1
|
Marchese S, Huckins LM. Trauma Matters: Integrating Genetic and Environmental Components of PTSD. ADVANCED GENETICS (HOBOKEN, N.J.) 2023; 4:2200017. [PMID: 37766803 PMCID: PMC10520418 DOI: 10.1002/ggn2.202200017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/28/2022] [Indexed: 09/29/2023]
Abstract
Trauma is ubiquitous, but only a subset of those who experience trauma will develop posttraumatic stress disorder (PTSD). In this review, it is argued that to determine who is at risk of developing PTSD, it is critical to examine the genetic etiology of the disorder and individual trauma profiles of those who are susceptible. First, the state of current PTSD genetic research is described, with a particular focus on studies that present evidence for trauma type specificity, or for differential genetic etiology according to gender or race. Next, approaches that leverage non-traditional phenotyping approaches are reviewed to identify PTSD-associated variants and biology, and the relative advantages and limitations inherent in these studies are reflected on. Finally, it is discussed how trauma might influence the heritability of PTSD, through type, risk factors, genetics, and associations with PTSD symptomology.
Collapse
Affiliation(s)
- Shelby Marchese
- Pamela Sklar Division of Psychiatric GenomicsIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Laura M. Huckins
- Pamela Sklar Division of Psychiatric GenomicsIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Seaver Autism Center for Research and TreatmentIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Present address:
Department of PsychiatryYale University School of MedicineNew HavenCT06511USA
| |
Collapse
|
2
|
Miller MW. Leveraging genetics to enhance the efficacy of PTSD pharmacotherapies. Neurosci Lett 2020; 726:133562. [DOI: 10.1016/j.neulet.2018.04.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/13/2018] [Accepted: 04/20/2018] [Indexed: 12/12/2022]
|
3
|
Bernhard A, Martinelli A, Ackermann K, Saure D, Freitag CM. Association of trauma, Posttraumatic Stress Disorder and Conduct Disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2018; 91:153-169. [DOI: 10.1016/j.neubiorev.2016.12.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 11/28/2016] [Accepted: 12/19/2016] [Indexed: 11/30/2022]
|
4
|
Murphy E, Gangwisch JE, Matsunaga JT, Ottman R. Familial aggregation of major depressive disorder in an African-American community. Depress Anxiety 2018; 35:674-684. [PMID: 29782058 PMCID: PMC6035763 DOI: 10.1002/da.22775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND African Americans (AAs) with major depressive disorder (MDD) experience more impairment and poorer treatment outcomes relative to Whites, yet are underrepresented in family studies of MDD. This is the first study to investigate the familial aggregation of major depression among AAs. METHODS Participants' reports of depression from clinical and family history (FH) interviews were used to examine depression rates among 435 first-degree relatives and half-siblings of 63 depressed cases and 222 relatives of 33 nondepressed controls. Binary logistic regression was used to compute odds ratios (ORs) for FH of MDD and level of trauma exposure (high and low) in cases versus controls. Poisson regression models with generalized estimating equations were used to assess MDD in relatives of cases versus relatives of controls. RESULTS Cases and controls did not differ in either FH of MDD (OR = 1.2, 95% confidence interval [CI] = 0.5-2.9), or prevalence of MDD in relatives (relative risk [RR] = 1.5, 95% CI = 0.8-2.5). However, exposure to high trauma was associated with increased risk of MDD (OR = 3.0, 95% CI = 1.22-7.17) and the combined effect of FH and trauma was greater than expected under an additive model. Similarly, the RR for MDD among relatives of cases with high-trauma levels was 2.2 (1.24-4.2), compared to relatives of controls with low trauma. CONCLUSION The effect of FH of MDD appears to be exacerbated among individuals exposed to high trauma. Replication and further research on the chronology and subtypes of trauma and MDD, and their interactions, remain essential in AA populations.
