nach oben

Journal of Behavioral Medicine

Erschienen in:

01.06.2014

Treatment-related reductions in PTSD and changes in physical health symptoms in women

verfasst von: Jillian C. Shipherd, Gretchen Clum, Michael Suvak, Patricia A. Resick

Erschienen in: Journal of Behavioral Medicine | Ausgabe 3/2014

Einloggen, um Zugang zu erhalten

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.

The orthogonal linear contrasts when using seven data points are −3, −2, −1, 0, 1, 2, 3 and 5, 0, −3, −4, −3, 0, 5 for the linear and quadratic parameters, respectively. One potential problem associated with using orthogonal linear contrasts is that sums of squares, and hence variance, are larger for quadratic contrasts than for linear contrasts (see Biesanz et al., 2004). To address this problem, we divided the linear and quadratic contrasts by the square root of the sums of square associated with the set of linear and quadratic contrasts, respectively, which produced the values of −.57, −.38, −.19, .00, 0.19, .38, .57 and .55, .00,−.33, −.44, −.33, .00, .55 for the linear and quadratic change components, respectively. The latter set of values still represent linear and quadratic change and they are still orthogonal (i.e., r = 0). However, the advantage of using the latter set of numbers is the variance of linear and quadratic parameters are equal.

We conducted analyses using both approaches (i.e., power polynomial and orthogonal linear contrasts). The results were the identical. However, parameter estimates of the orthogonal linear approach were easy to interpret. Therefore, we chose to report the results of the models using OPCs to model change over time.

One of the disadvantages of using the power polynomial approach is that the intercept does not correspond to initial status. The estimate of the intercept from the power polynomial model indicated that the average initial status was 29.93 (SD = 7.86).

The indirect path from a predictor variable (i.e., change in PTSD) to an outcome (i.e., changes in physical health symptoms) through an intervening variable (i.e., change NHH) is a function of the product of the path from the predictor to the mediator and the path from the mediator to the outcome (when controlling for the predictor variable). While one might surmise that this follow-up analysis was unnecessary because change in NHH was unrelated to change in physical health symptoms, it is not impossible for the significance of the product term representing the indirect effect to be statistically significant even when one of the paths contributing to the indirect effect is not statistically significant (e.g., Lebreton et al., 2009). Therefore we conducted the follow-up analyses to thoroughly explore the possibility that the relationship between changes in PTSD and changes in physical health symptoms may be accounted for by changes in NHH.

Many of the items from the PILL could be measuring physical manifestation of PTSD or anxiety more generally. We had two separate anxiety researchers review the PILL and denote items that could represent physical manifestations of PTSD or anxiety. We removed 22 (of 54) items (e.g., racing heart, out of breath, headaches, upset stomach) from the PILL that either of the researchers indicated could represent the physical manifestation of PTSD or anxiety. The revised/shortened version of the PILL was highly correlated with the full version (rs = .96, .97, .97, at the pre-treatment, post-treatment, and follow-up assessments, respectively). In addition, we conducted all of the analyses reported in the manuscript with the revised version of the PILL and the outcomes were similar.

Altemus, M., Dhabhar, F. S., & Yang, R. (2006). Immune function in PTSD. Annals of the New York Academy of Sciences, 1071, 167–183.PubMedCrossRef

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Asmundson, G. J. G., Stein, M. B., & McCreary, D. R. (2002). Posttraumatic stress disorder symptoms influence health status of deployed peacekeepers and nondeployed military personnel. Journal of Nervous and Mental Disease, 190, 807–815.PubMedCrossRef

Beckham, J. C., Crawford, A. L., Feldman, M. E., Kirby, A. C., Hertzberg, M. A., Davidson, J. R. T., et al. (1997). Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. Journal of Psychosomatic Research, 43, 379–389.PubMedCrossRef

Biesanz, J. C., Deeb-Sossa, N., Papadakis, A. A., Bollen, K. A., & Curran, P. J. (2004). The role of coding time in estimating and interpreting growth curve models. Psychological Methods, 9, 30–52.PubMedCrossRef

Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., & Charney, D. S. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90.PubMedCrossRef

Breslau, N., Kessler, R., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit area survey of trauma. Archives of General Psychiatry, 55, 626–632.PubMedCrossRef

Campbell, J. (2002). Health consequences of intimate partner violence. The Lancet, 359, 1331–1336.CrossRef

Campbell, R., Greeson, M. R., Bybee, D., & Raja, S. (2008). The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: A mediational model of posttraumatic stress disorder and physical health outcomes. Journal of Consulting and Clinical Psychology, 76, 194–207.PubMedCrossRef

Clum, G. A., Calhoun, K. S., & Kimerling, R. (2000). Associations among symptoms of depression and posttraumatic stress disorder and self-reported health in sexually assaulted women. Journal of Nervous and Mental Disease, 188, 671–678.PubMedCrossRef

Creamer, M., Elliott, P., Forbes, D., Biddle, D., & Hawthorne, G. (2006). Treatment for combat-related posttraumatic stress disorder: Two-year follow-up. Journal of Traumatic Stress, 19, 675–685.PubMedCrossRef

Dong, M., Dube, S. R., Felitti, V. J., Giles, W. H., & Anda, R. F. (2003). Adverse childhood experiences and self-reported liver disease: New insights into the causal pathway. Archives of Internal Medicine, 163, 1949–1956.PubMedCrossRef

Dutton, M. A., Green, B. L., Kaltman, S. I., Roesch, D. M., Zeffiro, T. A., & Krause, E. D. (2006). Intimate partner violence, PTSD, and adverse health outcomes. Journal of Interpersonal Violence, 21, 955–968.PubMedCrossRef

Foa, E. B. (1995). Posttraumatic Stress Diagnostic Scale (manual). Minneapolis, MN: National Computer Systems.

Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale. Psychological Assessment, 9, 445–451.CrossRef

Galovski, T. E., Monson, C., Bruce, S. E., & Resick, P. A. (2009). Does cognitive-behavioral therapy for PTSD improve perceived health and sleep impairment? Journal of Traumatic Stress, 22, 197–204.PubMedCentralPubMedCrossRef

Glover, D. A., Stuber, M., & Poland, R. E. (2006). Allostatic load in women with and without PTSD symptoms. Psychiatry: Interpersonal and Biological Processes, 69, 191–203.

Hickling, E. J., Blanchard, E. B., Schwarz, S. P., & Silverman, D. J. (1992). Headaches and motor vehicle accidents: Results of the psychological treatment of post-traumatic headache. Headache Quarterly, 3, 285–289.

Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., & Engel, C. C. (2007). Association of PTSD with somatic symptoms, health care visits, and absenteeism among Iraq War veterans. The American Journal of Psychiatry, 164, 150–153.PubMedCrossRef

Jakupcak, M., Luterek, J., Hunt, S., Conybeare, D., & McFall, M. (2008). Posttraumatic stress and its relationship to physical health functioning in a sample of Iraq and Afghanistan war veterans seeking postdeployment VA health care. Journal of Nervous and Mental Disease, 196, 425–428.PubMedCrossRef

Karoly, P., Ruehlman, L. S., & Lanyon, R. I. (2005). The assessment of adult health care orientations: development and preliminary validation of the multidimensional health profile-health functioning index (MHP-H) in a national sample. Journal of Clinical Psychology in Medical Settings, 12, 79–91.PubMedCentralPubMedCrossRef

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, R. O. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048–1060.PubMedCrossRef

Korte, S. M., Koolhaas, J. M., Wingfield, J. C., & McEwen, B. S. (2005). The Darwinian concept of stress: Benefits of allostasis and costs of allostatic load and the trade-offs in health and disease. Neuroscience and Biobehavioral Reviews, 29, 3–38.PubMedCrossRef

