key: cord-0999211-tvzu1b66
authors: Castillo, Monica Feliz; Troyer, Emily; Kohn, Jordan; Lobo, Judith; Ang, Gavrila; Cirilo, Anthony; Leal, Juan Andrew; Pung, Merideth; Wilson, Kathleen; Pruitt, Christopher; Redwine, Laura; Hong, Suzi
title: P635. Post-Traumatic Stress in Older Adults with Hypertension During the Early Phase of the COVID-19 Pandemic: Prevalence, Correlates, and Pro-Inflammatory Biomarkers
date: 2022-05-01
journal: Biological Psychiatry
DOI: 10.1016/j.biopsych.2022.02.872
sha: 6a1f86b4d26c0e92f7be65ae39fece1620181c11
doc_id: 999211
cord_uid: tvzu1b66

nan

found no significant association between subjective sleep quality and hippocampus volume. We examined an objective, actigraphy measure of sleep fragmentation in relation to hippocampus volumes in adults with PTSD.

Methods: Participants with PTSD (n ¼ 58; 47 female), underwent 3T magnetic resonance imaging and wore an actigraph collecting triaxial raw accelerometer data for a 14-day period. Sleep fragmentation equaled percent of time moving and restless during nightly sleep episodes, averaged across the 14 nights. We extracted volumes of the left hippocampus, right hippocampus, and intracranial volume (ICV) from T1-weighted images using Freesurfer 6.0. Analyses of covariance (ANCOVAs) examined sleep fragmentation as a predictor of left and right hippocampus volumes, using hemisphere as the repeated measure, covarying for ICV, sex, and age.

Results: ANCOVA identified a significant main effect of sleep fragmentation on hippocampus volumes (F(1,53) ¼ 7.041, p ¼ .011) and the interaction with hemisphere was not significant. Post-hoc tests showed this corresponded to significant negative partial correlations of sleep fragmentation with left (r(58) ¼ -0.333) and right (r(58) ¼ -0.331) hippocampus volumes.

Conclusions: Actigraphy-measured fragmented sleep correlated with smaller hippocampi in adults with PTSD. Longitudinal research should examine whether chronic sleep loss contributes to neuron compromise and volume loss of the hippocampus in PTSD. Background: PTSD is twice as prevalent in women compared to men, and sex hormones have been implicated in this disparity. While PTSD is associated with altered cardiovascular physiology, research on sex hormones and cardiovascular physiology is lacking in PTSD populations. We explored relationships between sex hormone levels, psychopathology, and heart rate (HR) and blood pressure (BP) among women with PTSD.

Methods: Sixteen women (M age ¼ 29.38) completed 5-minutes of resting HR and BP. Plasma was assayed for estradiol and progesterone. Surveys included the PTSD Checklist (PCL-5), the Beck Depression Inventory (BDI-II), and the State Trait Anxiety Inventory (STAI).

Results: Preliminary analyses focused on bivariate correlations. Progesterone and systolic BP were negatively correlated (r ¼ -.66, p ¼ .039), as were estradiol and STAI scores (r ¼ -.56, p ¼ .036). Diastolic BP and PCL-5 scores were positively correlated (r ¼ .52, p ¼ .040), as were HR and BDI-II scores (r ¼ .55, p ¼ .027).

Conclusions: This is the first study to examine progesterone and cardiovascular physiology in women with PTSD. The negative association between progesterone and BP, as well as estradiol and anxiety, support prior literature suggesting that these hormones may be protective against hypertension and psychopathology. The positive association between BP and PTSD severity, as well as HR and depression severity, supports literature linking elevated cardiovascular physiology with PTSD and depression. Data collection and analyses are ongoing and will further probe these associations to characterize how sex hormones influence cardiovascular physiology in women with PTSD. Background: Post-traumatic stress symptoms include intrusion phenomena, hypervigilance, avoidance, and negative alterations in mood and cognition and are associated with increased risk for cardiometabolic and neurodegenerative disorders, especially in older adults. As higher proinflammatory marker levels are shown in PTSD, immune dysregulation may underlie these associations. Cytokine dysregulation could underlie onset of neuropsychiatric symptoms in COVID-19 survivors.

Methods: Adults aged 60-90 years with hypertension completed hemodynamic testing, plasma biomarker measurements, and psychological and cognitive assessments. Prevalence of PTSS was determined based on a PC-PTSD cut-off score of 3. Group comparisons were conducted using Wilcoxon rank sum or Chi-squared tests. Binary and ordinal logistic regression analyses were used to test whether prepandemic measures predicted PTSS group status and PC-PTSD scores.

Results: Ninety-five subjects completed the study. Pre-COVID-19, the two PTSS groups did not differ by age, antihypertensive medication usage, Framingham Risk Score, or inflammatory biomarker levels. Framingham risk scores were marginally correlated with inflammatory biomarkers and MoCA scores. Prevalence of PTSS in this cohort of older adults with hypertension during the pandemic was 7.4%, greater than the pre-pandemic prevalence of PTSD in the general population of 4.7% but lower than 15-23% reported in other adult samples during the pandemic. Female sex and baseline anxiety levels Methods: Women 18 years of age presenting within 72 hours of SA to 1 of 12 emergency care (EC) sites were enrolled. Participants answered questionnaires at initial EC presentation and through one year post-assault assessing pre-and post-assault mental and physical health as well as pre-assault trauma exposure. Records from EC visits were reviewed to characterize assault details. These factors were assessed as possible risk factors for PCS at six months, the midpoint of follow-up, using univariate relative risk, t-tests, and multivariate LASSO logistic regression. Incidence of somatic symptoms at all timepoints was reported using descriptive statistics.

Results: 554/706 (78.6%) women SA survivors completed the six-month follow-up. More than half of women met criteria for PCS at all timepoints. However, only 30.8% of women sustained head and/or hypoxic injury during assault, which did not significantly increase the risk for PCS at six months. Past SA and multiple adult traumas increased risk by >30%. Multivariate analyses suggested 11 variables (e.g., back injury, difficulty concentrating) that together best predicted PCS at 6 months (AUC¼0.75, Brier score¼0.20).

Conclusions: PCS is common for months after SA, and these symptoms were predicted better by past experiences than by incidence of head or hypoxic injury during assault, calling into question the notion that these symptoms are best defined as PCS. Further research is needed to better understand the pathophysiology of PCS somatic symptoms. Background: To develop and validate a brief tool to stratify sexual assault (SA) survivors at the time of emergency department (ED) evaluation for risk of prolonged posttraumatic stress (PTS) symptoms.

Methods: Women SA survivors 18 years of age who presented to the emergency department for care within 72 hours of SA were enrolled in a multi-site study. Follow-up evaluation included an assessment for substantial PTS symptoms (PCL-5 score of 38) 6 months after SA. The222 predictors assessed included pre-trauma health status and life history (e.g., childhood trauma, previous life trauma), SA characteristics, and peritraumatic symptoms. Logistic regression modeling was used to derive and validate predictive models.

Results: 40.4% of SA survivors (n¼547, mean age 28

PTS 12 months after assault, n¼480) of 0.72, with a brier score of 0.21. Conclusions: A brief ED prediction tool may help to identify SA survivors at high risk of substantial PTS. Supported By: NIH R01AR064700 Keywords: PTS -Posttraumatic Stress, Sexual Assault, Women's Health, Clinical High Risk Predictors, Clinical Prediction Tool P638. Substance Use to Cope with Posttraumatic Stress Disorder in the Aftermath of Sexual Assault: Results From a Multi-Site Prospective Study of Women Sexual Assault Survivors Riya Thomas 1