Collapse
Affiliation(s)
- Eleanor Murphy
- New York State Psychiatric Institute, Unit 24, 1051 Riverside Drive, New York, NY, 10032,Corresponding Author. ;
| | - James E. Gangwisch
- New York State Psychiatric Institute, Unit 24, 1051 Riverside Drive, New York, NY, 10032
| | - Janet T. Matsunaga
- New York State Psychiatric Institute, Unit 24, 1051 Riverside Drive, New York, NY, 10032
| | - Ruth Ottman
- New York State Psychiatric Institute, Unit 24, 1051 Riverside Drive, New York, NY, 10032,G.H. Sergievsky Center and Departments of Epidemiology and Neurology, Columbia University, 630 W. 168 Street, P&S Box 16, New York, NY 10032
| |
Collapse
|
5
|
Logue MW, Amstadter AB, Baker DG, Duncan L, Koenen KC, Liberzon I, Miller MW, Morey RA, Nievergelt CM, Ressler KJ, Smith AK, Smoller JW, Stein MB, Sumner JA, Uddin M. The Psychiatric Genomics Consortium Posttraumatic Stress Disorder Workgroup: Posttraumatic Stress Disorder Enters the Age of Large-Scale Genomic Collaboration. Neuropsychopharmacology 2015; 40:2287-97. [PMID: 25904361 PMCID: PMC4538342 DOI: 10.1038/npp.2015.118] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 03/10/2015] [Accepted: 03/25/2015] [Indexed: 11/09/2022]
Abstract
The development of posttraumatic stress disorder (PTSD) is influenced by genetic factors. Although there have been some replicated candidates, the identification of risk variants for PTSD has lagged behind genetic research of other psychiatric disorders such as schizophrenia, autism, and bipolar disorder. Psychiatric genetics has moved beyond examination of specific candidate genes in favor of the genome-wide association study (GWAS) strategy of very large numbers of samples, which allows for the discovery of previously unsuspected genes and molecular pathways. The successes of genetic studies of schizophrenia and bipolar disorder have been aided by the formation of a large-scale GWAS consortium: the Psychiatric Genomics Consortium (PGC). In contrast, only a handful of GWAS of PTSD have appeared in the literature to date. Here we describe the formation of a group dedicated to large-scale study of PTSD genetics: the PGC-PTSD. The PGC-PTSD faces challenges related to the contingency on trauma exposure and the large degree of ancestral genetic diversity within and across participating studies. Using the PGC analysis pipeline supplemented by analyses tailored to address these challenges, we anticipate that our first large-scale GWAS of PTSD will comprise over 10 000 cases and 30 000 trauma-exposed controls. Following in the footsteps of our PGC forerunners, this collaboration-of a scope that is unprecedented in the field of traumatic stress-will lead the search for replicable genetic associations and new insights into the biological underpinnings of PTSD.
Collapse
Affiliation(s)
- Mark W Logue
- Research, VA Boston Healthcare System, Boston, MA, USA
- Biomedical Genetics, Boston University School of Medicine, Boston, MA, USA
- Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Dewleen G Baker
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, VA Center of Excellence for Stress and Mental Health (CESAMH), La Jolla, CA, USA
| | - Laramie Duncan
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Israel Liberzon
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- Veterans Affairs Ann Arbor Health System, Ann Arbor, MI, USA
| | - Mark W Miller
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Rajendra A Morey
- Duke-UNC Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Mental Illness Research Education and Clinical Center for Post Deployment Mental Health, Durham VA Medical Center, Durham, NC, USA
| | - Caroline M Nievergelt
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, VA Center of Excellence for Stress and Mental Health (CESAMH), La Jolla, CA, USA
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Center for Behavioral Neuroscience, Yerkes National Primate Research Center, Atlanta, GA, USA
- Howard Hughes Medical Institute, Bethesda, MD, USA
| | - Alicia K Smith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jordan W Smoller
- Center of Human Genetics Research, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Jennifer A Sumner
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Monica Uddin
- Carl R Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL, USA
| |
Collapse
|
6
|
Seixas AA, James C, Jean-Louis G, Butler M, Zizi F, Gardner A. The Mediating Effects of Social Support and Locus of Control on the Relationship between Post-Traumatic Stress and Depressive Symptoms in a Jamaican University Sample. JOURNAL OF DEPRESSION & ANXIETY 2015; 4:194. [PMID: 26798566 PMCID: PMC4718585 DOI: 10.4172/2167-1044.1000194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The increasing rate of comorbid posttraumatic stress and depressive symptoms among young adults presents a unique symptom presentation and challenges to treatment. The current study examined psychosocial barriers--external locus of control-- and facilitators-- social support-- in the posttraumatic stress and depressive symptoms association. METHODS The current cross-sectional study was conducted among 701 Jamaican university participants, ages 18-30 years. Participants completed self-report measures of general demographic information as well as target variables which include the CES-D-10, Sense of control (external and internal locus of control), Short screening scale for DSM-IV posttraumatic stress disorder and social support measures. RESULTS Majority of the sample was female (76.2%; n=534); and slightly more than half of the sample self-identified as Black/African ancestry (59.7%). External locus of control (LOC) partially mediated the relationship between posttraumatic stress and depressive symptoms, external locus of control (LOC) had a greater mediation magnitude than social support in the posttraumatic stress-depressive symptoms association (Indirect Effect=0.133, 95% CI-0.075-0.211). In post-hoc analyses women appeared more highly traumatized than their male counterparts (14.3%, χ2 =8.032, p=0.005). The sub-sample of highly traumatized individuals reported higher levels of depression, posttraumatic stress symptoms, external LOC, and lower levels of social support and internal LOC than did individuals with lower levels of trauma. CONCLUSION Contrary to previous research, our findings indicate that external LOC partially mediated the relationship between posttraumatic stress and depressive symptoms among a Jamaica university sample more so than social support. These findings therefore suggest that psychosocial treatments should consider locus of control focused interventions or skill building for young adults who suffer from posttraumatic stress and depressive symptoms.
