course of posttraumatic stress disorder (PTSD) and its determinants in samples of the general population. The authors examined determinants of remission and chronicity of PTSD and associations with other disorders in a prospective community sample. METHOD: The data were drawn from a prospective, longitudinal epidemiological study of adolescents and young adults (age 14-24 years) in Munich, Germany (N=2,548). The course of PTSD from baseline to follow-up 34-50 months later was studied in 125 respondents with DSM-IV PTSD or subthreshold PTSD at baseline. RESULTS: Although 52% of the PTSD cases remitted during the follow-up period, 48% showed no significant remission of PTSD symptoms. Respondents with a chronic course were more likely to experience new traumatic event(s) during follow-up (odds ratio=5.21, 95% confidence interval [CI]=1.95-13.92), to have higher rates of avoidant symptoms at baseline (odds ratio=10.16, 95% CI=1.73-59.51), and to report more help seeking (odds ratio=5.50, 95% CI=1.04-29.05), compared to respondents with remission. Rates of incident somatoform disorder (odds ratio=4.24, 95% CI=1.60-11.19) and other anxiety disorders (odds ratio=4.07, 95% CI=1.15-14.37) were also significantly associated with a chronic course. CONCLUSIONS: PTSD is often a persistent and chronic disorder. Specific symptom clusters--especially avoidant symptoms--might be associated with the course of PTSD. In addition, the occurrence of new traumatic events differentiates PTSD cases with a chronic course from those with remission.     

Childhood antecedents of exposure to traumatic events and posttraumatic stress disorder

OBJECTIVE: The authors prospectively examined childhood antecedents of exposure to traumatic events to estimate the risk of posttraumatic stress disorder (PTSD) among those exposed to trauma. METHOD: Two consecutive cohorts of children entering first grade of a public school system in a large mid-Atlantic city in the mid-1980s were followed into young adulthood (mean age=21). Exposure to traumatic events and PTSD were assessed in 75% of the original cohort (N=1,698). Childhood assessments, conducted upon entry into the first grade, included standardized measures of reading readiness, teacher ratings of behavioral problems, and child self-reports about depression and anxiety. Family characteristics were assessed by parental report. RESULTS: Young adults who had been rated by their first grade teacher as having aggressive/disruptive behavior problems were more likely to experience traumatic assaultive violence events (e.g., being mugged/threatened with a weapon, badly beaten-up) (relative risk=2.6) but not PTSD following trauma exposure. Youths with high levels of self-rated depressive and anxious feelings in first grade were more likely to experience PTSD once exposed to trauma (relative risk=1.5). Youths who scored in the highest quartile on a reading test in the first grade were at lower risk for exposure to assaultive violence traumas. CONCLUSIONS: Childhood behavioral and depressive/anxious problems may influence the risk for PTSD directly by increasing the vulnerability to the PTSD effects of trauma exposure, and indirectly by increasing the likelihood of exposure to assaultive violence.     

The stressor criterion in DSM-IV posttraumatic stress disorder: an empirical investigation.

BACKGROUND: The DSM-IV two-part definition of posttraumatic stress disorder (PTSD) widened the variety of stressors (A1) and added a subjective component (A2). The effects of the revised stressor criterion on estimates of exposure and PTSD in a community sample are evaluated. METHODS: A representative sample of 2181 persons in southeast Michigan were interviewed about lifetime history of traumatic events and PTSD. The evaluation of the revised two-part definition is based on a randomly selected sample of events that represents the total pool of traumatic events experienced in the community. RESULTS: The enlarged definition of stressors in A1 increased the total number of events that can be used to diagnose PTSD by 59%. The majority of A1 events (76.6%) involved the emotional response in A2. Females were more likely than males to endorse A2 (adjusted odds ratio = 2.66; 95% confidence interval 1.92, 3.71). Of all PTSD cases resulting from the representative sample of events, 38% were attributable to the expansion of qualifying events in A1. The identification of exposures that lead to PTSD were not improved materially by A2 however, events that did not involve A2 rarely resulted in PTSD. CONCLUSIONS: Compared to previous definitions, the wider variety of stressors in A1 markedly increased the number of events experienced in the community that can be used to diagnose PTSD. Furthermore, A2 might be useful as a separate criterion, an acute response necessary for the emergence of PTSD, and might serve as an early screen for identifying a subset of recently exposed persons at virtually no risk for PTSD. The utility of A2 as a screen must be tested prospectively.     

