Hugh Crean - Academia.edu (original) (raw)

Papers by Hugh Crean

Journal of Clinical Sleep Medicine, Jul 10, 2023

Sleep, Apr 1, 2019

Introduction: Tinnitus has been studied primarily in war veterans and refugees with PTSD, often e... more Introduction: Tinnitus has been studied primarily in war veterans and refugees with PTSD, often exposed to head injury. A 50% tinnitus prevalence is reported in PTSD (versus a 10%-15% general population prevalence). Tinnitus in PTSD patients has been attributed to various factors including increased arousal, mild traumatic head injury including blast exposure, and a conditioned response to memories of being struck in the head. Tinnitus is associated with both cochlear and central nervous pathologies including limbic activation. Overnight polysomnography of non-psychiatric tinnitus patients has revealed lower %REM (6.4%+/-4.9%) in tinnitus patients versus controls (21.5%+/-3.6%)(Attanasio G, 2013). To my knowledge, there are no polysomnographic studies of PTSD patients with tinnitus. Methods: 57 consenting civilian PTSD patients (52 female; mean+/-SD age: 46.91+/-13.09 years), with no head trauma history, underwent ≥1 nights of Level 3 polysomnography (WatchPAT200; Itamar Medical, Israel) and completed a battery of instruments including the Tinnitus Functional Index (TFI), a 25-item instrument that measures both severity and negative impact of tinnitus, the Pennebaker Inventory of Limbic Languidness (PILL), and PTSD Checklist for DSM-5(PCL-5). Results: 33/57(57.9%) endorsed experiencing tinnitus. TFI scores correlated directly (Pearson r=0.520, p=0.002) with PCL-5 scores (mean+/-SD PCL-5 score: 37.82+/-19.02). Multiple regression analysis using TFI score as dependent variable and PCL-5 clusters, PILL scores and age as independent variables revealed that only PCL-5 Cluster E(hyperarousal)(β=0.524,t=3.372,p=0.002) remained a significant predictor of TFI. Both %REM (r=-0.390, p=0.025) and REM duration (r=-0.430, p=0.012) were significantly inversely correlated with TFI. Conclusion: Tinnitus was associated with PTSD severity, especially the hyperarousal cluster, in civilian PTSD patients with no head trauma histories. Higher baseline REM sleep has been associated with reduced fear conditioning in humans, therefore an inverse relation of tinnitus with REM sleep percentage and duration may be indicative of a greater propensity for fear conditioning in PTSD patients with higher tinnitus levels. Tinnitus may be a core symptom of activation and limbic dysregulation in PTSD, independent of traumatic brain injury. Support (If Any

Psychotherapy and Psychosomatics, Jul 15, 2021

Introduction: Individuals exposed to interpersonal violence (IPV) commonly develop posttraumatic ... more Introduction: Individuals exposed to interpersonal violence (IPV) commonly develop posttraumatic stress disorder (PTSD) with co-occurring depression and insomnia. Standard PTSD interventions such as cognitive processing therapy (CPT) do not typically lead to remission or improved insomnia. Cognitive behavioral therapy for insomnia (CBTi) improves insomnia in individuals with PTSD, but PTSD severity remains elevated. Objective: To determine whether sequential treatment of insomnia and PTSD is superior to treatment of only PTSD. Methods: In a 20-week trial, 110 participants exposed to IPV who had PTSD, depression and insomnia were randomized to CBTi followed by CPT or to attention control followed by CPT. Primary outcomes following CBTi (or control) were the 6-week change in score on the Insomnia Severity Index (ISI), the Clinician-Administered PTSD Scale (CAPS), and the Hamilton Rating Scale for Depression (HAM-D). Primary outcomes following CPT were the 20-week change in scores. Results: At 6 weeks, the CBTi condition had greater reductions in ISI, HAM-D, and CAPS scores than the attention control condition. At 20 weeks, participants in the CBTi+CPT condition had greater reductions in ISI, HAM-D, and CAPS scores compared to control+CPT. Effects were larger for insomnia and for depression than for PTSD. Similar patterns were observed with respect to clinical response and remission. A tipping point sensitivity analyses supported the plausibility of the findings. Conclusions: The sequential delivery of CBTi and CPT had plausible, significant effects on insomnia, depression, and PTSD compared to CPT alone. The effects for PTSD symptoms were moderate and clinically meaningful.

Journal of Adolescent Health, Feb 1, 2010

have no prior HIV testing and not know their results (p < .001). Subjects receiving any health ca... more have no prior HIV testing and not know their results (p < .001). Subjects receiving any health care in the past year were less likely to have no prior testing (p ¼ .02), but didn't differ according to knowledge of status. Conclusions: This study shows that many youth at high risk for HIV are not being tested. A better understanding of high-risk youth who have not been tested may help direct targeted outreach to increase testing behaviors.

