Association of serotonin reuptake inhibitors with asthma control.

Background: Clinical trials demonstrated that selective serotonin reuptake inhibitors (SSRI) can improve asthma control in patients with comorbid major depressive disorder (MDD) and that this effect may be greater than the effect of SSRIs on depression. These findings suggest that SSRIs may improve asthma control in patients without MDD. Objective: The current retrospective study examined the effect of SSRIs and serotonin and norepinephrine reuptake inhibitors (SNRI) on asthma control in adult patients. We hypothesized that patients would have fewer asthma exacerbations after treatment with an SSRI or SNRI. Methods: Electronic health record data of adult patients (N = 592) who were seen at a University of Texas Southwestern (UTSW) hospital or clinic and had (1) an SSRI or SNRI prescription, (2) a previous asthma diagnosis, and (3) no mood disorder diagnosis were extracted by using the UTSW Clinical Data Exchange Network. Wilcoxon signed rank tests were used to compare oral corticosteroid prescriptions and asthma-related emergency department (ED) visits and hospitalizations in the 12 months before and after the start of an SSRI/SNRI. Results: Therapy with SSRIs/SNRIs was associated with a significant decrease in oral corticosteroid use (p = 0.003), ED visits (p = 0.002), and hospitalizations (p < 0.001). Conclusion: Results from the current study add to the existing literature by demonstrating a reduced rate of severe exacerbations in patients with asthma by using an SSRI/SNRI without limiting the analytic sample to a high-illness-severity subgroup defined by symptoms of asthma or depression. Future work should include a prospective, placebo controlled study with individuals who have asthma and no comorbid mental health condition, verified by a mental health professional.

A systematic review of alcohol consumption and disorders in relation to disasters.

BACKGROUND: Excessive alcohol use and alcohol use disorders (AUDs) are serious medical problems in general populations. Alcohol use is associated with stressful events. Thus it is possible that problems with alcohol use increase in association with disasters. It is important to know the extent to which disasters contribute to these problems in exposed populations. METHODS: This review focused on the associations of alcohol use, problematic alcohol use, and AUDs with disasters. Alcohol variables were examined for predisaster to postdisaster changes and differences between samples according to disaster exposures. RESULTS: In all, 44 studies were found that addressed the association of alcohol variables with disaster. Much of this research had substantive methodological difficulties limiting the conclusions. Most research examining changes in alcohol use after disasters reported increases, but the increases were clinically small, amounting to ≤1 drink per day, and alcohol use returned to predisaster levels over time. The research on problematic alcohol use provided little evidence of an association with disasters. The studies of AUDs did not support their association with disaster. CONCLUSIONS: Even without clear evidence that disasters cause increases in alcohol use problems, it is important in the postdisaster setting to assess problems of alcohol use along with psychopathology.

A Longitudinal Study of Suicidality in a Homeless Population Sample.

OBJECTIVE: Little research has been conducted on the timing of the onset and course of suicidality relative to the timing of the onset and temporal status of homelessness. Therefore, this longitudinal study investigated suicidal ideation and plans and suicide attempts in a homeless population in relation to housing attainment, psychiatric disorders, and substance use/disorders. METHOD: Prospective longitudinal follow-up data were collected from a representative sample of literally homeless adults in St. Louis (N = 255) using the Diagnostic Interview Schedule/Homeless Supplement, the Composite International Diagnostic Interview-Substance Abuse Module, and urine drug screens. Associations among suicidal symptom variables, housing status, psychiatric/substance use disorders, and substance use were examined at baseline and longitudinally. RESULTS: Lifetime prevalence of suicidal ideation/plan and suicide attempts in this homeless population were much higher than in the general population. Onset of suicidal symptoms had typically preceded onset of homelessness. Few individuals experienced suicidal ideation/plans or attempted suicide during this study, and even fewer experienced new suicidal symptoms after baseline. Securing stable housing during the study follow-up was associated with lower rates of suicidal ideation/plans. CONCLUSIONS: This study's findings contradict assumptions that the high prevalence of suicidal symptoms in homeless populations can be explained by the difficulties and miseries of homelessness. Psychiatric illness, substance abuse, and psychosocial factors associated with homelessness may be direct contributors to suicidal symptoms and thus represent strategic intervention targets.HIGHLIGHTSMost suicidality reported at baseline first emerged long before first homelessnessAfter baseline, few reported new suicidal symptoms or had active suicidal symptomsSignificantly fewer reports of suicidal ideation/plans over time were found in those with the most stable housing outcome.

Dissociation and psychopathology in Kenyan survivors of a terrorist bombing.

BACKGROUND: Dissociation is a serious psychological condition that is characterized as a pathological outcome of trauma-related experience. Thus, dissociation could be expected to develop in survivors of disaster trauma and to be associated with trauma exposure and psychopathology. METHODS: A sample of 278 disaster-affected Kenyans was assessed 8 to 10 months after the 1998 terrorist bombing of the US Embassy in Nairobi for a study of trauma-related psychopathology and dissociation in the context of personality and culture. Instruments of assessment were the Diagnostic Interview Schedule, the Dissociative Experiences Scale, and the Temperament and Character Inventory. RESULTS: Dissociation appeared to represent a largely nonpathological response to the disaster experience that reflected personality variables and a cultural context. CONCLUSIONS: These findings suggest that dissociation encountered in disaster-exposed groups in this cultural setting does not necessarily represent psychopathology, but attention to dissociative responses might help clinicians identify and provide interventions for individuals experiencing distressing intrusive and hyperarousal symptoms.

