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Reijnen A.,Leiden University | Rademaker A.R.,Research Center Military Mental Health | Vermetten E.,Leiden University | Geuze E.,University Utrecht
European Psychiatry | Year: 2014

Objective: Recent studies in troops deployed to Iraq and Afghanistan have shown that combat exposure and exposure to deployment-related stressors increase the risk for the development of mental health symptoms. The aim of this study is to assess the prevalence of mental health symptoms in a cohort of Dutch military personnel prior to and at multiple time-points after deployment. Methods: Military personnel (n = 994) completed various questionnaires at 5 time-points; starting prior to deployment and following the same cohort at 1 and 6. months and 1 and 2. years after their return from Afghanistan. Results: The prevalence of symptoms of fatigue, PTSD, hostility, depression and anxiety was found to significantly increase after deployment compared with pre-deployment rates. As opposed to depressive symptoms and fatigue, the prevalence of PTSD was found to decrease after the 6-month assessment. The prevalence of sleeping problems and hostility remained relatively stable. Conclusions: The prevalence of mental health symptoms in military personnel increases after deployment, however, symptoms progression over time appears to be specific for various mental health symptoms. Comprehensive screening and monitoring for a wide range of mental health symptoms at multiple time-points after deployment is essential for early detection and to provide opportunities for intervention. Declaration of interest: This project was funded by the Dutch Ministry of Defence. © 2014 Elsevier Masson SAS. Source

Den Uyl T.E.,University of Amsterdam | Gladwin T.E.,University of Amsterdam | Gladwin T.E.,Research Center Military Mental Health | Wiers R.W.,University of Amsterdam
Biological Psychology | Year: 2015

Previous research has shown that stimulation of the left dorsolateral prefrontal cortex (DLPFC) enhances working memory (e.g. in the n-back task), and reduces craving for cigarettes and alcohol. Stimulation of the right inferior frontal gyrus (IFG) improves response inhibition. The underlying mechanisms are not clearly understood, nor is it known whether IFG stimulation also reduces craving. Here, we compared effects of DLPFC, IFG, and sham stimulation on craving in heavy drinkers in a small sample (. n=. 41). We also tested effects of tDCS on overcoming response biases due to associations between alcohol and valence and alcohol and approach, using implicit association tests (IATs). Mild craving was reduced after DLPFC stimulation. Categorization of valence attribute words in the IAT was faster after DLPFC stimulation. We conclude that DLPFC stimulation can reduce craving in heavy drinkers, but found no evidence for tDCS induced changes in alcohol biases, although low power necessitates caution. © 2014 Elsevier B.V. Source

van Zuiden M.,University of Amsterdam | Kavelaars A.,University of Houston | Vermetten E.,Research Center Military Mental Health | Vermetten E.,University Utrecht | And 8 more authors.
Psychoneuroendocrinology | Year: 2015

Deployed soldiers are at risk of developing stress-related conditions, including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and severe fatigue. We previously observed condition- and cell-specific differences in sensitivity of immune cells for regulation by glucocorticoids (GCs) pre-deployment between male soldiers with and without subsequent development of high levels of these stress-related symptoms. Here we investigated whether these pre-deployment dysregulations in GC-sensitivity of immune cells persisted after return from military deployment.In a prospective, longitudinal study including 721 male and female soldiers, the in vitro GC-sensitivity of monocytes and T-cells was assessed prior to deployment and one and six months post-deployment. Differences in the longitudinal course of sensitivity for regulation by dexamethasone (DEX) of LPS-stimulated TNF-α production and PHA-stimulated T-cell proliferation between soldiers with and without subsequent symptom development were investigated using linear mixed models. Within the whole group, DEX-sensitivity of monocytes was significantly decreased at six months post-deployment compared to the assessments pre-deployment and one month post-deployment. The DEX-sensitivity of T-cells did not significantly change over time. Participants developing high levels of PTSD symptoms showed high DEX-sensitivity of T-cells, while participants developing high levels of depressive symptoms showed low DEX-sensitivity of T-cells before deployment that persisted at the two time points after return. In addition, participants developing severe fatigue had low DEX-sensitivity of monocytes at all assessments.Our finding that the previously observed pre-deployment group differences in peripheral GC-sensitivity persisted until at least six months after return indicates that in vitro GC-sensitivity of T-cells and monocytes may represent a persistent biological vulnerability factor for development of stress-related conditions PTSD, depression and fatigue. © 2014 Elsevier Ltd. Source

