Sandro Galea

Massachusetts Department of Public Health, Boston, Massachusetts, United States

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Publications (730)2096.93 Total impact

  • David S Fink, Sandro Galea
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    ABSTRACT: Traumatic events are ubiquitous exposures that interact with life course events to increase risk of acute psychopathology and alter mental health trajectories. While the majority of persons exposed to trauma experience mild to moderate psychological distress followed by a return to pre-trauma health, many persons exposed to trauma experience substantial distress that lasts for several years. Therefore, in an effort to understand why exposure to trauma can provoke such a range of reactions, we apply a life course approach that considers the complex accumulation and interaction of life experiences that range from social to biological factors, which occur over the life span-from gestation to death and across generations. We present this evidence in three categories: genetics and biology, individual exposures, and community experiences, followed by discussing challenges in existing research and directions for future study.
    Current Psychiatry Reports 05/2015; 17(5):566. DOI:10.1007/s11920-015-0566-0 · 3.05 Impact Factor
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    ABSTRACT: High rates of mental health (MH) problems have been documented among disaster relief workers. However, few workers utilize MH services, and predictors of service use among this group remain unexplored. The purpose of this study was to explore associations between predisposing, illness-related, and enabling factors from Andersen's behavioral model of treatment-seeking and patterns of service use among participants who completed at least one full day of cleanup work after the Deepwater Horizon oil spill and participated in home visits for the NIEHS GuLF STUDY (N = 8931). Workers reported on MH symptoms and whether they had used counseling or medication for MH problems since the oil spill. Hierarchical logistic regression models explored associations between predictors and counseling and medication use in the full sample, and type of use (counseling only, medication only, both) among participants who used either service. Analyses were replicated for subsamples of participants with and without symptom inventory scores suggestive of probable post-disaster mental illness. Having a pre-spill MH diagnosis, pre-spill service use, more severe post-spill MH symptoms, and healthcare coverage were positively associated with counseling and medication use in the full sample. Among participants who used either service, non-Hispanic Black race, pre-spill counseling, lower depression, and not identifying a personal doctor or healthcare provider were predictive of counseling only, whereas older age, female gender and pre-spill medication were predictive of medication only. The results were generally consistent among participants with and without probable post-disaster mental illness. The results suggest variability in which factors within Andersen's behavioral model are predictive of different patterns of service use among disaster relief workers. Copyright © 2015 Elsevier Ltd. All rights reserved.
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    ABSTRACT: Only very few studies have investigated the geographic distribution of psychological resilience and associated mental health outcomes after natural or man made disasters. Such information is crucial for location-based interventions that aim to promote recovery in the aftermath of disasters. The purpose of this study therefore was to investigate geographic variability of (1) posttraumatic stress (PTS) and depression in a Hurricane Sandy affected population in NYC and (2) psychological vulnerability and resilience factors among affected areas in NYC boroughs. Cross-sectional telephone survey data were collected 13 to 16 months post-disaster from household residents (N = 418 adults) in NYC communities that were most heavily affected by the hurricane. The Posttraumatic Stress Checklist for DSM-5 (PCL-5) was applied for measuring posttraumatic stress and the nine-item Patient Health Questionnaire (PHQ-9) was used for measuring depression. We applied spatial autocorrelation and spatial regimes regression analyses, to test for spatial clusters of mental health outcomes and to explore whether associations between vulnerability and resilience factors and mental health differed among New York City's five boroughs. Mental health problems clustered predominantly in neighborhoods that are geographically more exposed towards the ocean indicating a spatial variation of risk within and across the boroughs. We further found significant variation in associations between vulnerability and resilience factors and mental health. Race/ethnicity (being Asian or non-Hispanic black) and disaster-related stressors were vulnerability factors for mental health symptoms in Queens, and being employed and married were resilience factors for these symptoms in Manhattan and Staten Island. In addition, parental status was a vulnerability factor in Brooklyn and a resilience factor in the Bronx. We conclude that explanatory characteristics may manifest as psychological vulnerability and resilience factors differently across different regional contexts. Our spatial epidemiological approach is transferable to other regions around the globe and, in the light of a changing climate, could be used to strengthen the psychosocial resources of demographic groups at greatest risk of adverse outcomes pre-disaster. In the aftermath of a disaster, the approach can be used to identify survivors at greatest risk and to plan for targeted interventions to reach them.