The relationship of gender and trauma characteristics to posttraumatic stress disorder in a community sample of traumatized northern plains American Indian adolescents and young adults

OBJECTIVE: Previous studies have identified a high prevalence (25%-80%) of trauma among American Indian and non-American Indian adolescents and adults. However, only a fraction of traumatized individuals develop posttraumatic stress disorder (PTSD). This article examines the relationships of gender and trauma characteristics to a diagnosis of PTSD among a community sample of traumatized American Indian adolescents and young adults. METHOD: Complete data were collected from 349 American Indians aged 15 to 24 years who participated in a cross-sectional community-based study from July 1997 to December 1999 and reported experiencing at least 1 traumatic event. Traumatic events and PTSD were assessed using a version of the Composite International Diagnostic Interview. Logistic regression determined the relationships of gender, trauma type, age at first trauma, and number of traumas to the development of PTSD. RESULTS: Forty-two participants (12.0% of those who experienced a traumatic event) met criteria for lifetime PTSD. While all 4 of the independent variables noted above demonstrated univariate associations with PTSD, multivariate logistic regression analyses indicated that only experiencing a sexual trauma (odds ratio [OR] = 4.45, 95% confidence interval [CI] = 1.76 to 11.28) and having experienced 6 or more traumas (OR = 2.53, 95% CI = 1.06 to 6.04) were independent predictors of meeting criteria for PTSD. CONCLUSION: American Indian children and adolescents who experience sexual trauma and multiple traumatic experiences may be at particularly high risk for developing PTSD.     

Patterns of incidence and psychiatric risk factors for traumatic events

Individual differences are thought to influence the propensity for exposure to trauma and the subsequent development of post-traumatic stress disorder (PTSD) symptoms. Prior research has identified pre-existing mood disorders as one such individual risk factor for traumatic events as well as for PTSD. The present study reports the incidence of traumatic events (and PTSD) and examines psychiatric risk factors for trauma exposure in a prospective community sample. Data come from a prospective, longitudinal epidemiological study of adolescents and young adults (age 14-24) in Munich, Germany. Respondent diagnoses (N = 2,548) at baseline and at follow-up 34-50 months later were considered. Psychiatric diagnoses at baseline were examined as predictors of qualifying trauma. Baseline prevalence of persons having experienced trauma meeting DSM-IV A1 and A2 criteria ('qualifying trauma') was 16.7%; during the follow-up period, 20.3% persons had experienced incident (new) qualifying traumata. The prevalence of PTSD, including subthreshold cases, at baseline was 5.6%; by the end of the follow-up period this had increased to 10.3%. Presence of an anxiety disorder at baseline predicted exposure to qualifying traumas during the follow-up period (adjusted ORs ranging from 1.36 for any trauma type to 3.00 for sexual trauma); this association was apparently due to an increased tendency to report events as being particularly horrific (meeting A2 criteria). In contrast, presence of illicit drug use predicted the onset of traumatic events (specifically assaultive and sexual trauma) meeting at least A1 criteria, suggesting an actual exposure to these types of traumatic events for this class of disorders. In this prospective study of urban adolescents and young adults, certain classes of pre-existing psychiatric disorders (most notably anxiety disorders and illicit drug use disorders) were associated with increased risk for qualifying traumatic events. The mechanisms by which premorbid psychiatric disorders promote exposure to traumatic events are unknown. Better understanding of these pathways may lead to novel strategies for primary and secondary prevention of PTSD.     

What is the association between traumatic life events and alcohol abuse/dependence in people with and without PTSD? Findings from a nationally representative sample

Background: Approximately 60–90% of the general population will experience a traumatic event during their lifetime. However, relatively few will develop a trauma‐related psychological disorder. Possible psychological sequelae of trauma include posttraumatic stress disorder (PTSD) and alcohol‐use disorders (AUDs). While AUDs often occur in the context of PTSD, little is known about the degree to which AUDs are attributable to specific traumatic events. The purpose of the present investigation was to assess the degree to which specific traumatic events are predictive of AUDs in people with and without PTSD. Methods: The current sample was selected from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC; N = 34,160), a nationally representative sample of American adults. Multiple logistic regressions were performed to examine odds ratios of 27 traumatic events among individuals with and without PTSD in the prediction of AUD diagnoses. Results: Results indicated significant positive odds ratios among individuals meeting criteria for PTSD and having experienced a childhood trauma (OR = 1.40 [95% CI: 1.08–1.83], P<.01) or assaultive violence (OR = 1.41 [95% CI: 1.13–1.77], P<.01) for predicting AUDs. Also, among individuals without PTSD, childhood trauma (OR = 1.32 [95% CI: 1.23–1.41], P<.001), assaultive violence (OR = 1.42 [95% CI: 1.13–1.78], P<.001), unexpected death (OR = 1.19 [95% CI: 1.12–1.28], P<.001), and learning of trauma (OR = 1.22 [95% CI: 1.13–1.30], P<.001) positively predicted the presence of AUDs. Conclusions: Results indicate significant positive relationships between traumatic events and AUDs, particularly among individuals without PTSD. Specific associations and theoretical implications will be discussed. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma.

