Robert H. Pietrzak’s research while affiliated with U.S. Department of Veterans Affairs and other places

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Publications (715)


Posttraumatic Stress Disorder, Obesity, and Accelerated Epigenetic Aging Among US Military Veterans
  • Article

October 2024

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16 Reads

JAMA Psychiatry

Ian C Fischer

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Robert H Pietrzak

This cross-sectional study uses data from 1135 male, European-American US military veterans to assess whether risk and protective factors influenced associations between posttraumatic stress disorder and epigenetic age.





Loneliness Trajectories in U.S. Military Veterans: A 3-Year Longitudinal Study of Risk and Protective Factors

October 2024

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9 Reads

The Journals of Gerontology Series B Psychological Sciences and Social Sciences

Objectives Loneliness is a significant public health concern associated with adverse mental and physical health outcomes in older adults. This study examined the nature and correlates of predominant loneliness trajectories in a nationally representative sample of older U.S. military veterans. Methods Participants included 2,441 veterans (mean age = 63, 8% female, 80% white) from the National Health and Resilience in Veterans Study, a 3-year longitudinal cohort study. Growth mixture modeling (GMM) was used to identify distinct trajectory classes of loneliness based on self-reported ratings. Multinomial logistic three-step regression analyses examined potential psychosocial risk and protective factors associated with loneliness trajectories. Results GMM revealed three distinct loneliness trajectories: Low-decreasing loneliness (61.2%), moderate-increasing loneliness (31.6%), and high-increasing loneliness (7.2%). Being married/partnered and perceiving greater purpose in life emerged as protective factors against elevated levels of loneliness. Worse cognitive functioning was a risk factor for the moderate-increasing loneliness trajectory, while greater psychological distress and more adverse childhood experiences were risk factors for the high-increasing loneliness trajectory. Discussion Nearly 40% of older U.S. veterans exhibited trajectories characterized by moderate to high levels of loneliness, with both groups showing increases over time. Targeted interventions that promote social connectedness, enhance purpose in life, and address mental health concerns and early life adversities may help mitigate the negative health consequences associated with chronic loneliness in this vulnerable population.


Characteristics of the cohorts investigated.
Epigenetic and Genetic Profiling of Comorbidity Patterns among Substance Dependence Diagnoses
  • Preprint
  • File available

October 2024

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10 Reads

Objective: This study investigated the genetic and epigenetic mechanisms underlying the comorbidity patterns of five substance dependence diagnoses (SDs; alcohol, AD; cannabis, CaD; cocaine, CoD; opioid, OD; tobacco, TD). Methods: A latent class analysis (LCA) was performed on 31,197 individuals (average age 42+-11 years; 49% females) from six cohorts to identify comorbid DSM-IV SD patterns. In subsets of this sample, we tested SD-latent classes with respect to polygenic burden of psychiatric and behavioral traits and epigenome-wide changes in three population groups. Results: An LCA identified four latent classes related to SD comorbidities: AD+TD, CoD+TD, AD+CoD+OD+TD (i.e., polysubstance use, PSU), and TD. In the epigenome-wide association analysis, SPATA4 cg02833127 was associated with CoD+TD, AD+TD, and PSU latent classes. AD+TD latent class was also associated with CpG sites located on ARID1B, NOTCH1, SERTAD4, and SIN3B, while additional epigenome-wide significant associations with CoD+TD latent class were observed in ANO6 and MOV10 genes. PSU-latent class was also associated with a differentially methylated region in LDB1. We also observed shared polygenic score (PGS) associations for PSU, AD+TD, and CoD+TD latent classes (i.e., attention-deficit hyperactivity disorder, anxiety, educational attainment, and schizophrenia PGS). In contrast, TD-latent class was exclusively associated with posttraumatic stress disorder-PGS. Other specific associations were observed for PSU-latent class (subjective wellbeing-PGS and neuroticism-PGS) and AD+TD-latent class (bipolar disorder-PGS). Conclusions: We identified shared and unique genetic and epigenetic mechanisms underlying SD comorbidity patterns. These findings highlight the importance of modeling the co-occurrence of SD diagnoses when investigating the molecular basis of addiction-related traits.

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Association of Psychological Safety with Burnout and Intent to Leave Among Physician Faculty in New York City