    International Journal of Health Geographics 04/2015; 14(16). DOI:10.1186/s12942-015-0008-6 · 2.62 Impact Factor
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    ABSTRACT: Background Exposure to ongoing political violence and stressful conditions increases the risk of post traumatic stress disorder (PTSD) in low-resource contexts. However, much of our understanding of the determinants of PTSD in these contexts comes from cross-sectional data. Longitudinal studies that examine factors associated with incident PTSD may be useful to the development of effective prevention interventions and the identification of those who may be most at-risk for the disorder. Methods A 3-stage cluster random stratified sampling methodology was used to obtain a representative sample of 1,196 Palestinian adults living in Gaza, the West Bank and East Jerusalem. Face-to-face interviews were conducted at two time points 6-months apart. Logistic regression analyses were conducted on a restricted sample of 643 people who did not have PTSD at baseline and who completed both interviews. Results The incidence of PTSD was 15.0 % over a 6-month period. Results of adjusted logistic regression models demonstrated that talking to friends and family about political circumstances (aOR = 0.78, p = 0.01) was protective, and female sex (aOR = 1.76, p = 0.025), threat perception of future violence (aOR = 1.50, p = 0.002), poor general health (aOR = 1.39, p = 0.005), exposure to media (aOR = 1.37, p = 0.002), and loss of social resources (aOR = 1.71, p = 0.006) were predictive of incident cases of PTSD. Conclusions A high incidence of PTSD was documented during a 6-month follow-up period among Palestinian residents of Gaza, the West Bank, and East Jerusalem. Interventions that promote health and increase and forestall loss to social resources could potentially reduce the onset of PTSD in communities affected by violence.
    Social Psychiatry and Psychiatric Epidemiology 04/2015; 50(4):561-568. DOI:10.1007/s00127-014-0984-z · 2.58 Impact Factor
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    ABSTRACT: Depression and anxiety have been inconsistently associated with diabetes. Sex differences in the biological and behavioral correlates of these forms of distress could partially explain these inconsistencies. We investigated sex-specific associations between depression/anxiety symptoms and diabetes in two separate samples. The First National Health and Nutrition Examination Survey enrolled 3233 participants aged 25 to 74 years from 1971 to 1974. Depression and anxiety symptoms were measured via General Well Being schedule subscales. Incident diabetes for 17 years was defined by the following: a) death certificate, b) participant self-report, or c) health care facility discharge. The Detroit Neighborhood Health Study enrolled 1054 participants 18 years or older from 2008 to 2010. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 assessed depression and anxiety. Participants' self-reported physician-diagnosed prevalent diabetes. In the First National Health and Nutrition Examination Survey, the risk ratio (RR; 95% confidence interval) for incident diabetes among men with high versus low anxiety symptoms was 0.85 (0.56-1.29) and that among women was 2.19 (1.17-4.09; p for interaction = .005). RRs comparing high versus low depressive symptoms for men and women were 0.69 (0.43-1.100) and 2.11 (1.06-4.19); p for interaction = .007. In the Detroit Neighborhood Health Study, the RRs for prevalent diabetes comparing those with high versus low anxiety symptoms were 0.24 (0.02-2.42) for men and 1.62 (0.61-4.32) for women (p for interaction = < .001), whereas RRs for depression were 1.30 (0.46-3.68) for men and 2.32 (1.10-4.89) for women (p for interaction = .16). In two separate samples, depressive symptoms were related to increased diabetes risk among women but not men. Although less robust, findings for anxiety were differentially associated with diabetes by sex.
