Cardiovascular risk in relation to posttraumatic stress disorder in young women

描述（由申请人提供）：研究揭示了创伤后应激障碍（PTSD）和心血管健康状况差之间的关系。这些证据主要涉及对表现出心血管疾病（CVD）临床症状的退伍军人进行回顾性检查。许多平民也患有创伤后应激障碍，这些创伤后应激障碍是由性虐待/强奸、人身攻击和车祸等事件造成的。患有创伤后应激障碍的平民，特别是女性，在心血管风险方面的研究不足。心血管疾病危险因素的识别是2010年健康人群的一项重要举措，对疾病预防和及时干预具有重要意义。在患有创伤后应激障碍但目前没有心血管疾病的年轻人中研究心血管疾病的危险因素可能对理解创伤后应激障碍如何赋予心血管疾病的风险至关重要。在为数不多的研究中，研究了创伤后应激障碍的心血管疾病风险，风险因素聚集尚未进行系统评估。这项研究的主要目的是比较诊断为PTSD的年轻女性（18-39岁）与抑郁症（非PTSD）和非精神病对照组相比，CVD风险因素，以及心血管反应性和对心理压力的恢复。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。第二个目标是研究是否认知评估的压力介导的关系，创伤后应激障碍与心血管疾病的风险和反应/恢复。创伤后应激障碍组将从创伤康复诊所和社区心理健康诊所招募。抑郁症组将从成人服务诊所和社区心理健康诊所招募。对照组将从社区招募。诊断性访谈将决定是否纳入研究组。具体地说，假设1）PTSD组将比对照组证明更多数量的CVD危险因素，2）对于每个危险因素，PTSD参与者在风险连续体上将更高，3）PTSD组将比对照组具有更高的血压（BP）和总外周阻力反应性; PTSD组和抑郁症组的HR和心输出量反应性相似，但HR和心输出量反应性高于非精神病组。4）PTSD组的血压和外周阻力恢复低于对照组; PTSD和抑郁组将显示出可比的HR和心输出量恢复，并且HR和心输出量恢复比非精神病组少，5）对威胁的认知评估将介导诊断组与BP和外周阻力反应性/恢复的关系，（6）认知评价在诊断组与心血管危险因素的关系中起中介作用。公共卫生相关性：该项目将帮助确定改善遭受创伤后压力的妇女健康的方法。这项研究将提供开发健康风险降低和/或压力管理计划所需的信息，如果与标准谈话疗法沿着使用，可以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.