Jesse R. Cougle

Anxiety disorders and suicidality in the National Comorbidity Survey-Replication

OBJECTIVE The current study sought to examine the unique associations between anxiety disorders and suicidality using a large nationally representative sample and controlling for a number of established risk factors for suicide. METHOD Data from the National Comorbidity Survey-Replication were used for analyses. Lifetime diagnostic history and demographics were obtained in this survey through a structured interview. Lifetime suicidal ideation and attempts were also assessed. RESULTS Multivariate analyses covarying for psychiatric comorbidity and demographic variables found social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and panic disorder (PD) to be unique predictors of suicidal ideation, while only SAD, PTSD, and GAD were predictive of suicide attempts. Analyses by gender indicated that each of these four disorders were predictive of suicidal ideation or suicide attempts among women, while only PTSD and PD acted as risk factors among men. CONCLUSIONS Findings provide further evidence of the negative impact of anxiety disorders, suggest efforts should be made towards their early detection and treatment, and emphasize the importance of suicide risk assessment in treating individuals with anxiety disorders.

Examining the unique relationships between anxiety disorders and childhood physical and sexual abuse in the National Comorbidity Survey-Replication

Research has accumulated over the past several years demonstrating a relationship between childhood abuse and anxiety disorders. Extant studies have generally suffered from a number of methodological limitations, including low sample sizes and without controlling for psychiatric comorbidity and parental anxiety. In addition, research has neglected to examine whether the relationships between anxiety disorders and childhood abuse are unique to physical abuse as opposed to sexual abuse and vice versa. The current study sought to examine the unique relationships between anxiety disorders and childhood physical and sexual abuse using data from the National Comorbidity Survey-Replication. Participants (n=4141) completed structured interviews from which data on childhood abuse history, lifetime psychiatric history, parental anxiety, and demographics were obtained. After controlling for depression, other anxiety disorders, and demographic variables, unique relationships were found between childhood sexual abuse and social anxiety disorder (SAD), panic disorder (PD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD); in contrast, physical abuse was only associated with PTSD and specific phobia (SP). Further, among women, analyses revealed that physical abuse was uniquely associated with PTSD and SP, while sexual abuse was associated with SAD, PD, and PTSD. Among men, both sexual and physical abuse were uniquely associated with SAD and PTSD. Findings provide further evidence of the severe consequences of childhood abuse and help inform etiological accounts of anxiety disorders.

Posttraumatic stress disorder and cannabis use in a nationally representative sample.

The present study examined the relations between posttraumatic stress disorder (PTSD) and cannabis use in a large representative survey of adults (N = 5,672) from the United States (Kessler et al., 2004). After adjusting for sociodemographic variables (i.e., age, marital status, ethnicity, education, income, and sex), alcohol use disorders, and nicotine dependence, lifetime and current (past year) PTSD diagnoses were associated with increased odds of lifetime history of cannabis use as well as past year daily cannabis use. Lifetime, but not current, PTSD diagnosis also was uniquely associated with increased risk for any past year cannabis use. Additional analyses revealed that the relations between PTSD (lifetime and current) and lifetime cannabis use remained statistically significant when adjusting for co-occurring anxiety and mood disorders and trauma type frequency. Overall, these findings add to the emerging literature demonstrating a possibly important relationship between PTSD and cannabis use.

PTSD, depression, and their comorbidity in relation to suicidality: cross-sectional and prospective analyses of a national probability sample of women

Background: A growing body of literature implicates major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) as risk factors for suicidal ideation (SI) and suicide attempts (SA), though research has not adequately examined their differential contributions to increasing suicide risk prospectively or cross‐sectionally. Methods: The contribution of these disorders and their comorbidity to SI and SA was examined using a national household probability sample of women (N=3,085) and covarying for trauma history, substance abuse, and demographic variables. Results: Cross‐sectional analyses indicated that lifetime comorbidity of MDD and PTSD were associated with much higher prevalence of SI than either diagnosis alone; prevalence of SI was elevated and comparable for PTSD and MDD only. Comorbid diagnosis and PTSD only groups displayed greater prevalence of SA than those with MDD only. Lastly, a 2‐year prospective analysis indicated that PTSD only at baseline was predictive of greater subsequent SI risk than MDD only, though comorbid diagnosis did not differ from either PTSD only or MDD only. Conclusions: PTSD appears to be a particularly strong predictor of SI and SA. Overall, only 16% of women with lifetime SA did not have a history of MDD or PTSD, highlighting the importance of assessing these variables when assessing suicide risk. Depression and Anxiety, 2009.

Substance Use Associated with Unintended Pregnancy Outcomes in the National Longitudinal Survey of Youth.

Abortion is known to be associated with higher rates of substance abuse, but no studies have compared substance use rates associated with abortion compared to delivery of an unintended pregnancy. This study examines data for women in the National Longitudinal Survey of Youth whose first pregnancy was unintended. Women with no pregnancies were also used as a control group. Use of alcohol, marijuana, cocaine, and behaviors suggestive of alcohol abuse were examined an average of four years after the target pregnancy among women with prior histories of delivering an unintended pregnancy (n = 535), abortion (n = 213), or those who reported no pregnancies (n = 1144). Controls were instituted for age, race, marital status, income, education, and prepregnancy self‐esteem and locus of control. Compared to women who carried an unintended first pregnancy to term, those who aborted were significantly more likely to report use of marijuana (odds ratio: 2.0), with the difference in these two groups approaching significance relative to the use of cocaine (odds ratio: 2.49). Women with a history of abortion also reported more frequent drinking than those with a history of unintended birth. With the exception of less frequent drinking, the unintended birth group was not significantly different from the no pregnancy group. Resolution of an unintended pregnancy by abortion was associated with significantly higher rates of subsequent substance use compared to delivering an unintended pregnancy. A history of abortion may be a useful marker for identifying women in need of counseling for substance use.