Collapse
Affiliation(s)
- Azizi A. Seixas
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, NY, USA
| | - Caryl James
- The University of the West Indies, Mona, Jamaica
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, NY, USA
| | - Mark Butler
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, NY, USA
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, NY, USA
| | - Alex Gardner
- The University of the West Indies, Mona, Jamaica
| |
Collapse
|
7
|
The Comorbidity of PTSD and MDD: Implications for Clinical Practice and Future Research. BEHAVIOUR CHANGE 2015. [DOI: 10.1017/bec.2014.26] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The high prevalence of post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) comorbidity is well established, with comorbidity rates often between 30 and 50%. However, despite the high prevalence of this comorbidity, very few researchers have explored specific treatments for individuals who present with comorbid PTSD and MDD. Further, there has not been explicit examination of the mechanisms through which MDD influences trauma-focused therapy. As individuals with comorbid PTSD and MDD often present with a more chronic course of impairment and in some instances, a more delayed response to treatment, the need for such research is imperative. It will be proposed that there is merit in targeting depression within the treatment of comorbid PTSD and MDD. Accordingly, in this article we review explanations for the high PTSD and MDD comorbid relationship and highlight variables likely to explain such comorbidity. Theoretical accounts for how depression impedes optimal recovery from PTSD and the associated empirical findings are illustrated. We consequently argue that there is a need to develop and test treatments that target both PTSD and MDD symptoms. Directions for future research are highlighted.
Collapse
|
8
|
Nievergelt CM, Maihofer AX, Mustapic M, Yurgil KA, Schork NJ, Miller MW, Logue MW, Geyer MA, Risbrough VB, O'Connor DT, Baker DG. Genomic predictors of combat stress vulnerability and resilience in U.S. Marines: A genome-wide association study across multiple ancestries implicates PRTFDC1 as a potential PTSD gene. Psychoneuroendocrinology 2015; 51:459-71. [PMID: 25456346 DOI: 10.1016/j.psyneuen.2014.10.017] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 10/10/2014] [Accepted: 10/16/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Research on the etiology of post-traumatic stress disorder (PTSD) has rapidly matured, moving from candidate gene studies to interrogation of the entire human genome in genome-wide association studies (GWAS). Here we present the results of a GWAS performed on samples from combat-exposed U.S. Marines and Sailors from the Marine Resiliency Study (MRS) scheduled for deployment to Iraq and/or Afghanistan. The MRS is a large, prospective study with longitudinal follow-up designed to identify risk and resiliency factors for combat-induced stress-related symptoms. Previously implicated PTSD risk loci from the literature and polygenic risk scores across psychiatric disorders were also evaluated in the MRS cohort. METHODS Participants (N=3494) were assessed using the Clinician-Administered PTSD Scale and diagnosed using the DSM-IV diagnostic criterion. Subjects with partial and/or full PTSD diagnosis were called cases, all other subjects were designated controls, and study-wide maximum CAPS scores were used for longitudinal assessments. Genomic DNA was genotyped on the Illumina HumanOmniExpressExome array. Individual genetic ancestry was determined by supervised cluster analysis for subjects of European, African, Hispanic/Native American, and other descent. To test for association of SNPs with PTSD, logistic regressions were performed within each ancestry group and results were combined in meta-analyses. Measures of childhood and adult trauma were included to test for gene-by-environment (GxE) interactions. Polygenic risk scores from the Psychiatric Genomic Consortium were used for major depressive disorder (MDD), bipolar disorder (BPD), and schizophrenia (SCZ). RESULTS The array produced >800K directly genotyped and >21M imputed markers in 3494 unrelated, trauma-exposed males, of which 940 were diagnosed with partial or full PTSD. The GWAS meta-analysis identified the phosphoribosyl transferase domain containing 1 gene (PRTFDC1) as a genome-wide significant PTSD locus (rs6482463; OR=1.47, SE=0.06, p=2.04×10(-9)), with a similar effect across ancestry groups. Association of PRTFDC1 with PTSD in an independent military cohort showed some evidence for replication. Loci with suggestive evidence of association (n=25 genes, p<5×10(-6)) further implicated genes related to immune response and the ubiquitin system, but these findings remain to be replicated in larger GWASs. A replication analysis of 25 putative PTSD genes from the literature found nominally significant SNPs for the majority of these genes, but associations did not remain significant after correction for multiple comparison. A cross-disorder analysis of polygenic risk scores from GWASs of BPD, MDD, and SCZ found that PTSD diagnosis was associated with risk sores of BPD, but not with MDD or SCZ. CONCLUSIONS This first multi-ethnic/racial GWAS of PTSD highlights the potential to increase power through meta-analyses across ancestry groups. We found evidence for PRTFDC1 as a potential novel PTSD gene, a finding that awaits further replication. Our findings indicate that the genetic architecture of PTSD may be determined by many SNPs with small effects, and overlap with other neuropsychiatric disorders, consistent with current findings from large GWAS of other psychiatric disorders.