Lanyon, R. I., Maxwell, B. M., Karoly, P., & Ruehlman, L. S. (2007). Concurrent validity of the multidimensional health profile-health functioning scales (MHP-H) in the pre-operative assessment of applicants for gastric bypass surgery. Journal of Clinical Psychology in Medical Settings, 14, 41–49.CrossRef

Lauterbach, D., Vora, R., & Rakow, M. (2005). The relationship between posttraumatic stress disorder and self-reported health problems. Psychosomatic Medicine, 67, 939–947.PubMedCrossRef

Lebreton, J. M., Wu, J., & Bing, M. N. (2009). The truth on testing for mediation in the social and organizational sciences. In C. E. Lance & R. J. Vandenberg (Eds.), Statistical and methodological myths and urban legends: Doctrine, verity and fable in the organizational and social sciences (pp. 107–137). New York, NY USA: Taylor & Francis Group, LLC.

Leeies, M., Pagura, J., Sareen, J., & Bolton, J. M. (2010). The use of alcohol and drugs to self-medicate symptoms of posttraumatic stress disorder. Depression and Anxiety, 27, 731–736.PubMed

Linehan, M. M., & Heard, H. L. (1992). Dialectical behavior therapy for borderline personality disorder. In J. F. Clarkin, E. Marziali, & H. Munroe-Blum (Eds.), Borderline personality disorder: Clinical and empirical perspectives (pp. 248–267). New York, NY USA: Guilford Press.

Malik, M. L., Connor, K. M., Sutherland, S. M., Smith, R. D., Davison, R. M., & Davidson, J. R. T. (1999). Quality of life and posttraumatic stress disorder: A pilot study assessing changes in SF-36 scores before and after treatment in a placebo-controlled trial of fluoxetine. Journal of Traumatic Stress, 12, 387–393.PubMedCrossRef

McArdle, J. J. (2009). Latent variable modeling of differences and changes with longitudinal data. Annual Review of Psychology, 60, 577–605.PubMedCrossRef

McEwen, B. S., & Seeman, T. (1999). Protective and damaging effects of mediators of stress: Elaborating and testing the concepts of allostasis and allostatic load. In N. E. Adler, M. Marmot, B. S. McEwen, & J. Stewart (Eds.), Socioeconomic status and health in industrial nations: Social, psychological, and biological pathways (pp. 30–47). New York, NY USA: New York Academy of Sciences.

McEwen, B. S., & Wingfield, J. C. (2003). The concept of allostasis in biology and biomedicine. Hormones and Behavior, 43, 2–15.PubMedCrossRef

Meredith, W., & Tisak, J. (1990). Latent curve analysis. Psychometrika, 55, 107–122, as cited in Muthen, L. K., & Muthen, B. O. (2007). Mplus user’s guide (5th ed.). Los Angeles, CA: Author.

Muse, M. (1986). Stress-related, posttraumatic chronic pain syndrome: Behavioral treatment approach. Pain, 25, 389–394.PubMedCrossRef

Muthen, L. K., & Muthen, B. O. (1998). Mplus User’s Guide (6th ed.). Los Angeles, CA: Muthen & Muthen.

Norman, S. B., Means-Christensen, A. J., Craske, M. G., Sherbourne, C. D., Roy-Byrne, P. P., & Stein, M. B. (2006). Associations between psychological trauma and physical illness in primary care. Journal of Traumatic Stress, 19, 461–470.PubMedCrossRef

Norris, F. H. (1992). Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology, 60, 409–418.PubMedCrossRef

Pennebaker, J. W. (1982). The psychology of physical symptoms. New York: Springer.CrossRef

Ployhart, R. E., Holtz, B. C., & Bliese, P. D. (2002). Longitudinal data analysis: Applications of random coefficient modeling to leadership research. The Leadership Quarterly, 13, 455–486.CrossRef

Rasmusson, A. M., Schnurr, P. P., Zukowska, Z., Scioli, E., & Forman, D. E. (2010). Adaptation to extreme stress: Post-traumatic stress disorder, neuropeptide Y and metabolic syndrome. Experimental Biology and Medicine (Maywood), 235, 1150–1162.CrossRef