The psychology of abortion: A review and suggestions for future research

The literature base pertaining to abortion decision-making and adjustment has grown substantially since legalization of abortion in the U.S. 30 years ago. However, the available research has suffered from various theoretical and methodological shortcomings and the findings do not seem to do justice to the complexity of abortion experiences among women residing in a cultural context that continues to exhibit intense conflict over the legality and morality of abortion. The purpose of this review is to summarize previous research, offer suggestions for improving the quality of work on the topic of abortion, and to highlight specific content areas holding considerable promise for enhancing our understanding of the risks and benefits of abortion.

A prospective examination of PTSD symptoms as risk factors for subsequent exposure to potentially traumatic events among women

Previous research has suggested that both exposure to potentially traumatic events (PTEs) and emotional reactions to such events act as risk factors for subsequent exposure. Although some studies have implicated posttraumatic stress disorder (PTSD) symptoms as risk factors, extant research suffers from a number of methodological limitations, including the use of cross-sectional designs and student populations. The present study sought to address these limitations using a 2-year, 3-wave national probability household sample of 2,863 adult women. After controlling for demographic characteristics, prior exposure to PTEs, and Wave 1 depression and substance abuse, PTSD reexperiencing symptoms at Wave 1 predicted subsequent exposure to interpersonal violence victimization (IPVV) perpetrated by a nonintimate perpetrator; however, PTSD symptoms did not predict intimate partner IPVV. In addition, PTSD hyperarousal symptoms were unique predictors of subsequent exposure to other traumatic stressors. Findings suggest that efforts to prevent PTEs should focus attention on both prior exposure and PTSD symptoms in response to such exposure.

Anger problems across the anxiety disorders: findings from a population-based study.

Background: Previous research examining anger problems among the anxiety disorders has been limited by the use of nonrepresentative samples, univariate analyses, as well as low sample size. The current study examined the association between posttraumatic stress disorder (PTSD), panic disorder (PD), social anxiety disorder, specific phobia (SP), and generalized anxiety disorder (GAD) and anger experience and expression. We hypothesized that greater anger experience and expression would be associated with all anxiety disorders, but that it would be most consistently associated with PTSD and PD diagnoses, and that these relationships would remain significant after controlling for demographics (i.e. age, gender, ethnicity, marital status, and income) and comorbid disorders. Methods: Participants included 5,692 (54% female) adults from the National Comorbidity Survey—Replication, a large, nationally representative survey. Results: Our data suggest that there are unique relationships between multiple anxiety disorders and various indices of anger experience and expression that are not better accounted for by psychiatric comorbidity. Contrary to predictions, PTSD and PD were not consistently associated with anger experience and expression. Conclusions: Overall, these findings lend support to the emerging literature demonstrating a potentially important relationship between anxiety disorders and anger problems. Depression and Anxiety, 2011.© 2010 Wiley‐Liss, Inc.

Substance use among pregnant women in the context of previous reproductive loss and desire for current pregnancy

OBJECTIVE The primary objectives of this study were to explore maternal history of perinatal loss and pregnancy wantedness as correlates of substance use during pregnancy. METHOD The research design involved interviewing women who gave birth in Washington DC hospitals during 1992. Interview data included pregnancy history (prior births, induced abortions, miscarriages, and stillbirths), desire for the pregnancy (wanted, not wanted, mistimed), socio-demographic information, timing of onset of prenatal care, and substance use (cigarettes, alcohol, and drugs) during pregnancy. RESULTS A history of induced abortion was associated with elevated risk for maternal substance use of various forms; whereas other forms of perinatal loss (miscarriage and stillbirth) were not related to substance use. Unwanted pregnancy was associated with cigarette smoking during pregnancy, but not with any other forms of substance use. CONCLUSIONS Reproductive history information may offer insight to professionals pertaining to the likelihood of women using substances in a later pregnancy.

Excessive reassurance seeking and anxiety pathology: Tests of incremental associations and directionality

Excessive reassurance-seeking (ERS) is hypothesized to play a key role in emotional disorders but has been studied mostly in relation to depression. Study 1 reports a new measure of reassurance seeking that assessed ERS related to general and evaluative threats in a non-clinical student sample, and its factor structure was further examined in Study 2. In Study 3, the scale, along with other symptom-related measures and an existing measure of depressive ERS, was administered to an undergraduate sample at two different time points, one month apart. Greater ERS was associated with greater symptoms of social anxiety, generalized anxiety disorder, and obsessive-compulsive disorder (OCD), even after controlling for trait anxiety, depression, and intolerance of uncertainty. Among OCD symptoms, only thoughts of harm were uniquely related to ERS, a finding consistent with emerging literature. ERS involving general threats also predicted changes in social anxiety and GAD symptoms one month later. Overall, the findings implicate an important role for ERS across anxiety disorders.