Robert H Pietrzak

Icahn School of Medicine at Mount Sinai, Borough of Manhattan, New York, United States

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Publications (209)935.49 Total impact


  • No preview · Article · Feb 2016 · The Journal of Clinical Psychiatry
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    Preview · Article · Dec 2015 · The Journal of Clinical Psychiatry
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    Full-text · Dataset · Dec 2015
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    ABSTRACT: Cognitive composite scores developed for preclinical Alzheimer's disease (AD) often consist of multiple cognitive domains as they may provide greater sensitivity to detect β-amyloid (Aβ)–related cognitive decline than episodic memory (EM) composite scores alone. However, this has never been empirically tested. We compared the rate of cognitive decline associated with high Aβ (Aβ+) and very high Aβ (Aβ++) in cognitively normal (CN) older adults on three multidomain cognitive composite scores and one single-domain (EM) composite score.
    Full-text · Article · Dec 2015
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    Cherie Armour · Ateka Contractor · Tracie Shea · Jon D. Elhai · Robert H. Pietrzak
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    ABSTRACT: Scarce data are available regarding the dimensional structure of Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) posttraumatic stress disorder (PTSD) symptoms and how factors relate to external constructs. We evaluated six competing models of DSM-5 PTSD symptoms, including Anhedonia, Externalizing Behaviors, and Hybrid models, using confirmatory factor analyses in a sample of 412 trauma-exposed college students. We then examined whether PTSD symptom clusters were differentially related to measures of anger and impulsivity using Wald chi-square tests. The seven-factor Hybrid model was deemed optimal compared with the alternatives. All symptom clusters were associated with anger; the strongest association was between externalizing behaviors and anger (r = 0.54). All symptom clusters, except reexperiencing and avoidance, were associated with impulsivity, with the strongest association between externalizing behaviors and impulsivity (r = 0.49). A seven-factor Hybrid model provides superior fit to DSM-5 PTSD symptom data, with the externalizing behaviors factor being most strongly related to anger and impulsivity. Copyright
    Full-text · Article · Dec 2015 · Journal of Nervous & Mental Disease
  • Melissa R. Weiner · Joan K. Monin · Natalie Mota · Robert H. Pietrzak
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    ABSTRACT: To examine the associations between multiple aspects of social support—perceived support, structural support, and community integration—and mental health difficulties in younger and older male veterans. Drawing from Socioemotional Selectivity Theory (SST), we hypothesized that greater support would be more strongly negatively related to mental health difficulties in older than younger veterans.
    No preview · Article · Dec 2015
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    ABSTRACT: The fifth edition of the Diagnostic and Statistical Manual includes a dissociative subtype of posttraumatic stress disorder, but no existing measures specifically assess it. This article describes the initial evaluation of a 15-item self-report measure of the subtype called the Dissociative Subtype of Posttraumatic Stress Disorder Scale (DSPS) in an online survey of 697 trauma-exposed military veterans representative of the U.S. veteran population. Exploratory factor analyses of the lifetime DSPS items supported the intended structure of the measure consisting of three factors reflecting derealization/depersonalization, loss of awareness, and psychogenic amnesia. Consistent with prior research, latent profile analyses assigned 8.3% of the sample to a highly dissociative class distinguished by pronounced symptoms of derealization and depersonalization. Overall, results provide initial psychometric support for the lifetime DSPS scales; additional research in clinical and community samples is needed to further validate the measure.
    Full-text · Article · Nov 2015 · Assessment
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    ABSTRACT: Objective: There is a dearth of community-based epidemiologic literature that examines post-traumatic stress disorder (PTSD) across the adult lifespan. In the current study the authors address this gap by examining the ways in which PTSD differs among young (ages 20-34), middle-aged (ages 35-64), and older (age 65+) adults with respect to past-year prevalence, nature of "worst" stressful experience ever experienced before the onset of PTSD, all traumatic experiences, symptom expression, psychiatric comorbidities, and mental health-related quality of life. Methods: We analyzed Wave 2 data from the National Epidemiologic Survey on Alcohol and Related Conditions, including adults with past-year diagnoses of PTSD (N = 1,715). Results: The prevalence of past-year PTSD was significantly higher for young (4.3% [SE: 0.3]) and middle-aged (5.2% [SE: 0.2]) adults compared with older adults (2.6% [SE: 0.2]). Respondents in the three age groups differed with regard to their "worst" stressful experience ever experienced before the onset of PTSD and to all traumatic experiences. Older adults experienced significantly fewer traumatic experiences (mean: 5.2; SE: 0.2) compared with young (mean: 5.7; SE: 0.2) and middle-aged adults (mean: 6.4; SE: 0.1). Young and middle-aged adults had significantly greater symptom counts and greater odds of comorbid psychiatric disorders when compared with older adults. PTSD had similar effects on mental health-related quality of life across the adult lifespan. Conclusion: Results highlight key differences in the characteristics of PTSD across the adult lifespan. The overall pattern of findings indicates that increasing age is associated with less severe PTSD profiles, including lower prevalence, fewer traumatic experiences, lower symptom counts, and lower odds of psychiatric comorbidity.
