Angela Liegey Dougall

Urinary catecholamines and cortisol in recent-onset posttraumatic stress disorder after motor vehicle accidents.

Objective This study examined relationships among stress hormone levels, posttraumatic stress disorder (PTSD) diagnosis and symptoms, and gender shortly after a common civilian trauma. Methods Levels of catecholamines and cortisol in 15-hour urine samples were examined in 55 adults who had been in serious motor vehicle accidents and in 22 age-matched control. Results Catecholamines were related to PTSD diagnosis and symptoms, but only among men: PTSD-symptomatic men who had been in an accident exhibited elevated levels of epinephrine and norepinephrine 1 month after the accident and had higher epinephrine levels 5 months later. Intrusive thoughts predicted catecholamine levels at 1 month, and avoidance of trauma-relevant stimuli was associated with higher epinephrine levels 5 months later. These effects were not significant among women. Urinary cortisol was also elevated among PTSD-symptomatic men, but not women, and only immediately (1 month) after the accident. For men and women, greater emotional numbing predicted a lower cortisol level 6 months after the accident. Conclusions These findings were interpreted as limited support for the generalizability of findings in men with chronic, combat-related PTSD and indicate the need for additional research on psychoendocrine assessment of traumatized women and specific dimensions of PTSD symptomatology.

Predictors of posttraumatic stress among victims of motor vehicle accidents.

Objective This study identified factors that predict individual vulnerability to psychological trauma by examining the relationships among situation and person variables and symptoms of posttraumatic stress disorder (PTSD) 1, 6, and 12 months after a serious motor vehicle accident (MVA). Methods Background characteristics, exposure variables (ie, injury severity and accident characteristics), and psychosocial variables (ie, perceived loss of control, social support, and coping) were used to predict symptoms of PTSD and recovery in 115 injured MVA victims. All participants were injured during the MVA and provided data prospectively over the course of a year after their accidents. Results Along with background and exposure variables, use of wishful thinking coping distinguished between victims with and without symptoms of PTSD. Conclusions Psychosocial variables such as wishful thinking coping can be used to identify MVA victims who are at risk of developing chronic posttraumatic stress and warrant further investigation.

Media exposure to bioterrorism: stress and the anthrax attacks

Abstract This study examined media exposure and adjustment to anthrax bioterrorism attacks and the terrorist attacks on 9/11 in a sample of 300 people who lived distant from the attacks. Measures of direct and indirect exposure to terrorism, perceived risk of anthrax exposure, psychological distress, and outlook were assessed at 2 to 3 months and at 8 months after the first reported anthrax attack. Initial anthrax media exposure was a powerful predictor of distress, whereas subsequent anthrax media exposure only predicted negative changes in outlook over time. Perceived risk of anthrax exposure predicted distress and outlook but did not appear to mediate the effects of media exposure. Determining the nature and consequences of media exposure to threatening and frightening events like terrorism will help predict and manage response to future bioterrorism.

Assessment of characteristics of intrusive thoughts and their impact on distress among victims of traumatic events.

OBJECTIVE This study examines the psychometric properties of the Intrusive Thoughts Questionnaire (ITQ) and its utility as a predictor of distress among trauma victims. METHOD Victims of three types of trauma, a motor vehicle accident (N = 115), a hurricane (N = 182), and recovery work after an airline disaster (N = 159), completed the ITQ along with the Impact of Event Scale (IES) and the Symptom Checklist-90, Revised (SCL-90-R), at several different time points after their exposure. RESULTS The ITQ was a reliable and valid instrument that was positively related to concurrent measures of distress as well as a predictor of long-term stress responding. Characteristics of intrusive thoughts reflecting the extent to which they were unwanted or controllable, were identified as key determinants of distress. CONCLUSIONS The ITQ is a useful adjunct to current measures of intrusions, allowing for greater specificity in analyses of responses to trauma. Evaluation of characteristics of intrusions indicated that frequency of intrusions was neither the only predictor of distress nor the best predictor of trauma-related outcomes.

CHRONIC STRESS AND NATURAL KILLER CELL ACTIVITY AFTER EXPOSURE TO TRAUMATIC DEATH

Objective The present study examined the effects of working at the crash site of USAir Flight 427 on psychological, cardiovascular, and immunological sequelae of stress within 2 months of the recovery work and again 6 months after the crash. Method A total of 159 workers at the crash site and 41 controls were examined within 2 months of the crash and again 6 months after the crash. Subjects were initially grouped according to whether they had contact with human remains. For a finer-grained analysis of exposure to bodies, subjects were also grouped by degree of exposure, determined by the area in which the workers were stationed. Dependent measures included intrusive thoughts, coping styles, and symptom reporting, as well as heart rate and blood pressure, and NK cell number and activity. Results Workers exposed to body parts at the actual crash site, and those who were exposed to remains without expecting to be, exhibited more symptoms of stress than workers who saw bodies and body parts at the morgue and those who did not see human remains. Non-morgue workers who were exposed to bodies or body parts had the highest levels of intrusive thoughts at both time points, and the highest NK cell activity at Time 1. NK activity in this group decreased to levels comparable with other groups at Time 2. Conclusions Increased NK activity is unusual in chronic stress situations, and may be because of acute stress experienced as a result of being asked to talk and think about the crash. The finding that the more one was exposed to human remains the less distress he or she reported is discussed in terms of adaptation, expectancy, and control.

