Anxiety Disorders: Page GG

Gill JM, Page GG. · School of Nursing, Johns Hopkins University, Baltimore, Maryland 21205, USA. · Issues Ment Health Nurs. · Pubmed #16849259 No free full text.

Abstract: All individuals are at some risk of experiencing a traumatic event and developing posttraumatic stress disorder (PTSD); however some individuals are at higher risk due to individual and environmental factors. This critical literature review focuses on women, as they are twice as likely as men to develop PTSD in their lifetimes. Should a woman develop PTSD, she is then at risk of developing psychiatric and physical health comorbidities that can further impact her quality of life. The strengths and limitations of current studies regarding this topic are discussed as are directions for future research and issues for nurses treating traumatized individuals.

Gill JM, Szanton SL, Page GG. · Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA. · Biol Res Nurs. · Pubmed #15920002 No free full text.

Abstract: Women develop posttraumatic stress disorder (PTSD) at twice the rate of men, even though fewer women than men experience traumatic events over their lifetimes. Current studies of individuals with PTSD provide evidence of alterations in the neuroendocrine system that involve levels and activity of cortisol and DHEA and changes in immune function that predispose these individuals toward an innate (Th1) immune response. Yet few studies have addressed the possible role of these biologic alterations in women's increased vulnerability to developing PTSD. In addition, current studies are limited in their ability to link biologic alterations to the observed fourfold increase in medical conditions in women with PTSD as compared to women without PTSD. And finally, few studies have addressed the biologic impact of co-occurring major depressive disorder (MDD) in individuals with PTSD. This critical review provides an update on neuroendocrine and immune perturbations associated with PTSD with and without co-occurring MDD to suggest links to health and possible mechanisms underlying the observed sex disparity in the development of PTSD.

Gill JM, Szanton S, Taylor TJ, Page GG, Campbell JC. · National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892-1506, USA. · J Womens Health (Larchmt). · Pubmed #19183098 No free full text.

Abstract: BACKGROUND: Epidemiological studies have consistently reported rates of posttraumatic stress disorder (PTSD) in women that are twice that of men. In men and women, PTSD has been associated with comorbid medical conditions, medical symptoms and lower self-rating of health. In low-income urban women, rates of PTSD are even more elevated than in suburban women and may be related to observed health disparities. METHODS: In this study, 250 women seeking healthcare at an urban clinic were interviewed for a PTSD diagnosis, major depressive disorder (MDD), the experience of traumatic events, the experience of current and past common medical conditions and symptoms, and subjective rating of health. A chart review was used to assess healthcare use in the past year. RESULTS: More current (5.2 vs. 3.8, p < 0.05) and past medical conditions (4.6 vs. 3.3, p < 0.05) were reported by women with a lifetime history of PTSD than by women without this history, after controlling for demographics and current depression. Women with lifetime PTSD also had more annual clinic appointments (5.9 vs. 3.8 p < 0.03) and were 2.4 times (p < 0.05) more likely to report lower appraisal of their physical health. CONCLUSIONS: These findings suggest that urban health-seeking women with PTSD experience health impairments that may cause increased morbidity and that healthcare providers should consider the health ramifications of PTSD when providing medical care to women.

Gill J, Vythilingam M, Page GG. · National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892-1506, USA. · J Trauma Stress. · Pubmed #19107725 No free full text.

Abstract: Posttraumatic stress disorder (PTSD) has been associated with hypothalamic-pituitary-adrenal (HPA) axis and immune function alterations; however, few studies have simultaneously investigated these systems in participants with PTSD. In this study, HPA axis and immune function in 26 women with PTSD with and without major depressive disorder was compared to 24 traumatized controls and to 21 nontraumatized controls. Posttraumatic stress disorder was associated with low cortisol and higher levels of DHEA and greater production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) compared to traumatized and healthy controls. Women with PTSD and depression exhibited greater production of IL-6 and higher levels of dehydroepiandrosterone (DHEA) than those with PTSD, but without depression. These findings suggest dysregulated HPA axis and immune function in women with PTSD, and that comorbid depression may contribute to these abnormalities.

Gill JM, Page GG, Sharps P, Campbell JC. · National Institute of Nursing Research, National Institutes of Health, 10 Center Drive, 10/CRC 2-1339, Bethesda, MD 20892-1506, USA. · J Urban Health. · Pubmed #18581238 No free full text.

Abstract: Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines. Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used to determine the associations between traumatic events and PTSD development. Survival analysis was used to determine if PTSD developed from assaultive and nonassaultive events differed in symptom duration. Eighty-six percent of women reported at least one traumatic event, 14.8% of women were diagnosed with current PTSD, and 19.6% with past PTSD. More than half of women with PTSD had comorbid depression. Assaultive traumatic events were most predictive of PTSD development. More than two thirds of the women who developed PTSD developed chronic PTSD. Women who developed PTSD from assaultive events experienced PTSD for at least twice the duration of women who developed PTSD from nonassaultive events. In conclusion, PTSD was very prevalent in urban health care-seeking women. Assaultive violence was most predictive of PTSD development and also nonremittance.

Woods SJ, Wineman NM, Page GG, Hall RJ, Alexander TS, Campbell JC. · University of Akron College of Nursing, Akron, Ohio 44325, USA. · ANS Adv Nurs Sci. · Pubmed #16292017 No free full text.

Abstract: This study uses a predictive exploratory design to test the relationships between and among childhood maltreatment, intimate partner violence (IPV), posttraumatic stress disorder (PTSD) symptoms, and immune status in abused women. A convenience sample of 126 abused women and 12 nonabused women matched for age and race/ethnicity were recruited. The woman's current smoking habit, history of childhood maltreatment, experience of IPV, and PTSD symptoms predicted immune status. This prediction occurs through both direct and indirect pathways from IPV to immune status and from IPV to immune status through PTSD.

Woods AB, Page GG, O'Campo P, Pugh LC, Ford D, Campbell JC. · Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Room 442, Baltimore, Maryland 21205, USA. · Am J Community Psychol. · Pubmed #16134052 No free full text.

Abstract: BACKGROUND: Women who experience intimate partner violence (IPV) report greater stress and negative health consequences than nonabused women. Although an association between psychological stress and altered immune function has been shown, IPV studies have not investigated this relationship. OBJECTIVE: This study explored the association of IPV with mental health symptoms and an immune marker to determine if posttraumatic stress disorder (PTSD) symptoms mediate the effect of IPV on pro-inflammatory (IFN-gamma) cytokine levels. METHODS: A cross-sectional, comparative design was used to compare 62 women with IPV and 39 nonabused women. RESULTS: Mean IFN-gamma values were higher in abused women and in women with current PTSD symptoms. There were no significant relationships with potential confounding variables that could provide an alternative explanation for the increase in production of proinflammatory cytokines. CONCLUSIONS: PTSD symptoms mediate the association between IPV and IFN-gamma levels and may partially explain the association of mental health symptoms with physical health sequelae in IPV.