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Hicks EM, Niarchou M, Goleva S, Kabir D, Johnson J, Johnston KJ, Ciarcia J, Pathak GA, Smoller JW, Davis LK, Nievergelt CM, Koenen KC, Huckins LM, Choi KW. Comorbidity Profiles of Posttraumatic Stress Disorder Across the Medical Phenome. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:100337. [PMID: 39050781 PMCID: PMC11268109 DOI: 10.1016/j.bpsgos.2024.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 07/27/2024] Open
Abstract
Background Previous epidemiological research has linked posttraumatic stress disorder (PTSD) with specific physical health problems, but the comprehensive landscape of medical conditions associated with PTSD remains uncharacterized. Electronic health records provide an opportunity to overcome clinical knowledge gaps and uncover associations with biological relevance that potentially vary by sex. Methods PTSD was defined among biobank participants (N = 145,959) in 3 major healthcare systems using 2 ICD code-based definitions: broad (≥1 PTSD or acute stress codes vs. 0; n cases = 16,706) and narrow (≥2 PTSD codes vs. 0; n cases = 3325). Using a phenome-wide association study design, we tested associations between each PTSD definition and all prevalent disease umbrella categories, i.e., phecodes. We also conducted sex-stratified phenome-wide association study analyses including a sex × diagnosis interaction term in each logistic regression. Results A substantial number of phecodes were significantly associated with PTSDNarrow (61%) and PTSDBroad (83%). While the strongest associations were shared between the 2 definitions, PTSDBroad captured 334 additional phecodes not significantly associated with PTSDNarrow and exhibited a wider range of significantly associated phecodes across various categories, including respiratory, genitourinary, and circulatory conditions. Sex differences were observed in that PTSDBroad was more strongly associated with osteoporosis, respiratory failure, hemorrhage, and pulmonary heart disease among male patients and with urinary tract infection, acute pharyngitis, respiratory infections, and overweight among female patients. Conclusions This study provides valuable insights into a diverse range of comorbidities associated with PTSD, including both known and novel associations, while highlighting the influence of sex differences and the impact of defining PTSD using electronic health records.
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Affiliation(s)
- Emily M. Hicks
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Niarchou
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, Tennessee
| | - Slavina Goleva
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, Tennessee
| | - Dia Kabir
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Jessica Johnson
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keira J.A. Johnston
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Julia Ciarcia
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Gita A. Pathak
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Lea K. Davis
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, Tennessee
| | - Caroline M. Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, California
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, California
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, California
| | - Karestan C. Koenen
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Laura M. Huckins
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Karmel W. Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - PGC/PsycheMERGE PTSD & Trauma EHR Working Group
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, New York
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, Tennessee
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, University of California San Diego, La Jolla, California
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, California
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, California
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Seah C, Signer R, Deans M, Bader H, Rusielewicz T, Hicks EM, Young H, Cote A, Townsley K, Xu C, Hunter CJ, McCarthy B, Goldberg J, Dobariya S, Holtzherimer PE, Young KA, Noggle SA, Krystal JH, Paull D, Girgenti MJ, Yehuda R, Brennand KJ, Huckins LM. Common genetic variation impacts stress response in the brain. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.27.573459. [PMID: 38234801 PMCID: PMC10793429 DOI: 10.1101/2023.12.27.573459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
To explain why individuals exposed to identical stressors experience divergent clinical outcomes, we determine how molecular encoding of stress modifies genetic risk for brain disorders. Analysis of post-mortem brain (n=304) revealed 8557 stress-interactive expression quantitative trait loci (eQTLs) that dysregulate expression of 915 eGenes in response to stress, and lie in stress-related transcription factor binding sites. Response to stress is robust across experimental paradigms: up to 50% of stress-interactive eGenes validate in glucocorticoid treated hiPSC-derived neurons (n=39 donors). Stress-interactive eGenes show brain region- and cell type-specificity, and, in post-mortem brain, implicate glial and endothelial mechanisms. Stress dysregulates long-term expression of disorder risk genes in a genotype-dependent manner; stress-interactive transcriptomic imputation uncovered 139 novel genes conferring brain disorder risk only in the context of traumatic stress. Molecular stress-encoding explains individualized responses to traumatic stress; incorporating trauma into genomic studies of brain disorders is likely to improve diagnosis, prognosis, and drug discovery.
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Hicks EM, Niarchou M, Goleva S, Kabir D, Ciarcia J, Smoller JW, Davis LK, Nievergelt CM, Koenen KC, Huckins LM, Choi KW. Comorbidity Profiles of Posttraumatic Stress Disorder Across the Medical Phenome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.25.23294572. [PMID: 37693435 PMCID: PMC10491282 DOI: 10.1101/2023.08.25.23294572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Prior epidemiological research has linked PTSD with specific physical health problems, but the comprehensive landscape of medical conditions associated with PTSD remains uncharacterized. Electronic health records (EHR) provide an opportunity to overcome prior clinical knowledge gaps and uncover associations with biological relevance that potentially vary by sex. Methods PTSD was defined among biobank participants (total N=123,365) in a major healthcare system using two ICD code-based definitions: broad (1+ PTSD or acute stress codes versus 0; NCase=14,899) and narrow (2+ PTSD codes versus 0; NCase=3,026). Using a phenome-wide association (PheWAS) design, we tested associations between each PTSD definition and all prevalent disease umbrella categories, i.e., phecodes. We also conducted sex-stratified PheWAS analyses including a sex-by-diagnosis interaction term in each logistic regression. Results A substantial number of phecodes were significantly associated with PTSDNarrow (61%) and PTSDBroad (83%). While top associations were shared between the two definitions, PTSDBroad captured 334 additional phecodes not significantly associated with PTSDNarrow and exhibited a wider range of significantly associated phecodes across various categories, including respiratory, genitourinary, and circulatory conditions. Sex differences were observed, in that PTSDBroad was more strongly associated with osteoporosis, respiratory failure, hemorrhage, and pulmonary heart disease among male patients, and with urinary tract infection, acute pharyngitis, respiratory infections, and overweight among female patients. Conclusions This study provides valuable insights into a diverse range of comorbidities associated with PTSD, including both known and novel associations, while highlighting the influence of sex differences and the impact of defining PTSD using EHR.
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Affiliation(s)
- Emily M Hicks
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Niarchou
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Slavina Goleva
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Dia Kabir
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
| | - Julia Ciarcia
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jordan W Smoller
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA
| | - Lea K Davis
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Caroline M Nievergelt
- University of California San Diego, Department of Psychiatry, La Jolla, CA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA
| | - Karestan C Koenen
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, US
| | - Laura M Huckins
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Karmel W Choi
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
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