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Post-traumatic stress disorder as a predictor for incident hypertension: a 3-year retrospective cohort study

Published online by Cambridge University Press:  14 April 2021

Victoria Mendlowicz ,
Maria Luiza Garcia-Rosa ,
Marcio Gekker ,
Larissa Wermelinger ,
William Berger ,
Mariana Pires de Luz ,
Paulo Roberto Telles Pires-Dias ,
Carla Marques-Portela ,
Ivan Figueira  and
Mauro Vitor Mendlowicz Open the ORCID record for Mauro Vitor Mendlowicz [Opens in a new window]
Victoria Mendlowicz
Affiliation:
Universidade Federal Fluminense School of Medicine, Niteroi, Brazil
Maria Luiza Garcia-Rosa
Affiliation:
Department of Epidemiology and Biostatistics, Universidade Federal Fluminense (MEB-UFF), Niteroi, Brazil
Marcio Gekker
Affiliation:
Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
Larissa Wermelinger
Affiliation:
Universidade Federal Fluminense School of Medicine, Niteroi, Brazil
William Berger
Affiliation:
Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
Mariana Pires de Luz
Affiliation:
Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
Paulo Roberto Telles Pires-Dias
Affiliation:
Department of Epidemiology and Biostatistics, Universidade Federal Fluminense (MEB-UFF), Niteroi, Brazil
Carla Marques-Portela
Affiliation:
Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
Ivan Figueira
Affiliation:
Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
Mauro Vitor Mendlowicz*
Affiliation:
Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niteroi, Brazil
*
Author for correspondence: Mauro Vitor Mendlowicz, Email: mmendlowicz@yahoo.com
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Abstract

Background

The goal of the present study was to investigate the association between PTSD and the onset of hypertension in previously normotensive individuals in a population living in the stressful environment of the urban slums while controlling for risk factors for cardiovascular disease (CVD).

Methods

Participants were 320 normotensive individuals who lived in slums and were attending a family doctor program. Measurements included a questionnaire covering sociodemographic characteristics, clinical status and life habits, the Posttraumatic Stress Disorder Checklist – Civilian Version, and the Beck Depression Inventory. Incident hypertension was defined as the first occurrence at the follow-up review of the medical records of (1) systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, (2) the participant started taking antihypertensive medication, or (3) a new diagnosis of hypertension made by a physician. Differences in sociodemographic, clinical, and lifestyle characteristics between hypertensive and non-hypertensive individuals were compared using the χ2 and t tests. Multivariate Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI).

Results

Six variables – age, educational level, body mass, smoking, diabetes, and PTSD diagnosis – showed a statistically significant (p ≤ 0.20) association with the hypertensive status. In the Cox regression, only PTSD diagnosis was significantly associated with incident hypertension (multivariate HR = 1.94; 95% CI 1.11–3.40).

Conclusions

The present findings highlight the importance of considering a diagnostic hypothesis of PTSD in the prevention and treatment of cardiovascular diseases.

