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）和高敌意是健康不良的重要危险因素。我们已经开始确定许多行为和心理生理变量，这些变量可能导致这种风险增加。例如，在上一个资金期（NIMH R01MH62482）的研究中，例如，PTSD退伍军人吸烟更多，脂质较高，报告客观睡眠较差和每日的负面影响更多。在患有PTSD的敌对退伍军人中，气压恢复到压力的任务较慢，表明自主神经系统可能与具有高敌对性的PTSD退伍军人的风险增加有关。我们还记录了PTSD的严重程度与女性心率变异水平降低之间的密切关联。此外，患有PTSD的个体的睡眠持续时间降低和睡眠效率，这可能导致卧床心率变异性水平降低。此期间的试点数据还表明，我们参与者患有PTSD的代谢综合征率提高。尽管先前的工作表明，PTSD与受控实验室条件下心脏的副交感神经系统控制之间存在关系，但没有研究评估了在实验室以外24小时内的自主反应。综上所述，这项研究计划表明，PTSD和敌意增加了心血管和代谢危险因素，并可能导致健康状况较差和心血管死亡率的风险增加。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小时心率变异性和降压反射敏感性测得的心血管风险的生物标志物有关，并确定患有PTSD和敌对性的个体中的风险最高。并行分析将评估PTSD是否与胰岛素抵抗和代谢综合征的风险有关。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（包括有或没有合并症重大抑郁症的患者）来评估PTSD的独立作用。项目目标是检查：（1）PTSD与心血管和代谢疾病的生物标志物之间的独立关系，以及（2）敌对态度作为主持人和合并重度抑郁症对PTSD与PTSD与心血管疾病和代谢疾病生物标志物之间关系的贡献。研究结果将有助于为疾病轨迹早期患有PTSD患者的降低风险策略发展。此外，这项研究应大大提高有关与PTSD相关的死亡风险增加的机制的知识。通过评估可能在精神病患者样本中特定或放大的可能机制，我们可能会对精神疾病健康影响的精神病理学机制有了更完整的了解。公共卫生相关性：创伤后应激障碍（PTSD）在男性和女性中都是一种普遍的精神障碍，患有PTSD的人患心血管和代谢发病率和死亡率更大。这项研究将提供有关PTSD年轻人中心血管和代谢生物标志物发展的重要信息。