Combat stress reactions, posttraumatic stress disorder, cumulative life stress, and physical health among Israeli veterans twenty years after exposure to combat

This study examined the association of initial combat stress reaction (CSR), chronic post-traumatic stress disorder (PTSD) and cumulative life stress on physical health 20 years after the 1982 war with Lebanon, in a sample of 504 Israeli veterans of the war. Two groups were assessed: male veterans who fought and suffered from CSR and a matched group of male veterans from the same units who did not exhibit such reactions. Twenty years following the war, participants were asked to rate their general physical health status, report health complaints and risk behaviors, and were screened for PTSD. CSR and, to a greater extent, PTSD, were found to be associated with general self-rated health, chronic diseases and physical symptoms, and greater engagement in risk behaviors. CSR and PTSD were also related to greater cumulative life stress since the war. Both negative and positive life events were independently related to most of the physical health measures but did not account for the associations of CSR and PTSD with poorer health. Tests of the interactions between CSR, PTSD and life stress in their association with physical health and risk behaviors showed that PTSD suppressed the effects of additional life stress (negative life events had a weaker effect on health among participants with PTSD).     

汶川大地震后女性内分泌紊乱与创伤后应激障碍的相关性调查

目的探讨汶川大地震后女性内分泌紊乱与创伤后应激障碍(PTSD)的相关性,为其临床防治提供有效措施。方法采用横断面调查和队列随访研究方案,收集1 000例汶川大地震后妇女为研究对象,根据是否发生内分泌紊乱分为两组:内分泌失调组477例和内分泌正常组523例。分别采用自制调查量表、PTSD症状清单平民版调查其一般情况和PTSD患病情况,并抽取所有研究对象的外周静脉血,采用ELISA实验测定雌激素与孕激素水平,分析PTSD症状评分与血清激素水平的相关性。结果调查对象中发生内分泌失调477例,占47.7%,内分泌失调组年龄偏大,地震时在建筑物内、房屋倒塌、受伤、掩埋、家庭成员伤亡的发生率偏高,地震后获得居所所需时间更长,食物短缺和药物短缺的比例更高,组间差异均有统计学意义(均P0.05)。内分泌失调组PTSD发生率和症状评分高于内分泌正常组,血清雌二醇(E_2)、孕激素(P)和卵泡刺激素(FSH)水平低于内分泌正常组,组间差异均有统计学意义(均P0.05);经相关性分析,PTSD症状评分与血清E_2、P和FSH水平呈直线负相关关系(P0.05)。结论汶川大地震后女性内分泌紊乱可能是PTSD的信号,应引起重视,做好临床防治工作。     

Life events, combat stress reaction and post-traumatic stress disorder

The implication of life events just preceding a war in acute combat stress reaction and chronic PTSD were assessed in a sample of 716 Israeli combatants. Results show that life events were unrelated to combat stress reaction but were related to subsequent PTSD. Conceptual and methodological issues were discussed to explain the results.     

Prospectively assessed posttraumatic stress disorder and associated physical activity

Objectives

We examined the association of physical activity with prospectively assessed posttraumatic stress disorder (PTSD) symptoms in a military cohort.

Methods

Using baseline and follow-up questionnaire data from a large prospective study of U.S. service members, we applied multivariable logistic regression to examine the adjusted odds of new-onset and persistent PTSD symptoms associated with light/moderate physical activity, vigorous physical activity, and strength training at follow-up.

Results

Of the 38,883 participants, 89.4% reported engaging in at least 30 minutes of physical activity per week. At follow-up, those who reported proportionately less physical activity were more likely to screen positive for PTSD. Vigorous physical activity had the most consistent relationship with PTSD. Those who reported at least 20 minutes of vigorous physical activity twice weekly had significantly decreased odds for new-onset (odds ratio [OR] = 0.58, 95% confidence interval [CI] 0.49, 0.70) and persistent (OR=0.59, 95% CI 0.42, 0.83) PTSD symptoms.