Collapse
Affiliation(s)
- Caroline M Nievergelt
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA; VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, La Jolla, CA 92161, USA.
| | - Adam X Maihofer
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA
| | - Maja Mustapic
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA; Department of Medicine, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA
| | - Kate A Yurgil
- VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, La Jolla, CA 92161, USA
| | - Nicholas J Schork
- Department of Molecular and Experimental Medicine, J. Craig Venter Institute, La Jolla, CA 92037, USA
| | - Mark W Miller
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Mark W Logue
- Biomedical Genetics, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Mark A Geyer
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA
| | - Victoria B Risbrough
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA; VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, La Jolla, CA 92161, USA
| | - Daniel T O'Connor
- Department of Medicine, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA
| | - Dewleen G Baker
- VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, La Jolla, CA 92161, USA; Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA
| |
Collapse
|
9
|
Lockwood E, Forbes D. Posttraumatic Stress Disorder and Comorbidity: Untangling the Gordian Knot. PSYCHOLOGICAL INJURY & LAW 2014. [DOI: 10.1007/s12207-014-9189-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
10
|
Etiology of depression comorbidity in combat-related PTSD: a review of the literature. Clin Psychol Rev 2013; 34:87-98. [PMID: 24486520 DOI: 10.1016/j.cpr.2013.12.002] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 12/05/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022]
Abstract
Posttraumatic stress disorder is often diagnosed with other mental health problems, particularly depression. Although PTSD comorbidity has been associated with more severe and chronic symptomology, relationships among commonly co-occurring disorders are not well understood. The purpose of this study was to review the literature regarding the development of depression comorbid with combat-related PTSD among military personnel. We summarize results of commonly tested hypotheses about the etiology of PTSD and depression comorbidity, including (1) causal hypotheses, (2) common factor hypotheses, and (3) potential confounds. Evidence suggests that PTSD may be a causal risk factor for subsequent depression; however, associations are likely complex, involving bidirectional causality, common risk factors, and common vulnerabilities. The unique nature of PTSD-depression comorbidity in the context of military deployment and combat exposure is emphasized. Implications of our results for clinical practice and future research are discussed.
Collapse
|
11
|
Logue MW, Baldwin C, Guffanti G, Melista E, Wolf EJ, Reardon AF, Uddin M, Wildman D, Galea S, Koenen KC, Miller MW. A genome-wide association study of post-traumatic stress disorder identifies the retinoid-related orphan receptor alpha (RORA) gene as a significant risk locus. Mol Psychiatry 2013; 18:937-42. [PMID: 22869035 PMCID: PMC3494788 DOI: 10.1038/mp.2012.113] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 05/16/2012] [Accepted: 06/26/2012] [Indexed: 01/26/2023]
Abstract
We describe the results of the first genome-wide association study (GWAS) of post-traumatic stress disorder (PTSD) performed using trauma-exposed white non-Hispanic participants from a cohort of veterans and their intimate partners (295 cases and 196 controls). Several single-nucleotide polymorphisms (SNPs) yielded evidence of association. One SNP (rs8042149), located in the retinoid-related orphan receptor alpha gene (RORA), reached genome-wide significance. Nominally significant associations were observed for other RORA SNPs in two African-American replication samples-one from the veteran cohort (43 cases and 41 controls) and another independent cohort (100 cases and 421 controls). However, only the associated SNP from the veteran African-American replication sample survived gene-level multiple-testing correction. RORA has been implicated in prior GWAS studies of psychiatric disorders and is known to have an important role in neuroprotection and other behaviorally relevant processes. This study represents an important step toward identifying the genetic underpinnings of PTSD.
