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.

Pretreatment biomarkers predicting PTSD psychotherapy outcomes: A systematic review.

Although our understanding of the relationship between posttraumatic stress disorder (PTSD), brain structure and function, neural networks, stress-related systems, and genetics is growing, there is considerably less attention given to which biological markers predict evidence-based PTSD psychotherapy outcomes. Our systematic PRISMA-informed review of 20 studies examined biomarkers as predictors of evidence-based PTSD psychotherapy outcomes. Results provide preliminary evidence that specific structural and functional neural systems (involved in information processing), glucocorticoid sensitivity and metabolism (part of the hypothalamic-pituitary-adrenal axis and the response to stress), heart rate (involved with fear habituation), gene methylation, and certain genotypes (associated with serotonin and glucocorticoids) predicted positive response to PTSD treatment. These pre-treatment biomarkers are associated with processes integral to PTSD treatment, such as those affecting fear learning and extinction, cognitive restructuring, information processing, emotional processing, and interoceptive monitoring. Identifying pre-treatment biomarkers that predict treatment response may offer insight into the mechanisms of psychological treatment, provide a foundation for improving the pharmaceutical augmentation of treatment, and inform treatment matching.

Multi-site evaluation of a complementary, spiritually-based intervention for Veterans: The Mantram Repetition Program.

BACKGROUND: Mental and physical symptoms affect Veterans' quality of life. Despite available conventional treatments, an increasing number of Veterans are seeking complementary approaches to symptom management. Research on the Mantram Repetition Program (MRP), a spiritually-based intervention, has shown significant improvements in psychological distress and spiritual well-being in randomized trials. However, these findings have not been replicated in real-world settings. METHODS: In this naturalistic study, we analyzed outcomes from 273 Veterans who participated in MRP at six sites and explored outcomes based on facilitator training methods. Measures included satisfaction and symptoms of anxiety, depression, and somatization using the Brief Symptom Inventory-18; Functional Assessment of Chronic Illness Therapy-Spiritual Well-being questionnaire; and the Mindfulness Attention Awareness Scale. RESULTS: There were significant improvements in all outcomes (p's < .001) regardless of how facilitators were trained. Patient satisfaction was high. CONCLUSION: The MRP was disseminated successfully yielding improvements in psychological distress, spiritual well-being, and mindfulness.

Efficacy of yoga for depressed postpartum women: A randomized controlled trial.

BACKGROUND: Up to 20% of women experience postpartum depression (PPD). PPD is associated with anxiety and poor health-related quality of life (HRQOL). Efficacious treatments are critical; many women with PPD prefer complementary therapies. Thus, the current study examined yoga as a complementary therapy for PPD. METHODS: Fifty-seven postpartum women with scores ≥12 on the Hamilton Depression Rating Scale were randomly assigned to a yoga (N = 28) or wait-list control (N = 29) group. The yoga intervention consisted of 16 classes over 8 weeks. Outcomes were depression, anxiety, and HRQOL. RESULTS: The yoga group experienced significantly greater rate of improvement in depression, anxiety, and HRQOL, relative to the control group with moderate to large effects. Reliable Change Index analyses revealed that 78% of women in the yoga group experienced clinically significant change. CONCLUSION: These findings support yoga as a promising complementary therapy for PPD, and warrant large-scale replication studies. TRIAL REGISTRATION: http://clinicaltrials.gov/NCT02213601.

Patterns of women׳s mood after delivery: a growth curve analysis.

BACKGROUND: The course and predictors of women׳s mood following childbirth have informed clinically significant phenomena, such as postpartum depression (PPD), with some contradictory findings due to methodological limitations. It is important to further investigate mood during this unique period of time to inform assessment and improve interventions. METHODS: Recently delivered mothers (n=216) recruited from the maternity unit at a University hospital completed sociodemographic questions and the Daily Experiences Questionnaire (DEQ), a measure of Negative Affect (NA) and Positive Affect (PA), for 10 consecutive days. The Structured Clinical Interview for DSM-IV was administered to assess postpartum depression diagnosis. RESULTS: Growth curve modeling (GCM) techniques revealed average trends in mood following delivery. NA changed in a curvilinear fashion with a peak at day 5. PA declined rapidly during the days immediately following delivery and then stabilized. Women diagnosed with PPD experienced higher overall levels of NA and lower levels of PA from delivery to 10 days postpartum. Patterns of mood varied as a function of neuroticism and several well-established sociodemographic variables. LIMITATIONS: Small sample size and relatively few ethnic minority participants may affect generalizability of the findings. CONCLUSIONS: NA changed in a pattern consistent with the "peaking phenomenon". Well-established risk factors of the blues had significant associations with mood from delivery to day 10. Increased understanding into the nature of NA and PA in the early postpartum, and its role in identifying women susceptible to experiencing PPD, can inform screening and therapeutic interventions for PPD.