October 2024

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3 Reads

Journal of General Internal Medicine

Data on the potential protective effect of psychological safety (PS) on well-being and satisfaction among physicians are lacking. We sought to examine (1) prevalence of PS; (2) relationship between PS, burnout, and intent to leave one’s job (ILJ); and (3) demographic and occupational factors associated with PS within our physician faculty. Participants: An institution-wide survey was sent to all faculty within our eight-hospital health system, between July and September 2022. Main measures: PS was assessed using the seven-item Fearless Organization Questionnaire and burnout with the Maslach Burnout Inventory-2. Demographics and a measure of ILJ were assessed. Multivariable logistic regression analyses were conducted to determine associations between PS, burnout, ILJ, and demographic and occupational correlates of PS. A total of 867 out of 3086 total estimated clinical faculty members (28.1%) participated in the survey. The majority were 40 and older (67.4%), female (51.9%), white (60.0%), and married/partnered (80.4%); worked in ambulatory care departments (53.7%); and ranked assistant or associate professors (75.8%). On average, 57.6% of physicians evaluated their workplace as psychologically safe (range across items = 40.9–69.9%), with 35.2% screening positive for burnout and 13.4% reporting ILJ. After adjusting for demographic and occupational characteristics, each standard deviation unit increase in PS scores was associated with 27% lower odds of screening positive for burnout (odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.63–0.84) and 38% lower odds of ILJ (OR = 0.62, 95% CI = 0.52–0.74). Female gender was associated with lower scores of PS. A majority of faculty physicians reported working in a psychologically safe environment. Greater PS was associated with lower odds of burnout and ILJ. Investment in gender and diversity equity training may be one concrete step in advancing PS in the workplace.


Sexual Orientation Moderates the Association Between Health Care Utilization-Related Factors and Mental Health Service Nonutilization Among United States Military Veterans

September 2024

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18 Reads

Psychological Services

This study examined mental health treatment nonutilization among sexual minority versus heterosexual Veterans with demonstrated psychiatric need. Data were analyzed from 820 Veterans with psychiatric need who participated in the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of U.S. military Veterans. Results revealed that current mental health service nonutilization did not differ between sexual minority versus heterosexual Veterans (70.5% vs. 74.0%). Significant interactions between sexual orientation and sex assigned at birth, primary source of health care (Veteran Affairs [VA] vs. non-VA), and beliefs that peers would blame them for their mental health problems were observed in analyses predicting current mental health treatment utilization. Among Veterans primarily utilizing VA health care, sexual minority Veterans were less likely than heterosexual Veterans to engage in mental treatment; among those primarily using non-VA, this pattern was reversed. Sexual minority Veterans were significantly more likely than heterosexual Veterans to report not knowing where to get help, not having adequate transportation, and having difficulty scheduling an appointment. Taken together, the results of this study suggest that rates of mental health nonutilization are high for both sexual minority and heterosexual Veterans, and that factors that influence utilization may differ by sexual orientation.


Gambling and Substance Use Disorders in U.S. Military Veterans: Prevalence, Clinical Characteristics, and Suicide Risk

September 2024

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9 Reads

Journal of Gambling Studies

Gambling and substance use disorders (SUDs) are prevalent among U.S. military veterans and often co-occur. However, little is known about the clinical and behavioral correlates and suicidal risk of SUDs and gambling among veterans that can help inform targeted interventions for their co-occurrence. In the current study, we analyzed data from a nationally representative sample of 4069 veterans who participated in the National Health and Resilience in Veterans Study. Self-reported measures of lifetime SUDs and past-year gambling (Brief Problem Gambling Screen) were administered. A multinomial logistic regression analysis was conducted to examine differences between four groups: non-SUD/non-gambling, 40.3%; SUD-only 27.3%; Gambling-only 16.3%; and SUD + Gambling, 16.1%. The Gambling-only, SUD-only, and SUD + Gambling groups reported more adverse childhood experiences relative to the non-SUD/non-gambling group. The SUD-only and SUD + Gambling groups had higher odds for all lifetime and current clinical and trauma variables relative to the non-SUD/non-gambling group. The SUD + Gambling group had higher odds of suicidality, non-suicidal self-injury, nicotine dependence and mental health treatment relative to the SUD-only group and all assessed clinical measures relative to the Gambling-only group. Results suggest that SUDs and gambling are associated with substantial trauma and mental health burden among U.S. veterans, with co-occurring SUDs and gambling linked particularly to suicidality/self-harm and mental health treatment. The findings underscore the importance of multicomponent assessments and interventions targeting SUDs, gambling, and related concerns, such as trauma-related mental health difficulties, in this population.



Citations (37)


... Goldstein et al. (5) also found that individuals with ASPD are more likely to have comorbid substance misuse and other psychiatric disorders. The ASPD is associated with greater odds of any substance use disorder (SUD), specifically alcohol, nicotine, and any drug use disorder (6). Similarly, data from cohorts of prisoners has shown that alcohol dependence syndrome (ADS) shows high comorbidity with ASPD, suggesting that there may be common biological risk mechanisms (7). ...

Reference:

Clinical characteristics of adults with alcohol dependence syndrome comorbid with antisocial personality disorder: a cross-sectional study
Association patterns of antisocial personality disorder across substance use disorders

Translational Psychiatry

... Co-occurring chronic pain and posttraumatic stress disorder (PTSD) affects up to 8% of Veterans overall [1,2], could be as high as 50% among Veterans in specialty pain care [3,4], and is associated with higher levels of pain severity, pain-related disability, depression, and healthcare utilization [5,6]. Veterans are more likely than non-Veterans to experience PTSD if they have chronic pain [7], making this a particularly concerning issue for Veteran populations. ...