    Full-text · Article · Nov 2015 · American Journal of Geriatric Psychiatry
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    ABSTRACT: Purpose The current longitudinal study examined posttraumatic stress disorder (PTSD) symptom severity in relation to smoking abstinence and reduction over time among responders to the World Trade Center (WTC) disaster. Method Participants were 763 police and 1881 non-traditional (e.g., construction workers) WTC responders who reported being smokers at an initial examination obtained between July 2002 and July 2011 at the WTC Health Program (WTC-HP). WTC responders were reassessed, on average, 2.5 years later. Results For police WTC responders, higher levels of WTC-related PTSD symptoms at the initial visit were associated with a decreased likelihood of smoking abstinence (OR = 0.98, p =.002) and with decreased smoking reduction (β = -.06, p =.012) at the follow-up visit. WTC-related PTSD symptom severity was not related to likelihood of smoking abstinence or change in number of cigarettes smoked among non-traditional responders. Post hoc analyses suggested that for police, hyperarousal PTSD symptoms were predictive of decreased abstinence likelihood at the follow-up visit (OR = 0.56, p =.006). Discussion The present findings suggest that PTSD symptoms may be differentially related to smoking behavior among police and non-traditional WTC responders in a naturalistic, longitudinal investigation. Future work may benefit from exploring further which aspects of PTSD (as compared to each other and to common variance) explain smoking maintenance.
    Full-text · Article · Nov 2015 · Comprehensive Psychiatry
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    ABSTRACT: Ecologically valid typologies of adverse child experiences (ACEs) were identified to investigate the link between ACEs and adult incarceration. In a nationally representative sample (N=34,653, age 20+), latent class analysis (LCA) was conducted with childhood maltreatment [physical, sexual, and emotional abuse, interpersonal violence (IPV) exposure, physical neglect] and caregiver maladjustment (substance use, incarceration, mental illness, suicidal behavior) indicators. LCA identified a 5-typology model (1. Low Adversity Risk, 2. Caregiver Substance Use, and Maltreatment Acts of Omission, 3. Physical and Emotional Maltreatment, 4. Severe Cross-Subtype Maltreatment and Caregiver Substance Use, and 5. Caregiver Maladjustment). Controlling for sociodemographics and substance use problems, logistic regression analyses determined that, compared to the Low Adversity Risk typology, all typologies (except Caregiver Maladjustment) had elevated incarceration risk (adjusted odds ratios: 1.76-4.18). Maltreatment experiences were more predictive of incarceration for females vs. males. Childhood maltreatment confers risk for incarceration beyond established risk factors, but caregiver maladjustment, alone, does not. Preventative efforts should focus on understanding and targeting pathways to delinquency for individuals with childhood maltreatment.
    Full-text · Article · Oct 2015 · American Journal of Orthopsychiatry
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    ABSTRACT: Although most resilience science has focused on individual-level psychosocial factors that promote individual resilience, theorists and researchers have begun to examine neurobiological and systems-level factors implicated in resilience. In this commentary we argue that the development of effective interventions to enhance resilience necessitates understanding that resilience in the individual is dependent on multiple layers of society. Further, we suggest that there is a bidirectional relationship between systems-level resilience (i.e., resilience of romantic partners, family members, neighborhoods, and larger social contexts) and individual resilience. We suggest directions for future research and interventions, with the goal of stimulating research efforts that address these questions among trauma-exposed individuals.