Conclusions

Engagement in physical activity, especially vigorous activity, is significantly associated with decreased odds of PTSD symptoms among U.S. service members. While further longitudinal research is necessary, a physical activity component may be valuable to PTSD treatment and prevention programs.Recent military operations in Iraq and Afghanistan have been characterized by sustained ground combat, persistent risk, and multiple protracted deployments. Increased psychological symptom reporting has engendered heightened concern for the postdeployment mental health of service members and, in particular, the public health burden of posttraumatic stress disorder (PTSD).^1–4 A previous study using data from all U.S. service branches identified new-onset self-reported PTSD symptoms in 7.6%–8.7% of deployers who reported combat exposures, 1.4%–2.1% of deployers who did not report combat exposures, and 2.3%–3.0% of nondeployers.⁴PTSD is associated with poor physical health as well as negative health behaviors, such as tobacco use and problem alcohol drinking.^5–11 The extent to which behavioral correlates of PTSD mitigate or mediate PTSD symptoms and associated morbidities is currently under investigation.¹² While research has focused on adverse health behaviors, the relationship between positive health behaviors (e.g., physical activity) and PTSD has not been fully explored.Studies of depression and anxiety have pointed to the mental health benefits of physical activity, and researchers have postulated a number of mechanisms by which physical activity may modulate mood and the stress response.^13–19 While previous research indicates that physical activity may mitigate PTSD and related symptoms, other studies indicate that exercise habits of PTSD patients may be substandard.^20–23 In a retrospective study among Brazilians, physical activity levels decreased after the onset of PTSD.²⁴ These previous studies, however, were limited by small sample sizes, retrospective designs, and an inability to control for possible confounders.^20,22–25 The purpose of this study was to investigate new-onset, resolution, and persistence of PTSD symptoms in relation to type and quantity of physical activity in a large, population-based cohort of U.S. military service members.     

Self-reported diabetes and posttraumatic stress disorder among adults in the community

OBJECTIVE: To determine the association between self-reported diabetes and posttraumatic stress disorder (PTSD) among adults in the community and to investigate the specificity of this link. METHOD: Data were drawn from the National Comorbidity Survey (NCS), a household probability sample of adults ages 15-54 in the United States. Multiple logistic regression analyses were used to investigate the association between self-reported diabetes and PTSD (past 12-month prevalence), adjusted for differences in sociodemographic characteristics. RESULTS: Self-reported diabetes was associated with an increased likelihood of PTSD [OR = 2.3 (1.02, 5.21)], which persisted after adjusting for differences in sociodemographic characteristics. Self-reported diabetes was not associated with a significantly increased likelihood of any other mental disorders. CONCLUSIONS: These findings are consistent with and extend previous data suggesting that there is an association between self-reported diabetes and PTSD by showing that this link appears to have some specificity and is generalizable to adults in the community. These data do not address the possible mechanisms of this association. Our results do not support a link between depression and diabetes, which has been previously reported. Replication of these results is needed with longitudinal, epidemiologic data, which include ages of onset and physiologic data in diagnosis of diabetes. If these findings are replicated, further investigation into the possible mechanisms of this association may be fruitful.     

Prediction of posttraumatic stress disorder among adults in flood district

Background  

Flood is one of the most common and severe forms of natural disasters. Posttraumatic stress disorder (PTSD) is a common disorder among victims of various disasters including flood. Early prediction for PTSD could benefit the prevention and treatment of PTSD. This study aimed to establish a prediction model for the occurrence of PTSD among adults in flood districts.     

“5.12”地震三年后北川县地震亲历者心理应激水平评估

目的探讨"5.12"地震三年后北川县地震亲历者心理应激水平及其影响因素。方法以自制一般情况调查表、创伤后应激障碍筛查量表(PCL-C)为调查工具,采用系统抽样方法,评估北川县605名地震亲历者的心理应激水平及其相关影响因素。结果地震三年后北川县地震亲历者中11.2%发生创伤后应激障碍(PTSD)。PTSD阳性者以反复重现体验和警觉性增高为常见症状。PTSD影响因素的Logistic回归分析显示:女性、财产损失重、有亲友死亡是PTSD发生的危险因素,其OR值分别为:2.848、1.778、3.297。结论地震三年后北川县地震亲历者的心理应激水平虽有所改善,但仍不容乐观。应重点关注女性、财产损失重、有亲友死亡的亲历者及反复重现体验和警觉性增高等症状。     

工作场所欺凌对护理人员创伤后应激障碍的影响

目的探讨工作场所欺凌与护士个体创伤后应激障碍（PTSD）的关系,分析心理资本在其中的作用。方法于2014年12月至2015年6月,采用便利抽样方法,收集某省5所3级甲等综合性医院496名护士。采用负性行为问卷、心理资本量表和PTSD自评量表调查护士的工作场所欺凌、心理资本和PTSD状况,采用结构方程模型分析各变量之间的关系。结果护士负性行为得分为37.15±12.83,心理资本得分为78.81±16.54,PTSD得分为34.56±12.52;负性行为各维度与PTSD各维度得分均呈正相关（P〈0.01）;心理资本各维度与PTSD、负性行为各维度得分均呈负相关（P〈0.01）。负性行为对PTSD呈正向预测作用（β=0.539,P〈0.01）;纳入心理资本后,负性行为对PTSD的效应降低（β=0.513,P〈0.01）。负性行为对PTSD的路径系数为0.62,负性行为对心理资本的路径系数为-0.18,心理资本对PTSD的路径系数为-0.11（P〈0.05）。结论工作场所欺凌是PTSD的预测因子,心理资本在工作场所欺凌和PTSD中间起中介作用;管理者应注意减少工作场所欺凌现象,提升护理人员的心理资本,预防和缓解PTSD。     