SLEEP

Introduction There is an established association between insomnia and suicide. As with many condi... more Introduction There is an established association between insomnia and suicide. As with many conditions, the preponderance of patients with either insomnia or with suicidal ideation (SI) are seen in primary care settings. Brief forms of cognitive behavioral therapy for insomnia (bCBTi) have been delivered in primary care including to patients with mental health conditions. We sought to test the efficacy of bCBTi among primary care insomnia patients endorsing SI. Methods A sample of 194 participants endorsing SI and meeting criteria for insomnia disorder along with depression and/or posttraumatic stress disorder (PTSD) were randomly assigned to receive either four weekly sessions of bCBTi (n=98) or Sleep Hygiene (n=96). Participants engaged in suicide safety planning or a review of their existing safety plan. To be consistent with the primary care milieu, intervention sessions averaged < 30 minutes in duration with all intervention sessions audio-recorded and subjected to fidelity ...

International Journal of Translational Medical Research and Public Health

Background and Objective: Globally, father engagement is deemed an important factor in mothers’ b... more Background and Objective: Globally, father engagement is deemed an important factor in mothers’ breastfeeding practices. In the U.S., the role of the father in breastfeeding is understudied. This study examines the association between voluntary legal paternity and maternal breastfeeding outcomes. Methods: Using data from a modified Pregnancy Risk Assessment Monitoring System survey (Monroe County, NY, 2015-2017) linked to New York State’s birth certificate data, we assessed breastfeeding outcomes (exclusivity and duration) by voluntary legal paternity (VLP) establishment. We examined breastfeeding duration (breastfeeding cessation at 13 weeks or less) and exclusive breastfeeding (at 13 weeks) among mothers whose infants had VLP (i.e., married, acknowledgment at birth), and those who had no-VLP (i.e., a court-mandated Paternity Affidavit or no legal paternity established). Univariate analyses were conducted, with additional variables (parental demographics, maternal social and clinic...

Family Medicine, 2021

Background and Objectives: One-third of individuals who die by suicide had primary care contact i... more Background and Objectives: One-third of individuals who die by suicide had primary care contact in the preceding month. Primary care trainees need engaging and effective suicide prevention training that can be delivered within tight time and resource constraints. However, training is currently scarce and its effectiveness unknown. The objective of this study was to assess learner engagement, learning, self-efficacy, and perceived ability to transfer training to practice from brief video-based modules centered around visual concept mapping of suicide prevention practices. Methods: We assigned 127 primary care trainees 21 brief instructional videos to watch. We analyzed engagement by monitoring the proportion of learners who began each video and the proportion of the video watched. We assessed knowledge and self-efficacy pre- and posttraining. Learners provided feedback on satisfaction with modules and ability to transfer training to practice. Results: Engagement was high, with most l...

Background: Despite recent biobehavioral advances in HIV prevention, black men continue to bear a... more Background: Despite recent biobehavioral advances in HIV prevention, black men continue to bear a disproportionate burden of the epidemic. Pre-exposure prophylaxis is an efficacious intervention to prevent HIV acquisition; however, despite the promise of pre-exposure prophylaxis, uptake among black men remains low. Purpose: The purpose of this study is to examine awareness of pre-exposure prophylaxis among black men in a moderately rural midwestern city to determine barriers and facilitators to pre-exposure uptake and access. Methods: Black men who live in Bloomington, Indiana (mean age category 25-34) were asked to participate in a cross-sectional survey, consisting of 67 closed-ended questions. 111 surveys with >90% completion were eligible for analysis, using logistic regression procedure of SPSS. Conclusions, and Results: A logistic regression analysis was performed on knowledge of pre-exposure prophylaxis as the outcome variable and five predictor variables: comfort using bi...

Archives of Sexual Behavior, 2021

The original article has been updated.

AIDS Patient Care and STDs, 2020

Studies have suggested that effective patient-provider relationships may reduce health disparitie... more Studies have suggested that effective patient-provider relationships may reduce health disparities and foster engagement across the HIV care continuum among people living with HIV/AIDS. However, no studies have explored specific mechanisms between medical mistrust/poor communication and HIV-related/psychosocial health outcomes among HIV-positive men of color who have sex with women (MCSW) in the United States. From 2011 to 2012, the research team recruited 317 eligible participants in New York City. Using validated explanatory and predictive modeling strategies, we explored the associations between mistrust/poor communication and HIV-related/psychosocial health outcomes among this group. Subgroup analyses were further conducted to assess the different effects of non-Hispanic black and Hispanic men. A total of 313 males (204 black, 93 Hispanic, and 16 others) reported that valid responses were included in the current analysis. In the explanatory models, both mistrust and poor communication were negatively associated with various HIV-related and psychosocial outcomes among this group of HIV-positive MCSW. In the predictive models, predictors of mistrust for the overall sample and the black subsample were nearly the same. On the contrary, predictors of poor communication were substantially different when comparing black and Hispanic HIV-positive MCSW. Our findings confirm that patient-provider relationship quality is associated with poor HIV-related and psychosocial outcomes in black and Hispanic MCSW. A different set of multi-level predictors are associated with mistrust and poor communication comparing black and Hispanic MCSW. We call for interventions addressing patient-provider relationship quality that are tailored differently for black and Hispanic men.