    Psychosomatic Medicine 04/2015; DOI:10.1097/PSY.0000000000000169 · 4.09 Impact Factor
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    ABSTRACT: We examined the association between posttraumatic stress disorder (PTSD) and gene expression using whole blood samples from a cohort of trauma-exposed white non-Hispanic male veterans (115 cases and 28 controls). 10,264 probes of genes and gene transcripts were analyzed. We found 41 that were differentially expressed in PTSD cases versus controls (multiple-testing corrected p<0.05). The most significant was DSCAM, a neurological gene expressed widely in the developing brain and in the amygdala and hippocampus of the adult brain. We then examined the 41 differentially expressed genes in a meta-analysis using two replication cohorts and found significant associations with PTSD for 7 of the 41 (p<0.05), one of which (ATP6AP1L) survived multiple-testing correction. There was also broad evidence of overlap across the discovery and replication samples for the entire set of genes implicated in the discovery data based on the direction of effect and an enrichment of p<0.05 significant probes beyond what would be expected under the null. Finally, we found that the set of differentially expressed genes from the discovery sample was enriched for genes responsive to glucocorticoid signaling with most showing reduced expression in PTSD cases compared to controls. Published by Elsevier Ltd.
    Psychoneuroendocrinology 04/2015; 57. DOI:10.1016/j.psyneuen.2015.03.016 · 5.59 Impact Factor
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    ABSTRACT: Studies about racial disparities in infant mortality suggest that racial differences in socioeconomic position (SEP) and maternal risk behaviors explain some, but not all, excess infant mortality among Blacks relative to non-Hispanic Whites. We examined the contribution of these to disparities in specific causes of infant mortality. We analyzed data about 2,087,191 mother-child dyads in Michigan between 1989-2005. First, we calculated crude Black-White infant mortality ratios independently and by specific cause of death. Second, we fit multivariable Poisson regression models of infant mortality, overall and by cause, adjusting for SEP and maternal risk behaviors. Third, Crude Black-White mortality ratios were compared to adjusted predicted probability ratios, overall and by specific cause. SEP and maternal risk behaviors explained nearly a third of the disparity in infant mortality overall, and over 25% of disparities in several specific causes including homicide, accident, sudden infant death syndrome, and respiratory distress syndrome. However, SEP and maternal risk behaviors had little influence on disparities in other specific causes, such as septicemia and congenital anomalies. These findings help focus policy attention toward disparities in those specific causes of infant mortality most amenable to social and behavioral intervention, as well as research attention to disparities in specific causes unexplained by SEP and behavioral differences. Copyright © 2015. Published by Elsevier Inc.
    Preventive Medicine 04/2015; 76. DOI:10.1016/j.ypmed.2015.03.021 · 2.93 Impact Factor
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    ABSTRACT: We used an individual-based model to evaluate the effects of hypothetical prevention interventions on HIV incidence trajectories in a concentrated, mixed epidemic setting from 2011 to 2021, and using Cabo Verde as an example. Simulations were conducted to evaluate the extent to which early HIV treatment and optimization of care, HIV testing, condom distribution, and substance abuse treatment could eliminate new infections (i.e., reduce incidence to less than 10 cases per 10,000 person-years) among non-drug users, female sex workers (FSW), and people who use drugs (PWUD). Scaling up all four interventions resulted in the largest decreases in HIV, with estimates ranging from 1.4 (95 % CI 1.36-1.44) per 10,000 person-years among non-drug users to 8.2 (95 % CI 7.8-8.6) per 10,000 person-years among PWUD in 2021. Intervention scenarios prioritizing FWS and PWUD also resulted in HIV incidence estimates at or below 10 per 10,000 person-years by 2021 for all population sub-groups. Our results suggest that scaling up multiple interventions among entire population is necessary to achieve elimination. However, prioritizing key populations with this combination prevention strategy may also result in a substantial decrease in total incidence.