van Zuiden M.,University of Amsterdam | Geuze E.,Research Center Military Mental Health | Geuze E.,University Utrecht | Kavelaars A.,University of Houston | And 4 more authors.
Psychoneuroendocrinology | Year: 2015

Objective: Combat stress exposed soldiers may respond to post-deployment stressful life events (SLE) with increases in symptoms of posttraumatic stress disorder (PTSD), consistent with a model of stress sensitization. Several lines of research point to sensitization as a model to describe the relations between exposure to traumatic events, subsequent SLE, and symptoms of PTSD. Based on previous findings we hypothesized that immune activation, measured as a high in vitro capacity of leukocytes to produce cytokines upon stimulation, underlies stress sensitization. Methods: We assessed mitogen-induced cytokine production at 1 month, SLE at 1 year, and PTSD symptoms from 1 month up to 2 years post-deployment in soldiers returned from deployment to Afghanistan (. N=. 693). Exploratory structural equation modeling as well as latent growth models were applied. Results: The data demonstrated significant three-way interaction effects of combat stress exposure, cytokine production, and post-deployment SLE on linear change in PTSD symptoms over the first 2 years following return from deployment. In soldiers reporting high combat stress exposure, both high mitogen-stimulated T-cell cytokine production and high innate cytokine production were associated with increases in PTSD symptoms in response to post-deployment SLE. In low combat stress exposed soldiers as well as those with low cytokine production, post-deployment SLE were not associated with increases in PTSD symptoms. Conclusion: High stimulated T-cell and innate cytokine production may contribute to stress sensitization in recently deployed, high combat stress exposed soldiers. These findings suggest that detecting and eventually normalizing immune activation may potentially complement future strategies to prevent progression of PTSD symptoms following return from deployment. © 2014 Elsevier Ltd. Source

Smid G.E.,Foundation Centrum45 Arq | Kleber R.J.,Foundation Centrum45 Arq | Kleber R.J.,University Utrecht | Rademaker A.R.,Research Center Military Mental Health | And 5 more authors.
Social Psychiatry and Psychiatric Epidemiology | Year: 2013

Purpose: Military personnel exposed to combat are at risk for experiencing post-traumatic distress that can progress over time following deployment. We hypothesized that progression of post-traumatic distress may be related to enhanced susceptibility to post-deployment stressors. This study aimed at examining the concept of stress sensitization prospectively in a sample of Dutch military personnel deployed in support of the conflicts in Afghanistan. Method: In a cohort of soldiers (N = 814), symptoms of post-traumatic stress disorder (PTSD) were assessed before deployment as well as 2, 7, 14, and 26 months (N = 433; 53 %) after their return. Data were analyzed using latent growth modeling. Using multiple group analysis, we examined whether high combat stress exposure during deployment moderated the relation between post-deployment stressors and linear change in post-traumatic distress after deployment. Results: A higher baseline level of post-traumatic distress was associated with more early life stressors (standardized regression coefficient = 0.30, p < 0.001). In addition, a stronger increase in posttraumatic distress during deployment was associated with more deployment stressors (standardized coefficient = 0.21, p < 0.001). A steeper linear increase in posttraumatic distress post-deployment (from 2 to 26 months) was predicted by more post-deployment stressors (standardized coefficient = 0.29, p < 0.001) in high combat stress exposed soldiers, but not in a less combat stress exposed group. The group difference in the predictive effect of post-deployment stressors on progression of post-traumatic distress was significant (χ2(1) = 7.85, p = 0.005). Conclusions: Progression of post-traumatic distress following combat exposure may be related to sensitization to the effects of post-deployment stressors during the first year following return from deployment. © 2013 Springer-Verlag Berlin Heidelberg. Source

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