OBJECTIVE: With the exception of a few reports of higher rates of childhood trauma in Vietnam veterans with posttraumatic stress disorder (PTSD), little is known about the influence of previous exposure to trauma on the PTSD effects of subsequent trauma. The authors examine interrelated questions about the effects of previous exposure to trauma. METHOD: A representative sample of 2,181 individuals in southeast Michigan were interviewed by telephone to record lifetime history of traumatic events specified in DSM-IV as potentially leading to PTSD. PTSD was assessed with respect to a randomly selected index trauma from the list of events reported by each respondent. RESULTS: History of any previous exposure to traumatic events was associated with a greater risk of PTSD from the index trauma. Multiple previous events had a stronger effect than a single previous event. The effect of previous assaultive violence persisted over time with little change. When they examined several features of the previous exposure to trauma, the authors found that subjects who experienced multiple events involving assaultive violence in childhood were more likely to experience PTSD from trauma in adulthood. Furthermore, previous events involving assaultive violence--single or multiple, in childhood or later on--were associated with a higher risk of PTSD in adulthood. CONCLUSIONS: Previous exposure to trauma signals a greater risk of PTSD from subsequent trauma. Although these results are consistent with a sensitization hypothesis, like the results from previous research on PTSD, they do not address the mechanism of increased responsivity to trauma. Long-term observational studies can further elucidate these observations.     

Heart rate and posttraumatic stress in injured children

BACKGROUND: Elevated, acute heart rate has been related to later posttraumatic stress disorder (PTSD) development in injured adults, but this has not been examined in children and adolescents. Better understanding of the relationship between acute physiological arousal and later child PTSD could help elucidate the etiology of posttrauma responses in children and might identify useful markers for PTSD risk. OBJECTIVE: To evaluate the relationship between heart rate assessed in the emergency department (ED) during normal clinical care and later PTSD outcome in traumatically injured children. DESIGN: Prospective cohort study assessed heart rate at ED triage and PTSD an average of 6 months' postinjury. SETTING: Large, urban pediatric academic medical center in the northeastern United States. PARTICIPANTS: One hundred ninety children and adolescents (aged 8-17 years) hospitalized for traffic-related injury.Main Outcome Measure Clinician-Administered PTSD Scale for Children and Adolescents. RESULTS: The group of children who developed partial or full PTSD had a higher mean +/- SD heart rate at ED triage than those who did not go on to have PTSD (109.6 +/- 22.3 vs 99.7 +/- 18.0 beats per minute). Children with an elevated heart rate (defined as >/=2 SDs higher than the normal resting heart rate for their age and sex) at ED triage were more likely to meet criteria for partial or full PTSD at follow-up, even after adjusting for age, sex, and injury (adjusted odds ratio, 2.4 [95% confidence interval, 1.1-5.4]). CONCLUSION: These results suggest an association between early physiological arousal and the development or persistence of PTSD symptoms in injured children and point to the importance of better understanding the interplay between physiological and psychological functioning after a traumatic stressor.     

Early childhood behavior trajectories and the likelihood of experiencing a traumatic event and PTSD by young adulthood

This study modeled children’s trajectories of teacher rated aggressive-disruptive behavior problems assessed at six time points between the ages of 6 and 11 and explored the likelihood of being exposed to DSM-IV qualifying traumatic events and posttraumatic stress disorder (PTSD) in 837 urban first graders (71% African American) followed-up for 15 years. Childhood trajectories of chronic high or increasing aggressive-disruptive behavior distinguished males more likely to be exposed to an assaultive violence event as compared to males with a constant course of low behavior problems (OR_{chronic high} = 2.8, 95% CI = 1.3, 6.1 and OR_increasing = 4.5, 95% CI = 2.3, 9.1, respectively). Among females, exposure to traumatic events and vulnerability to PTSD did not vary by behavioral trajectory. The findings illustrate that repeated assessments of disruptive classroom behavior during early school years identifies more fully males at increased risk for PTSD-level traumatic events, than a single measure at school entry does.     