AIDS and Behavior, 2020

Intimate partner violence (IPV) significantly increases HIV risk among MSM. Pre-exposure prophyla... more Intimate partner violence (IPV) significantly increases HIV risk among MSM. Pre-exposure prophylaxis (PrEP) may provide MSM experiencing IPV an option for self-protection from HIV without requiring condom negotiation or compromising safety. This study examined relationships among various forms of IPV (physical, emotional, monitoring, controlling, and forced sex) and PrEP use among 863 MSM participating in a cross-sectional, internet-based survey. Participants reported IPV rates during the prior six months that were consistent with prior research (physical violence, 23.3%; emotional violence, 36.3%; monitoring, 45.1%; controlling, 25.3%; forced sex, 20.0%). Forced sex and emotional IPV were negatively associated with PrEP use in our sample; in contrast, controlling was positively associated with PrEP use. We suggest clinical IPV screenings among MSM seeking PrEP, as well as PrEP-focused interventions that explicitly address IPV.

Journal of Interpersonal Violence, 2018

The linkages between intimate partner violence (IPV), posttraumatic stress disorder (PTSD), and i... more The linkages between intimate partner violence (IPV), posttraumatic stress disorder (PTSD), and insomnia have been the subject of inquiry. This study is the first to explore the associations between clinical-level insomnia, PTSD symptoms, danger, and victim socio-demographics, and whether IPV victims pursue permanent orders of protection (OPs). Data for this secondary analysis were collected through surveys, interviews, and reviews of court records on 112 women who resided in upstate New York. Women initiated actions to obtain OPs from the Domestic Violence Intensive Intervention Court (DVIIC), from 2007 to 2008. The following factors were analyzed to determine their impact on whether a woman returned to court: (a) age, (b) race, (c) employment status, (d) perceived danger, (e) PTSD symptoms, and (f) clinical-level insomnia. This study finds that the following factors significantly relate to return to court: race, clinical-level insomnia and perceived danger, clinical-level insomnia...

Translational Behavioral Medicine, 2019

A brief cognitive-behavioral insomnia therapy significantly improved insomnia and depression for ... more A brief cognitive-behavioral insomnia therapy significantly improved insomnia and depression for primary care patients with insomnia, suicidal thoughts, and either major depression and/or posttraumatic stress disorder.

Maternal and Child Health Journal, 2018

Introduction-Although poverty is an established correlate of poorer mental health for pregnant wo... more Introduction-Although poverty is an established correlate of poorer mental health for pregnant women, limited research has examined the mental health effects of material hardship (i.e., difficulties meeting basic needs such as for food, transportation, or stable housing) during pregnancy. Method-The current research examined rates of material hardship among pregnant women seeking prenatal care and the relationships of both income and material hardship with depression and anxiety during pregnancy. Pregnant women (N = 892) responded to self-report measures of mental health symptoms, annual household income, and current material hardship in the waiting areas of community-based obstetrics/gynecology practices serving primarily financially disadvantaged patients. Results-About 56% of the sample reported some form of material hardship. About 19% of the sample reported elevated depression, and 17% reported elevated anxiety. Both depression and anxiety were uniquely associated with lower income and greater material hardship, even after controlling for age, race/ethnicity, relationship status, and number of children in the home. Furthermore, material hardship partially mediated the effect of income on mental health symptoms. Discussion-The physical, emotional, and social effects of deprivation of basic daily needs may contribute to pregnant women's experiences of mental health symptoms. These results converge

Journal of interpersonal violence, 2017

Most of current scales for assessing intimate partner violence (IPV) were developed for Western p... more Most of current scales for assessing intimate partner violence (IPV) were developed for Western populations. The Chinese Risk Assessment Tool for Victims (CRAT-V) was a new scale evaluating the risk of IPV, which was developed based on Chinese populations in the context of Chinese culture. To determine whether the CRAT-V could add further value to research involving IPV and violence against women in rural China, we sought to implement the CRAT-V and to explore its factor structure among a rural population in the mainland of China. This study included women from rural Sichuan Province of China, who aged 16 years and older, had been living locally for at least 2 years, and reported that they were married or in a relationship in the preceding year. A total of 670 participants completed the CRAT-V during the field survey. We utilized exploratory factor analysis to validate the fact structure of CRAT-V. The Cronbach's alpha of the CRAT-V was 0.90, indicating good reliability. The CRA...