Keywords

Post-Traumatic Stress DisorderPTSDhypertensionrisk factorscohort study
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 1 , January 2023 , pp. 132 - 139
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR®). Arlington, VA: American Psychiatric Publishing, Inc.Google Scholar
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington: American Psychiatric Publishing.Google Scholar
Andersen, J., Wade, M., Possemato, K., & Ouimette, P. (2010). Association between post-traumatic stress disorder and primary care provider-diagnosed disease among Iraq and Afghanistan veterans. Psychosomatic Medicine, 72, 498–504.CrossRefGoogle ScholarPubMed
Araujo, A. X., Berger, W., Coutinho, E. S., Marques-Portella, C., Luz, M. P., Cabizuca, M., … Mendlowicz, M. V. (2014). Comorbid depressive symptoms in treatment-seeking PTSD outpatients affect multiple domains of quality of life. Comprehensive Psychiatry, 55, 56–63.CrossRefGoogle ScholarPubMed
Bartoli, F., Crocamo, C., Alamia, A., Amidani, F., Paggi, E., Pini, E., … Carra, G. (2015). Post-traumatic stress disorder and risk of obesity: Systematic review and meta-analysis. Journal of Clinical Psychiatry, 76, e1253–e1261.CrossRefGoogle ScholarPubMed
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle ScholarPubMed
Berger, W., Figueira, I., Maurat, A. M., Bucassio, E. P., Vieira, I., Jardim, S. R., … Mendlowicz, M. V. (2007). Partial and full PTSD in Brazilian ambulance workers: Prevalence and impact on health and on quality of life. Journal of Traumatic Stress, 20, 637–642.CrossRefGoogle ScholarPubMed
Berger, W., Mendlowicz, M. V., Souza, W., & Figueira, I. (2004). Semantic equivalence of the Portuguese version of the Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C) for the screening of post-traumatic stress disorder. Revista de Psiquiatria do Rio Grande do Sul, 26, 167–175.CrossRefGoogle Scholar
Booth, J. N. 3rd, Li, J., Zhang, L., Chen, L., Muntner, P., & Egan, B. (2017). Trends in prehypertension and hypertension risk factors in US adults: 1999–2012. Hypertension 70, 275–284.CrossRefGoogle ScholarPubMed
Brewin, C. R. (2005). Systematic review of screening instruments for adults at risk of PTSD. Journal of Traumatic Stress, 18, 53–62.CrossRefGoogle ScholarPubMed
Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., … Reed, G. M. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical Psychology Review, 58, 1–15.CrossRefGoogle ScholarPubMed
Buckley, T. C., Blanchard, E. B., & Hickling, E. J. (1998). A confirmatory factor analysis of post-traumatic stress symptoms. Behaviour Research and Therapy, 36, 1091–1099.CrossRefGoogle Scholar
Buckley, T. C., & Kaloupek, D. G. (2001). A meta-analytic examination of basal cardiovascular activity in post-traumatic stress disorder. Psychosomatic Medicine, 63, 585–594.CrossRefGoogle Scholar
Burg, M. M., Brandt, C., Buta, E., Schwartz, J., Bathulapalli, H., Dziura, J., … Haskell, S. (2017). Risk for incident hypertension associated with posttraumatic stress disorder in military veterans and the effect of posttraumatic stress disorder treatment. Psychosomatic Medicine, 79, 181–188.CrossRefGoogle ScholarPubMed
Davis, M. (2006). Planet of slums. New Perspectives Quarterly, 23, 6–11.CrossRefGoogle Scholar
Debell, F., Fear, N. T., Head, M., Batt-Rawden, S., Greenberg, N., Wessely, S., & Goodwin, L. (2014). A systematic review of the comorbidity between PTSD and alcohol misuse. Social Psychiatry and Psychiatric Epidemiology, 49, 1401–1425.CrossRefGoogle ScholarPubMed