    Full-text · Article · Oct 2015 · ECOLOGY AND SOCIETY
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    ABSTRACT: Typologies of DSM-5 PTSD symptoms and personality traits were evaluated in regard to coping styles and treatment preferences using data from 1266 trauma-exposed military veterans of which the majority were male (n=1097; weighted 89.6%). Latent profile analyses indicated a best-fitting 5-class solution; PTSD asymptomatic and emotionally stable (C1); predominant re-experiencing and avoidance symptoms and less emotionally stable (C2); subsyndromal PTSD (C3); predominant negative alterations in mood/cognitions and combined internalizing-externalizing traits (C4); and high PTSD severity and combined internalizing-externalizing traits (C5). Compared to C5, C1 members were less likely to use self-distraction, denial, and substance use and more likely to use active coping; C2 and C4 members were less likely to use denial and more likely to use behavioral disengagement; C3 members were less likely to use denial and instrumental coping and more likely to use active coping; most classes were less likely to seek mental health treatment. Compared to C1, C2 members were more likely to use self-distraction, substance use, behavioral disengagement and less likely to use active coping; C3 members were more likely to use self-distraction, and substance use, and less likely to use positive reframing, and acceptance; and C4 members were more likely to use denial, substance use, emotional support, and behavioral disengagement, and less likely to use active coping, positive reframing, and acceptance; all classes were more likely to seek mental health treatment. Emotional stability was most distinguishing of the typologies. Other implications are discussed.
    Full-text · Article · Oct 2015 · Journal of Anxiety Disorders
  • Jack Tsai · Natalie P. Mota · Steven M. Southwick · Robert H. Pietrzak
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    ABSTRACT: Background: Posttraumatic growth (PTG) is commonly observed among trauma survivors. However, few studies have treated PTG as multi-dimensional and examined how different PTG dimensions may be protective against the negative effects of future trauma. Methods: Using a nationally representative web-based survey of 1057 U.S. military veterans followed for two years, we examined whether different PTG dimensions had a protective effect on the severity and diagnosis of posttraumatic stress disorder (PTSD) in the face of new traumatic life events. Results: Greater scores on the Personal Strength domain of the PTG Inventory-Short Form at baseline was associated with reduced severity (β=-.05, p<.05) and incidence (OR=.68, 95% CI=.50-.93) of PTSD at a two-year follow-up. Limitations: Results are associational and causality cannot be inferred so replication is needed. Conclusions: This study highlights the multi-dimensional nature of PTG and demonstrates a salubrious effect of trauma-related gains in personal strength on incident PTSD.
    No preview · Article · Sep 2015 · Journal of Affective Disorders
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    ABSTRACT: Veterans of Operations Iraqi Freedom/Enduring Freedom/New Dawn (OEF/OIF/OND) tend not to engage in mental health care. Identifying modifiable factors related to mental health service utilization could facilitate development of interventions to increase utilization. The current study examined the relationship between mental health care utilization and measures of PTSD symptoms, resilience, stigma, beliefs about mental health care, perceived barriers to mental health care, posttraumatic growth and meaning, social support, and personality factors in a sample of 100 OEF/OIF/OND veterans with PTSD symptoms referred to VA mental health care. Participants who received psychotherapy and pharmacotherapy (PP) scored higher on measures of PTSD symptoms, stigma, and adaptive beliefs about mental health treatment, and lower on measures of resilience, postdeployment social support, emotional stability, and conscientiousness, than participants who received no treatment (NT). Participants who received psychotherapy only (PT) scored higher on a measure of PTSD symptoms than NT participants. PT participants scored higher on an emotional stability measure and lower on measures of PTSD symptoms and stigma than PP participants. Multinomial logistic regression including all variables significantly related to treatment utilization indicated that PTSD symptoms and adaptive beliefs about psychotherapy and pharmacotherapy were higher in the PT and PP groups than in the NT group, and concerns about discrimination were higher in the PP group than the NT group. Interventions targeting beliefs about mental health care could increase mental health treatment utilization among OEF/OIF/OND veterans. Concerns about stigma may affect the utilization process differently at different decision points. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    No preview · Article · Aug 2015 · Psychological Trauma Theory Research Practice and Policy
