Evaluation of a family-centered prevention intervention for military children and families facing wartime deployments.

OBJECTIVES: We evaluated the Families OverComing Under Stress program, which provides resiliency training designed to enhance family psychological health in US military families affected by combat- and deployment-related stress. METHODS: We performed a secondary analysis of Families OverComing Under Stress program evaluation data that was collected between July 2008 and February 2010 at 11 military installations in the United States and Japan. We present data at baseline for 488 unique families (742 parents and 873 children) and pre-post outcomes for 331 families. RESULTS: Family members reported high levels of satisfaction with the program and positive impact on parent-child indicators. Psychological distress levels were elevated for service members, civilian parents, and children at program entry compared with community norms. Change scores showed significant improvements across all measures for service member and civilian parents and their children (P < .001). CONCLUSIONS: Evaluation data provided preliminary support for a strength-based, trauma-informed military family prevention program to promote resiliency and mitigate the impact of wartime deployment stress.

Autonomic activation during sleep in posttraumatic stress disorder and panic: a mattress actigraphic study.

BACKGROUND: While it has been reported that persons with posttraumatic stress disorder (PTSD) manifest tonic autonomic activation, the literature contains numerous counterexamples. In revisiting the question, this study employed a novel method of mattress actigraphy to unobtrusively estimate heart rate and respiratory sinus arrhythmia over multiple nights of sleep in the home. METHODS: Sleep cardiac autonomic status was estimated in four diagnostic groups, posttraumatic stress disorder, panic disorder, persons comorbid for both conditions, and control subjects. All 59 participants were community-residing nonveterans screened for sleep apnea and periodic leg movement disorder with polysomnography. Heart rate and respiratory sinus arrhythmia were calculated from the kinetocardiogram signal measured via accelerometers embedded in a mattress topper. Times in bed and asleep were also estimated. Per participant data were obtained from a median of 12 nights. RESULTS: Both posttraumatic stress disorder and posttraumatic stress disorder/panic disorder comorbid groups exhibited significantly higher heart rates and lower respiratory sinus arrhythmia magnitudes than panic disorder participants and control subjects. Panic disorder participants were indistinguishable from control subjects. The PTSD-only group exhibited longer times in bed and longer times presumably asleep than the other three groups. CONCLUSIONS: In this study, posttraumatic stress disorder, but not panic disorder, was associated with altered cardiac autonomic status during sleep. Among participants meeting criteria for PTSD alone, autonomic activation co-occurred with prolongation of actigraphic sleep.

Intimate partner violence and miscarriage: examination of the role of physical and psychological abuse and posttraumatic stress disorder.

Despite research documenting high rates of violence during pregnancy, few studies have examined the impact of physical abuse, psychological abuse, and posttraumatic stress disorder (PTSD) on miscarriage. Secondary analysis of data collected by the Chicago Women's Health Risk Study permitted an exploration of the relationships among physical abuse, psychological abuse, PTSD, and miscarriage among 118 primarily ethnic minority women. The interaction between maximum severity of abuse and age provided the best multivariate predictor of miscarriage rate, accounting for 26.9% of the variance between live birth and miscarriage outcome. Mean scores of psychological abuse, physical violence, forced sex, and PTSD were significantly higher in the miscarriage group than in the live birth group. Women who experience physical violence and psychological abuse during pregnancy may be at greater risk for miscarriage. Prospective studies can confirm findings and determine underlying mechanisms. Routine screening for traumatic stress and PTSD may reduce rates of miscarriage.

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury.

In this article, we review the literature on posttraumatic stress disorder (PTSD) and PTSD-like symptoms that can occur along with mild traumatic brain injury (TBI) and concussion, with specific reference to concussive injuries in the military. We address four major areas: (1) clinical aspects of TBI and PTSD, including diagnostic criteria, incidence, predictive factors, and course; (2) biological overlap between PTSD and TBI; (3) comorbidity between PTSD and other mental disorders that can occur after mild TBI; and (4) current treatments for PTSD, with specific considerations related to treatment for patients with mild TBI or concussive injuries.

Sleep in post-traumatic stress disorder and panic: convergence and divergence.

Disturbed sleep is a common clinical problem in anxiety disorders, particularly in patients with post-traumatic stress disorder (PTSD) and panic disorder (PD). Several studies have attempted to validate the subjective sleep complaints of these disorders using laboratory polysomnography. These attempts, typically focusing on PTSD or PD independently, have demonstrated inconsistent results. To our knowledge, no such studies have attempted to directly compare and contrast sleep disturbances in PTSD and PD together. Our review of the studies of subjective sleep disturbances, sleep architecture, and sleep-related biologic phenomena suggests that a comparative characterization of sleep disturbances in these two disorders is timely. Such an inference is based on our identification of several areas of convergence and divergence between PTSD and PD found in the published literature, as well as our own preliminary investigations. Specifically, PTSD and PD seem to converge on several sleep-related parameters, namely, sleep quality, presence of episodic parasomnias, and movement time. They also appear to diverge in other important sleep-related areas such as respiratory disturbances and the particular phenomenological nature of episodic parasomnias, namely nightmares or nocturnal panic attacks. Investigations focusing on such overlapping phenomena may provide groundwork for further elucidation of central fear systems underlying these two disorders. Additionally, such sleep studies have the potential to provide important insights into ongoing efforts to develop a cohesive conceptual framework into the patho-physiologies of these disorders.

Sleep respiratory concomitants of comorbid panic and nightmare complaint in post-traumatic stress disorder.