Genetic and environmental influences on trauma exposure and posttraumatic stress disorder symptoms: a twin study

OBJECTIVE: Posttraumatic stress disorder (PTSD) develops in only a subset of persons exposed to traumatic stress, suggesting the existence of stressor and individual differences that influence risk. In this study the authors examined the heritability of trauma exposure and PTSD symptoms in male and female twin pairs of nonveteran volunteers. METHOD: Scores on a traumatic events inventory and a DSM-IV PTSD symptom inventory were examined in 222 monozygotic and 184 dizygotic twin pairs. Biometrical model fitting was conducted by using standard statistical methods. RESULTS: Additive genetic, common environmental, and unique environmental effects best explained the variance in exposure to assaultive trauma (e.g., robbery, sexual assault), whereas exposure to nonassaultive trauma (e.g., motor vehicle accident, natural disaster) was best explained by common and unique environmental influences. PTSD symptoms were moderately heritable, and the remaining variance was accounted for by unique environmental experiences. Correlations between genetic effects on assaultive trauma exposure and on PTSD symptoms were high. CONCLUSIONS: Genetic factors can influence the risk of exposure to some forms of trauma, perhaps through individual differences in personality that influence environmental choices. Consistent with symptoms in combat veterans, PTSD symptoms after noncombat trauma are also moderately heritable. Moreover, many of the same genes that influence exposure to assaultive trauma appear to influence susceptibility to PTSD symptoms in their wake.     

Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population

The aim of the study was to assess sleep disturbances in subjects with posttraumatic stress disorder (PTSD) from an urban general population and to identify associated psychiatric disorders in these subjects. The study was performed with a representative sample of 1,832 respondents aged 15 to 90 years living in the Metropolitan Toronto area who were surveyed by telephone (participation rate, 72.8%). Interviewers used Sleep-EVAL, an expert system specifically designed to conduct epidemiologic studies of sleep and mental disorders in the general population. Overall, 11.6% of the sample reported having experienced a traumatic event, with no difference in the proportion of men and women. Approximately 2% (1.8%) of the entire sample were diagnosed by the system as having PTSD at the time of interview. The rate was higher for women (2.6%) than for men (0.9%), which translated into an odds ratio (OR) of 2.8 (95% confidence interval [CI], 1.3 to 6.1). PTSD was strongly associated with other mental disorders: 75.7% of respondents with PTSD received at least one other diagnosis. Most concurrent disorders (80.7%) appeared after exposure to the traumatic event. Sleep disturbances also affected about 70% of the PTSD subjects. Violent or injurious behaviors during sleep, sleep paralysis, sleep talking, and hypnagogic and hypnopompic hallucinations were more frequently reported in respondents with PTSD. Considering the relatively high prevalence of PTSD and its important comorbidity with other sleep and psychiatric disorders, an assessment of the history of traumatic events should be part of a clinician's routine inquiry in order to limit chronicity and maladjustment following a traumatic exposure. Moreover, complaints of rapid eye movement (REM)-related sleep symptoms could be an indication of an underlying problem stemming from PTSD.     

Do statins reduce risk of incident dementia and Alzheimer disease? The Cache County Study

BACKGROUND: Prior reports suggest reduced occurrence of dementia and Alzheimer disease (AD) in statin users, but, to our knowledge, no prospective studies relate statin use and dementia incidence. OBJECTIVE: To examine the association of statin use with both prevalence and incidence of dementia and AD. DESIGN: Cross-sectional studies of prevalence and incidence and a prospective study of incidence of dementia and AD among 5092 elderly residents (aged 65 years or older) of a single county. Participants were assessed at home in 1995-1997 and again in 1998-2000. A detailed visual inventory of medicines, including statins and other lipid-lowering agents, was collected at both assessments. MAIN OUTCOME MEASURES: Diagnosis of dementia and of AD. RESULTS: From 4895 participants with data sufficient to determine cognitive status, we identified 355 cases of prevalent dementia (200 with AD) at initial assessment. Statin use was inversely associated with prevalence of dementia (adjusted odds ratio, 0.44; 95% confidence interval, 0.17-0.94). Three years later, we identified 185 cases of incident dementia (104 with AD) among 3308 survivors at risk. Statin use at baseline did not predict incidence of dementia or AD (adjusted hazard ratio for dementia, 1.19; 95% confidence interval, 0.53-2.34; adjusted hazard ratio for AD, 1.19; 95% confidence interval, 0.35-2.96), nor did statin use at follow-up (adjusted odds ratio for dementia, 1.04; 95% confidence interval, 0.56-1.81; adjusted odds ratio for AD, 0.85; 95% confidence interval, 0.32-1.88). CONCLUSIONS: Although statin use might be less frequent in those with prevalent dementia, we found no association between statin use and subsequent onset of dementia or AD. Further research is warranted before costly dementia prevention trials with statins are undertaken.     

