Doctor of Philosophy, Alliant International Universi (2017)
Bachelor of Arts, University of San Francisco (2007)
Craig Rosen, Postdoctoral Faculty Sponsor
Improving and sustaining delivery of CPT for PTSD in mental health systems: A cluster-randomized trial
2017; 12 (32)
View details for DOI 10.1186/s13012-017-0544-5
Trauma Exposure and Risk of Suicidal Ideation Among Older Adults.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
2016; 24 (8): 639-643
To determine if trauma exposure is associated with suicidal ideation in a nationally representative sample of older adults.This study included 3,277 participants 55 years and older involved in the Collaborate Psychiatric Epidemiology Surveys (2001-2003).Of the 84.8% of older adults who were exposed to any trauma, 2.2% endorsed late-life suicidal ideation. Multivariable models fully adjusted for sociodemographics, post-traumatic stress disorder, major depressive disorder, and substance use revealed exposure to serious accidents/illness was associated with suicidal ideation (odds ratio: 2.55; 95% confidence interval: 1.16-5.59; Wald χ(2) = 5.47, df = 1, p = 0.019). Investigation of specific traumas within the category revealed that life-threatening illness was specifically associated with suicidal ideation in older adults (odds ratio: 2.12; 95% confidence interval: 1.34-3.36; Wald χ(2) = 10.33, df = 1, p = 0.001).These findings highlight the need for monitoring of suicidal ideation among older adults who have been informed of a life-threatening illness diagnosis.
View details for DOI 10.1016/j.jagp.2016.02.055
View details for PubMedID 27067069
View details for PubMedCentralID PMC4949107
TRAUMA EXPOSURE AND RISK OF SUICIDAL IDEATION AMONG ETHNICALLY DIVERSE ADULTS
DEPRESSION AND ANXIETY
2016; 33 (6): 495-501
Little is known about the association between trauma exposure and suicidal ideation across racial/ethnic groups. Our study aim was to determine the association between trauma exposure and suicidal ideation in a nationally representative ethnically diverse sample of adults.This study included 14,866 White, Hispanic, Black, and Asian participants 18 years and older involved in the Collaborate Psychiatric Epidemiology Surveys (2001-2003), comprised of three nationally representative studies (NCS-R, NSAL, and NLAAS). Lifetime history of suicidal ideation as assessed in the World Health Organization's World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (WMH-CIDI).Of the 81% respondents who reported being exposed to trauma as assessed in the WMH-CIDI, 12.1% endorsed lifetime suicidal ideation. Additionally, of the 19% who did not report trauma, 1.1% endorsed lifetime suicidal ideation. Fully adjusted, multivariable logistic regression models revealed two traumas consistently associated with significantly higher odds for suicidal ideation across all four racial groups examined: Assaultive/interpersonal violence and child maltreatment. Asians, in particular, had the highest likelihood for suicidal ideation in both trauma categories, with a near threefold increased odds for assaultive/interpersonal violence exposure (OR: 2.56; 95% CI: 1.71-3.83) and nearly ninefold increased odds for child maltreatment exposure (OR: 8.43; 95% CI: 4.91-14.49).Suicidal ideation in racially/ethnically diverse American adults is strongly associated with assaultive/interpersonal violence and child maltreatment, independent of PTSD, MDD, and substance use. These findings highlight the need for monitoring of suicidal behavior following assaultive/interpersonal trauma and child maltreatment, regardless of the presence of a psychiatric disorder.
View details for DOI 10.1002/da.22485
View details for Web of Science ID 000383708200005
View details for PubMedID 26992150
View details for PubMedCentralID PMC4889491
PTSD and Risk of Incident Cardiovascular Disease in Aging Veterans
AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY
2016; 24 (3): 192-200
To determine if late-life posttraumatic stress disorder (PTSD) is associated with cardiovascular disease in a sample of older veterans, and whether the association is independent of medical and psychiatric comorbities.Retrospective cohort study conducted using the Department of Veterans Affairs (VA) National Patient Care Database (2000-2011).VA medical centers in the United States.A total of 138,341 veterans 55 years and older without cardiovascular disease at study baseline (2000-2003).PTSD and cardiovascular disease (as defined by diagnoses of: cerebrovascular disease [CVD], congestive heart failure [CHF], myocardial infarction [MI], and peripheral vascular disease [PVD]) were identified by ICD-9 codes during study baseline (2000-2003) and follow-up (2004-2011), respectively.3% of veterans (N = 4,041) had a baseline diagnosis of PTSD. Unadjusted increased risk of incidence of CVD was 80%, CHF was 56%, MI was 82%, and PVD was 60% in veterans with PTSD compared with those without PTSD. After adjustment for demographics, medical comorbidities, substance use, and psychiatric comorbidities, veterans with late-life PTSD were at a 45% increased risk for incident CVD, 26% increased risk for incident CHF, 49% increased risk for incident MI, and 35% increased risk for PVD compared with veterans without late-life PTSD.Findings highlight the longitudinal impact of PTSD on increasing the incidence of cardiovascular disease in older adults. This study implies the need for greater monitoring and treatment of PTSD in older persons, particularly older veterans, to assist in preventing adverse outcomes, such as cardiovascular disease, over the long term.
View details for DOI 10.1016/j.jagp.2014.12.003
View details for Web of Science ID 000372309300003
View details for PubMedID 25555625
Preventing Loss of Independence through Exercise (PLIE): A Pilot Clinical Trial in Older Adults with Dementia
2015; 10 (2)
Current dementia medications have small effect sizes, many adverse effects and do not change the disease course. Therefore, it is critically important to study alternative treatment strategies. The goal of this study was to pilot-test a novel, integrative group exercise program for individuals with mild-to-moderate dementia called Preventing Loss of Independence through Exercise (PLIÉ), which focuses on training procedural memory for basic functional movements (e.g., sit-to-stand) while increasing mindful body awareness and facilitating social connection.We performed a 36-week cross-over pilot clinical trial to compare PLIÉ with usual care (UC) at an adult day program for individuals with dementia in San Francisco, CA. Assessments of physical performance, cognitive function, physical function, dementia-related behaviors, quality of life and caregiver burden were performed by blinded assessors at baseline, 18 weeks (cross-over) and 36 weeks. Our primary outcomes were effect sizes based on between-group comparisons of change from baseline to 18 weeks; secondary outcomes were within-group comparisons of change before and after cross-over.Twelve individuals enrolled (7 PLIÉ, 5 UC) and 2 withdrew (1 PLIÉ, 18 weeks; 1 UC, 36 weeks). Participants were 82% women (mean age, 84 ± 4 years); caregivers were 82% daughters (mean age, 56 ± 13 years). Effect sizes were not statistically significant but suggested potentially clinically meaningful (≥ 0.25 SDs) improvement with PLIÉ versus UC for physical performance (Cohen's D: 0.34 SDs), cognitive function (0.76 SDs) and quality of life (0.83 SDs) as well as for caregiver measures of participant's quality of life (0.33 SDs) and caregiver burden (0.49 SDs). Results were similar when within-group comparisons were made before and after cross-over.PLIÉ is a novel, integrative exercise program that shows promise for improving physical function, cognitive function, quality of life and caregiver burden in individuals with mild-to-moderate dementia. Larger randomized, controlled trials are warranted.ClinicalTrials.gov NCT01371214.
View details for DOI 10.1371/journal.pone.0113367
View details for Web of Science ID 000349545300002
View details for PubMedID 25671576
View details for PubMedCentralID PMC4324943
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