    International Journal of Public Health 04/2015; DOI:10.1007/s00038-015-0676-9 · 1.97 Impact Factor
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    Jennifer Ahern, Laura Balzer, Sandro Galea
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    ABSTRACT: Alcohol outlet density and norms shape alcohol consumption. However, due to analytic challenges we do not know: (a) if alcohol outlet density and norms also shape alcohol use disorder, and (b) whether they act in combination to shape disorder. We applied a new targeted minimum loss-based estimator for rare outcomes (rTMLE) to a general population sample from New York City (N=4000) to examine the separate and combined relations of neighborhood alcohol outlet density and norms around drunkenness with alcohol use disorder. Alcohol use disorder was assessed using the World Mental Health Comprehensive International Diagnostic Interview (WMH-CIDI) alcohol module. Confounders included demographic and socioeconomic characteristics, as well as history of drinking prior to residence in the current neighborhood. Alcohol use disorder prevalence was 1.78%. We found a marginal risk difference for alcohol outlet density of 0.88% (95% CI 0.00-1.77%), and for norms of 2.05% (95% CI 0.89-3.21%), adjusted for confounders. While each exposure had a substantial relation with alcohol use disorder, there was no evidence of additive interaction between the exposures. Results indicate that the neighborhood environment shapes alcohol use disorder. Despite the lack of additive interaction, each exposure had a substantial relation with alcohol use disorder and our findings suggest that alteration of outlet density and norms together would likely be more effective than either one alone. Important next steps include development and testing of multi-component intervention approaches aiming to modify alcohol outlet density and norms toward reducing alcohol use disorder. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and Alcohol Dependence 03/2015; DOI:10.1016/j.drugalcdep.2015.03.014 · 3.28 Impact Factor
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    ABSTRACT: Estimate prevalence of lifetime, current year, and current month depression and post-traumatic stress disorder (PTSD) among US military reservists. Structured interviews were performed with a nationally representative military reserve sample (n = 2,003). Sociodemographic characteristics, military experiences, lifetime stressors, and psychiatric conditions were assessed. Depression was measured with the PHQ-9, and PTSD (deployment and non-deployment related) was assessed with the PCL-C. Depression (21.63 % lifetime, 14.31 % current year, and 5.99 % current month) was more common than either deployment-related PTSD (5.49 % lifetime, 4.98 % current year, and 3.62 % current month) or non-deployment-related PTSD (5.40 % lifetime, 3.91 % current year, and 2.32 % current month), and branch-related differences were found. Non-deployment-related trauma was associated with non-deployment-related PTSD and depression in a dose-response fashion; deployment-related trauma was associated with deployment-related PTSD and depression in a dose-response fashion. The study reveals notable differences in PTSD and depression prevalence by service branch that may be attributable to a combination of factors including greater lifetime trauma exposures and differing operational military experiences. Our findings suggest that service branch and organizational differences are related to key protective and/or risk factors, which may prove useful in guiding prevention and treatment efforts among reservists.
    Social Psychiatry and Psychiatric Epidemiology 03/2015; 50(4):639. DOI:10.1007/s00127-014-0981-2 · 2.58 Impact Factor
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    ABSTRACT: Tuberculosis (TB) is a major threat to global public health. Kazakhstan has the second highest percentage of multidrug-resistant tuberculosis (MDR-TB) cases among incident tuberculosis cases in the world (WHO 2013). A high burden of MDR-TB suggests TB prevention, control, and treatment programs are failing. This study provides an epidemiologic profile of TB among injection drug users (IDUs), a high-risk and chronically underserved population, in Kazakhstan. Cross-sectional study. The authors studied the characteristics and risk environment of IDUs with self-reported previous active TB and their primary sexual partners in Almaty, Kazakhstan. 728 individuals (364 couples) participated in a couple-based study in 2009. 16.75% of participants reported at least one positive TB test (x-ray) in their lifetime. In a multivariable logistic regression adjusting for couple-based sampling, persons with positive TB test were significantly more likely to be older (odds ratio (OR) 7.26, 95% confidence interval (CI): 1.73, 30.43), male (OR 5.53, 95% CI: 2.74, 11.16), have a shorter duration of injection drug use (OR 0.17, 95% CI: 0.04, 0.65), have received high social support from their significant other (OR 2.13, 95% CI: 1.03, 4.40) and more likely (non-significantly) to have been incarcerated (OR 7.03, 95% CI: 0.64, 77.30). Older men with a history of incarceration and recent injection drug use were more likely to have positive TB test in Kazakhstan. Social network support, while potentially positive for many aspects of population health, may increase risk of TB among IDUs in this context. Public health policies that target high-risk populations and their at-risk networks may be necessary to stem the rise of MDR-TB in Central Asia. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
    Public health 03/2015; DOI:10.1016/j.puhe.2015.01.022 · 1.48 Impact Factor
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    ABSTRACT: Curricular change is essential for maintaining vibrant, timely, and relevant educational programming. However, major renewal of a long-standing curriculum at an established university presents many challenges for leaders, faculty, staff, and students. We present a case study of a dramatic curriculum renewal of one of the nation's largest Master of Public Health degree programs: Columbia University's Mailman School of Public Health. We discuss context, motivation for change, the administrative structure established to support the process, data sources to inform our steps, the project timeline, methods for engaging the school community, and the extensive planning that was devoted to evaluation and communication efforts. We highlight key features that we believe are essential for successful curricular change.