De Souza, B. D. S. N., Rosa, M. L. G., Lugon, J. R., Yokoo, E. M., Mesquita, E. T., Rodrigues, M., … Cagy, M. (2011). Dietary habits and inadequate control of blood pressure in hypertensive adults assisted by a Brazilian Family Doctor Program. Public Health Nutrition, 14, 2176–2184.CrossRefGoogle ScholarPubMed
Diamond, D. M., & Zoladz, P. R. (2016). Dysfunctional or hyperfunctional? The amygdala in post-traumatic stress disorder is the bull in the evolutionary China shop. Journal of Neuroscience Research, 94, 437–444.CrossRefGoogle ScholarPubMed
Dunlop, B. W., & Wong, A. (2019). The hypothalamic-pituitary-adrenal axis in PTSD: Pathophysiology and treatment interventions. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 89, 361–379.CrossRefGoogle ScholarPubMed
Edmondson, D., & von Kanel, R. (2017). Post-traumatic stress disorder and cardiovascular disease. The Lancet Psychiatry, 4, 320–329.CrossRefGoogle ScholarPubMed
Elhai, J. D., Gray, M. J., Kashdan, T. B., & Franklin, C. L. (2005). Which instruments are most commonly used to assess traumatic event exposure and post-traumatic effects? A survey of traumatic stress professionals. Journal of Traumatic Stress, 18, 541–545.CrossRefGoogle ScholarPubMed
Ezeh, A., Oyebode, O., Satterthwaite, D., Chen, Y. F., Ndugwa, R., Sartori, J., … Lilford, R. J. (2017). The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet (London, England), 389, 547–558.CrossRefGoogle ScholarPubMed
Fernandes, N. F., Guimarães, R. F., Gomes, R. A., Vieira, B. C., Montgomery, D. R., & Greenberg, H. (2004). Topographic controls of landslides in Rio de Janeiro: Field evidence and modeling. Catena, 55, 163–181.CrossRefGoogle Scholar
Fu, S. S., McFall, M., Saxon, A. J., Beckham, J. C., Carmody, T. P., Baker, D. G., & Joseph, A. M. (2007). Post-traumatic stress disorder and smoking: A systematic review. Nicotine & Tobacco Research, 9, 1071–1084.CrossRefGoogle ScholarPubMed
Gordon, T., Moore, F. E., Shurtleff, D., & Dawber, T. R. (1959). Some methodologic problems in the long-term study of cardiovascular disease: Observations on the Framingham Study. Journal of Chronic Diseases, 10, 186–206.CrossRefGoogle Scholar
Gorenstein, C., Andrade, L., Vieira Filho, A. H., Tung, T. C., & Artes, R. (1999). Psychometric properties of the Portuguese version of the Beck Depression Inventory on Brazilian college students. Journal of Clinical Psychology, 55, 553–562.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
Gradus, J. L. (2017). Prevalence and prognosis of stress disorders: A review of the epidemiologic literature. Clinical Epidemiology, 9, 251–260.CrossRefGoogle ScholarPubMed
Gradus, J. L., Farkas, D. K., Svensson, E., Ehrenstein, V., Lash, T. L., Milstein, A., … Sorensen, H. T. (2015). Associations between stress disorders and cardiovascular disease events in the Danish population. BMJ Open, 5, e009334.CrossRefGoogle ScholarPubMed
Hall, K. S., Hoerster, K. D., & Yancy, W. S. Jr. (2015). Post-traumatic stress disorder, physical activity, and eating behaviors. Epidemiologic Reviews 37, 103–115.CrossRefGoogle ScholarPubMed
Hoge, C. W., Yehuda, R., Castro, C. A., McFarlane, A. C., Vermetten, E., Jetly, R., … Rothbaum, B. O. (2016). Unintended consequences of changing the definition of posttraumatic stress disorder in DSM-5: Critique and call for action. JAMA Psychiatry, 73, 750–752.CrossRefGoogle ScholarPubMed
Hooper, L., Stockton, P., Krupnick, J., & Green, B. (2011). Development, use, and psychometric properties of the trauma history questionnaire. Journal of Loss and Trauma, 16, 258–283.CrossRefGoogle Scholar
