Kathryn M. Godfrey

Posttraumatic stress disorder and health: a preliminary study of group differences in health and health behaviors

BackgroundIndividuals with posttraumatic stress disorder (PTSD) are more likely to undertake harmful health behaviors like substance use. Less is known about the association of PTSD with healthful behaviors such as healthy diet and exercise. The purpose of this study was to examine differences across physical health indicators and health behaviors in individuals with and without PTSD.MethodsA cross-sectional, case–control study of health indicators and self-reported health behaviors in a community and military veteran sample was used.ResultsBased on a structured psychiatric interview, 25 participants had PTSD, and the remaining 55 without PTSD served as the comparison group. Participants were 40 years old on average and 45% were female. Multivariate analysis of variance analyses revealed that participants with PTSD had significantly higher body mass index (p = 0.004), had more alcohol use (p = 0.007), and reported fewer minutes of vigorous exercise (p = 0.020) than those without PTSD. Chi-square analysis of diet content and eating behavior constructs found that individuals with PTSD ate fewer fruits (p = 0.035) and had more guilt after overeating (p = 0.006).ConclusionsThese findings replicate prior research on the link between PTSD and negative health outcomes and engagement in harmful health behaviors and highlight the need for further examination of the association between PTSD and other health behaviors like diet content, eating behaviors, and exercise.

Hookah Use Predicts Cigarette Smoking Progression Among College Smokers

INTRODUCTION Hookah use is increasingly common among U.S. college students, but little is known regarding the relationship between hookah and cigarette use. The purpose of this study was to test the hypothesis that the added nicotine exposure from hookah use may accelerate the uptake of cigarettes. METHODS An ethnically diverse sample of college students (n = 256; 43% female) who had smoked cigarettes in the past month completed 2 in-person interviews over 6 months. This study was a secondary analysis of data collected for a longitudinal study of young adult cigarette smoking patterns. Analyses examined 6-month changes in past 30 day cigarettes smoked and number of days smoking, controlling for age, nicotine dependence, marijuana use, and the respective baseline variable for each outcome. RESULTS Current hookah use (any use in past 30 days) was endorsed by 34% of participants at baseline, while 94% reported lifetime use. Change in past 30 day number of cigarettes (p = .043) and number of smoking days (p = .040) differed significantly between those who did or did not report recent hookah use at baseline. Hookah users reported a greater number of cigarettes smoked at the 6-month follow-up, while nonusers decreased their smoking quantity. For number of smoking days in the past 30, hookah users reported a smaller decrease than nonusers. CONCLUSIONS Recent hookah use predicted increased cigarette smoking over 6 months in a college sample. These are the first prospective data demonstrating this relationship, indicating the value of developing strategies to prevent hookah use among college students.

Associations of military sexual trauma, combat exposure, and number of deployments with physical and mental health indicators in Iraq and Afghanistan veterans.

Trauma exposure (TE) and numerous deployments have been associated with negative health outcomes in veterans, many of whom have military sexual trauma (MST) and combat exposure (CE). The aims of this study were to examine the relationships between physical and mental health symptoms with MST and CE and number of deployments. Iraq and Afghanistan veterans at the Veterans Affairs San Diego Healthcare System completed self-report measures for MST, CE, number of deployments, posttraumatic stress disorder (PTSD) symptoms, depression symptoms, alcohol use, somatic symptoms, health functioning, and body mass index (BMI). Regression analyses examined main and interaction effects of CE and MST and the linear and quadratic trends of number of deployments. The sample (N = 1,294) had a mean age of 31 and was 85% male. The MST by CE interaction on BMI was significant (p = .005), such that MST was associated with lower BMI in veterans with CE and with higher BMI in veterans without CE. MST and CE were associated with higher somatic, PTSD, and depression symptoms and with lower mental health functioning (ps < .001 to .002). CE was associated with lower physical health functioning and higher alcohol use (ps < .001 to .025). Number of deployments was linearly related to higher BMI (p = .004) and had a quadratic association with alcohol use (p = .008). Findings highlight the relationship between TE and poor health outcomes and the need to further study the mechanisms of TE on physical and mental health.