Rauch, S. A. M., Grunfeld, T. E. E., Yadin, E., Cahill, S. P., Hembree, E., & Foa, E. B. (2009). Changes in reported physical health symptoms and social function with prolonged exposure therapy for chronic posttraumatic stress disorder. Depression and Anxiety, 26, 732–738.PubMedCrossRef

Rauch, S. A. M., Morales, K. H., Zubritsky, C., Knott, K., & Oslin, D. (2006). Posttraumatic stress, depression, and health among older adults in primary care. The American Journal of Geriatric Psychiatry, 14, 316–324.PubMedCrossRef

Resick, P. A., Galovski, T. E., Uhlmansiek, M. O. B., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243–258.PubMedCentralPubMedCrossRef

Resnick, H. S., Acierno, R., & Kilpatrick, D. G. (1997). Health impact of interpersonal violence 2: Medical and mental health outcomes. Behavioral Medicine, 23, 65–78.PubMedCrossRef

Rheingold, A. A., Acierno, R., & Resnick, H. S. (2004). Trauma, posttraumatic stress disorder, and health risk behaviors. In P. P. Schnurr & B. L. Green (Eds.), Trauma and health: Physical health consequences of exposure to extreme stress (pp. 217–243). Washington, DC USA: American Psychological Association.CrossRef

Ruehlman, L. S., Lanyon, R. I., & Karoly, P. (1999). Development and validation of the multidimensional health profile. Part I: Psychosocial functioning. Psychological Assessment, 11, 166–176.PubMedCentralPubMedCrossRef

Sareen, J., Cox, B. J., Stein, M. B., Afifi, T. O., Fleet, C., & Asmundson, G. J. G. (2007). Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosomatic Medicine, 69, 242–248.PubMedCrossRef

Schnurr, P. P., & Green, B. L. (2004). Understanding relationships among trauma, PTSD, and health outcomes. Advances in Pain and Research Therapy, 20, 18–29.

Schnurr, P. P., Hayes, A. F., Lunney, C. A., McFall, M., & Uddo, M. (2006). Longitudinal analysis of the relationship between symptoms and quality of life in veterans treated for PTSD. Journal of Consulting and Clinical Psychology, 74, 707–713.PubMedCrossRef

Schnurr, P. P., & Jankowski, M. K. (1999). Physical health and post-traumatic stress disorder: Review and synthesis. Seminars in Clinical Neuropsychiatry, 4, 295–304.PubMed

Schnurr, P. P., & Spiro, A. (1999). Combat disorder, posttraumatic stress disorder symptoms, and health behaviors as predictors of self-reported physical health in older veterans. Journal of Nervous and Mental Disease, 187, 353–359.PubMedCrossRef

Schnurr, P. P., Spiro, A., & Paris, A. H. (2000). Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans. Health Psychology, 19, 91–97.PubMedCrossRef

Shiner, B., Watts, B. V., Pomerantz, A., Young-Xu, Y., & Schnurr, P. P. (2011). Sensitivity of the SF-36 to PTSD symptom change in veterans. Journal of Traumatic Stress, 24, 111–115.PubMedCrossRef

Shipherd, J. C., Beck, J. G., Hamblen, J. L., Lackner, J. M., & Freeman, J. B. (2003). A preliminary examination of treatment for posttraumatic stress disorder in chronic pain patients: A case study. Journal of Traumatic Stress, 16, 451–457.PubMedCrossRef

Shipherd, J. C., Keyes, M., Jovanovic, T., Ready, D. J., Baltzell, D., Worley, V., et al. (2007). Veterans seeking treatment for posttraumatic stress disorder: What about comorbid chronic pain? Journal of Rehabilitation Research and Development, 44, 153–166.PubMedCrossRef

Shipherd, J. C., Pineles, S. L., Gradus, J. L., & Resick, P. A. (2009). Sexual harassment in the Marines, posttraumatic stress symptoms, and perceived health: Evidence for sex differences. Journal of Traumatic Stress, 22, 3–10.PubMedCrossRef