Association between headache and suicidality: An analysis of universal suicide screening data at a large urban county hospital.

BACKGROUND: Identifying individuals at increased risk of suicide is important, particularly those who present for treatment for nonpsychiatric chief complaints who may go undetected. It has been found that pain symptoms, such as headache, are associated with suicide, although this association requires further characterization. This study examined specific components of suicidality in relation to headache subtypes. METHODS: This study retrospectively reviewed 2,832,835 nonpsychiatric adult clinical encounters at a large county hospital, where a standardized suicide risk screening tool, the Columbia-Suicide Severity Rating Scale (C-SSRS), was universally implemented. The C-SSRS assesses specific components of suicidality: wish to be dead and suicidal ideation, method, intent, plan, and action. Multivariate logistic regressions were performed to assess the association between headache, as well as headache subtype (migraine, tension, or cluster), and each component of suicidality. RESULTS: There were significant positive associations between presenting with a headache and 2 specific components of suicidality: wish to be dead and suicidal action. Individuals with tension headache may have a lower risk of wishing to be dead compared to those with migraine and cluster headaches. CONCLUSIONS: The association of headaches with specific elements of sui-cidality demonstrates the potential yield of identification of suicide risk among individuals with nonpsychiatric presentations.

Employee Job Satisfaction and Performance in Association With Workplace Responses to the 9/11 Attacks on New York City's World Trade Center.

OBJECTIVE: Research is needed on disaster-affected workplaces, particularly on employee job satisfaction and performance, to inform workplace responses promoting employee postdisaster adjustment and wellbeing. METHODS: Quantitative and qualitative data were collected from a volunteer sample of 255 employees of eight workplaces affected by the 9/11 attacks on New York City's World Trade Center nearly 3 years post disaster. RESULTS: The effects of 9/11 on both job satisfaction and job performance were more negative than positive, especially for the Ground Zero employees. Effects on job satisfaction and job performance were generally congruent. Workplace responses focused on individual needs were perceived as positive and those focused on workplace needs as negative. CONCLUSIONS: Workplace responses focused on business improvement intended to improve workplace performance may not have the desired effect and may reduce employee job satisfaction and performance.

Personality and Psychiatric Disorders among Employees of New York City Workplaces Affected by the 9/11 Attacks on the World Trade Center.

OBJECTIVE: Personality is associated with psychopathology after disasters, but its association with the portion of postdisaster psychopathology that is incident remains unclear. It is also unclear whether any particular attributes of personality are associated with resistance to the persistence or recurrence of preexisting psychopathology after disasters. This exploratory study of employees of workplaces affected by the September 11, 2001, attacks on the World Trade Center in New York City examined the specific relationships of personality variables (specifically, novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativeness, and self-transcendence) to incident postdisaster psychiatric disorders and resistance to the persistence/recurrence of preexisting psychiatric disorders after the disaster. METHODS: Approximately 3 years after the 9/11 attacks, 379 employees were recruited from 8 selected affected workplaces (3 in the World Trade Center towers, 5 at varied distances in the geographic area). Lifetime predisaster and postdisaster psychiatric disorders were assessed retrospectively with the Diagnostic Interview Schedule for DSM-IV, disaster experience details were collected with the Disaster Supplement, and personality was assessed with the Temperament and Character Inventory. RESULTS: Underdeveloped executive functioning (low self-directedness and/or low cooperativeness) was associated with incident postdisaster psychopathology, and components of resilience (low harm avoidance, high self-directedness, and high persistence) were associated with postdisaster resistance to persistence/recurrence of preexisting psychiatric illness. CONCLUSIONS: Personality is related to both incident and persistent/recurrent portions of postdisaster psychopathology, not clearly distinguished in previous research. Personality variables related to executive functioning and resilience may aid in assessing risk and developing treatments to prevent disaster-related psychopathology.

Psychosocial Effects on US Government Personnel of Exposure to the 1998 Terrorist Attack on the US Embassy in Nairobi.

Objective: The mental health effects of major terrorist attacks on diplomatic government personnel have not been well studied. This study examined the psychiatric and psychosocial effects of the 1998 terrorist bombing of the US Embassy in Nairobi, Kenya, on US government personnel exposed to the bombing. Method: At 8-10 months after the bombing, 179 US government employees (53 Americans, 126 Kenyans, 53% male, age mean = 40.6 and SD = 8.4 years ranging 21-65) were assessed with the Diagnostic Interview Schedule for DSM-IV for disaster-related psychiatric diagnoses and the Disaster Supplement Interview and Questionnaire about their immediate disaster experiences, subjective responses, mental health interventions/treatment, safety perceptions, and coping. Results: About one-third (32%) of these US government personnel developed postdisaster psychiatric disorders, mostly bombing-related PTSD (20%), but few received psychiatric treatment. Prevalence rates of all postdisaster psychiatric disorders, including bombing-related PTSD, were similar between subgroups of Americans and Kenyans, despite the Kenyans reporting more direct disaster trauma exposures, subjective postdisaster distress, and posttraumatic stress symptoms. These US government personnel had fewer psychiatric consequences of the Nairobi bombing than their previously studied civilian counterparts. Conclusions: Possible explanatory factors in the lower prevalence of postdisaster psychopathology in these government personnel compared to the civilians are selection for greater personal resilience for government employment and stigma-based underreporting of mental health needs in governmental workplaces. Stigma is a potential barrier to psychiatric treatment that needs to be addressed in government workplaces.