Hearing loss associated with US military combat deployment

The objective of this study was to define the risk of hearing loss among US military members in relation to their deployment experiences. Data were drawn from the Millennium Cohort Study. Self-reported data and objective military service data were used to assess exposures and outcomes. Among all 48,540 participants, 7.5% self-reported new-onset hearing loss. Self-reported hearing loss showed moderate to substantial agreement (k = 0.57-0.69) with objective audiometric measures. New-onset hearing loss was associated with combat deployment (adjusted odds ratio [AOR] = 1.63, 95% confidence interval [CI] = 1.49-1.77), as well as male sex and older age. Among deployers, new-onset hearing loss was also associated with proximity to improvised explosive devices (AOR = 2.10, 95% CI = 1.62-2.73) and with experiencing a combat-related head injury (AOR = 6.88, 95% CI = 3.77-12.54). These findings have implications for health care and disability planning, as well as for prevention programs.     

胚胎停育患者创伤后应激症状及相关因素分析

目的:了解胚胎停育患者的心理损伤情况和创伤后应激障碍(PTSD)症状阳性的相关因素。方法:对2012年10月~2013年10月就诊于宁夏医科大学总医院、银川市妇幼保健院的206对胚胎停育患者及配偶,应用创伤后应激障碍筛查量表平民版(PCL-C)对其反复创伤性体验症状、情感麻木与回避状及警觉性过强所致易激惹症状进行客观测量。结果:206名胚胎停育患者PCL-C量表分值为23.7±2.7分,PTSD筛查症状阳性率为13.6%(28/206)。多因素非条件logistic回归分析结果显示,配偶PTSD症状筛查阳性时,胚胎停育患者PTSD症状阳性率高(OR:2.9,95%CI:1.8~9.7),社会支持中从兄弟姐妹得到支持和照顾时,胚胎停育患者PTSD症状阳性率低(OR:0.5,95%CI:0.3~0.9)。结论:胚胎停育事件可能会引起孕妇产生创伤后应激障碍症状。配偶PTSD症状阳性会增加胚胎停育孕妇PTSD症状阳性率,而社会支持,尤其是从兄弟姐妹得到支持和照顾,有助于缓解胚胎停育孕妇PTSD症状。     

Social support and posttraumatic stress disorder among flood victims in Hunan, China

PURPOSE: To explore the relationship between social support and posttraumatic stress disorder (PTSD) among flood victims. METHODS: A cross-sectional survey was carried out in 2000 among individuals who had suffered floods in 1998 in Hunan, China. Multistage sampling was used to select the subjects from the flood-affected areas. PTSD was diagnosed according to DSM-IV criteria, and social support was measured according to a social support rating scale. Data were collected through face-to-face interviews using a structured questionnaire. Multiple logistic regression analysis and confirmatory factor analysis was used to examine the relationship between social support and PTSD. RESULTS: Out of a total of 25,478 subjects interviewed, 2336 (9.7%) were diagnosed as having PTSD. PTSD was significantly associated with total social support (odds ratio [OR] 0.80, 95% confidence interval [CI], 0.78-0.82), subjective support (OR 0.48, 95%CI, 0.44-0.52), and support utilization (OR 0.53, 95%CI, 0.49-0.57). CONCLUSION: PTSD in flood victims is significantly associated with social support; subjective support and support utilization may play more important roles in mitigating the impact of flood than objective support.     

常见危重病患者人群并发创伤后应激障碍研究进展

既往对创伤后应激障碍(Posttraumatic Stress Disorder,PTSD)的研究主要集中于战争、自然灾害和人为灾害相关的创伤事件。近年来,人们逐渐开始认识到危及生命的疾病同样可视为导致PTSD的应激源。一些危重病并发PTSD不仅不利于患者危重病自身的治疗,还严重影响其生存质量。为尽可能降低危重病并发PTSD的可能性,提高危重病患者的生存质量,本文就一些常见危重病诱发PTSD进行初步探讨,以期对危重病患者并发PTSD进行早期预警及早期干预。