Collapse
Affiliation(s)
- Mark W. Logue
- Biomedical Genetics, Boston University School of Medicine, Boston, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Clinton Baldwin
- Biomedical Genetics, Boston University School of Medicine, Boston, MA
- Center for Human Genetics, Boston University School of Medicine, Boston Massachusetts
| | - Guia Guffanti
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Columbia University/NYSPI, New York, NY
| | - Efi Melista
- Center for Human Genetics, Boston University School of Medicine, Boston Massachusetts
| | - Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | | | - Monica Uddin
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
| | - Derek Wildman
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Sandro Galea
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Karestan C. Koenen
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| |
Collapse
|
12
|
Goswami S, Rodríguez-Sierra O, Cascardi M, Paré D. Animal models of post-traumatic stress disorder: face validity. Front Neurosci 2013; 7:89. [PMID: 23754973 PMCID: PMC3668155 DOI: 10.3389/fnins.2013.00089] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 05/13/2013] [Indexed: 01/20/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating condition that develops in a proportion of individuals following a traumatic event. Despite recent advances, ethical limitations associated with human research impede progress in understanding PTSD. Fortunately, much effort has focused on developing animal models to help study the pathophysiology of PTSD. Here, we provide an overview of animal PTSD models where a variety of stressors (physical, psychosocial, or psychogenic) are used to examine the long-term effects of severe trauma. We emphasize models involving predator threat because they reproduce human individual differences in susceptibility to, and in the long-term consequences of, psychological trauma.
Collapse
Affiliation(s)
- Sonal Goswami
- Center for Molecular and Behavioral Neuroscience, Rutgers State University Newark, NJ, USA
| | | | | | | |
Collapse
|
13
|
Brewin CR, Andrews B, Hejdenberg J, Stewart L. Objective predictors of delayed-onset post-traumatic stress disorder occurring after military discharge. Psychol Med 2012; 42:2119-2126. [PMID: 22348623 DOI: 10.1017/s0033291712000189] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) that develops after military personnel have been discharged may lead to severe impairment. We investigated whether personnel who develop PTSD after discharge can be identified by independent evidence of internalizing signs such as depression or of externalizing signs such as disciplinary offences while still serving. METHOD Veterans in receipt of a war pension who only developed PTSD post-discharge were compared with matched veterans who developed PTSD in service or never suffered from PTSD. Contemporaneous medical and personnel records were searched for objective evidence of internalizing and externalizing disorder. RESULTS Service personnel who developed PTSD post-discharge were indistinguishable from controls with no PTSD on their psychiatric presentation in service. Those with post-discharge PTSD had significantly more disciplinary offences, specifically absence without leave, disobedience, and dishonesty, than the no-PTSD group, and this excess of offences was present before any exposure to trauma. CONCLUSIONS This is the first study to find objective evidence independent of self-report for the claimed link between externalizing disorder and vulnerability to PTSD. Early signs of externalizing disorders may play an important role in helping to identify service personnel at risk of PTSD after military discharge.
Collapse
Affiliation(s)
- C R Brewin
- Clinical, Educational and Health Psychology, University College London, London, UK.
| | | | | | | |
Collapse
|
14
|
Sartor CE, Grant JD, Lynskey MT, McCutcheon VV, Waldron M, Statham DJ, Bucholz KK, Madden PAF, Heath AC, Martin NG, Nelson EC. Common heritable contributions to low-risk trauma, high-risk trauma, posttraumatic stress disorder, and major depression. ACTA ACUST UNITED AC 2012; 69:293-9. [PMID: 22393221 DOI: 10.1001/archgenpsychiatry.2011.1385] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Understanding the relative contributions of genetic and environmental factors to trauma exposure, posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) is critical to developing etiologic models of these conditions and their co-occurrence. OBJECTIVES To quantify heritable influences on low-risk trauma, high-risk trauma, PTSD, and MDD and to estimate the degree of overlap between genetic and environmental sources of variance in these 4 phenotypes. DESIGN Adult twins and their siblings were ascertained from a large population-based sample of female and male twin pairs on the basis of screening items for childhood sexual abuse and physical abuse obtained in a previous assessment of this cohort. SETTING Structured psychiatric telephone interviews. PARTICIPANTS Total sample size of 2591: 996 female and 536 male twins; 625 female and 434 male nontwin siblings. MAIN OUTCOME MEASURE Lifetime low- and high-risk trauma exposure, PTSD, and MDD. RESULTS In the best-fitting genetic model, 47% of the variance in low-risk trauma exposure and 60% of the variance in high-risk trauma exposure was attributable to additive genetic factors. Heritable influences accounted for 46% of the variance in PTSD and 27% of the variance in MDD. An extremely high degree of genetic overlap was observed between high-risk trauma exposure and both PTSD (r = 0.89; 95% CI, 0.78-0.99) and MDD (r = 0.89; 95% CI, 0.77-0.98). Complete correlation of genetic factors contributing to PTSD and to MDD (r = 1.00) was observed. CONCLUSIONS The evidence suggests that almost all the heritable influences on high-risk trauma exposure, PTSD, and MDD, can be traced to the same sources; that is, genetic risk is not disorder specific. Individuals with a positive family history of either PTSD or MDD are at elevated risk for both disorders and should be closely monitored after a traumatic experience for symptoms of PTSD and MDD.
