Cardiovascular risk in relation to posttraumatic stress disorder in young women

描述（申请人提供）：研究揭示了创伤后应激障碍（PTSD）与心血管健康状况不佳之间的关系。这一证据主要涉及对表现出心血管疾病临床症状的退伍军人进行回顾性检查。许多平民也遭受创伤后应激障碍造成的事件，如性虐待/强奸，身体攻击，和车祸。患有创伤后应激障碍的平民，特别是妇女，在心血管风险方面的研究不足。识别心血管疾病的危险因素是2010年健康人的一项重要举措，对疾病预防和及时干预具有重要意义。研究无心血管疾病的年轻PTSD患者的心血管危险因素可能对理解PTSD如何导致心血管疾病的风险至关重要。在少数研究PTSD患者心血管疾病风险的研究中，风险因素聚类尚未得到系统评估。本研究的主要目的是比较被诊断为PTSD的年轻女性（18-39岁）与抑郁症（无PTSD）和非精神病学对照组的心血管疾病危险因素、心血管反应性和心理应激源的恢复情况。由于抑郁症通常与PTSD同时发生，并且与CVD风险和心血管反应性相关，因此确定PTSD是否比抑郁症状具有更大的风险至关重要。第二个目的是研究应激的认知评估是否介导PTSD与CVD风险和反应性/恢复的关系。创伤后应激障碍组将从创伤恢复诊所和社区精神健康诊所招募。抑郁症组将从成人服务诊所和社区精神健康诊所招募。对照组将从社区中招募。诊断性访谈将决定纳入研究小组。具体而言，假设1)PTSD组比对照组有更多的心血管疾病危险因素，2)PTSD参与者的每个危险因素在连续风险上都更高，3)PTSD组的血压（BP）和总外周抵抗反应性高于对照组；PTSD和抑郁组的心率和心输出量反应性相当，且高于非精神病组。4)PTSD组的血压和外周阻力恢复低于对照组；PTSD和抑郁组的心率和心输出量恢复与非精神病组相当，但心率和心输出量恢复低于非精神病组；5)威胁的认知评价将中介诊断组与血压和外周抵抗反应性/恢复的关系；6)认知评价将中介诊断组与心血管危险因素的关系。公共卫生相关性：该项目将有助于确定改善遭受创伤后压力的妇女健康的方法。这项研究将为制定降低健康风险和/或压力管理计划提供所需的信息，如果与标准谈话疗法一起使用，可能会降低心脏病的发病率。

DESCRIPTION (provided by applicant): Research has revealed a relationship between posttraumatic stress disorder (PTSD) and poor cardiovascular health. This evidence primarily involves retrospective examinations among combat veterans who exhibit clinical symptoms of cardiovascular disease (CVD). Many civilians also suffer from PTSD resulting from incidents such as sexual abuse/rape, physical assault, and automobile accidents. Civilians with PTSD, women in particular, have been understudied with regard to cardiovascular risk. The identification of risk factors for CVD is a critical initiative of Healthy People 2010, and has implications for disease prevention and timely intervention. Studies of cardiovascular risk factors in young adults with PTSD and no current CVD may be critical in understanding how PTSD confers risk for CVD. Among the few studies that have examined CVD risk in PTSD, risk factor clustering has not been systematically assessed. The primary objective of the proposed study is to compare CVD risk factors, and cardiovascular reactivity and recovery in response to psychological stressors, of young women (ages 18-39) diagnosed with PTSD compared with both a depression (no-PTSD) and a non-psychiatric comparison group. Because depression often co-occurs with PTSD and is associated with both CVD risk and cardiovascular reactivity, it is critical to determine whether PTSD confers any greater risk than depressive symptoms. A second objective is to examine whether cognitive appraisals of stress mediate the relationships of PTSD with CVD risk and reactivity/recovery. The PTSD group will be recruited from a trauma recovery clinic and community mental health clinic. The depression group will be recruited from an adult services clinic and community mental health clinic. The control group will be recruited from community. Diagnostic interviews will determine inclusion in the study groups. Specifically, it is hypothesized that 1) the PTSD group will evidence a greater number of CVD risk factors than the comparison groups, 2) for each risk factor participants with PTSD will be higher on the continuum of risk, 3) the PTSD group will have greater blood pressure (BP) and total peripheral resistance reactivity than the comparison groups; the PTSD and depression groups will exhibit comparable HR and cardiac output reactivity, and greater HR and cardiac output reactivity than the non-psychiatric group, 4) the PTSD group will evidence less BP and peripheral resistance recovery than the comparison groups; the PTSD and depression groups will display comparable HR and cardiac output recovery, and less HR and cardiac output recovery than the non-psychiatric group, 5) cognitive appraisals of threat will mediate the relationships of diagnostic group to BP and peripheral resistance reactivity/recovery, and 6) cognitive appraisals will mediate the relationships of diagnostic group to the cardiovascular risk factors. PUBLIC HEALTH RELEVANCE: This project will help to identify ways of improving health for women who experience posttraumatic stress. This study will provide information needed to develop health risk reduction and/or stress management programs, which could reduce rates of heart disease if used along with standard talk therapies.