Emily Goldmann

Epigenetic and immune function profiles associated with posttraumatic stress disorder

The biologic underpinnings of posttraumatic stress disorder (PTSD) have not been fully elucidated. Previous work suggests that alterations in the immune system are characteristic of the disorder. Identifying the biologic mechanisms by which such alterations occur could provide fundamental insights into the etiology and treatment of PTSD. Here we identify specific epigenetic profiles underlying immune system changes associated with PTSD. Using blood samples (n = 100) obtained from an ongoing, prospective epidemiologic study in Detroit, the Detroit Neighborhood Health Study, we applied methylation microarrays to assay CpG sites from more than 14,000 genes among 23 PTSD-affected and 77 PTSD-unaffected individuals. We show that immune system functions are significantly overrepresented among the annotations associated with genes uniquely unmethylated among those with PTSD. We further demonstrate that genes whose methylation levels are significantly and negatively correlated with traumatic burden show a similar strong signal of immune function among the PTSD affected. The observed epigenetic variability in immune function by PTSD is corroborated using an independent biologic marker of immune response to infection, CMV—a typically latent herpesvirus whose activity was significantly higher among those with PTSD. This report of peripheral epigenomic and CMV profiles associated with mental illness suggests a biologic model of PTSD etiology in which an externally experienced traumatic event induces downstream alterations in immune function by reducing methylation levels of immune-related genes.

Borrowing And Selling To Pay For Health Care In Low-And Middle-Income Countries

Many families around the world make sizable out-of-pocket payments for health care. We calculated the frequency of borrowing money or selling assets to buy health services in forty low- and middle-income countries and estimated how various factors are associated with these coping strategies. The data represented a combined population of 3.66 billion, or 58 percent of the worlds population. On average, 25.9 percent of households borrowed money or sold items to pay for health care. The risk was higher among the poorest households and in countries with less health insurance. Health systems in developing countries are failing to protect families from the financial risks of seeking health care.

SLC6A4 methylation modifies the effect of the number of traumatic events on risk for posttraumatic stress disorder

Background: Posttraumatic stress disorder (PTSD) is a common and debilitating mental disorder that occurs following exposure to a traumatic event. However, most individuals do not develop PTSD following even a severe trauma, leading to a search for new variables, such as genetic and other molecular variation, associated with vulnerability and resilience in the face of trauma exposure. Method: We examined whether serotonin transporter (SLC6A4) promoter genotype and methylation status modified the association between number of traumatic events experienced and PTSD in a subset of 100 individuals from the Detroit Neighborhood Health Study. Results: Number of traumatic events was strongly associated with risk of PTSD. Neither SLC6A4 genotype nor methylation status was associated with PTSD in main effects models. However, SLC6A4 methylation levels modified the effect of the number of traumatic events on PTSD after controlling for SLC6A4 genotype. Persons with more traumatic events were at increased risk for PTSD, but only at lower methylation levels. At higher methylation levels, individuals with more traumatic events were protected from this disorder. This interaction was observed whether the outcome was PTSD diagnosis, symptom severity, or number of symptoms. Conclusions: Gene‐specific methylation patterns may offer potential molecular signatures of increased risk for and resilience to PTSD. Depression and Anxiety, 2011.  © 2011 Wiley‐Liss, Inc.

Mental Health Consequences of Disasters

We present in this review the current state of disaster mental health research. In particular, we provide an overview of research on the presentation, burden, correlates, and treatment of mental disorders following disasters. We also describe challenges to studying the mental health consequences of disasters and discuss the limitations in current methodologies. Finally, we offer directions for future disaster mental health research.

Pervasive exposure to violence and posttraumatic stress disorder in a predominantly African American Urban Community: The Detroit neighborhood health study

Exposure to traumatic events is common, particularly among economically disadvantaged, urban African Americans. There is, however, scant data on the psychological consequences of exposure to traumatic events in this group. We assessed experience with traumatic events and posttraumatic stress disorder (PTSD) among 1,306 randomly selected, African American residents of Detroit. Lifetime prevalence of exposure to at least 1 traumatic event was 87.2% (assault = 51.0%). African Americans from Detroit have a relatively high burden of PTSD; 17.1% of those who experienced a traumatic event met criteria for probable lifetime PTSD. Assaultive violence is pervasive and is more likely to be associated with subsequent PTSD than other types of events. Further efforts to prevent violence and increase access to mental health treatment could reduce the mental health burden in economically disadvantaged urban areas.

