Clinically Meaningful PTSD Improvement: Reducing Risk for Adverse Outcomes in Comorbid Cardiometabolic Disease
具有临床意义的 PTSD 改善:降低共病心脏代谢疾病不良后果的风险
基本信息
- 批准号:10683312
- 负责人:
- 金额:$ 41.43万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2022
- 资助国家:美国
- 起止时间:2022-08-15 至 2025-06-30
- 项目状态:未结题
- 来源:
- 关键词:AccountingAddressAdverse eventAfrican AmericanAgeArousalCardiac rehabilitationCardiometabolic DiseaseCardiovascular DiseasesCessation of lifeCharacteristicsChronic DiseaseClinicalClinical TrialsCognitionComplications of Diabetes MellitusConfounding Factors (Epidemiology)DSM-VDataData CollectionData SourcesDiabetes MellitusDiagnosisDiseaseDisease ManagementDisease OutcomeDisparityFundingFutureGenderGoalsGrantGuidelinesHealth behaviorHigh PrevalenceHospitalizationHypertensionIndividualKnowledgeLaboratoriesLinkLiteratureMeasuresMediatingMediatorMedical RecordsMental DepressionMental disordersMinorityMoodsMyocardial InfarctionNational Heart, Lung, and Blood InstituteNon-Insulin-Dependent Diabetes MellitusOutcomePatientsPersonsPharmaceutical PreparationsPhenotypePost-Traumatic Stress DisordersPremature MortalityProviderPsychotherapyRaceRecurrenceReduce health disparitiesResearchResidual stateRiskRisk FactorsRisk ReductionSamplingSelf CareSeveritiesStrokeSymptomsTestingTimeTreatment outcomeUnderrepresented PopulationsUnited StatesUnited States Department of Veterans AffairsVeterans Health AdministrationWorkadverse outcomeage groupassociated symptomblood pressure controlburden of illnesscardiometabolismcomorbiditydesigndisparities in morbiditydisparity reductionexperienceglycemic controlhealth disparityimprovedimproved outcomeindexingmedication compliancemodifiable riskmortalitypublic health prioritiesracial populationreduce symptomstreatment guidelines
项目摘要
Posttraumatic stress disorder (PTSD) is the 4th most common, non-substance related, psychiatric disorder in
the United States. Patients with PTSD vs. those without have a significantly greater risk for type 2 diabetes
(T2D) and cardiovascular disease (CVD) and mortality. Determining if PTSD improvement is associated with
addresses NHLBI priorities and informs efforts to reduce health
disparities related to psychiatric disorders. But even in patients who experience improvement, residual PTSD
symptoms may contribute to adverse T2D/CVD outcomes. Thus, it is important to determine which PTSD
symptoms or combination of symptoms are most strongly associated with adverse T2D/CVD outcomes in
patients with comorbid PTSD and T2D or CVD.
better T2D/CVD outcomes and lower mortality
This proposal builds on our past 4-years of funded research
We now move our
focus away from incident T2D/CVD to outcomes in comorbid PTSD and T2D/CVD. There are no studies that
have determined if patients with comorbid PTSD and T2D or CVD who do vs. do not have clinically meaningful
PTSD improvement are at lower risk for adverse T2D/CVD outcomes and death. There are no studies which
have determined if specific PTSD symptoms (e.g., hyperarousal) or combination of symptoms are associated
with adverse T2D/CVD outcomes and mortality. Our design determines if PTSD improvement is followed by
better T2D/CVD outcomes and whether this is mediated by disease management variables such as medication
adherence.
focused on PTSD treatment and improved health behaviors, and incident T2D and CVD.