Maternal Smoking in Pregnancy and Externalizing Behavior in 18-Month-Old Children: Results From a Population-Based Prospective Study

ObjectiveThe relation between prenatal smoking and child behavioral problems has been investigated in children of school age and older, but prospective studies in younger children are lacking. Using the population-based prospective Norwegian Mother and Child Cohort Study, we examined the risk for externalizing behaviors among 18-month-old children after exposure to maternal smoking during pregnancy.MethodParticipants were 22,545 mothers and their 18-month-old children. Mothers reported their smoking habits at the 17th week of gestation and their child's externalizing behavior at 18 months of age by means of standardized questionnaires. Data were analyzed using logistic regression, with scores of externalizing behavior above the 88.6th percentile as the dependent variable and self-reported smoking as the independent variable. We examined the child's sex as a possible moderator.ResultsWe documented a threshold effect of smoking 10 cigarettes or more per day during pregnancy on subsequent externalizing behaviors among 18-month-old children, even after adjusting for relevant confounders (odds ratio 1.32, 95% confidence interval 1.03–1.70). The child's sex did not moderate these effects (odds ratio 0.98, 95% confidence interval 0.83–1.16).ConclusionsMaternal smoking during pregnancy increases offspring's subsequent risk for externalizing behavior problems at 18 months of age. The pattern of risk does not differ between boys and girls. Our findings suggest a population attributable risk of 17.5% (i.e., the proportion of externalizing cases that could potentially be avoided if prenatal smoking was eliminated or reduced to fewer than 10 cigarettes per day).     

Long-term associations of childhood suicide ideation

OBJECTIVE: We investigated in a prospective longitudinal population-based study whether childhood suicide ideation is associated with negative mental health outcome in adulthood. METHOD: A total of 1,022 Dutch children who were 11 years or younger in 1983 were prospectively followed over 10 to 14 years into adulthood. Parent reports of suicide ideation in childhood (11 years or younger; n = 20) were examined in relation to mental health in adulthood assessed with a structured psychiatric interview (mood disorder, anxiety disorder, alcohol abuse/dependence, and externalizing disorder) and self-reported suicide ideation and history of suicide attempt. RESULTS: Childhood suicide ideation was highly predictive of suicide ideation in adulthood (odds ratio 10.70, 95% confidence interval 3.26-35.09), and lifetime history of suicide attempt (odds ratio 5.80, 95% confidence interval 1.53-22.02). Childhood suicide ideation was associated with an increased likelihood of mood disorder and anxiety disorder in adulthood and to a lesser extent externalizing disorder, although these effects decreased considerably after adjusting for childhood internalizing and externalizing behavior. CONCLUSIONS: Suicide ideation in childhood may be a stable characteristic with worrying consequences in adulthood. Children with parent-reported suicide ideation at a young age may require additional resources, age-appropriate intervention, and careful monitoring into adulthood.     

Association between prenatal exposure to bacterial infection and risk of schizophrenia

