Hostility, PTSD and Physical Health Risk Factors

描述(由申请人提供)：创伤后应激障碍(PTSD)和高度敌意是导致健康状况不佳的重要风险因素。我们已经开始确定一些行为和心理生理学变量可能导致这种增加的风险。例如，在上一个资助期(NIMH R01MH62482)的研究表明，PTSD退伍军人吸烟更多，血脂更高，客观睡眠更差，日常负面影响更多。研究发现，患有创伤后应激障碍的敌意退伍军人的动态心率更高，血压恢复到压力任务的速度更慢，这表明自主神经系统可能参与了高度敌意的创伤后应激障碍退伍军人的风险增加。我们还记录了女性创伤后应激障碍的严重程度与心率变异性水平降低之间的密切联系。此外，患有创伤后应激障碍的人睡眠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。这一时期的试验数据还表明，患有创伤后应激障碍的参与者代谢综合征的发生率增加。尽管以前的工作已经证明了创伤后应激障碍与副交感神经系统在受控实验室条件下对心脏的控制减少之间的关系，但还没有研究评估实验室外24小时内的自主神经反应。总而言之，这项研究表明，创伤后应激障碍和敌意会增加心血管和代谢风险因素，并可能导致较差的健康结果和心血管死亡的风险增加。这项拟议的研究将评估年轻人群中的创伤后应激障碍是否与从血管内皮功能、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记物有关，并将确定在患有创伤后应激障碍和高度敌意的个体中，风险生物标记物是否最高。平行分析将评估创伤后应激障碍是否与胰岛素抵抗和代谢综合征风险有关。由于抑郁也与心血管危险因素有关，我们将通过比较两组PTSD患者(包括合并和不合并严重抑郁障碍的患者)来评估PTSD的独立效果。该项目的目标是检查：(1)创伤后应激障碍与心血管和代谢疾病的生物标记物之间的独立关系，以及(2)敌意作为调节因素和共病的严重抑郁障碍对创伤后应激障碍和心血管和代谢疾病的生物标志物之间的关系的贡献。研究结果将有助于为创伤后应激障碍患者在疾病发展轨迹的早期制定降低风险的策略提供信息。此外，这项研究应该显著提高对创伤后应激障碍相关死亡风险增加的机制的了解。通过评估可能的机制，可能是特定的或放大的精神疾病患者样本，我们可能获得更全面的了解精神障碍的健康影响的心理病理机制。公共卫生相关性：创伤后应激障碍(PTSD)是一种在男性和女性中普遍存在的精神障碍，患有创伤后应激障碍的人患心血管和新陈代谢疾病和死亡的风险更大。这项研究将为创伤后应激障碍年轻患者心血管和代谢疾病生物标记物的发展提供重要信息。

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.