We do not study a specific type of PTSD therapy because we want to demonstrate whether PTSD
is a modifiable risk factor for T2D/CVD adverse outcomes and mortality. As in the prior funding period, we use
Department of Veterans Affairs’ medical record data. This is an ideal ‘laboratory’ to test our hypotheses. In a
10 year observation period (2012-2022) we will sample 15,193 patients with PTSD and comorbid T2D and
17,442 patients with PTSD and comorbid CVD. Our aims are 1) determine if separate PTSD phenotypes
(derived from latent class analysis of PTSD symptoms), and symptom change, in patients with comorbid PTSD-
T2D/CVD, are differentially associated with an increased risk for adverse T2D and CVD outcomes, including
disease related and all-cause mortality, 2) determine whether risks for adverse T2D and CVD outcomes, all-
cause and cause specific mortality are lower in patients with vs. without a clinically meaningful PTSD
improvement
; 3) determine if measures of T2D/CVD management, such as good glycemic control, statin
medication adherence and improved depression, mediate the association between clinically meaningful PTSD
improvement and T2D/ CVD outcomes.
and 4) conduct planned age, gender, and race sub-group
comparisons. Decades of research on depression and T2D/CVD led to guidelines that acknowledge
depression as a risk factor for poor CVD outcomes. Positive results and confirmatory studies may eventually
lead to similar guidelines that advise providers to screen and treat PTSD to improve T2D/CVD outcomes.
创伤后应激障碍(PTSD)是美国第四大常见的非物质相关精神疾病,
美国的患有PTSD的患者与没有PTSD的患者相比,患2型糖尿病的风险明显更高
(T2D)心血管疾病(CVD)和死亡率。确定PTSD的改善是否与
解决NHLBI的优先事项,并为减少健康
与精神疾病有关的差异。但即使在经历了改善的患者中,
这些症状可能导致不良的T2 D/CVD结局。因此,重要的是要确定哪些PTSD
症状或症状组合与T2 D/CVD不良结局关系最密切,
患有PTSD和T2 D或CVD的患者。
更好的T2 D/CVD结局和更低的死亡率
这项提案建立在我们过去4年的资助研究基础上
我们现在把我们的
将注意力从T2 D/CVD事件转移到PTSD和T2 D/CVD共病的结果。没有研究
我已经确定了患有PTSD和T2 D或CVD共病的患者是否具有临床意义,
PTSD改善对不良T2 D/CVD结局和死亡的风险较低。没有研究表明,
已经确定是否有特定的创伤后应激障碍症状(例如,过度觉醒)或症状组合相关
T2 D/CVD的不良结局和死亡率。我们的设计决定了PTSD的改善是否会伴随着
更好的T2 D/CVD结局,以及这是否由疾病管理变量(如药物)介导
坚持。
专注于PTSD治疗和改善健康行为,以及T2 D和CVD事件。
我们不研究特定类型的PTSD治疗,因为我们想证明PTSD是否
是T2 D/CVD不良结局和死亡率的可改变风险因素。与上一个融资期一样,我们使用
退伍军人事务部的医疗记录数据。这是一个理想的“实验室”来测试我们的假设。中
10年观察期(2012-2022年),我们将对15,193例PTSD和共病T2 D患者进行抽样,
17,442例PTSD和共病CVD患者。我们的目标是1)确定是否单独的PTSD表型
(来自PTSD症状的潜在类别分析)和症状变化,在共病PTSD患者中,
T2 D/CVD与不良T2 D和CVD结局的风险增加差异相关,包括
疾病相关死亡率和全因死亡率,2)确定T2 D和CVD不良结局的风险,所有-
与没有临床意义的PTSD患者相比,PTSD患者的病因和病因特异性死亡率较低
改进
3)确定T2 D/CVD管理的措施,如良好的血糖控制、他汀类药物
药物依从性和改善抑郁,介导临床意义的PTSD之间的关联
改善和T2 D/ CVD结局。
和4)进行计划的年龄、性别和种族分组
比较。数十年来对抑郁症和T2 D/CVD的研究导致了承认
抑郁症是CVD不良结局的危险因素。积极的结果和验证性研究可能最终
导致类似的指导方针,建议提供者筛选和治疗PTSD,以改善T2 D/CVD的结果。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Jeffrey F. Scherrer其他文献
Self-Reported Lifetime Depression and Current Mental Distress Among Veterans Across Service Eras.
