Methods

Overview

The Mind Your Heart Study is a prospective cohort study of Veterans, with and without post-traumatic stress disorder (PTSD), designed to better understand the impact of PTSD on metabolic and cardiovascular health and outcomes. It has two main aims: 1. to determine whether PTSD is an independent risk factor for subsequent cardiovascular disease and 2. to identify mechanisms responsible for this association.

Inclusion Criteria

All participants needed to be over the age of 18 at the time of recruitment. For the PTSD Cohort, all participants had to have a lifetime and/or current diagnosis of PTSD. For the control group, all participants needed to NOT have a lifetime and/or current diagnosis of PTSD.

Exclusion Criteria

(a) inability to walk one block

(b) acute coronary event within the previous 6 months

(d) lack of a stable mailing address or contact information

Participants underwent baseline, in-person exams consisting of the measures identified below. Since that time, they have participated in annual interviews. All measures recorded during those follow-up interviews can be found below. A pilot cohort of participants returned during Year 5 for a second, in person exam.

Measures

Baseline In-Person Interview

PSYCHOSOCIAL QUESTIONNAIRES

The Medical Outcomes Study (MOS) Short Form (SF-36): Physical Functioning

Brief Trauma Questionnaire (BTQ)

Combat Exposure Scale (CES)

PTSD Checklist (PCL-17)

The Positive Affect Negative Affect Schedule (PANAS)

Patient Health Questionnaire - 9 item (PHQ-9)

Berkman-Syme Social Networks Index (SNI)

Multidimensional Scale of Perceived Social Support (MSPSS)

Hospital Anxiety and Depression Scale (HADS-A)

A Two-Item Measure for Depression Screening

A Social Functioning Item from SF-36

Anger Temperament (T-Anger)

Negative Affectivity, Social Inhibition, and Type D Personality (DS14)

Life Orientation Test (LOT)

Emotion Regulation Questionnaire (ERQ)

Barefoot subset of Cook-Medley Hostility Scale

Full CAPS interview with trauma history, PTSD symptoms for current and lifetime.

CIDI- depression, mania, generalized anxiety disorder, psychosis screen

HEALTH BEHAVIOR QUESTIONNAIRES

Diet- PRIME Screen Dietary Questionnaire

Physical Activity

Smoking

Drinking (AUDIT-C)

Drug

Sleep

NEUROCOGNITIVE QUESTIONNAIRES

Digit Symbol Test

Trailmaking Test A

Trailmaking Test B

Verbal Fluency (L-words and F-words)

Category Fluency (animals and fruits/vegetables)

Hopkins Verbal Learning Test Free Recall and Recognition)

DEMOGRAPHICS/OTHER QUESTIONNAIRES

Age

Sex

Marital Status

Education

Ethnicity

Job/volunteering/satisfaction

Income

Live Alone

Medical Conditions

Medications- Coded in EpoCrates

CARDIAC TESTING

Resting EKG

Exercise Treadmill Test with VO2 max

Resting Echocardiogram

24 Hr. Holter monitor

LABORATORY TESTS

CBC

ESR

Renal Panel (lytes, BUN, Cr, EGFR)

Calcium

Phosphorus

Fasting Glucose

Hemoglobin A1c

Lipid Panel (Total Cholesterol, LDL, HDL, TGs)

Direct LDL

Liver Panel

Fibrinogen

Urinalysis

24-hour urine Epinephrine

24-hour urine Norepinephrine

24-hour urine Dopamine

24-hour urine Cortisol

Urine Microalbumin

Telomeres

Inflammatory biomarkers (CRP, IL-6, -10, -12, 1β)

Year 1 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Overall Health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Tobacco (current cigarette/current other)

Alcohol (AUDIT-C)

Illicit Drugs/Prescription drugs

Medication Inventory

Year 2 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

Military Service History (currently serving, rank, branch, component, job title, MOS, service wars, in theater wars, total years, number of warzone deployments, months in warzone)

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Brief Pain Inventory (BPI)

Insomnia Severity Index

Overall health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Incarceration history

Tobacco (current cigarette/current other)

Alcohol (AUDIT-C)

Detailed Illicit Drug/Prescription Narcotics use history - adapted from the Addiction Severity Index (ASI)

Medication Inventory

Year 3 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Overall Health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Tobacco (current cigarette/current other)

Alcohol (AUDIT-C)

Illicit Drugs/Prescription drugs

Homelessness

Health Literacy

Traumatic Brain Injury

Sleep Apnea Screening

Medication Inventory (only psychiatric/sleep medications)

Year 4 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Overall Health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Tobacco (current cigarette/current other)

Alcohol (AUDIT-C)

Illicit Drugs/Prescription drugs

Drafted vs. Enlisted in military service

Medication Inventory (only psychiatric/sleep medications)

Years 5-7 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Overall Health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Tobacco (current cigarette/current other)

Alcohol (AUDIT-C)

Illicit Drugs/Prescription drugs

Medication Inventory (only psychiatric/sleep medications)

Year 8 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Overall Health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Tobacco (current cigarette/current other)

Alcohol (AUDIT-C)

Illicit Drugs/Prescription drugs

Berkman-Syme Social Networks Index (SNI)

Multidimensional Scale of Perceived Social Support (MSPSS)

Medication Inventory (only psychiatric/sleep medications)

Year 9 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Overall Health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Tobacco (current cigarette/current other)

Alcohol (AUDIT-C)

Illicit Drugs/Prescription drugs

Brief Inventory of Psychosocial Functioning (B-IPF)

Medication Inventory (only psychiatric/sleep medications)

Year 10 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Overall Health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Tobacco (current cigarette/current other)

Alcohol (AUDIT-C)

Illicit Drugs/Prescription drugs

Brief Pain Inventory (BPI)

Emotion Regulation Questionnaire (ERQ)

Medication Inventory (only psychiatric/sleep medications)

Year 11 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Overall Health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Tobacco (current cigarette/current other/current vaping)

Alcohol (AUDIT-C)

Illicit Drugs/Prescription drugs (including additional marijuana use questions)

Medication Inventory (only psychiatric/sleep medications)

Year 12 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Overall Health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Tobacco (current cigarette/current other)

Alcohol (AUDIT-C)

Illicit Drugs/Prescription drugs

Medication Inventory (only psychiatric/sleep medications)

Year 13 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Overall Health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Tobacco (current cigarette/current other)

Alcohol (AUDIT-C)

Illicit Drugs/Prescription drugs

Healthcare Engagement

Posttraumatic Growth (PTGI-SF)

Medication Inventory (only psychiatric/sleep medications)

Year 14 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Overall Health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Tobacco (current cigarette/current other)

Alcohol (AUDIT-C)

Illicit Drugs/Prescription drugs

Energy Levels

Eating Habits (PHQ)

Medication Inventory (only psychiatric/sleep medications)

Year 15 Phone Follow-Up Interview

Outcomes - Cardiac events, psychiatric hospitalizations, and other hospitalizations

PTSD Treatments (medications, counseling, complementary alternative medicines, other)

PTSD Checklist (PCL-17)

Patient Health Questionnaire - 9 item (PHQ-9)

Overall Health

Quality of Life

Physical Activity

Physical Functioning (SF-36)

Tobacco (current cigarette/current other)

Alcohol (AUDIT-C)

Illicit Drugs/Prescription drugs

Medication Inventory (only psychiatric/sleep medications)

Pet Inventory

Hip/ Bone Fracture Inventory

Moral Injury and Distress Scale (MIDS)