Howard, J. T., Sosnov, J. A., Janak, J. C., Gundlapalli, A. V., Pettey, W. B., Walker, L. E., & Stewart, I. J. (2018). Associations of initial injury severity and posttraumatic stress disorder diagnoses with long-term hypertension risk after combat injury. Hypertension, 71, 824–832.CrossRefGoogle ScholarPubMed
Hughes, K. C., & Shin, L. M. (2011). Functional neuroimaging studies of post-traumatic stress disorder. Expert Review of Neurotherapeutics, 11, 275–285.CrossRefGoogle ScholarPubMed
Keys, A., Fidanza, F., Karvonen, M. J., Kimura, N., & Taylor, H. L. (1972). Indices of relative weight and obesity. Journal of Chronic Diseases, 25, 329–343.CrossRefGoogle ScholarPubMed
Kibler, J. L., Joshi, K., & Ma, M. (2009). Hypertension in relation to post-traumatic stress disorder and depression in the US National Comorbidity Survey. Behavioral Medicine, 34, 125–132.CrossRefGoogle ScholarPubMed
Li, J., Zweig, K. C., Brackbill, R. M., Farfel, M. R., & Cone, J. E. (2018). Comorbidity amplifies the effects of post-9/11 post-traumatic stress disorder trajectories on health-related quality of life. Quality of Life Research, 27, 651–660.CrossRefGoogle ScholarPubMed
Lilford, R. J., Oyebode, O., Satterthwaite, D., Melendez-Torres, G. J., Chen, Y. F., Mberu, B., … Ezeh, A. (2017). Improving the health and welfare of people who live in slums. Lancet (London, England), 389, 559–570.CrossRefGoogle ScholarPubMed
Lima, E. D. P., Barreto, S. M., & Assunção, AÁ (2012). Factor structure, internal consistency and reliability of the Posttraumatic Stress Disorder Checklist (PCL): An exploratory study. Trends in Psychiatry and Psychotherapy, 34, 215–222.CrossRefGoogle ScholarPubMed
Lin, C. E., Chung, C. H., Chen, L. F., You, C. H., Chien, W. C., & Chou, P. H. (2019). Risk of incident hypertension, diabetes, and dyslipidemia after first post-traumatic stress disorder diagnosis: A nationwide cohort study in Taiwan. General Hospital Psychiatry, 58, 59–66.CrossRefGoogle ScholarPubMed
Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., … Memish, Z. A. (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet (London, England) 380, 2095–2128.CrossRefGoogle ScholarPubMed
Luz, M. P., Mendlowicz, M., Marques-Portella, C., Gleiser, S., Berger, W., Neylan, T. C., … Figueira, I. (2011). PTSD criterion A1 events: A literature-based categorization. Journal of Traumatic Stress, 24, 243–251.CrossRefGoogle ScholarPubMed
Manne, S. L., Du Hamel, K., Gallelli, K., Sorgen, K., & Redd, W. H. (1998). Post-traumatic stress disorder among mothers of pediatric cancer survivors: Diagnosis, comorbidity, and utility of the PTSD checklist as a screening instrument. Journal of Pediatric Psychology, 23, 357–366.CrossRefGoogle ScholarPubMed
McDonald, S. D., & Calhoun, P. S. (2010). The diagnostic accuracy of the PTSD checklist: A critical review. Clinical Psychology Review, 30, 976–987.CrossRefGoogle ScholarPubMed
Meng, L., Chen, D., Yang, Y., Zheng, Y., & Hui, R. (2012). Depression increases the risk of hypertension incidence: A meta-analysis of prospective cohort studies. Journal of Hypertension, 30, 842–851.CrossRefGoogle ScholarPubMed
Oliveira, N. S. (1996). Favelas and ghettos: Race and class in Rio de Janeiro and New York City. Latin American Perspectives, 23, 71–89.CrossRefGoogle Scholar
Pagotto, L. F., Mendlowicz, M. V., Coutinho, E. S., Figueira, I., Luz, M. P., Araujo, A. X., & Berger, W. (2015). The impact of post-traumatic symptoms and comorbid mental disorders on the health-related quality of life in treatment-seeking PTSD patients. Comprehensive Psychiatry, 58, 68–73.CrossRefGoogle ScholarPubMed