Co-occurring Chronic Pain and PTSD Among US Military Veterans: Prevalence, Correlates, and Functioning
  • Citing Article
  • May 2024

Journal of General Internal Medicine

... Responses to the MIDS items can be summed to create a continuous full-scale score with higher values representing more severe distress. Additionally, an empirically-derived cut score of 27 [117] or greater has been suggested for detecting clinically meaningful and functionally impairing MI. Feelings of betrayal are assessed as a symptom rather than as a PMIE. ...

Using the Moral Injury and Distress Scale to identify clinically meaningful moral injury

Journal of Traumatic Stress

... There is a powerful link between trauma and mental health; traumatic stress is a major precipitating factor in the development of several psychiatric disorders, particularly mood and anxiety disorders, such as post-traumatic stress disorder (PTSD) and major depressive disorder (MDD). Yet, the molecular mechanisms linking traumatic stress to psychiatric disorder risk are only beginning to be elucidated [1][2][3] . Traumatic experiences are processed through corticolimbic circuits 4 and mount a whole body-endocrine response through glucocorticoid (GC) signaling 5,6 . ...

Genome-wide association analyses identify 95 risk loci and provide insights into the neurobiology of post-traumatic stress disorder

Nature Genetics

... Furthermore, the study underscores the need for tailored interventions that consider the specific contexts and experiences of different military groups. Developing specialized programs for injured servicemen that address both physical and psychological rehabilitation can facilitate their recovery and improve their overall well-being (Kang et al., 2024;Vus & Esterlis, 2022). ...

Well-being of mental health workers during the Russian-Ukrainian War

Mental Health Global Challenges Journal

... (Alonso et al., 2011) It has been noted that adults aged 50 y and older have recently experienced the fastest increase in depression of all age groups (Greenberg et al., 2015). Depression is a known risk factor for chronic diseases including obesity, (Shell et al., 2024) metabolic syndrome and diabetes, (Shell et al., 2024)cardiovascular disease, (Cao et al., 2024;Duivis et al., 2013) neurodegenerative diseases, (Hussain et al., 2024;Jimenez et al., 2024) substance use disorders, (Na et al., 2024) and others. (Eby & Eby, 2010;Karlsdotter et al., 2016) Strategies for earlier identification, prevention and treatment of depression are urgently needed to improve health and quality of life among older adults in the U.S. Older Latinos suffer a disproportionate burden of depression: the lifetime prevalence of Major Depressive Disorder (MDD) in Latinos aged between 54 and 65 is approximately 40% greater than in non-hispanic whites (NHW) of the same age. ...

Problem Opioid Use Among US Military Veterans: Prevalence, Correlates, and Psychiatric Characteristics
  • Citing Article
  • March 2024

Journal of Addiction Medicine

... 3 For example, PRS derived from a multi-trait analysis of GWAS (MTAG) across seven different cohorts accounted for 3.8% of the variance in predicting opioid dependence (OUD; we use the term OUD to abbreviate either opioid use disorder or opioid dependence). 4 However, while statistically significant, the predictive utility of this PRS is not clinically meaningful. ...

Genetic and non-genetic predictors of risk for opioid dependence
  • Citing Article
  • February 2024

Psychological Medicine

... 49 Veterans, especially combat veterans, are at a significantly increased risk for negative mental health outcomes, including depression, anxiety, and PTSD. 50,51 The risk for these negative outcomes is compounded when VI is also experienced. Important work has been done to address challenges related to PTSD and to optimize mental health outcomes in the veteran population by fostering PTG. ...

Generalized anxiety and mild anxiety symptoms in U.S. military veterans: Prevalence, characteristics, and functioning

Journal of Psychiatric Research

... The microbiotagut-brain axis is the idea that there is bidirectional communication between the gut microbiome, neuroendocrine and neurotransmitter systems, and immune signaling pathways (Ke et al., 2023). Additionally, alterations in this axis have been linked to several psychiatric conditions including schizophrenia, depression, and bipolar disorder (He et al., 2024). Further, dysregulation of the microbiota-gut-brain axis have been linked to physical comorbidities such as inflammatory bowel disease, cardiometabolic disorders, and diabetes (Ke et al., 2023). ...

Potential causal association between gut microbiome and posttraumatic stress disorder

Translational Psychiatry

... The study of post-traumatic stress disorder (PTSD) requires an understanding of both its physiological and psychological aspects. This includes knowledge of the biological mechanisms of stress, neuropsychology, as well as an understanding of the psychosocial and cultural factors influencing the symptoms and development of PTSD [9][10][11][12][13]. ...

Functional correlates of a novel 8-factor model of PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study
  • Citing Article
  • January 2024

Journal of Psychiatric Research