Pre‐ejection period (PEP) is an index of sympathetic nervous system activity that can be computed from electrocardiogram (ECG) and impedance cardiogram (ICG) signals, but sensitive to speech/motion artifact. We sought to validate an ICG noise removal method, three‐stage ensemble‐average algorithm (TEA), in data acquired from a clinical trial comparing active versus sham non‐invasive vagal nerve stimulation (tcVNS) after standardized speech stress. We first compared TEA's performance versus the standard conventional ensemble‐average algorithm (CEA) approach to classify noisy ICG segments. We then analyzed ECG and ICG data to measure PEP and compared group‐level differences in stress states with each approach. We evaluated 45 individuals, of whom 23 had post‐traumatic stress disorder (PTSD). We found that the TEA approach identified artifact‐corrupted beats with intraclass correlation coefficient > 0.99 compared to expert adjudication. TEA also resulted in higher group‐level differences in PEP between stress states than CEA. PEP values were lower in the speech stress (vs. baseline rest) group using both techniques, but the differences were greater using TEA (12.1 ms) than CEA (8.0 ms). PEP differences in groups divided by PTSD status and tcVNS (active vs. sham) were also greater when using the TEA versus CEA method, although the magnitude of the differences was lower. In conclusion, TEA helps to accurately identify noisy ICG beats during speaking stress, and this increased accuracy improves sensitivity to group‐level differences in stress states compared to CEA, suggesting greater clinical utility.
Post‐traumatic stress disorder (PTSD) is an independent risk factor for incident heart failure, but the underlying cardiac mechanisms remained elusive. Impedance cardiography (ICG), especially when measured during stress, can help understand the underlying psychophysiological pathways linking PTSD with heart failure. We investigated the association between PTSD and ICG‐based contractility metrics (pre‐ejection period (PEP) and Heather index (HI)) using a controlled twin study design with a laboratory‐based traumatic reminder stressor. PTSD status was assessed using structured clinical interviews. We acquired synchronized electrocardiograms and ICG data while playing personalized‐trauma scripts. Using linear mixed‐effects models, we examined twins as individuals and within PTSD‐discordant pairs. We studied 137 male veterans (48 pairs, 41 unpaired singles) from Vietnam War Era with a mean (standard deviation) age of 68.5(2.5) years. HI during trauma stress was lower in the PTSD vs. non‐PTSD individuals (7.2 vs. 9.3 [ohm/s2],
- NSF-PAR ID:
- 10392292
- Publisher / Repository:
- Wiley-Blackwell
- Date Published:
- Journal Name:
- Psychophysiology
- Volume:
- 60
- Issue:
- 3
- ISSN:
- 0048-5772
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Abstract Objectives The COVID‐19 pandemic in South Africa introduced new societal adversities and mental health threats in a country where one in three individuals are expected to develop a psychiatric condition sometime in their life. Scientists have suggested that psychosocial stress and trauma during childhood may increase one's vulnerability to the mental health consequences of future stressors—a process known as stress sensitization. This prospective analysis assessed whether childhood adversity experienced among South African children across the first 18 years of life, coinciding with the post‐apartheid transition, exacerbates the mental health impacts of psychosocial stress experienced during the 2019 coronavirus (COVID‐19) pandemic (ca. 2020–2021).
Materials and Methods Data came from 88 adults who participated in a follow‐up study of a longitudinal birth cohort study in Soweto, South Africa. Childhood adversity and COVID‐19 psychosocial stress were assessed as primary predictors of adult PTSD risk, and an interaction term between childhood adversity and COVID‐19 stress was calculated to evaluate the potential effect of stress sensitization.
Results Fifty‐six percent of adults exhibited moderate‐to‐severe PTSD symptoms. Greater childhood adversity and higher COVID‐19 psychosocial stress independently predicted worse post‐traumatic stress disorder symptoms in adults. Adults who reported greater childhood adversity exhibited non‐significantly worse PTSD symptoms from COVID‐19 psychosocial stress.
Discussion These results highlight the deleterious mental health effects of both childhood trauma and COVID‐19 psychosocial stress in our sample and emphasize the need for greater and more accessible mental health support as the pandemic progresses in South Africa.
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Abstract Objective Many individuals diagnosed with an eating disorder (ED) have been exposed to traumatic events, and some of these individuals are diagnosed with posttraumatic stress disorder (PTSD). Although theorized by researchers and clinicians, it is unclear whether traumatic event exposure or PTSD interferes with outcomes from ED treatment. The objective of the current study was to systematically review the literature on traumatic events and/or PTSD as either predictors or moderators of psychological treatment outcomes in EDs.
Method A PRISMA search was conducted to identify studies that assessed the longitudinal association between traumatic events or PTSD and ED outcomes. Eighteen articles met the inclusion criteria for review.
Results Results indicated that traumatic event exposure was associated with greater ED treatment dropout, but individuals with a traumatic event history benefited from treatment similarly to their unexposed peers. Findings also indicated that traumatic events may be associated with greater symptom relapse posttreatment.
Discussion Given the limited number of studies examining PTSD, results are considered very tentative; however, similar to studies comparing trauma‐exposed and nontrauma‐exposed participants, individuals with PTSD may have similar treatment gains compared to individuals without PTSD, but individuals with PTSD may experience greater symptom relapse posttreatment. Future researchers are encouraged to examine whether trauma‐informed care or integrated treatment for EDs and PTSD mitigates dropout from treatment and improves symptom remission outcomes. Furthermore, researchers are encouraged to examine how the developmental timing of traumatic events, self‐perceived impact of trauma, and cumulative trauma exposure may be associated with differential ED treatment outcomes.
Public Significance Eating disorders (EDs), trauma, and posttraumatic stress disorder (PTSD) often co‐occur. Individuals with traumatic event exposure and/or PTSD demonstrate greater ED symptoms; it is unclear whether these individuals benefit similarly in ED treatment to their peers. The current study found that individuals with traumatic event exposure are more likely to drop out of treatment but benefit from treatment with similar symptom remission. Traumatic history was associated with greater relapse posttreatment.
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