Monica M. Bennett Ph.D.

Tolia, V. N., K. Murthy, M. M. Bennett, E. S. Miller, D. K. Benjamin, P. B. Smith and R. H. Clark (2017). “Antenatal methadone vs buprenorphine exposure and length of hospital stay in infants admitted to the intensive care unit with neonatal abstinence syndrome.” J Perinatol: 2017 Oct [Epub ahead of print].

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OBJECTIVE: Antenatal exposure to methadone or buprenorphine often causes neonatal abstinence syndrome (NAS) in newborns. However, comparative effects on affected infants’ hospital courses are inconclusive. We sought to estimate the relationship of antenatal exposure with methadone or buprenorphine and infants’ length of stay among hospitalized infants with NAS. STUDY DESIGN: This was a retrospective cohort study of hospitalized infants with NAS with either maternal exposure. Eligible infants were singleton infants born 36 weeks’ gestation and diagnosed with NAS<7 days of age between 2011 and 2014 in the Pediatrix Clinical Data Warehouse. Infant with congenital anomalies and those of multiple gestation were excluded. RESULTS: Of 3364 eligible infants, 2202 (65%) were exposed to methadone and 1162 (34%) to buprenorphine. Infants exposed to buprenorphine had a lower rate of pharmacologic treatment for NAS (88 vs 91%, P<0.001). Median length of hospital stay was shorter among infants exposed to buprenorphine (21 days (inter-quartile range; 13-31) vs methadone (24 days (15-38), P<0.0001)). On multivariable Cox proportional hazard analyses, buprenorphine was associated with a shorter length of stay (hazard ratio (HR)=1.47 (95% confidence interval (CI): 1.32-1.62, P<0.001) after controlling for maternal age, parity, race or ethnicity, prenatal care, smoking status, use of antidepressants, use of benzodiazepines, and infant gestational age, small for gestational age status, cesarean delivery, sex, out born status, type of pharmacotherapy, breast milk use, year and center. We observed similar results in model using infants matched 1:1 with propensity scores for antenatal medication exposure (HR 1.39 for buprenorphine, CI 1.32-1.62, P<0.001). CONCLUSION: Among infants born 36 weeks' gestation with NAS, antenatal buprenorphine exposure was associated with a decreased length of stay relative to antenatal methadone exposure.

Roden-Foreman, J. W., M. M. Bennett, E. E. Rainey, J. S. Garrett, M. B. Powers and A. M. Warren (2017). “Secondary traumatic stress in emergency medicine clinicians.” Cogn Behav Ther 46(6): 522-532.

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Previously called Secondary Traumatic Stress (STS), secondary exposure to trauma is now considered a valid DSM-5 Criterion A stressor for posttraumatic stress disorder (PTSD). Previous studies have found high rates of STS in clinicians who treat traumatically injured patients. However, little research has examined STS among Emergency Medicine (EM) physicians and advanced practice providers (APPs). The current study enrolled EM providers (N = 118) working in one of 10 hospitals to examine risk factors, protective factors, and the prevalence of STS in this understudied population. Most of the participants were physicians (72.9%), Caucasian (85.6%), and male (70.3%) with mean age of 39.7 (SD = 8.9). Overall, 12.7% of the sample screened positive for STS with clinical levels of intrusion, arousal, and avoidance symptom clusters, and 33.9% had at least one symptom cluster at clinical levels. Low resilience and a history of personal trauma were positively associated with positive STS screens and STS severity scores. Borderline significance suggested that female gender and spending >/=10% of one’s time with trauma patients could be additional risk factors. Findings suggest that resilience-building interventions may be beneficial.

McLaughlin, C., N. T. Kearns, M. Bennett, J. W. Roden-Foreman, K. Roden-Foreman, E. E. Rainey, G. Funk, M. B. Powers and A. M. Warren (2017). “Alcohol and drug toxicology screens at time of hospitalization do not predict ptsd or depression after traumatic injury.” Am J Surg 214(3): 390-396.