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    ABSTRACT: Background Longitudinal studies of posttraumatic stress (PTS) have documented environmental factors as predictors of trajectories of higher, versus lower, symptoms, among them experiences of childhood physical abuse. Although it is now well-accepted that genes and environments jointly shape the risk of PTS, no published studies have investigated genes, or gene-by-environment interactions (GxEs), as predictors of PTS trajectories. The purpose of this study was to fill this gap.Methods and MaterialsWe examined associations between variants of the retinoid-related orphan receptor alpha (RORA) gene and trajectory membership among a sample of predominantly non-Hispanic Black urban adults (N = 473). The RORA gene was selected based on its association with posttraumatic stress disorder (PTSD) in the first PTSD genome wide association study. Additionally, we explored GxEs between RORA variants and childhood physical abuse history.ResultsWe found that the minor allele of the RORA SNP rs893290 was a significant predictor of membership in a trajectory of consistently high PTS, relatively to a trajectory of consistently low PTS. Additionally, the GxE of rs893290 with childhood physical abuse was significant. Decomposition of the interaction showed that minor allele frequency was more strongly associated with membership in consistently high or decreasing PTS trajectories, relative to a consistently low PTS trajectory, among participants with higher levels of childhood physical abuse.Conclusion The results of the study provide preliminary evidence that variation in the RORA gene is associated with membership in trajectories of higher PTS and that these associations are stronger among persons exposed to childhood physical abuse. Replication and analysis of functional data are needed to further our understanding of how RORA relates to PTS trajectories.
    03/2015; DOI:10.1002/brb3.323
  • Karestan C Koenen, Sandro Galea
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    ABSTRACT: IntroductionA large body of research has now firmly established that traumatic events, such as natural disasters, combat, sexual assault, and child abuse, are frequent occurrences throughout the world and that there are substantial consequences of traumatic event experiences. In most countries, the majority of adults report exposure to at least one traumatic event in their lifetime [1]. PTSD, the paradigmatic stress-related mental disorder, emerges in some persons in response to an unpredictable and uncontrollable traumatic event. PTSD is common with lifetime estimates ranging from 1.7 % in South Korea to 8.8 % in Northern Ireland, and past-year prevalences from a high of 3.8 % in Northern Ireland to a low of 0.2 % in China [2]. Separately, evidence shows that persons who experience traumatic events are more likely to report cardiovascular disease, respiratory disease, and other physical illness [3].Researchers and health professionals commonly treat the brain and the body as if they a ...