Journal of Family Violence, 2017

Despite evidence of an intersection between suicide risk and intimate partner violence (IPV), cri... more Despite evidence of an intersection between suicide risk and intimate partner violence (IPV), crisis hotlines tend to focus on callers at-risk for suicide or callers involved in IPV, but not both. In an effort to begin to address this gap, we developed and conducted an initial pilot test of a suicide prevention curriculum for hotline workers at the National Domestic Violence Hotline (NDVH), highlighting the intersection of these two public health issues. A mixed methods approach was used as a first step to assess the impact of the 3-h suicide prevention training for 42 domestic violence hotline workers. Results showed significant increase in knowledge regarding suicide risk from pre to post-training and a high degree of satisfaction among attendees. Focus groups conducted with hotline workers 3 months after training indicated a greater willingness to engage callers in suicide screening and prevention efforts. A 6-month follow-up focus group with NDVH managers revealed that suicide prevention had become more integrated in the agency culture, a finding that was consistent with an environmental scan of the workplace that showed an increase in displays of suicide prevention information. In sum, suicide prevention training can be feasibly incorporated into domestic violence hotline workers' roles. Limitations and suggestions for future studies are discussed.

Sleep, 2017

Introduction: In addition to posttraumatic stress disorder (PTSD) and depression, exposure to tra... more Introduction: In addition to posttraumatic stress disorder (PTSD) and depression, exposure to traumatic events is often associated with sleep disturbance. Compared to other forms of trauma, little work has examined sleep and mental health morbidity associated with interpersonal violence (IPV) exposure. We sought to do so in a large, ethnically diverse sample of persons at risk for IPV exposure and to determine whether race was associated with any differences in comorbidity. Methods: Some 2,500 adults were approached for screening at community-based locations, primarily a County Domestic Integrated Family Court and a battered women's shelter outpatient service. Nearly 800 participants completed surveys on demographics, past year exposure to IPV and current living arrangement. Measures included the PTSD Checklist (PCL), Insomnia Severity Index (ISI), and 8-item Patient Health Questionnaire depression scale (PHQ-8). Descriptive statistics on morbidity prevalence, Spearman's rank correlations between measures, and mean symptom severity differences by race were calculated. Results: Among 797 participants, with mean age 34.5 (SD=10.6) years, 764 (95.9%) were female, 44.0% African American (AA), 41.4% white, 14.6% other or multiple races and 18.5% reported Hispanic background. Approximately 95% of participants experienced IPV in the past year (the remainder in prior years). Mean(SD) total scores were ISI = 18.6(6.0), PCL = 59.6(14.2) and PHQ-8 = 15.7(5.6). Based on the ISI, 17.4% of participants had subthreshold, 42.6% moderate, and 34.7% severe insomnia. For the PCL, 84.2% scored above the cut-point for PTSD. PHQ-8 scores indicated 22.6% had moderate and 62.6% severe depression. The ISI was strongly positively correlated with both PCL (rs = .620, p < .001) and PHQ-8 scores (rs = .592, p < .001), after removing sleep items. There were no significant differences between white and AA participants in mean symptom severity on the ISI, PCL or PHQ-8. Conclusion: The prevalence of insomnia and other trauma-related morbidities is exceptionally high among people exposed to IPV. In this sample, insomnia severity did not differ by race, though data to control for socioeconomic status was unavailable. While sampling bias may have occurred, nearly 8 in 10 participants endorsed symptoms consistent with moderate to severe insomnia. Support (If Any): R01NR013909.

Journal of clinical nursing, Jan 2, 2016

The aims were to describe and explore relationships among catheter problems in long-term indwelli... more The aims were to describe and explore relationships among catheter problems in long-term indwelling urinary catheter users, including excess health care utilization for treating catheter problems. Long-term urinary catheter users experience repeated problems with catheter-related urinary tract infection (CAUTI) and blockage of the device, yet little has been reported of the patterns and relationships among relevant catheter variables. Secondary data analysis was conducted from a sample in a randomized clinical trial, using data from the entire sample of 202 persons over 12 months' participation. Descriptive statistics were used to characterize the sample over time. Zero-inflated negative binomial models were employed for logistic regressions to evaluate predictor variables of the presence/absence and frequencies of CAUTI and blockage. CAUTI was marginally associated with catheter blockage. Problems reported at least once per person in the 12 months were: CAUTI 57%, blockage 34%,...

Journal of Adolescent Health, 2010