Salivary Cortisol and Cold Pain Sensitivity in Female Twins

BackgroundThere is a dearth of knowledge about the link between cortisol and pain sensitivity.PurposeWe examined the association of salivary cortisol with indices of cold pain sensitivity in 198 female twins and explored the role of familial confounding.MethodsThree-day saliva samples were collected for cortisol levels and a cold pressor test was used to collect pain ratings and time to threshold and tolerance. Linear regression modeling with generalized estimating equations examined the overall and within-pair associations.ResultsLower diurnal variation of cortisol was associated with higher pain ratings at threshold (p = 0.02) and tolerance (p < 0.01). The relationship of diurnal variation with pain ratings at threshold and tolerance was minimally influenced by familial factors (i.e., genetics and common environment).ConclusionsUnderstanding the genetic and non-genetic mechanisms underlying the link between HPA axis dysregulation and pain sensitivity may help to prevent chronic pain development and maintenance.

Pain sensitivity in posttraumatic stress disorder and other anxiety disorders: a preliminary case control study

BackgroundDespite substantial research on the comorbidity of anxiety disorders including posttraumatic stress disorder (PTSD) and chronic pain, little is known about the mechanisms underlying these conditions that might be potentially similar. Evoked pain sensitivity is one factor that has been associated with several pain conditions which might also have relevance to anxiety disorders and PTSD. The aim of this preliminary study was to examine evoked pain sensitivity in PTSD compared to other anxiety disorders and in control participants.MethodThe study used a cross-sectional case-control design in which participants completed a battery of questionnaires and structured interview and underwent cold pressor testing.ResultsOf 61 total participants, those in the PTSD (n =16) and other anxiety groups (n =12) endorsed significantly higher levels of psychological symptoms and poorer health functioning than control participants (n =33). The linear trend across baseline, threshold, and tolerance pain ratings from the cold pressor task significantly differed between participants with PTSD and the other anxiety and control groups suggesting lower pain sensitivity to a standardized stimulus of pain in individuals with PTSD.ConclusionsThese findings are similar to some of the prior research and suggest that individuals with PTSD may exhibit lower cold pain sensitivity compared to those with other anxiety disorders. There is a need for future research to determine explanatory mechanisms.

Combat exposure and pain in male and female Afghanistan and Iraq veterans: The role of mediators and moderators

Veterans experience physical health problems associated with disability and poor quality of life following combat exposure (CE). Understanding the CE-physical health relationship, specifically pain intensity and somatic pain, may inform etiological models and interventions. This study examined the CE-pain relationship, associated mediators, and gender as a moderator. 2381 veterans at the VA San Diego Healthcare System completed paper or electronic self-report measures of pain intensity and somatic pain. Analyses examined associations of pain with CE and posttraumatic stress disorder (PTSD), depression, and resilience as mediators of the CE-pain association. Moderated mediation models explored gender as a moderator of significant mediated pathways. Controlling for age, veterans with CE had significantly higher pain intensity and somatic pain, and PTSD and depression scores significantly mediated the CE-pain relationships. Gender significantly moderated the CE-pain intensity association through depression scores such that the indirect effect was stronger for female veterans relative to male veterans. CE is associated with pain intensity and somatic pain, with greater levels of PTSD and depression mediating the CE-pain link and gender moderating the depression mediated CE-pain association. Future studies should examine gender differences and mediators in the CE-pain relationships using longitudinal designs to inform etiological models and targeted pain interventions.

The many wounds of war: The association of service-related and clinical characteristics with problems with the law in Iraq and Afghanistan veterans

Previous research has demonstrated that veterans with posttraumatic stress disorder (PTSD) are at higher risk for aggression, hostility, and anger, potentially leading to problems with the law or disciplinary action while in the military. There have been calls for increased consideration of the unique aspects of the judicial system in legal matters with veterans involved. The bulk of the research so far has considered the link between PTSD, traumatic brain injury (TBI), and combat exposure, but little is known about the potential role of chronic pain and Military Sexual Trauma (MST) in a veterans experience of anger, aggression, and discipline while in the military and legal concerns. The present study used retrospective cross-sectional health screening data in a sample of 1250 Iraq and Afghanistan veterans to examine the associations of demographic, service-related, and clinical characteristics with self-reported legal problems. A total of 440 veterans (34.6%) endorsed having experienced some type of problems with the law. Independent logistic regression analyses demonstrated that those who screened positive for PTSD, MST, TBI, and clinical levels of pain were more likely to report legal problems; only the associations with positive PTSD (p=0.001) and MST (p=0.007) screens remained significant in multivariate regression analyses. The findings underscore the need for a thorough psychological evaluation when veterans are involved in the legal system with a special emphasis on factors prevalent to Iraq and Afghanistan veterans.