    Social Psychiatry and Psychiatric Epidemiology 02/2015; 50(4). DOI:10.1007/s00127-015-1035-0 · 2.58 Impact Factor
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    ABSTRACT: Attempts at predicting individual risk of disease based on common germline genetic variation have largely been disappointing. The present paper formalises why genetic prediction at the individual level is and will continue to have limited utility given the aetiological architecture of most common complex diseases. Data were simulated on one million populations with 10 000 individuals in each populations with varying prevalences of a genetic risk factor, an interacting environmental factor and the background rate of disease. The determinant risk ratio and risk difference magnitude for the association between a gene variant and disease is a function of the prevalence of the interacting factors that activate the gene, and the background rate of disease. The risk ratio and total excess cases due to the genetic factor increase as the prevalence of interacting factors increase, and decrease as the background rate of disease increases. Germline genetic variations have high predictive capacity for individual disease only under conditions of high heritability of particular genetic sequences, plausible only under rare variant hypotheses. Under a model of common germline genetic variants that interact with other genes and/or environmental factors in order to cause disease, the predictive capacity of common genetic variants is determined by the prevalence of the factors that interact with the variant and the background rate. A focus on estimating genetic associations for the purpose of prediction without explicitly grounding such work in an understanding of modifiable (including environmentally influenced) factors will be limited in its ability to yield important insights about the risk of disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Journal of Epidemiology &amp Community Health 02/2015; DOI:10.1136/jech-2014-204983 · 3.29 Impact Factor
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    ABSTRACT: Objective: The individual and economic burden of psychiatric illnesses is substantial. Although treatment of psychiatric disorders mitigates the burden of illness, over half of military personnel with disorders do not receive mental health care. However, there is a paucity of research examining the relationship between psychiatric disorder categories and treatment-seeking behavior in representative military populations. This study aimed to document, by psychiatric disorder category, the annualized rate of Guard members who obtained psychiatric services and the factors associated with service utilization. Methods: Face-to-face clinical assessments were conducted between 2008 and 2012 to assess lifetime and current psychiatric disorders and recent psychiatric service use among 528 Ohio Army National Guard soldiers. Results: An annualized rate of 31% of persons per year accessed psychiatric services between 2010 and 2012. Persons with substance use disorders had the lowest annualized rate of service use, and these were the only disorders not predictive of accessing services. Current mood disorder, current anxiety disorder, and lifetime history of service use were the strongest predictors of recent service use. There were no socioeconomic or other group predictors of psychiatric service use. Conclusions: About half of the soldiers who could benefit from mental health services used them, yet soldiers with substance use disorders were predominantly going untreated. There were no differences in treatment utilization by group characteristics, suggesting no systematic barriers to care for particular groups. Efforts to encourage broader adoption of treatment seeking, particularly among persons with substance use disorders, are necessary to mitigate psychiatric health burden in this population.
    Psychiatric services (Washington, D.C.) 02/2015; DOI:10.1176/appi.ps.201400128 · 1.99 Impact Factor
  • Katherine Keyes, Sandro Galea
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    ABSTRACT: Risk factor epidemiology has contributed to substantial public health success. In this essay, we argue, however, that the focus on risk factor epidemiology has led epidemiology to ever increasing focus on the estimation of precise causal effects of exposures on an outcome at the expense of engagement with the broader causal architecture that produces population health. To conduct an epidemiology of consequence, a systematic effort is needed to engage our science in a critical reflection both about how well and under what conditions or assumptions we can assess causal effects and also on what will truly matter most for changing population health. Such an approach changes the priorities and values of the discipline and requires reorientation of how we structure the questions we ask and the methods we use, as well as how we teach epidemiology to our emerging scholars. Copyright © 2015 Elsevier Inc. All rights reserved.
    Annals of Epidemiology 02/2015; DOI:10.1016/j.annepidem.2015.01.016 · 2.15 Impact Factor
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    ABSTRACT: Background: Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are frequently comorbid. One explanation for this comorbidity is that PTSD has a constellation of " dysphoria " symptoms resembling depression. Method: Using confirmatory factor analysis we tested the role of DSM-5 PTSD's dysphoria factor in relation to MDD symptom dimensions of somatic and non-somatic psychopathology. 672 Ohio National Guard soldiers completed DSM-5 measures of PTSD and MDD symptoms in an epidemiological study. Results: Results indicated that in contrast to other PTSD factors, PTSD's dysphoria factor was more related to MDD's somatic and non-somatic factors. Limitations: Limitations include generalizability to the epidemiological population of trauma-exposed military veterans rather than civilians, and reliance on self-report measures. Conclusions: Implications concerning clinical psychopathology and comorbidity of PTSD are discussed, including whether PTSD should be refined by removing its non-specific symptoms.