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    ABSTRACT: Objectives The aim of this study was to evaluate the role of resource-oriented variables such as self-efficacy, locus of control (LOC) and post-traumatic growth (PTG) in predicting treatment response in older adults with post-traumatic stress.Methods Fifty-eight older adults with subsyndromal or greater severity of war-associated post-traumatic stress disorder (PTSD) symptoms completed a randomized controlled Internet-based cognitive-behavioural therapy (CBT) with immediate and delayed treatment groups. Assessments of PTSD severity and resource-oriented variables of self-efficacy, LOC and PTG were conducted at baseline, post-treatment and at a 6-month follow-up.ResultsResults revealed that pre-treatment scores on measures of internal LOC and PTG predicted PTSD symptom severity at post-treatment, even after controlling for initial PTSD. At a 6-month follow-up, internal LOC continued to predict PTSD symptom severity. In addition, repeated-measures analyses of variance revealed that, relative to older adults with low internal LOC and PTG, older adults with high internal LOC and PTG, respectively, did not differ with respect to initial PTSD severity, but they showed a more pronounced response to treatment.Conclusion These findings suggest that greater locus of control and post-traumatic growth is associated with greater improvement in PTSD symptoms following Internet-based CBT. Assessment of these constructs may be useful in identifying trauma survivors who are most likely to respond to CBT.Practitioner pointsGreater internal locus of control and post-traumatic growth is associated with greater improvement in PTSD symptoms following Internet-based CBT.Older adults with initial high internal locus of control and post-traumatic growth, respectively, did not differ with respect to initial PTSD severity, but they showed a more pronounced response to treatment.It could be assumed that patients with initial functional appraisals could benefit easier and faster from a trauma-focused cognitive-behavioural therapy compared to individuals with lower internal locus of control and post-traumatic growth
    No preview · Article · Aug 2015
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    ABSTRACT: Posttraumatic stress disorder (PTSD) is a heterogeneous construct, and some have suggested that PTSD triggered by acute coronary syndrome (ACS) may differ from PTSD due to prototypical traumas. We conducted the first examination of the latent structure of PTSD symptoms after suspected ACS in 399 adults in the REactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of patients recruited from the emergency department during evaluation for ACS. Using confirmatory factor analysis, we compared the 4-factor dysphoria, 4-factor numbing, and 5-factor dysphoric arousal models of PTSD. Although all models fit well, the dysphoria model was selected as the best-fitting model. Further, there was measurement invariance of the dysphoria model by sex. PTSD dimensions evidenced differential associations with indicators of threat perception during ACS evaluation and adherence to cardioprotective medication. One limitation of this investigation is the use of self-report measures. In addition, only one-third of the sample was diagnosed with ACS at discharge; the remaining participants received diagnoses such as chest pain without a cardiac diagnosis, another symptom/disease process (e.g., hypertensive chronic kidney disease), or another cardiac disease. Findings suggest that suspected ACS-related PTSD symptoms are best-represented by a 4-factor structure distinguishing between specific (e.g., re-experiencing) and non-specific (dysphoria) symptoms of PTSD that has received support in the broader PTSD literature. Copyright © 2015 Elsevier B.V. All rights reserved.
    No preview · Article · Jul 2015 · Journal of Affective Disorders
  • Jack Tsai · Cherie Armour · Steven M. Southwick · Robert H. Pietrzak
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    ABSTRACT: The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) formally introduced a dissociative subtype of posttraumatic stress disorder (PTSD). This study examined the proportion of U.S. veterans with DSM-5 PTSD that report dissociative symptoms; and compared veterans with PTSD with and without the dissociative subtype and trauma-exposed controls on sociodemographics, clinical characteristics, and quality of life. Multivariable analyses were conducted on a nationally representative sample of 1484 veterans from the National Health and Resilience in Veterans Study (second baseline survey conducted September-October, 2013). Of the 12.0% and 5.2% of veterans who screened positive for lifetime and past-month DSM-5 PTSD, 19.2% and 16.1% screened positive for the dissociative subtype, respectively. Among veterans with PTSD, those with the dissociative subtype reported more severe PTSD symptoms, comorbid depressive and anxiety symptoms, alcohol use problems, and hostility than those without the dissociative subtype. Adjusting for PTSD symptom severity, those with the dissociative subtype continued to report more depression and alcohol use problems. These results underscore the importance of assessing, monitoring, and treating the considerable proportion of veterans with PTSD and dissociative symptoms. Published by Elsevier Ltd.
