Hostility, PTSD and Physical Health Risk Factors

敌意、创伤后应激障碍和身体健康风险因素

• 批准号: 8065317
• 负责人: JEAN C. BECKHAM
• 金额: $ 1.73万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-18 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8065317
• 关键词: Affect; Affective; Age; Anger; Area; Arts; Attenuated; Autonomic nervous system; Baroreflex; Beck depression inventory; Behavior; Behavioral; Belief; Biological Markers; Blood Pressure; Blood Vessels; Body mass index; Cardiac; Cardiovascular system; Characteristics; Circadian Rhythms; Clinical Markers; Cognitive; Comorbidity; Complement component C1s; Control Groups; Data; Development; Diagnosis; Diagnostic; Disease; Equation; Evaluation; Exercise; Funding; Gender; Goals; Health; Heart; Heart Rate; Homeostasis; Hostility; Hour; Hypertension; Individual; Insulin Resistance; Knowledge; Laboratories; Lead; Lipids; Major Depressive Disorder; Measurement; Measures; Mediating; Medical; Mental Depression; Mental disorders; Metabolic; Metabolic Diseases; Metabolic syndrome; Methods; Minority; Modeling; Morbidity - disease rate; National Institute of Mental Health; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Parasympathetic Nervous System; Participant; Patient Self-Report; Patients; Pattern; Physicians; Post-Traumatic Stress Disorders; Pressoreceptors; Psychopathology; Psychophysiology; Recovery; Relative (related person); Reporting; Research; Respondent; Risk; Risk Factors; Risk Reduction; Sampling; Severities; Sleep; Smoke; Smoking; Smoking Status; Social support; Socioeconomic Status; Staging; Symptoms; Testing; Trauma; Variant; Veterans; Woman; Work; brachial artery; cardiovascular risk factor; cohort; diaries; health care service utilization; heart rate variability; high risk; men; mortality; physical conditioning; pre-clinical; programs; psychologic; public health relevance; response

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) and high hostility are significant risk factors for poor health. We have begun to identify a number of behavioral and psychophysiological variables that may contribute to this increased risk. Research in the last funding period (NIMH R01MH62482) indicated, for example, that PTSD veterans smoke more, have higher lipids, report poorer objective sleep and more daily negative affect. Findings that ambulatory heart rate is higher, and blood pressure recovery to a stressful task is slower in hostile veterans with PTSD suggest that the autonomic nervous system may be involved in the increased risk in PTSD veterans with high hostility. We also documented a close association between the severity of PTSD and reduced levels of heart rate variability in women. In addition, individuals with PTSD have reduced sleep duration and sleep efficiency, which may lead to reduced levels of ambulatory heart rate variability. Pilot data from this period also suggest an increased rate of metabolic syndrome in our participants with PTSD. Although previous work has demonstrated a relationship between PTSD and reduced parasympathetic nervous system control of the heart under controlled laboratory conditions, no study has evaluated autonomic responses across a 24-hour period outside the laboratory. Taken together, this program of research suggests that PTSD and hostility increase cardiovascular and metabolic risk factors and may contribute to increased risk of poorer health outcomes and cardiovascular mortality. The proposed study will evaluate whether PTSD in a younger cohort is associated with biomarkers of cardiovascular risk measured from vascular endothelial function, 24-hour heart rate variability, and baroreflex sensitivity, and will determine whether the biomarkers of risk are highest among individuals with PTSD and high hostility. Parallel analyses will evaluate whether PTSD is related to insulin resistance and risk of metabolic syndrome. As depression has also been related to cardiovascular risk factors, we will evaluate the independent effects of PTSD by comparing two groups of patients with PTSD including those with and without co-morbid major depressive disorder. The project goals are to examine: (1) the independent relationship between PTSD and biomarkers of cardiovascular and metabolic disease and (2) the contribution of hostility as a moderator and co-morbid major depressive disorder to the relationship between PTSD and biomarkers of cardiovascular and metabolic disease. Study results will serve to inform development of risk reduction strategies in individuals with PTSD early in the trajectory of their disorder. In addition, this study should significantly advance knowledge about the mechanisms that are involved in the increased risk of mortality associated with PTSD. By evaluating possible mechanisms that may be specific to or amplified in a psychiatric patient sample, we may gain a more complete understanding of the psychopathological mechanisms in health effects of psychiatric disorder. PUBLIC HEALTH RELEVANCE: Posttraumatic stress disorder (PTSD) is a prevalent mental disorder in both men and women, and those with PTSD have a greater risk of cardiovascular and metabolic morbidity and mortality. This study will provide important information on the development of cardiovascular and metabolic disease biomarkers in younger individuals with PTSD.

描述（由申请人提供）：创伤后应激障碍（PTSD）和高度敌意是健康状况不佳的重要风险因素。我们已经开始确定一些可能导致这种风险增加的行为和心理生理变量。例如，上一个资助期的研究（NIMH R01MH62482）表明，创伤后应激障碍（PTSD）退伍军人吸烟更多，血脂更高，客观睡眠质量较差，日常负面情绪更多。研究发现，患有 PTSD 的敌对退伍军人的动态心率较高，并且血压恢复到压力任务的速度较慢，这表明自主神经系统可能与高度敌对的 PTSD 退伍军人的风险增加有关。我们还记录了女性 PTSD 严重程度与心率变异性降低之间的密切关系。此外，患有创伤后应激障碍（PTSD）的人睡眠持续时间和睡眠效率降低，这可能导致动态心率变异性水平降低。这一时期的试点数据还表明，患有创伤后应激障碍（PTSD）的参与者中代谢综合征的发病率有所增加。尽管之前的工作已经证明了 PTSD 与在受控实验室条件下副交感神经系统对心脏的控制减弱之间存在关系，但没有研究评估实验室外 24 小时内的自主反应。总而言之，该研究项目表明，创伤后应激障碍和敌意会增加心血管和代谢危险因素，并可能导致健康状况不佳和心血管死亡的风险增加。拟议的研究将评估年轻队列中的 PTSD 是否与通过血管内皮功能、24 小时心率变异性和压力反射敏感性测量的心血管风险生物标志物相关，并将确定风险生物标志物是否在 PTSD 患者和 PTSD 患者中最高。高度敌意。并行分析将评估 PTSD 是否与胰岛素抵抗和代谢综合征风险相关。由于抑郁症也与心血管危险因素有关，因此我们将通过比较两组 PTSD 患者（包括患有和不患有共病重度抑郁症的患者）来评估 PTSD 的独立影响。该项目的目标是检查：(1) PTSD 与心血管和代谢疾病生物标志物之间的独立关系，以及 (2) 敌意作为调节因素和共病重度抑郁症对 PTSD 与心血管和代谢疾病生物标志物之间关系的贡献。代谢性疾病。研究结果将有助于为患有创伤后应激障碍（PTSD）的个体在疾病发展的早期阶段制定降低风险的策略提供信息。此外，这项研究应该显着增进对与 PTSD 相关的死亡风险增加的机制的认识。通过评估精神病患者样本中可能特有或放大的可能机制，我们可以更全面地了解精神疾病对健康影响的精神病理学机制。公共卫生相关性：创伤后应激障碍 (PTSD) 是男性和女性中普遍存在的精神障碍，患有 PTSD 的人心血管和代谢疾病发病和死亡的风险更大。这项研究将为患有创伤后应激障碍的年轻个体心血管和代谢疾病生物标志物的发展提供重要信息。