The Impact of Adverse Childhood Experiences (ACEs) and Combat Exposure on Mental Health Conditions Among New Post-9/11 Veterans
PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY
Authors: Aronson, Keith R.; Perkins, Daniel F.; Morgan, Nicole R.; Bleser, Julia A.; Vogt, Dawne; Copeland, Laurel A.; Finley, Erin P.; Gilman, Cynthia L.
Abstract
Objective: Adverse childhood experiences (ACEs) are early life experiences of abuse and neglect, and observed violence, among others. For military veterans, both ACEs and combat exposure are associated with mental health problems. Method: This study examines the relationship between ACEs and combat exposure on the current mental health in a large sample of recent post-9/11 U.S. veterans. Results: Fifty-nine percent of female and 39% of male veterans reported exposure to 1 ACE, whereas 44% of female and 25% of male veterans were exposed to multiple ACEs. Female veterans were more likely to experience 4 or more ACEs. ACEs were more consistently associated with mental health problems for male veterans than their female peers. For female veterans, exposure to 1 or 2 ACEs did not increase the odds of having any mental health condition, whereas for males, this level of exposure was associated with probable PTSD and anxiety. Combat patrol events were associated with an increase in the likelihood of having a probable mental health problem, with 2 exceptions-combat patrol events were not associated with depression in male veterans and not associated with alcohol misuse in female veterans. Combat was not associated with alcohol misuse. Experiencing a corollary of combat (e.g., accidents, moral injury) was inconsistently associated with the odds of having a probable mental health problem. Conclusions: This study confirms prior studies demonstrating a relationship between ACEs and combat on subsequent mental health problems. Importantly, 2 different types of combat exposure had differential effects on mental health problems.
Good or bad: Application of RAAS inhibitors in COVID-19 patients with cardiovascular comorbidities
PHARMACOLOGY & THERAPEUTICS
Authors: Wang, James Jiqi; Edin, Matthew L.; Zeldin, Darryl C.; Li, Chenze; Wang, Dao Wen; Chen, Chen
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is caused by a newly emerged coronavirus (CoV) called Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). COVID-19 patients with cardiovascular disease (CVD) comorbidities have significantly increased morbidity and mortality. The use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor type 1 blockers (ARBs) improve CVD outcomes; however, there is concern that they may worsen the prognosis of CVD patients that become infected with SARS-CoV-2 because the virus uses the ACE2 receptor to bind to and subsequently infect host cells. Thus, some health care providers and media sources have questioned the continued use of ACE inhibitors and ARBs. In this brief review, we discuss the effect of ACE inhibitor-induced bradykinin on the cardiovascular system, on the renin-angiotensin-aldosterone system (RAAS) regulation in COVID-19 patients, and analyze recent clinical studies regarding patients treated with RAAS inhibitors. We propose that the application of RAAS inhibitors for COVID-19 patients with CVDs may be beneficial rather than harmful. (C) 2020 The Author(s). Published by Elsevier Inc.