Can familial factors account for the association of body mass index with poor mental health in men or women

OBJECTIVE This study examined if associations between body mass index (BMI) and mental and physical health were independent of genetic and familial factors. METHOD Data from 2831 twins (66% female) were used in an epidemiological co-twin control design with measures of BMI and mental and physical health outcomes. Generalized estimating equation regressions assessed relationships between BMI and health outcomes controlling for interdependency among twins and demographics. Within-pair regression analyses examined the association of BMI with health outcomes controlling for genetic and familial influences. RESULTS Adjusted analyses with individual twins found associations in women between BMI and perceived stress (P=.01) and depression (P=.002), and the link between BMI and depression (P=.03) was significant in men. All physical health outcomes were significantly related to BMI. Once genetic and familial factors were taken into account, mental health outcomes were no longer significantly associated with BMI. BMI in women remained related to ratings of physical health (P=.01) and body pain (P=.004), independent of genetic and familial influences. CONCLUSION These findings suggest that genetic and familial factors may account for the relationship between increased weight and poor mental health.

Feasibility, Acceptability, and Exploratory Outcomes of Acceptance and Commitment Therapy for Binge Eating Symptoms in Veterans: A Preliminary Clinic-Based Study

Overweight and obesity are disabling problems for veterans and place a heavy toll on their physical and mental health. Acceptance and commitment therapy (ACT) is an empirically supported intervention that shows promise in improving binge eating, weight, and psychological functioning. This preliminary study evaluated the feasibility and acceptability of an 8-week ACT group intervention for binge eating in veterans (N = 85) who were overweight or obese and explored preliminary intervention effects on binge eating and physical and mental health functioning. Veterans were predominantly male (86.7%) with an average age of 58 years, and 65% endorsed clinically significant binge eating. Qualitative results indicated the majority of veterans found the intervention useful. Baseline to post-treatment comparisons found significant reductions in binge eating symptoms, depression, global psychological distress, and body mass index, as well as improvement in functioning. Findings suggest implementing ACT for binge eating in veterans is feasible and deserves further exploration, addressing binge eating and weight control. Future studies should examine ACT for this population in a randomized controlled trial.

Dexamethasone-suppressed Salivary Cortisol and Pain Sensitivity in Female Twins

Objectives: Hypothalamic-pituitary-adrenal (HPA) axis dysregulation is associated with chronic pain. Studying pain sensitivity and the HPA axis could elucidate the role of stress in chronic pain development, which might be influenced by familial factors, including genes. Methods: Associations between pain sensitivity and salivary cortisol and familial confounding in these associations were examined in 88 female, community-based twin pairs (75% monozygotic, mean age 29 y). Cortisol was assessed after 0.25 mg dexamethasone (DEX), recovery from 0.25 mg DEX, and after 0.5 mg DEX. Cold pressor task (CPT) pain ratings were obtained at threshold and at tolerance. Conditioned pain modulation (CPM) was examined using thermal heat as the testing stimulus and hot water as the conditioning stimulus. Generalized estimating equation models were used and adjusted for baseline pain rating, age, and other relevant covariates. Results: After controlling for baseline cortisol, greater cortisol suppression following DEX administration and lower recovery cortisol levels were associated with higher pain ratings at tolerance during the CPT (Bs=−2.42 to −17.82; Ps=0.031 to<0.001) as well as with reduced CPM (Bs=−0.92 to −1.68; Ps=0.003 to 0.046). Interestingly, familial confounding was evident in the CPT and CPM during recovery from DEX administration, but not immediately following DEX administration. Discussion: These findings contribute to understanding possible mechanisms underlying chronic pain by demonstrating that HPA axis response to negative feedback is related to pain sensitivity.