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BACKGROUND: Identifying risk factors for the development of PTSD and depression is critical for intervention and recovery after injury. Given research linking toxicology screens and substance use and the evidenced relationship between substance misuse and distress, the current study aimed to gauge the predictive value of toxicology testing on PTSD and depression. METHODS: Patients admitted to a Level I Trauma Center (N = 379) completed the PC-PTSD, PCL-C, and PHQ-8 at baseline, 3, 6, and 12 months. RESULTS: Results showed 52% of tested patients had a positive toxicology test, 51% screened for PTSD, and 54% screened for depression. Positive drug or alcohol toxicology tests were not significantly associated with PTSD or depression. CONCLUSIONS: Toxicology testing may not meaningful predict depression or PTSD in traumatic injury patients. Future research using validated measures of problematic substance use is needed to better understand how misuse may influence the development of psychological distress.

Roden-Foreman, K., J. Solis, A. Jones, M. Bennett, J. W. Roden-Foreman, E. E. Rainey, M. L. Foreman and A. M. Warren (2017). “Prospective evaluation of posttraumatic stress disorder and depression in orthopaedic injury patients with and without concomitant traumatic brain injury.” J Orthop Trauma 31(9): e275-e280.

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OBJECTIVES: Psychological morbidities after injury [eg, posttraumatic stress disorder (PTSD) and depression] are increasingly recognized as a significant determinant of overall outcome. Traumatic brain injury (TBI) negatively impacts outcomes of patients with orthopaedic injury, but the association of concurrent TBI, orthopaedic injury, and symptoms of PTSD and depression has not been examined. This study’s objective was to examine symptoms of PTSD and depression in patients with orthopaedic trauma with and without TBI. DESIGN: Longitudinal prospective cohort study. SETTING: Urban Level I Trauma Center in the Southwest United States. PATIENTS/PARTICIPANTS: Orthopaedic trauma patients older than 18 years admitted for >/=24 hours. MAIN OUTCOME MEASUREMENTS: Questionnaires examining demographics, injury-related variables, PTSD, and depression were administered during hospitalization and 3, 6, and 12 months later. Orthopaedic injury and TBI were determined based on ICD-9 codes. Generalized linear models determined whether PTSD and depression at follow-up were associated with TBI. RESULTS: Of the total sample (N = 214), 44 (21%) sustained a TBI. Those with TBI had higher rates of PTSD symptoms, 12 months postinjury (P = 0.04). The TBI group also had higher rates of depressive symptoms, 6 months postinjury (P = 0.038). CONCLUSIONS: Having a TBI in addition to orthopaedic injury was associated with significantly higher rates of PTSD at 12 months and depression at 6 months postinjury. This suggests that sustaining a TBI in addition to orthopaedic injury places patients at a higher risk for negative psychological outcomes. The findings of this study may help clinicians to identify patients who are in need for psychological screening and could potentially benefit from intervention.

Driver, S., M. Reynolds, M. Douglas and M. Bennett (2017). “Describing weight loss attempts and physical activity among individuals with tbi prior to participation in a weight-loss program.” J Head Trauma Rehabil: 2017 May [Epub ahead of print].

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OBJECTIVE: Describe (1) weight loss history, (2) perceptions about lifestyle changes, and (3) physical activity among a sample of individuals with traumatic brain injury prior to a 12-month lifestyle change program. SETTING: Community-based. PARTICIPANTS: Individuals enrolled in a lifestyle change program, 6 months or more post-traumatic brain injury, body mass index of 25 or greater, 18 to 64 years of age, with physician’s clearance to participate. DESIGN: Convenience sample. MAIN MEASURES: Self-report data were collected before beginning the lifestyle change program including descriptive, weight loss history and physical activity behavior using the Modifiable Activity Questionnaire. RESULTS: The final sample included 22 participants (M age = 46 years) injured a median of 8 years ago. Mean weight was 208.5 lb (SD = 40.2), with average body mass index of 31.84 (SD = 4.4). Since injury, 72.7% reported prior weight loss attempts, with 50% gaining 10 lb or more. All participants indicated high motivation for lifestyle changes. Perceived benefits included feeling better, improving overall health, and increased energy. Barriers included physical health complications. Types of physical activity completed included walking (68%, 180 min/mo) and swimming (32%, 79 min/mo). CONCLUSION: Results indicate that many individuals gained weight since injury and attempted weight loss, demonstrating a need for evidence-based lifestyle interventions. Future research is needed to determine whether individuals with traumatic brain injury are able to achieve and maintain weigh loss through intervention.