Peerzada, A., & De Sousa, A. (2016). An exploratory qualitative study on the effects of intimate partner violence in lower socio-economic status women: Findings from an urban slum cohort. Indian Journal of Mental Health, 3, 324–334.Google Scholar
Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2011). Prevalence and Axis I comorbidity of full and partial post-traumatic stress disorder in the United States: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Anxiety Disorders, 25, 456–465.CrossRefGoogle ScholarPubMed
Pole, N. (2007). The psychophysiology of post-traumatic stress disorder: A meta-analysis. Psychological Bulletin, 133, 725–746.CrossRefGoogle ScholarPubMed
Protogerou, A. D., Panagiotakos, D. B., Zampeli, E., Argyris, A. A., Arida, K., Konstantonis, G. D., … Sfikakis, P. P. (2013). Arterial hypertension assessed ‘out-of-office’ in a contemporary cohort of rheumatoid arthritis patients free of cardiovascular disease is characterized by high prevalence, low awareness, poor control and increased vascular damage-associated ‘white coat’ phenomenon. Arthritis Research & Therapy, 15, R142.CrossRefGoogle Scholar
Rashid, S., & Halder, S. R. (1998). Flood’98 and BRAC – a case study on three slums in Dhanmandi area of Dhaka city. Social Studies, 18, 18–28.Google Scholar
Ribeiro, W. S., Mari, J. J., Quintana, M. I., Dewey, M. E., Evans-Lacko, S., Vilete, L. M., … Andreoli, S. B. (2013). The impact of epidemic violence on the prevalence of psychiatric disorders in Sao Paulo and Rio de Janeiro, Brazil. PLoS ONE, 8, e63545.CrossRefGoogle Scholar
Richter, P., Werner, J., Heerlein, A., Kraus, A., & Sauer, H. (1998). On the validity of the Beck Depression Inventory. A review. Psychopathology, 31, 160–168.CrossRefGoogle ScholarPubMed
Rodgers, D. (2009). Slum wars of the 21st century: Gangs, mano dura and the new urban geography of conflict in Central America. Development and Change, 40, 949–976.CrossRefGoogle Scholar
Rosenbaum, S., Stubbs, B., Ward, P. B., Steel, Z., Lederman, O., & Vancampfort, D. (2015). The prevalence and risk of metabolic syndrome and its components among people with post-traumatic stress disorder: A systematic review and meta-analysis. Metabolism: Clinical and Experimental, 64, 926–933.CrossRefGoogle ScholarPubMed
Santic, Z., Lukic, A., Sesar, D., Milicevic, S., & Ilakovac, V. (2006). Long-term follow-up of blood pressure in family members of soldiers killed during the war in Bosnia and Herzegovina. Croatian Medical Journal, 47, 416–423.Google ScholarPubMed
Schnurr, P. P., Spiro, A. 3rd, & Paris, A. H. (2000). Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans. Health Psychology 19, 91–97.CrossRefGoogle ScholarPubMed
Silverman, M. N., & Sternberg, E. M. (2012). Glucocorticoid regulation of inflammation and its functional correlates: From HPA axis to glucocorticoid receptor dysfunction. Annals of the New York Academy of Sciences, 1261, 55–63.CrossRefGoogle Scholar
Smyth, C. G., & Royle, S. A. (2000). Urban landslide hazards: Incidence and causative factors in Niteroi, Rio de Janeiro State. Brazil. Applied Geography, 20, 95–117.CrossRefGoogle Scholar
Solak, Y., Afsar, B., Vaziri, N. D., Aslan, G., Yalcin, C. E., Covic, A., & Kanbay, M. (2016). Hypertension as an autoimmune and inflammatory disease. Hypertension Research, 39, 567–573.CrossRefGoogle ScholarPubMed
Speer, K., Upton, D., Semple, S., & McKune, A. (2018). Systemic low-grade inflammation in post-traumatic stress disorder: A systematic review. Journal of Inflammation Research, 11, 111–121.CrossRefGoogle ScholarPubMed
Stein, D. J., Aguilar-Gaxiola, S., Alonso, J., Bruffaerts, R., de Jonge, P., Liu, Z., … Scott, K. M. (2014). Associations between mental disorders and subsequent onset of hypertension. General Hospital Psychiatry, 36, 142–149.CrossRefGoogle ScholarPubMed