Time course of natural killer cell activity and lymphocyte proliferation in response to two acute stressors in healthy men.

To clarify the time course of immune system activity during and after acute stressor exposure, this study collected immune measures from 31 men at 6 times (before, during, and after 2 common laboratory stressors; mental arithmetic with harassment or a cold pressor task). The 6-min stressor period was associated with increased self-report of pain and distress in both stressor groups and with increased systolic and diastolic blood pressure and heart rate in the mental arithmetic group. Increased natural killer cell activity in this group was observed during the task (2 and 5 min into the task) and 5 min after the task ended. A significant Group x Time effect was observed for lymphocyte proliferation to pokeweed mitogen, and a significant Group x Time x Dilution effect was observed for proliferation to concanavalin A. Inspection of the data suggested that this interaction was due to a reduction in proliferation in both stressor groups during the task period.

Chronic exposure to stress hormones promotes transformation and tumorigenicity of 3T3 mouse fibroblasts

Epinephrine and norepinephrine are produced during psychological stress and can directly bind to cells to induce DNA damage. These effects may have more long-lasting consequences such as DNA mutations resulting in an increased potential for cellular transformation and/or tumor progression. This study examined the molecular effects of a chronic (24 h) in vitro exposure to these stress hormones on murine 3T3 cells. Long exposures (24 h) in dose–response experiments with norepinephrine or epinephrine induced significant increases in DNA damage in treated cells compared to that of untreated controls as measured by the alkaline comet assay. Pre-treatment with a blocking agent (the β-adrenergic receptor antagonist propranolol) eliminated this increase in damage. In addition, both norepinephrine and epinephrine increased cellular transformation, as assessed by growth in soft agar, and 3T3 cells pre-treated with either norepinephrine or epinephrine induced a more rapid onset of tumors and more aggressive tumor growth in nude mice. In summary, incubation of 3T3 cells with catecholamines results in long-term DNA damage as measured by increased transformed phenotypes and tumor progression, indicating that they are important mediators of stress effects on genomic instability and vulnerability to tumor formation.

Cues, Frequency, and the Disturbing Nature of Intrusive Thoughts: Patterns Seen in Rescue Workers After the Crash of Flight 427

Intrusive thoughts have been identified as key elements of chronic or traumatic stress, but many questions remain about how they operate and what causes persistence of disturbing intrusions. The present study considers these questions, examining the impact of having intrusive thoughts that are cued by stimuli in ones environment as opposed to uncued intrusions that seem to “come out of the blue.” In addition, this research evaluates the extent to which distress accompanying intrusive thoughts shortly after a traumatic event predicts persistence of intrusions over time. Rescue workers who responded to the crash of Flight 427 were studied 4 to 8 weeks, and 6, 9, and 12 months after the disaster. Participants who reported crash-related thoughts that were not prompted by cues showed higher levels of distress than those reporting only cued thoughts or those reporting neither. The magnitude of distress that these thoughts caused in the first 2 months after the crash was important in predicting subsequent frequency of unwanted thoughts. The presence or absence of cues and their role in the maintenance of distress also is discussed.

Coping with genetic testing for breast cancer susceptibility

Objective: To examine how women cope with genetic testing for heightened susceptibility to breast cancer. Methods: Participants were 126 White women (age = 44 ± 9 years) who were participants in a larger study of genetic testing for risk of different chronic diseases. All women were at higher-than-average risk for breast cancer due to a personal and/or family history and were considering genetic testing. Distress (Symptom Checklist-90-Revised, Impact of Event Scale, Perceived Stress Scale, Spielberger State-Trait Anxiety Inventory, and the Center for Epidemiological Studies Depression Scale) was assessed at four assessments; one before and three after the decision to have genetic testing. The majority of women (n = 100) had testing. The follow-up assessments occurred at 1 week after receiving results (or 3–4 months after baseline if testing was not elected), and then at 3 and 6 months after the second assessment. Coping (Brief COPE) was measured at the first and third assessments. Results: Coping was relatively stable over time and did not vary as a function of genetic test results. Active coping strategies were used more often by women with a personal cancer history than by women without cancer. Use of avoidant coping was reliably and positively associated with distress over time independent of cancer history and test result. Conclusions: The identification of specific coping styles that were associated with more or less distress is useful as a means of identifying and targeting coping interventions and predicting which participants may be at risk for distress. BRCA 1 = breast cancer 1 gene; BRCA 2 = breast cancer 2 gene; CGP = Cancer Genetics Program; SCL-90R = Symptom Checklist-90 Revised; GSI = Global Severity Index; MANCOVA = multivariate analysis of covariance.

Posttraumatic stress disorder symptoms in newly diagnosed patients with head and neck cancer and their partners.

Head and neck cancer is a life‐threatening illness requiring aversive treatments. Despite clear potential for posttraumatic stress disorder (PTSD) symptoms in both patients and their partners, research is scant.