Longitudinal determinants of posttraumatic stress in a population-based cohort study

Background: Posttraumatic stress disorder is a prevalent and disabling psychologic pathology. Longitudinal research on the predictors of posttraumatic stress symptomatology is limited. Methods: We recruited 2752 participants to a prospective, population-based cohort study by conducting a telephone survey of adult residents of the New York City metropolitan area in 2002; participants completed 3 follow-up interviews over a 30-month period. Censoring weights were estimated to account for potential bias. We used generalized estimating equation logistic regression models with bootstrapped confidence intervals to assess the predictors of posttraumatic stress over time in multivariable models. Results: Predictors of posttraumatic stress over time included ongoing stressors (odds ratio [OR] = 1.91 per 1 unit increase in number of stressors, [95% confidence interval = 1.55–2.36]) and traumatic events (OR = 1.92 per 1 unit increase in number of traumatic events [CI = 1.71–2.22]), social support (compared with high levels, OR = 1.71 for medium [1.09–2.52]; OR = 1.57 for low [1.08–2.35]), low income (OR = 0.87 per

PTSD comorbidity and suicidal ideation associated with PTSD within the Ohio Army National Guard

10,000 increase [0.81–0.92]), female sex (1.60 [1.11–2.23]), and Latino ethnicity (compared with white, OR = 1.74 [1.05–2.97]). Conclusions: These findings suggest that ongoing stressors play a central role in explaining the trajectory of posttraumatic stress over time, and that factors beyond the experience of stressors and traumas may account for sex and ethnic differences in posttraumatic stress risk. Interventions that focus on reducing ongoing adversity may help mitigate the consequences of traumatic events.

Child maltreatment increases sensitivity to adverse social contexts: Neighborhood physical disorder and incident binge drinking in Detroit

OBJECTIVE To study the relation between posttraumatic stress disorder (PTSD) psychiatric comorbidity and suicidal ideation in a representative sample of Ohio Army National Guard soldiers. METHOD Using retrospective data collected on the telephone from a random sample of 2,616 National Guard soldiers who enrolled in a 10-year longitudinal study (baseline data collected November 2008-November 2009), we examined (1) the prevalence of other psychopathologies among those with DSM-IV-diagnosed PTSD compared to those without PTSD and (2) the association between PTSD comorbidity and suicidal ideation (reporting thoughts of being better off dead or hurting themselves). All analyses were carried out using logistic regression. RESULTS Of guard members with PTSD in the last year, 61.7% had at least 1 other psychopathology; 20.2% had at least 2 other co-occurring conditions. The most common co-occurring psychopathology was depression. While those with PTSD overall were 5.4 (95% CI, 3.8-7.5) times more likely to report suicidality than those without PTSD, those who had at least 2 additional conditions along with PTSD were 7.5 (95% CI, 3.0-18.3) times more likely to report suicidal ideation at some point in their lifetime than those with PTSD alone. CONCLUSIONS Soldiers with PTSD were at increased risk for suicidality, and, among those with PTSD, those with at least 2 additional conditions were at the highest risk of suicidal ideation. Future research should address the mechanisms that contribute to multimorbidity in this population and the appropriate treatment methods for this high-risk group.

Investigating the Effect of Social Changes on Age-Specific Gun-Related Homicide Rates in New York City During the 1990s

INTRODUCTION Exposure to child maltreatment is associated with elevated risk for behavioral disorders in adulthood. One explanation for this life-course association is that child maltreatment increases vulnerability to the effects of subsequent stressors; however, the extent to which maltreatment increases sensitivity to social context has never been examined. We evaluated whether the association between neighborhood physical disorder and binge drinking was modified by child maltreatment exposure. METHODS Data were drawn from the Detroit Neighborhood Health Study, a prospective representative sample of predominately African Americans in the Detroit population. Neighborhood physical disorder was measured via systematic neighborhood assessment. Child maltreatment indicators included self-reported physical, sexual, and emotional abuse. Incident binge drinking was defined as at least one episode of ≥5 drinks (men) or ≥4 drinks (women) in the past 30-day period among those with no binge drinking at baseline (N=1013). RESULTS Child maltreatment and neighborhood physical disorder interacted to predict incident binge drinking (B=0.16, p=0.02) and maximum number of past 30-day drinks (B=0.15, p=0.04), such that neighborhood physical disorder predicted problematic alcohol use only among individuals with high exposure to child maltreatment. CONCLUSION The results add to the growing literature that African Americans in the US are exposed to an array of stressors that have pernicious consequences for problematic alcohol use. Our results document the need for increased attention to the potential for at-risk alcohol use among populations with a high degree of stress exposure.

Discharge educational strategies for reduction of vascular events (DESERVE): design and methods

OBJECTIVES We assessed whether New York Citys gun-related homicide rates in the 1990s were associated with a range of social determinants of homicide rates. METHODS We used cross-sectional time-series data for 74 New York City police precincts from 1990 through 1999, and we estimated Bayesian hierarchical models with a spatial error term. Homicide rates were estimated separately for victims aged 15-24 years (youths), 25-34 years (young adults), and 35 years or older (adults). RESULTS Decreased cocaine consumption was associated with declining homicide rates in youths (posterior median [PM] = 0.25; 95% Bayesian confidence interval [BCI] = 0.07, 0.45) and adults (PM = 0.07; 95% BCI = 0.02, 0.12), and declining alcohol consumption was associated with fewer homicides in young adults (PM = 0.14; 95% BCI = 0.02, 0.25). Receipt of public assistance was associated with fewer homicides for young adults (PM = -104.20; 95% BCI = -182.0, -26.14) and adults (PM = -28.76; 95% BCI = -52.65, -5.01). Misdemeanor policing was associated with fewer homicides in adults (PM = -0.01; 95% BCI = -0.02, -0.001). CONCLUSIONS Substance use prevention policies and expansion of the social safety net may be able to cause major reductions in homicide among age groups that drive city homicide trends.