    No preview · Article · Apr 2015 · Journal of Psychiatric Research
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    ABSTRACT: Posttraumatic stress disorder (PTSD) is associated with high medical morbidity, but the nature of this association remains unclear. Among responders to the World Trade Center (WTC) disaster, PTSD is highly comorbid with lower respiratory symptoms (LRS), which cannot be explained by exposure alone. We sought to examine this association longitudinally to establish the direction of the effects and evaluate potential pathways to comorbidity. 18,896 responders (8466 police and 10,430 nontraditional responders) participating in the WTC-Health Program were first evaluated between 2002 and 2010 and assessed again 2.5 years later. LRS were ascertained by medical staff, abnormal pulmonary function by spirometry, and probable WTC-related PTSD with a symptom inventory. In both groups of responders, initial PTSD (standardized regression coefficient: β = 0.20 and 0.23) and abnormal pulmonary function (β = 0.12 and 0.12) predicted LRS 2.5 years later after controlling for initial LRS and covariates. At follow-up, LRS onset was 2.0 times more likely and remission 1.8 times less likely in responders with initial PTSD than in responders without. Moreover, PTSD mediated, in part, the association between WTC exposures and development of LRS (p < .0001). Initial LRS and abnormal pulmonary function did not consistently predict PTSD onset. These analyses provide further evidence that PTSD is a risk factor for respiratory symptoms and are consistent with evidence implicating physiological dysregulation associated with PTSD in the development of medical conditions. If these effects are verified experimentally, treatment of PTSD may prove helpful in managing physical and mental health of disaster responders.
    No preview · Article · Apr 2015 · Psychosomatic Medicine
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    ABSTRACT: To the Editor: Recently, we found that greater norepinephrine transporter (NET) availability in the locus ceruleus of trauma survivors with posttraumatic stress disorder (PTSD) was associated with increased severity of anxious arousal (ie, hypervigilance and exaggerated startle) symptoms, but not any of the other empirically derived symptom clusters that characterize this disorder. This finding suggests that greater NET availability in the locus ceruleus may serve a compensatory function of clearing elevated synaptic norepinephrine and maintaining anxious arousal symptoms in persons with PTSD.A single-nucleotide polymorphism (SNP) found in the promoter region of the NET gene SLC6A2 (solute carrier family 6 [neurotransmitter transporter], member 2) (rs2242446) has been associated with panic disorder. © Copyright 2015 Physicians Postgraduate Press, Inc.
    Full-text · Article · Apr 2015 · The Journal of Clinical Psychiatry
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    ABSTRACT: This study examinedrisk and resilience factors associated with posttraumatic stress symptomatology (PTSS) in an ethno-racially diverse sample of Hawai׳i National Guard members comprised of Native Hawaiians, Filipino Americans, Japanese Americans, and European Americans. In the full sample, identifying as Japanese American and higher scores on measures of perceived social support and psychological resilience were negatively associated with PTSS, while Army Guard (vs. Air Guard) status and stronger family norms against disclosing mental health problems were positively associated with PTSS. Exploratory analyses of ethno-racial subgroups identified different patterns of within and between-group correlates of PTSS. For example, when controlling for other factors, higher psychological resilience scores were negatively associated with PTSS only among Native Hawaiian and European Americans. Overall, results of this study suggest that some risk and resilience factors associated with posttraumatic stress disorder (PTSD) may extend to military populations with high numbers of Filipino American, Japanese American, and Native Hawaiian Veterans. Results further suggest differences in risk and resilience factors unique to specific ethno-racial subgroups. Published by Elsevier Ireland Ltd.
    No preview · Article · Apr 2015

Publication Stats

4k Citations
935.49 Total Impact Points

Institutions

  • 2012-2015
    • Icahn School of Medicine at Mount Sinai
      • • Department of Psychiatry
      • • Department of Preventive Medicine
      Borough of Manhattan, New York, United States
  • 2009-2015
    • Yale University
      • Department of Psychiatry
      New Haven, Connecticut, United States
  • 2008-2015
    • Yale-New Haven Hospital
      • Department of Laboratory Medicine
      New Haven, Connecticut, United States
  • 2014
    • United States Department of Veterans Affairs
      Bedford, Massachusetts, United States
  • 2005-2008
    • University of Connecticut
      • • Department of Psychiatry
      • • Department of Psychology
      Сторс, Connecticut, United States
    • Colby College
      • Psychology Department
      WVL, Maine, United States