Collapse
Affiliation(s)
- Carolyn E Sartor
- Department of Psychiatry, Yale School of Medicine, VA Connecticut Healthcare System, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Sartor CE, McCutcheon VV, Pommer NE, Nelson EC, Duncan AE, Waldron M, Bucholz KK, Madden PAF, Heath AC. Posttraumatic stress disorder and alcohol dependence in young women. J Stud Alcohol Drugs 2011; 71:810-8. [PMID: 20946737 DOI: 10.15288/jsad.2010.71.810] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of the current study is to characterize the relationship between posttraumatic stress disorder (PTSD) and alcohol dependence (AD) in women, distinguishing PTSD-specific influences on AD from the contribution of co-occurring psychiatric conditions and from the influences of trauma more generally. METHOD Trauma histories and DSM-IV lifetime diagnoses, including PTSD and AD, were obtained via telephone interview from 3,768 female twins. Based on PTSD status and trauma history, participants were categorized as no trauma (43.7%), trauma without PTSD (52.6%), or trauma with PTSD (3.7%). Cox proportional hazards regression analyses were conducted using trauma/PTSD status to predict AD, first adjusting only for ethnicity and parental problem drinking, then including conduct disorder, major depressive disorder, regular smoking, and cannabis abuse. RESULTS Before accounting for psychiatric covariates, elevated rates of AD were evident in both trauma-exposed groups, but those with PTSD were at significantly greater risk for AD than those without PTSD. This distinction was no longer statistically significant when psychiatric covariates were included in the model, but both trauma-exposed groups continued to show elevated odds of developing AD compared with the no trauma group. CONCLUSIONS The elevated rates of AD in women who have experienced trauma are not accounted for in full by psychiatric conditions that commonly co-occur with AD and trauma exposure. The greater likelihood of developing AD in the subset of trauma-exposed individuals who develop PTSD may reflect higher levels of distress and/ or higher rates of psychopathology associated with traumas that lead to PTSD rather than PTSD-specific influences.
Collapse
Affiliation(s)
- Carolyn E Sartor
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Kremen WS, Koenen KC, Afari N, Lyons MJ. Twin studies of posttraumatic stress disorder: differentiating vulnerability factors from sequelae. Neuropharmacology 2011; 62:647-53. [PMID: 21443892 DOI: 10.1016/j.neuropharm.2011.03.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 03/07/2011] [Accepted: 03/11/2011] [Indexed: 11/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) is defined by one's response to an environmental event. However, genetic factors are important in determining people's response to that event, and even their likelihood of being exposed to particular traumatic events in the first place. Classical twin designs can decompose genetic and environmental sources of variance. Such studies are reviewed extensively elsewhere, and we cover them only briefly in this review. Instead, we focus primarily on the identical co-twin control design. This design makes it possible to resolve the "chicken-egg" dilemma inherent in standard case-control designs, namely, distinguishing risk from sequelae. Abnormalities that are present in both the twin with PTSD and the unaffected co-twin suggest pre-existing vulnerability indicators. These include smaller hippocampal volume, large cavum septum pellucidum, more neurological soft signs, lower general intellectual ability, and poorer performance in the specific cognitive abilities of executive function, attention, declarative memory, and processing of contextual cues. In contrast, abnormalities in a twin with PTSD that are not present in the identical co-twin suggest consequences of PTSD or trauma exposure. These include psychophysiological responding, higher resting anterior cingulate metabolism, event-related potential abnormalities associated with attentional processes, recall intrusions, and possibly some types of chronic pain. Most co-twin control studies of PTSD have been small and come from the same twin registry of middle-aged male veterans. Consequently, there is a great need for replication and extension of the findings, particularly in women and younger individuals. The creation of new twin registries would do much toward accomplishing this goal. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.