    Journal of Affective Disorders 01/2015; 175:373-378. DOI:10.1016/j.jad.2015.01.034 · 3.71 Impact Factor
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Publication Stats

15k Citations
2,096.93 Total Impact Points

Institutions

  • 2015
    • Massachusetts Department of Public Health
      Boston, Massachusetts, United States
  • 2008–2015
    • Boston University
      • Department of Psychiatry
      Boston, Massachusetts, United States
  • 2002–2015
    • Columbia University
      • • Department of Epidemiology
      • • Teachers College
      New York, New York, United States
  • 2005–2014
    • CUNY Graduate Center
      New York City, New York, United States
    • City University of New York - Hunter College
      Borough of Manhattan, New York, United States
  • 2013
    • Wayne State University
      • Center for Molecular Medicine and Genetics
      Detroit, MI, United States
    • Stony Brook University Hospital
      Stony Brook, New York, United States
  • 2004–2013
    • Gracie Square Hospital, New York, NY
      New York City, New York, United States
    • New York Presbyterian Hospital
      • Department of Emergency Medicine
      New York City, NY, United States
  • 2012
    • University of Oxford
      • Department of Public Health
      Oxford, ENG, United Kingdom
    • McGill University
      • Department of Epidemiology, Biostatistics and Occupational Health
      Montréal, Quebec, Canada
  • 2007–2012
    • Yale University
      • Department of Psychiatry
      New Haven, Connecticut, United States
    • Harvard University
      Cambridge, Massachusetts, United States
    • New York State Psychiatric Institute
      New York City, New York, United States
  • 2005–2012
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2002–2012
    • University of Michigan
      • • Department of Epidemiology
      • • Department of Health Behavior and Health Education
      Ann Arbor, Michigan, United States
  • 2011
    • City University of New York - John Jay College of Criminal Justice
      New York City, New York, United States
    • University of California, San Francisco
      • Division of Hospital Medicine
      San Francisco, CA, United States
    • New York City Department of Health and Mental Hygiene
      New York, United States
  • 2006–2011
    • University of California, Berkeley
      • Division of Epidemiology
      Berkeley, CA, United States
    • Cornell University
      • Department of Public Health
      Итак, New York, United States
    • Idaho State University
      • Department of Psychology
      Idaho Falls, ID, United States
    • Beth Israel Medical Center
      New York City, New York, United States
    • San Francisco State University
      • Department of Health Education
      San Francisco, CA, United States
  • 2010
    • University of Haifa
      • School of Political Sciences
      Haifa, Haifa District, Israel
  • 2009–2010
    • Rush University Medical Center
      • Department of Behavioral Sciences
      Chicago, IL, United States
    • University of Washington Seattle
      • School of Social Work
      Seattle, WA, United States
  • 2001–2010
    • New York Academy of Medicine
      New York City, New York, United States
  • 2003–2009
    • Weill Cornell Medical College
      • Department of Psychiatry
      New York City, NY, United States
    • Medical University of South Carolina
      • Department of Psychiatry and Behavioral Sciences
      Charleston, SC, United States
  • 2005–2008
    • Johns Hopkins Bloomberg School of Public Health
      • • Department of Epidemiology
      • • Department of Mental Health
      Baltimore, MD, United States
  • 2004–2006
    • Complutense University of Madrid
      • Facultad de Psicología
      Madrid, Madrid, Spain
  • 2003–2005
    • Icahn School of Medicine at Mount Sinai
      • Department of Psychiatry
      Manhattan, New York, United States
  • 1990
    • University of Toronto
      • Department of Immunology
      Toronto, Ontario, Canada