各服役时期退伍军人自我报告的终生抑郁症和当前精神困扰。
- DOI:
- 发表时间:
2017 - 期刊:
- 影响因子:1.2
- 作者:
E. Boakye;P. Buchanan;Jing Wang;L. Stringer;Christian Geneus;Jeffrey F. Scherrer - 通讯作者:
Jeffrey F. Scherrer
Is obesity associated with odds of prescription opioid use independent of depression?
肥胖与处方阿片类药物使用的几率相关,与抑郁无关吗?
- DOI:
10.1097/j.pain.0000000000002105 - 发表时间:
2021 - 期刊:
- 影响因子:7.4
- 作者:
Jeffrey F. Scherrer;M. Sullivan - 通讯作者:
M. Sullivan
Endothelin-C-terminal hexapeptide increases grooming in mice
内皮素 C 末端六肽可增强小鼠的梳理行为
- DOI:
10.1016/0091-3057(94)90216-x - 发表时间:
1994 - 期刊:
- 影响因子:3.6
- 作者:
Jeffrey F. Scherrer;J. Morley;J. Flood - 通讯作者:
J. Flood
Response and Rebuttal to Editorial Comment Regarding "Sexual Dysfunction in Primary Care: An Exploratory Descriptive Analysis of Medical Record Diagnoses".
对有关“初级保健中的性功能障碍:病历诊断的探索性描述性分析”的编辑评论的回应和反驳。
- DOI:
10.1016/j.jsxm.2017.11.011 - 发表时间:
2018 - 期刊:
- 影响因子:0
- 作者:
K. Heiden;J. Salas;S. Gebauer;M. Witthaus;Jeffrey F. Scherrer;Kristin McDaniel;D. Carver - 通讯作者:
D. Carver
Achievement of glycemic control and antidepressant medication use in comorbid depression and type 2 diabetes.
共病抑郁症和 2 型糖尿病的血糖控制和抗抑郁药物使用的成就。
- DOI:
- 发表时间:
2022 - 期刊:
- 影响因子:6.6
- 作者:
Jay A Brieler;J. Salas;Elizabeth Keegan;Jeffrey F. Scherrer - 通讯作者:
Jeffrey F. Scherrer
Jeffrey F. Scherrer的其他文献
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{{ truncateString('Jeffrey F. Scherrer', 18)}}的其他基金
Clinically Meaningful PTSD Improvement: Reducing Risk for Adverse Outcomes in Comorbid Cardiometabolic Disease
具有临床意义的 PTSD 改善:降低共病心脏代谢疾病不良后果的风险
- 批准号:
10510354 - 财政年份:2022
- 资助金额:
$ 41.43万 - 项目类别:
Pathways from Chronic Prescription Opioid Use to New Onset Mood Disorder
从长期处方阿片类药物使用到新发情绪障碍的途径
- 批准号:
10348114 - 财政年份:2019
- 资助金额:
$ 41.43万 - 项目类别:
Pathways from Chronic Prescription Opioid Use to New Onset Mood Disorder
从长期处方阿片类药物使用到新发情绪障碍的途径
- 批准号:
9908067 - 财政年份:2019
- 资助金额:
$ 41.43万 - 项目类别:
Pathways from Chronic Prescription Opioid Use to New Onset Mood Disorder
从长期处方阿片类药物使用到新发情绪障碍的途径
- 批准号:
10553647 - 财政年份:2019
- 资助金额:
$ 41.43万 - 项目类别:
A Big Data Research Study on the Relationship Between Metformin Use and Dementia
二甲双胍使用与痴呆症关系的大数据研究
- 批准号:
9289078 - 财政年份:2017
- 资助金额:
$ 41.43万 - 项目类别:
PTSD Treatment: Effects on Health Behavior, Cardiovascular and Metabolic Disease
PTSD 治疗:对健康行为、心血管和代谢疾病的影响
- 批准号:
9265123 - 财政年份:2016
- 资助金额:
$ 41.43万 - 项目类别:
Prescription Opioid Analgesics and Risk of Major Depression
处方阿片类镇痛药与重度抑郁症的风险
- 批准号:
8700918 - 财政年份:2014
- 资助金额:
$ 41.43万 - 项目类别:
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