Smith, B. N., Shipherd, J. C., Schuster, J. L., Vogt, D. S., King, L. A., & King, D. W. (2011). Posttraumatic stress symptomatology as a mediator of the association between military sexual trauma and post-deployment physical health in women. Journal of Trauma & Dissociation, 12, 275–289.CrossRef

Taft, C. T., Stern, A. S., King, L. A., & King, D. W. (1999). Modeling physical health and functional health status: The role of combat exposure, posttraumatic stress disorder, and personal resource attributes. Journal of Traumatic Stress, 12, 3–23.PubMedCrossRef

Wald, J., & Taylor, S. (2006). Trauma to the psyche and soma: A case study of posttraumatic stress disorder and comorbid problems arising from a road traffic collision. Cognitive and Behavioral Practice, 13, 1–7.CrossRef

Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66, 579–592.PubMedCrossRef

Walsh, K., DiLillo, D., & Scalora, M. J. (2011). The cumulative impact of sexual revictimization on emotion regulation difficulties: An examination of female inmates. Violence Against Women, 17, 1103–1118.PubMedCentralPubMedCrossRef

Weaver, T. L., Nishith, P., & Resick, P. A. (1998). Prolonged exposure therapy and irritable bowel syndrome: A case study examining the impact of a trauma-focused treatment on a physical condition. Cognitive and Behavioral Practice, 5, 103–122.PubMedCentralPubMedCrossRef

Weisberg, R. B., Bruce, S. E., Machan, J. T., Kessler, R. C., Culpepper, L., & Keller, M. B. (2002). Nonpsychiatric illness among primary care patients with trauma histories and posttraumatic stress disorder. Psychiatric Services, 53, 848–854.PubMedCrossRef

Zoellner, L. A., Goodwin, M. L., & Foa, E. B. (2000). PTSD severity and health perceptions in female victims of sexual assault. Journal of Traumatic Stress, 13, 635–649.PubMedCrossRef

Titel: Treatment-related reductions in PTSD and changes in physical health symptoms in women
verfasst von: Jillian C. Shipherd
Gretchen Clum
Michael Suvak
Patricia A. Resick
Publikationsdatum: 01.06.2014
Verlag: Springer US
Erschienen in: Journal of Behavioral Medicine / Ausgabe 3/2014
Print ISSN: 0160-7715
Elektronische ISSN: 1573-3521
DOI: https://doi.org/10.1007/s10865-013-9500-2

Neu im Fachgebiet Psychiatrie

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

23.04.2024 Depression antepartal oder postpartal Nachrichten

Bislang gibt es kein Medikament zur Prävention von Wochenbettdepressionen. Das Injektionsanästhetikum Esketamin könnte womöglich diese Lücke füllen.

„Psychotherapie ist auch bei sehr alten Menschen hochwirksam!“

22.04.2024 DGIM 2024 Kongressbericht

Die Kombination aus Medikamenten und Psychotherapie gilt als effektivster Ansatz bei Depressionen. Das ist bei betagten Menschen nicht anders, trotz Besonderheiten.

Auf diese Krankheiten bei Geflüchteten sollten Sie vorbereitet sein

22.04.2024 DGIM 2024 Nachrichten

Um Menschen nach der Flucht aus einem Krisengebiet bestmöglich medizinisch betreuen zu können, ist es gut zu wissen, welche Erkrankungen im jeweiligen Herkunftsland häufig sind. Dabei hilft eine Internetseite der CDC (Centers for Disease Control and Prevention).

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2014

An online stress management workbook for breast cancer

Perceived susceptibility to AIDS predicts subsequent HIV risk: a longitudinal evaluation of jail inmates

Resilience in the year after cancer diagnosis: a cross-lagged panel analysis of the reciprocity between psychological distress and well-being

Relationships between discrimination in health care and health care outcomes among four race/ethnic groups

Longitudinal measurement invariance, stability and change of anger and cynicism