Posttraumatic Stress, Depression, and Health Among Older Adults in Primary Care

Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States
American Journal of Geriatric Psychiatry (Impact Factor: 4.24). 05/2006; 14(4):316-24. DOI: 10.1097/01.JGP.0000199382.96115.86
Source: PubMed


The authors examined 1) rates of trauma and posttraumatic stress (PTS) in older adults in primary care; 2) factors related to more posttraumatic stress symptoms; and 3) the influence of posttraumatic stress and depression on health perceptions and negative health behaviors (i.e., suicidal ideation, smoking, and at-risk drinking).
As part of participation in a study at the Philadelphia VAMC and the University of Pennsylvania, a random subset (N = 2,718) of older adults (age > or = 65 years) with scheduled primary care visits were screened concerning demographics, the General Health Questionnaire-12, suicidal thoughts, alcohol consumption, cigarette smoking, perceived health status, PTS, and cognitive impairment.
The rate of trauma in older adult primary care patients was high in both the VA (37%) and university-based clinics (24%). Many older adults reported interference from at least one of the three posttraumatic stress items assessed (VA, 18%; university-based primary care, 8%). In a model including demographic factors, higher PTS and depression were uniquely related to more negative health perceptions. In a model including demographic factors, both higher PTS and depression were uniquely related to higher likelihood of suicidal ideation. In contrast, PTS no longer contributed to a model of smoking once depression was included. Neither PTS nor depression significantly contributed to a model of at-risk drinking.
Trauma and posttraumatic stress are frequent and significant problems for older adults in primary care. Both posttraumatic stress and depression are related to more negative health perceptions and higher likelihood of suicidal ideation.

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Available from: Sheila A M Rauch, Jan 02, 2014
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    • "The ability to differentiate between danger and safety is necessary for survival. Exposure to traumatic stress can alter this fundamental process and individuals with post-traumatic stress disorder (PTSD) display an inability to utilize environmental safety signals (Jovanovic et al., 2009), overgeneralize fear (Rauch, et al., 2006a), and fail to extinguish trauma-induced fear responses (Orr et al., 2000; Milad et al., 2009). A major effort in translational neuroscience has revealed much of the neural circuitry underlying fear learning and recall (LeDoux, 2000; Johansen et al., 2011; Beyeler et al., 2014) and we are beginning to understand how stressors modulate these systems (Baratta et al., 2007; Rodrigues et al., 2009; Martijena and Molina, 2012). "
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    ABSTRACT: The capacity to discriminate between safety and danger is fundamental for survival, but is disrupted in individuals with posttraumatic stress disorder (PTSD). Acute stressors cause a release of serotonin (5-HT) in the forebrain, which is one mechanism for enhanced fear and anxiety; these effects are mediated by the 5-HT2C receptor. Using a fear discrimination paradigm where a danger signal conditioned stimulus (CS+) co-terminates with a mild footshock and a safety signal (CS-) indicates the absence of shock, we demonstrate that danger/safety discrimination and fear inhibition develop over the course of 4 daily conditioning sessions. Systemic administration of the 5-HT2C receptor antagonist SB 242084 (0.25 or 1.0mg/kg) prior to conditioning reduced behavioral freezing during conditioning, and improved learning and subsequent inhibition of fear by the safety signal. Discrimination was apparent in the first recall test, and discrimination during training was evident after 3days of conditioning versus 5days in the vehicle treated controls. These results suggest a novel therapeutic use for 5-HT2C receptor antagonists to improve learning under stressful circumstances. Potential anatomical loci for 5-HT2C receptor modulation of fear discrimination learning and cognitive performance enhancement are discussed. Ethical StatementJohn P. Christianson and Allison R. Foilb, the authors, verify that animal research was carried out in accordance with the National Institute of Health Guide for the Care and Use of Laboratory Animals (NIH Publications No. 80-23) and all procedures involving animals were reviewed and approved by the Boston College Animal Care and Use Committee. All efforts were made to limit the number of animals used and their suffering.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 09/2015; 65. DOI:10.1016/j.pnpbp.2015.08.017 · 3.69 Impact Factor
    • "Posttraumatic Stress Disorder (PTSD) is highly prevalent in Veterans Affairs (VA) primary care patients, with an estimated 12% prevalence rate [1] [2]. PTSD is associated with significant functional impairment, compromised health, early mortality, and substantial economic costs [3] [4] [5] [6]. While effective psychotherapies for PTSD are available in specialty mental healthcare settings, patients do not routinely receive them due to limited time, fear of being stigmatized, or reluctance to disclose emotional problems [7] [8]. "
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    • "including self-reported health symptoms and global health, cardiovascular, respiratory, gastrointestinal, cancer and chronic pain problems (Hoge et al., 2007; Sareen et al., 2007; Schnurr et al., 2000; Smith et al., 2011). The role of PTSD in the association between trauma and physical health appears robust, even after controlling for demographic factors and comorbid mental health complaints, including depression (Jakupcak et al., 2008; Rauch et al., 2006; Zoellner et al., 2000). Given the importance of PTSD following trauma for the development of health problems, it is important to evaluate if PTSD treatment also results in concomitant reductions in health problems. "
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    ABSTRACT: This study examined the relationship between change in posttraumatic stress disorder (PTSD) symptoms over the course of PTSD treatment and the association with changes in general physical health symptoms. Both positive health habits (e.g., exercise) and negative (e.g., smoking), were examined to determine if they accounted for the association between changes in PTSD severity over time and changes in physical health. Participants were 150 women seeking treatment for PTSD. Latent growth curve modeling indicated a substantial relationship (R 2 = 34 %) between changes in PTSD and changes in physical health that occurred during and shortly following treatment for PTSD. However, there was no evidence to suggest that changes in health behaviors accounted for this relationship. Thus, PTSD treatment can have beneficial effects on self-reported physical health symptoms, even without direct treatment focus on health per se, and is not accounted for by shifts in health behavior.
    Journal of Behavioral Medicine 03/2013; 37(3). DOI:10.1007/s10865-013-9500-2 · 3.10 Impact Factor
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