Examination of premenstrual symptoms as a risk factor for depression in postpartum women.

Postpartum depression (PPD) is a significant public health concern with prevalence of major and minor depressions reaching 20 % in the first three postpartum months. Sociodemographic and psychopathology correlates of PPD are well established; however, information on the relationship between premenstrual disorders and the development of PPD is less well established. Thus, the aim of this study was to examine the role of premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) as a risk factor for PPD. Premenstrual symptoms were assessed retrospectively using the premenstrual symptoms screening tool (PSST) and depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and assessed using the Hamilton Depression Rating Scale (HDRS). A two-stage screening procedure was applied. In the first stage, the Patient Health Questionnaire (PHQ-9) was employed. In the second stage, women endorsing ≥5 symptoms on the PHQ-9 were administered the Structured Clinical Interview for DSM-IV, HDRS, and PSST. Hierarchical linear regression showed that history of depression and PMS/PMDD contributed an additional 2 % of the variance (p < 0.001), beyond that of sociodemographic factor effects. The full model accounted for 13 % of the variance in postpartum depressive symptoms. Using logistic regression, a significant association also emerged between PMS/PMDD and PPD (OR = 1.97). The findings of this study suggest that PMS/PMDD is an important risk factor for PPD. Women endorsing a history of PMS/PMDD should be monitored during the perinatal period.

The structure of women's mood in the early postpartum.

The "postpartum blues" is a mild, predictable mood disturbance occurring within the first several days following childbirth. Previous analyses of the "blues" symptom structure yielded inconclusive findings, making reliable assessment a significant methodological limitation. The current study aimed to explicate the symptom structure of women's mood following childbirth, and to examine psychometric properties of the Daily Experiences Questionnaire (DEQ), an adapted version of the Kennerley Blues Questionnaire that included additional items from the Positive and Negative Affect Schedule. Mothers who recently delivered (N = 216) were recruited from a university hospital and asked to complete mood ratings on six consecutive days using the DEQ. Exploratory factor analysis yielded an interpretable two-factor solution identified as Negative Affect and Positive Affect. Scale reliability indices were excellent, with a high level of agreement in factor structure over time. This two-factor model provides reliable assessment of women's mood in the early postpartum, informing the study of reproductive-related mood disorders.

Sexual function in the postpartum period: effects of maternal depression and interpersonal psychotherapy treatment.

Women's sexual functioning in the postpartum period is understudied given its potential impact on women's mental health and their relationships with their partners. The sexual functioning of women with postpartum depression (PPD) in particular is not well characterized. The goals of this study were to examine factors associated with the sexual functioning of postpartum women and to compare the long-term sexual functioning of depressed postpartum women treated with interpersonal psychotherapy with a group of postpartum women who had never been depressed. Depressed (120) and never depressed (56) postpartum women were enrolled. Self-report questionnaires and clinician-rated measures were completed at initial entry to study, immediately post-treatment, and at 6, 12, and 18 months post-treatment. Analyses revealed significant differences in sexual interest between depressed and never depressed postpartum women (t (171) = 11.82, p <0.001). Although sexual interest improved significantly following treatment for depression (t (104) = -3.18, p < 0.01), those women who fully recovered continued to experience less interest (F (2, 140) = 32.24, p < 0.0001) and less sexual satisfaction through 2 years postpartum than never depressed women. These findings suggest that differences in sexual functioning exist between depressed and never depressed postpartum women, even after depressed women are treated and have recovered from their depression. Clinicians should inquire about changes in sexual functioning when treating women with PPD.