Collapse
Affiliation(s)
- William S Kremen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA.
| | | | | | | |
Collapse
|
17
|
Nugent NR, Tyrka AR, Carpenter LL, Price LH. Gene-environment interactions: early life stress and risk for depressive and anxiety disorders. Psychopharmacology (Berl) 2011; 214:175-96. [PMID: 21225419 PMCID: PMC3615637 DOI: 10.1007/s00213-010-2151-x] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 12/13/2010] [Indexed: 12/22/2022]
Abstract
RATIONALE Prior reviews have examined how stress, broadly defined, interacts with genetic diathesis in the pathogenesis of internalizing (i.e., depressive and anxiety) disorders. Recent findings have suggested a unique role for early life stress (ELS) in the development of internalizing disorders, contributing to the rapid proliferation of research in this area. OBJECTIVE This paper critically reviews studies in humans examining gene-environment interaction (GxE) effects of ELS on the risk for depression and anxiety, primarily from a candidate gene perspective. Major methodological challenges that are unique to such studies are considered. RESULTS The majority of published studies have focused on candidates that regulate the serotonin system, especially the serotonin transporter. More recent work has addressed interactions of ELS with candidates from the hypothalamic-pituitary-adrenal axis and neurotrophin system. Available studies vary greatly with respect to definitions of ELS, examination of gene-gene interactions, consideration of gender effects, and attention to analytic limitations. CONCLUSIONS Overall, there is support for GxE effects of ELS on the risk for depressive and anxiety outcomes. Future studies of ELS in this context will require careful attention to methodologic considerations. Such studies would benefit from more systematic assessment of positive environmental factors (e.g., social support) and greater utilization of developmentally sensitive paradigms.
Collapse
Affiliation(s)
- Nicole R. Nugent
- Bradley/Hasbro Children’s Research Center, Rhode Island Hospital, Coro West Building, One Hoppin Street, Suite 204, Providence, RI 02903, USA. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Audrey R. Tyrka
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA. Mood Disorders Research Program, Butler Hospital, Providence, RI, USA
| | - Linda L. Carpenter
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA. Mood Disorders Research Program, Butler Hospital, Providence, RI, USA
| | - Lawrence H. Price
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA. Mood Disorders Research Program, Butler Hospital, Providence, RI, USA
| |
Collapse
|
18
|
PTSD and gene variants: new pathways and new thinking. Neuropharmacology 2011; 62:628-37. [PMID: 21356219 DOI: 10.1016/j.neuropharm.2011.02.013] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 02/14/2011] [Indexed: 01/24/2023]
Abstract
Posttraumatic Stress Disorder (PTSD) is an anxiety disorder which can develop as a result of exposure to a traumatic event and is associated with significant functional impairment. Family and twin studies have found that risk for PTSD is associated with an underlying genetic vulnerability and that more than 30% of the variance associated with PTSD is related to a heritable component. Using a fear conditioning model to conceptualize the neurobiology of PTSD, three primary neuronal systems have been investigated - the hypothalamic-pituitary-adrenal axis, the locus coeruleus-noradrenergic system, and neurocircuitry interconnecting the limbic system and frontal cortex. The majority of the initial investigations into main effects of candidate genes hypothesized to be associated with PTSD risk have been negative, but studies examining the interaction of genetic polymorphisms with specific environments in predicting PTSD have produced several positive results which have increased our understanding of the determinants of risk and resilience in the aftermath of trauma. Promising avenues of inquiry into the role of epigenetic modification have also been proposed to explain the enduring impact of environmental exposures which occur during key, often early, developmental periods on gene expression. Studies of PTSD endophenotypes, which are heritable biomarkers associated with a circumscribed trait within the more complex psychiatric disorder, may be more directly amenable to analysis of the underlying genetics and neural pathways and have provided promising targets for elucidating the neurobiology of PTSD. Knowledge of the genetic underpinnings and neuronal pathways involved in the etiology and maintenance of PTSD will allow for improved targeting of primary prevention amongst vulnerable individuals or populations, as well as timely, targeted treatment interventions. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.
Collapse
|
19
|
Collimore KC, Carleton RN, Hofmann SG, Asmundson GJG. Posttraumatic stress and social anxiety: the interaction of traumatic events and interpersonal fears. Depress Anxiety 2010; 27:1017-26. [PMID: 20721907 DOI: 10.1002/da.20728] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 06/12/2010] [Accepted: 06/16/2010] [Indexed: 02/05/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) are frequently comorbid among veteran and community samples. Several studies have demonstrated significant comorbidity between trauma, PTSD, and social anxiety (SA), and a growing number of studies have explored the nature of this association. Although a diagnosis of either PTSD or SAD alone can result in significant impairment in social and occupational functioning, these difficulties are often magnified in persons suffering from both disorders. This review describes the current state-of-the-art regarding the co-occurrence of trauma, PTSD, and SA. First, we provide an overview of empirical data on the prevalence of co-occurring trauma, PTSD, and SAD. Second, we describe possible explanatory models of the co-occurrence, with a specific focus on the shared vulnerability model. Third, we review the available empirical data addressing the postulates of this model, including both genetic and psychological vulnerabilities. Fourth, we describe additional factors-guilt, shame, and depressive symptoms-that may help to explain the co-occurrence of PTSD and SA. A better understanding of this complex relationship will improve the efficacy of treatment for individuals suffering from both disorders. We conclude with key areas for future research.
