PTSD, comorbid depression, and the cortisol waking response in victims of intimate partner violence: preliminary evidence.
MENTAL depression; POST-traumatic stress disorder; HYDROCORTISONE; HYPOTHALAMIC-pituitary-adrenal axis; INTIMATE partner violence; VICTIMS
Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two highly comorbid and debilitating disorders experienced by more than half of intimate partner violence victims (IPV). Hypothalamic–pituitary–adrenal (HPA) abnormalities are common in both disorders, though the direction of abnormalities often differs. The present study examined the relationship between comorbid PTSD and MDD, and the (salivary) cortisol waking response in 104 recently abused IPV victims. Waking cortisol levels, area under the waking curve with respect to ground (AUCg), and AUC with respect to increase (AUCi) were examined to determine the relation of HPA dynamics to comorbidity for basal versus more dynamic measures. Prior to accounting for comorbidity, women with PTSD or MDD showed significantly greater AUCi than women without the respective disorder. Accounting for comorbidity, PTSD only did not differ from other groups, while MDD only and PTSD + MDD showed greater AUCi than women with neither disorder. Results were nonsignificant for waking cortisol levels or AUCg. Results suggest that MDD drives elevated waking cortisol response, but not basal cortisol activity in recently abused IPV victims. Results demonstrate the importance of examining comorbid diagnoses and HPA activity from a dynamic perspective. Therapeutic implications are discussed. [ABSTRACT FROM AUTHOR]
Pinna Keri LM; Johnson Dawn M; Delahanty Douglas L
Anxiety, Stress & Coping
2014
2014-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/10615806.2013.852185" target="_blank" rel="noreferrer noopener">10.1080/10615806.2013.852185</a>
Exploring comorbid depression and physical health trajectories: A case-based computational modelling approach.
artificial intelligence; case-based modelling; Child Abuse; cluster analysis; comorbid depression and physical health; Comorbidity; complexity theory; Computer Simulation; Depression – Therapy; differential equations; Health Status; Human; Intimate Partner Violence; longitudinal analysis; Models; nonlinear dynamics; primary care; Primary Health Care; Prospective Studies; Questionnaires; Research Personnel; Scales; Theoretical
While comorbid depression/physical health is a major clinical concern, the conventional methods of medicine make it difficult to model the complexities of this relationship. Such challenges include cataloguing multiple trends, developing multiple complex aetiological explanations, and modelling the collective large-scale dynamics of these trends. Using a case-based complexity approach, this study engaged in a richly described case study to demonstrate the utility of computational modelling for primary care research. N = 259 people were subsampled from the Diamond database, one of the largest primary care depression cohort studies worldwide. A global measure of depressive symptoms (PHQ-9) and physical health (PCS-12) were assessed at 3, 6, 9, and 12 months and then annually for a total of 7 years. Eleven trajectories and 2 large-scale collective dynamics were identified, revealing that while depression is comorbid with poor physical health, chronic illness is often low dynamic and not always linked to depression. Also, some of the cases in the unhealthy and oscillator trends remain ill without much chance of improvement. Finally, childhood abuse, partner violence, and negative life events are greater amongst unhealthy trends. Computational modelling offers a major advance for health researchers to account for the diversity of primary care patients and for developing better prognostic models for team-based interdisciplinary care.
Castellani Brian; Griffiths Frances; Rajaram Rajeev; Gunn Jane
Journal of evaluation in clinical practice
2018
2018-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/jep.13042" target="_blank" rel="noreferrer noopener">10.1111/jep.13042</a>