Recent research suggests that prenatal exposure to nonviral infection may be associated with increased risk of schizophrenia, and we hypothesized an association between maternal bacterial infection during pregnancy and elevated offspring risk of schizophrenia. Data on maternal infections from the Copenhagen Perinatal Cohort were linked with the Danish National Psychiatric Register. Offspring cases of narrowly defined schizophrenia (International Classification of Diseases, Eighth Revision [ICD-8]) and more broadly defined schizophrenia (ICD-8 and ICD-10) were identified before the ages of 32-34 and 45-47 years, respectively. The effect of prenatal exposure to bacterial infections was adjusted for prenatal exposure to analgesics and parental social status. In a risk set of 7941 individuals, 85 cases (1.1%) of ICD-8 schizophrenia were identified by the age of 32-34 years and 153 cases (1.9%) of more broadly defined schizophrenia by the age of 45-47 years. First-trimester exposure conferred an elevated risk of ICD-8 schizophrenia (odds ratio 2.53; 95% confidence interval [CI] 1.07-5.96) and also of broadly defined schizophrenia (odds ratio 2.14; 95% CI 1.06-4.31). Second-trimester exposure also conferred a significantly elevated risk of schizophrenia but only in unadjusted analyses. These findings suggest a relationship between maternal bacterial infection in pregnancy and offspring risk of schizophrenia, and this effect was somewhat stronger for ICD-8 schizophrenia with earlier onset. Post hoc analyses showed that upper respiratory tract and gonococcal infections were associated with elevated risk of the disease. An association between risk of schizophrenia and prenatal exposure to bacterial infections might be mediated through transplacental passage of maternally produced cytokines in response to bacterial infections.     

Association of incident Alzheimer disease and blood pressure measured from 13 years before to 2 years after diagnosis in a large community study

BACKGROUND: It is uncertain whether high blood pressure increases the risk of developing Alzheimer disease (AD). OBJECTIVE: To examine the association between incident AD and blood pressure measured up to 13 years before diagnosis. DESIGN: Longitudinal cohort study conducted from 1982 to 1988, with blood pressure measured every 3 years in home interviews, and in 1973 for a portion (60%) of the sample. SETTING: Community of East Boston, Mass. PARTICIPANTS: Six hundred thirty-four subjects 65 years or older and without AD were selected as a stratified random sample of participants of the East Boston Established Populations for Epidemiologic Studies of the Elderly. MAIN OUTCOME MEASURE: Alzheimer disease was diagnosed by a neurologist using a structured clinical evaluation. RESULTS: High blood pressure was not associated with an increased risk of AD in logistic regression models adjusted for age, sex, and level of education. There was no association with systolic pressure measured 13 years before diagnosis (odds ratio = 1.03/10 mm Hg; 95% confidence interval, 0.80-1.32) and an inverse association with systolic pressure measured 4 years before diagnosis (odds ratio = 0.82/10 mm Hg; 95% confidence interval, 0.72-0.95). Associations for diastolic pressure were in the same direction as those for systolic pressure except with wider confidence intervals. The odds ratios were not materially different with further adjustment for cardiovascular risk factors and diseases. CONCLUSION: In this large community study, high blood pressure was not associated with an increased risk of AD.     

Telomere length predicts poststroke mortality, dementia, and cognitive decline

OBJECTIVE: Long-term cognitive development is variable among stroke survivors, with a high proportion developing dementia. Early identification of those at risk is highly desirable to target interventions for secondary prevention. Telomere length in peripheral blood mononuclear cells was tested as prognostic risk marker. METHODS: A cohort of 195 nondemented stroke survivors was followed prospectively from 3 months after stroke for 2 years for cognitive assessment and diagnosis of dementia and for 5 years for survival. Telomere lengths in peripheral blood mononuclear cells were measured at 3 months after stroke by in-gel hybridization. Hazard ratios for survival in relation to telomere length and odds ratios for dementia were estimated using multivariate techniques, and changes in Mini-Mental State Examination scores between baseline and 2 years were related to telomere length using multivariate linear regression. RESULTS: Longer telomeres at baseline were associated with reduced risk for death (hazard ratio for linear trend per 1,000 bp = 0.52; 95% confidence interval, 0.28-0.98; p = 0.04, adjusted for age) and dementia (odds ratio for linear trend per 1,000 bp = 0.19; 95% confidence interval, 0.07-0.54; p = 0.002) and less reduction in Mini-Mental State Examination score (p = 0.04, adjusted for baseline score). INTERPRETATION: Telomere length is a prognostic marker for poststroke cognitive decline, dementia, and death.     

Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults

CONTEXT: Controversy exists whether anxiety disorders are independently associated (ie, after adjusting for comorbid mental disorders) with suicidal ideation and suicide attempts. OBJECTIVE: To examine whether anxiety disorders are risk factors for suicidal ideation and suicide attempts in a large population-based longitudinal study. METHODS: Data come from the Netherlands Mental Health Survey and Incidence Study, a prospective population-based survey with a baseline and 2 follow-up assessments over a 3-year period. The Composite International Diagnostic Interview was used to assess DSM-III-R mental disorders. Lifetime diagnoses of anxiety disorders (social phobia, simple phobia, generalized anxiety disorder, panic disorder, agoraphobia, obsessive-compulsive disorder) were assessed at baseline. Multiple logistic regression analyses were used to examine whether anxiety disorders were associated with suicidal ideation and attempts at baseline (n = 7076) and whether anxiety disorders were risk factors for subsequent onset of suicidal ideation and attempts (n = 4796). RESULTS: After adjusting for sociodemographic factors and all other mental disorders assessed in the survey, baseline presence of any anxiety disorder was significantly associated with suicidal ideation and suicide attempts in both the cross-sectional analysis (adjusted odds ratio for suicidal ideation, 2.29; 95% confidence interval, 1.85-2.82; adjusted odds ratio for suicidal attempts, 2.48; 95% confidence interval, 1.70-3.62) and longitudinal analysis (adjusted odds ratio for suicidal ideation, 2.32; 95% confidence interval, 1.31-4.11; adjusted odds ratio for suicide attempts, 3.64; 95% confidence interval, 1.70-7.83). Further analyses demonstrated that the presence of any anxiety disorder in combination with a mood disorder was associated with a higher likelihood of suicide attempts in comparison with a mood disorder alone. CONCLUSIONS: This is the first study to demonstrate that a preexisting anxiety disorder is an independent risk factor for subsequent onset of suicidal ideation and attempts. Moreover, the data clearly demonstrate that comorbid anxiety disorders amplify the risk of suicide attempts in persons with mood disorders. Clinicians and policymakers need to be aware of these findings, and further research is required to delineate whether treatment of anxiety disorders reduces the risk of subsequent suicidal behavior.     

Antenatal risk factors associated with unfavorable neurologic status in newborns and at 2 years of age

The aim of this prospective cohort study was to evaluate the influence of different antenatal factors on neurologic signs in the first days of life and neurodevelopmental outcome at 2 years of age. The study group consisted of 390 children drawn from a cohort of 828 consecutive live births. The data about potential antenatal risk factors, birth complications, and neonatal course were abstracted from pregnancy and delivery records and the hospital register. Odds ratio estimates with 95% confidence intervals were used to measure the associations between antenatal factors and neurologic status in newborns and at 2 years of age. Significance level was set at P < .05. At the mean age of 2 years, 49 of 390 children exhibited adverse neurodevelopmental outcome (cerebral palsy and other developmental disorders). The development of 341 children was normal. Comparative analysis of risk factors was conducted. The strongest correlation with development of hypoxic-ischemic encephalopathy during the first days of life was found in trichomoniasis during pregnancy (odds ratio 4.34; 95% confidence interval 1.32-14.23) and acute respiratory disease (temperature > or = 38 degrees C) in the second half of pregnancy (odds ratio 2.86; 95% confidence interval 1.08-7.58). Of various antenatal factors, bacterial vaginosis combined with impending abortion in the first half of pregnancy (odds ratio 4.96; 95% confidence interval 1.35-18.26) had a significant association with adverse outcome at 2 years of age. The presence of at least one complication at delivery placed the child at risk of adverse neurologic outcome (odds ratio 2.44; 95% confidence interval 1.32-4.54). The study provides supportive evidence that antenatal factors associated with maternal infections can influence the development of hypoxic-ischemic encephalopathy and later neurodevelopmental outcome. These children should be assigned to risk groups for early intervention.     

Predictive factors for borderline personality disorder: patients' early traumatic experiences and losses suffered by the attachment figure. The Italian Group for the Study of Dissociation

OBJECTIVE: To test the hypothesis that serious losses in the life of the attachment figure and patients' early traumatic experiences are risk factors for the development of borderline personality disorder. METHOD: A multicentric hospital-based case-control study of 66 cases and 146 controls. RESULTS: We estimated an odds ratio of 2.5 (95% CI 1.1-5.8) for mothers' serious losses experienced within 2 years of patients' birth and an odds ratio of 5.3 (95% CI 2.1-13) for patients' early traumatic experiences. Both of them are adjusted for the confounding effect of the other as well as for that of age, size of family and type of patient (in- or out-patient), using a multiple logistic function. CONCLUSION: Mourning process in the mother within 2 years of the patient's birth and patients' early traumatic experiences are predictive factors for the development of borderline personality disorder.