Sumner, J. A., Kubzansky, L. D., Roberts, A. L., Gilsanz, P., Chen, Q., Winning, A., … Koenen, K. C. (2016). Post-traumatic stress disorder symptoms and risk of hypertension over 22 years in a large cohort of younger and middle-aged women. Psychological Medicine, 46, 3105–3116.CrossRefGoogle Scholar
Tawakol, A., Ishai, A., Takx, R. A., Figueroa, A. L., Ali, A., Kaiser, Y., … Pitman, R. K. (2017). Relation between resting amygdalar activity and cardiovascular events: A longitudinal and cohort study. Lancet (London, England), 389, 834–845.CrossRefGoogle ScholarPubMed
Trindade Fortes, J., Giordani Cano, F., Alcoforado Miranda, V., Chung Kang, H., Fontenelle, L. F., Mendlowicz, M. V., & Garcia-Rosa, M. L. (2020). PTSD predicts smoking cessation failure in a trauma-exposed population. Journal of Dual Diagnosis, 16, 392–401.CrossRefGoogle Scholar
Unger, A., & Riley, L. W. (2007). Slum health: From understanding to action. PLoS Medicine, 4, 1561–1566.CrossRefGoogle ScholarPubMed
United Nations Human Settlements Programme (2003). The challenge of slums: Global report on human settlements (pp. 310). London, UK: Earthscan Publications Ltd.Google Scholar
US Department of Health and Human Services (2008). 2008 Physical activity guidelines for Americans: Be active, healthy, and happy!. Washington, DC: US Department of Health and Human Services.Google Scholar
US Preventive Services Task Force (2007). Screening for high blood pressure: US Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine, 147, 783–786.CrossRefGoogle Scholar
von Glischinski, M., von Brachel, R., & Hirschfeld, G. (2019). How depressed is ‘depressed’? A systematic review and diagnostic meta-analysis of optimal cut points for the Beck Depression Inventory revised (BDI-II). Quality of Life Research, 28, 1111–1118.CrossRefGoogle ScholarPubMed
Vukovic, I. S., Jovanovic, N., Kolaric, B., Vidovic, V., & Mollica, R. F. (2014). Psychological and somatic health problems in Bosnian refugees: A three year follow-up. Psychiatria Danubina, 26(Suppl 3), 442–449.Google ScholarPubMed
Wang, Z., & Young, M. R. (2016). PTSD, a disorder with an immunological component. Frontiers in Immunology, 7, 219.CrossRefGoogle ScholarPubMed
Weathers, F. W., Litz, B. T., Herman, D., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. In Annual Meeting of International Society for Traumatic Stress Studies: San Antonio, TX.Google Scholar
Weathers, F., Litz, B., Keane, T., Palmieri, P., Marx, B., & Schnurr, P. (2013). The life events checklist for DSM-5 (LEC-5). Scale available from the National Center for PTSD.Google Scholar
Widows, M. R., Jacobsen, P. B., & Fields, K. K. (2000). Relation of psychological vulnerability factors to post-traumatic stress disorder symptomatology in bone marrow transplant recipients. Psychosomatic Medicine, 62, 873–882.CrossRefGoogle ScholarPubMed
Wong, J. M., Nyachieo, D. O., Benzekri, N. A., Cosmas, L., Ondari, D., Yekta, S., … Breiman, R. F. (2014). Sustained high incidence of injuries from burns in a densely populated urban slum in Kenya: An emerging public health priority. Burns: Journal of the International Society for Burn Injuries, 40, 1194–1200.CrossRefGoogle Scholar
World Medical Association, . (2001). Declaration of Helsinki. Bulletin of the World Health Organization, 79, 373–374.Google Scholar
Zaluar, A. (2000). Perverse integration: Drug trafficking and youth in the ‘favelas’ of Rio de Janeiro. Journal of International Affairs, 53, 653–671.Google Scholar