Posttraumatic stress disorder (PTSD) patients with comorbid panic disorder (PD) may express additive symptoms of central fear system disturbance. They endorse elevated levels of sleep and nightmare disturbance [Leskin GA, et al., J Psychiatr Res 2002;36:449-452], and demonstrate movement suppression during laboratory sleep [Woodward SH, et al., Sleep 2002;25:681-688]. We estimated respiratory rate and rate variability separately for rapid-eye movement (REM) and non-rapid-eye movement (NREM) sleep. Subjects were 49 Vietnam combat-related PTSD inpatients (11 with comorbid PD and 38 without) and 15 controls. Computer-based estimates of respiratory rate and variability were derived from 10 to 18 hr of baseline sleep collected over two or three nights. Neither rate nor rate variability distinguished PTSD patients with comorbid PD from those without, or PTSD patients from controls; however, PTSD patients failed to exhibit the expected differences between REM and NREM respiratory rates. Moreover, the difference between REM and NREM respiratory rate was inversely related to a continuous measure of PTSD severity. PTSD patients with trauma-related nightmare complaint exhibited higher sleep respiration rates over both REM and NREM sleep. Conversely, in addition to slowed respiration, nightmare-free patients exhibited reduced respiratory rate variability in REM relative to NREM sleep, which was a reversal of the normal pattern. These finding are discussed in light of known telencephalic regulatory influences upon respiration rate.

Pentagon Family Assistance Center inter-agency mental health collaboration and response.

After the September 11, 2001 terrorist attack on the Pentagon, the Department of Defense established a Family Assistance Center to provide a single source of information and services for the families of those missing and deceased. Twice daily briefings were conducted for families by top Department of Defense leadership so that information provided was timely, accurate, and authoritative. Within the Pentagon Family Assistance Center, families were able to receive mental health, spiritual, financial, legal, and benefits support/counseling from a wide range of helping agencies and organizations. Family members were also provided meals, lodging assistance, and assistance with travel arrangements. This centralization of services along with a clear and coherent command structure may provide a model to be emulated in future community disasters.

Lifetime trauma history and panic disorder: findings from the National Comorbidity Survey.

OBJECTIVE: The purpose of this article is to examine prevalence of lifetime traumatic experiences in a community sample of panic disorder patients. METHOD: We examined trauma rates in a cohort of panic disorder patients. Also, we statistically disaggregated comorbid PTSD from individuals diagnosed with panic disorder in the National Comorbidity Survey. FINDINGS: Panic disorder patients suffer lifetime traumatic experiences at high rates. We found that 24.2% of females and 5% of males with panic disorder reported previous history of being sexually molested. CONCLUSIONS: These results suggest that trauma may act as a risk factor for panic disorder, as well as comorbid panic disorder and PTSD.

Effects of comorbid diagnoses on sleep disturbance in PTSD.

OBJECTIVE: Patients with post-traumatic stress disorder (PTSD) are frequently diagnosed with other psychiatric comorbid conditions. This study tested the hypothesis that PTSD patients suffer a greater proportion of sleep problems according to comorbid diagnoses. METHOD: National Comorbidity Survey (NCS) data from 591 individuals diagnosed with PTSD were analyzed. Revised versions of the Diagnostic Interview Schedule and Composite International Diagnostic Interview were administered to a representative sample of males and females. Groups consisted of patients diagnosed with lifetime PTSD and with current comorbid panic disorder, major depressive disorder, generalized anxiety disorder, and alcohol dependence. RESULTS: Patients diagnosed with PTSD/panic disorder reported a significantly greater proportion of nightmare complaints (96%) and insomnia (100%) compared with the other comorbid groups. CONCLUSIONS: A greater proportion of PTSD patients with comorbid panic disorder complain of sleep-related problems than other comorbid groups. This effect appears unique to panic, rather than other general anxiety disorder or depression. Prospective sleep studies are needed to differentiate the role of sleep in PTSD and PD, as well as to examine the role of psychiatric comorbidity in worsening sleep in PTSD patients.

Movement during sleep: associations with posttraumatic stress disorder, nightmares, and comorbid panic disorder.

STUDY OBJECTIVES: To corroborate findings from the National Comorbidy study with objective sleep data. DESIGN: Retrospective data review. SETTING: Sleep Laboratory, National Center for Posttraumatic Stress Disorder PARTICIPANTS: Male Vietnam combat veteran. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: We reanalyzed laboratory sleep data obtained from subjects undergoing inpatient treatment for posttraumatic stress disorder. Comorbid panic disorder was not associated with a significant worsening of objective sleep in this sample. Posttraumatic stress disorder, comorbid panic disorder, and trauma-related nightmare complaint were all associated with significant and systematic reductions of sleep movement time. Analyses of potential "rescoring" artifacts provided further support for this effect. CONCLUSIONS: A curvilinear function may describe the relationship between anxiety symptom severity and sleep-movement time in both posttraumatic stress disorder and panic disorder. Evidence for movement suppression in association with pathologic levels of human anxiety is consistent with the suppression of movement ("freezing") exhibited by animals under conditions of perceived threat.

Gender differences in panic disorder: findings from the National Comorbidity Survey.

OBJECTIVE: Several epidemiological studies have demonstrated a higher prevalence of panic disorder in women than in men. This study explored whether the prevalence of specific panic symptoms differs by gender. METHOD: National Comorbidity Survey data from 609 respondents who met DSM-III-R criteria for panic disorder or panic attacks were analyzed to test for gender differences across 18 panic symptoms. RESULTS: Among National Comorbidity Survey respondents with panic disorder or panic attacks, female respondents were more likely than male respondents to experience respiration-related difficulties during panic attacks. CONCLUSIONS: Specific symptoms occurring during panic attacks differ by gender. The pathophysiology of these symptom differences may involve gender differences in sensitivity to CO(2) and in the threshold for panic attacks during hypoxic and hypercapnic states.