Collapse
Affiliation(s)
- Kelsey C Collimore
- The Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | | | | | | |
Collapse
|
20
|
Cerdá M, Sagdeo A, Johnson J, Galea S. Genetic and environmental influences on psychiatric comorbidity: a systematic review. J Affect Disord 2010; 126:14-38. [PMID: 20004978 PMCID: PMC2888715 DOI: 10.1016/j.jad.2009.11.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 11/10/2009] [Accepted: 11/12/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this review is to systematically appraise the peer-reviewed literature about the genetic and environmental determinants of psychiatric comorbidity, focusing on four of the most prevalent types of psychopathology: anxiety disorders, depression, conduct disorder and substance abuse. METHODS We summarize existing empirical research on the relative contribution that genetic, nonshared and shared environmental factors make to the covariance between disorders, and evidence about specific genes and environmental characteristics that are associated with comorbidity. RESULTS Ninety-four articles met the inclusion criteria and were assessed. Genetic factors play a particularly strong role in comorbidity between major depression and generalized anxiety disorder or posttraumatic stress disorder, while the non-shared environments make an important contribution to comorbidity in affective disorders. Genetic and non-shared environmental factors also make a moderate-to-strong contribution to the relationship between CD and SA. A range of candidate genes, such as 5HTTLPR, MAOA, and DRD1-DRD4, as well as others implicated in the central nervous system, has been implicated in psychiatric comorbidity. Pivotal social factors include childhood adversity/life events, family and peer social connections, and socioeconomic and academic difficulties. LIMITATIONS Methodological concerns include the use of clinical case-control samples, the focus on a restricted set of individual-level environmental risk factors, and restricted follow-up times. CONCLUSIONS Given the significant mental health burden associated with comorbid disorders, population-based research on modifiable risk factors for psychiatric comorbidity is vital for the design of effective preventive and clinical interventions.
Collapse
Affiliation(s)
- M Cerdá
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, 10029, USA.
| | | | | | | |
Collapse
|
21
|
Goswami S, Cascardi M, Rodríguez-Sierra OE, Duvarci S, Paré D. Impact of predatory threat on fear extinction in Lewis rats. Learn Mem 2010; 17:494-501. [PMID: 20929713 DOI: 10.1101/lm.1948910] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Humans with post-traumatic stress disorder (PTSD) are deficient at extinguishing conditioned fear responses. A study of identical twins concluded that this extinction deficit does not predate trauma but develops as a result of trauma. The present study tested whether the Lewis rat model of PTSD reproduces these features of the human syndrome. Lewis rats were subjected to classical auditory fear conditioning before or after exposure to a predatory threat that mimics a type of traumatic stress that leads to PTSD in humans. Exploratory behavior on the elevated plus maze 1 wk after predatory threat exposure was used to distinguish resilient vs. PTSD-like rats. Properties of extinction varied depending on whether fear conditioning and extinction occurred before or after predatory threat. When fear conditioning was carried out after predatory threat, PTSD-like rats showed a marked extinction deficit compared with resilient rats. In contrast, no differences were seen between resilient and PTSD-like rats when fear conditioning and extinction occurred prior to predatory threat. These findings in Lewis rats closely match the results seen in humans with PTSD, thereby suggesting that studies comparing neuronal interactions in resilient vs. at-risk Lewis rats might shed light on the causes and pathophysiology of human PTSD.
Collapse
Affiliation(s)
- Sonal Goswami
- Center for Molecular and Behavioral Neuroscience, Rutgers State University, Newark, New Jersey 07102, USA
| | | | | | | | | |
Collapse
|
22
|
Amstadter AB, Nugent NR, Koenen KC. Genetics of PTSD: Fear Conditioning as a Model for Future Research. Psychiatr Ann 2009; 39:358-367. [PMID: 19779593 DOI: 10.3928/00485713-20090526-01] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the last decade, the number of publications in psychiatric genetics has nearly tripled but little attention has been paid to the role of genetic factors in the etiology of posttraumatic stress disorder (PTSD). The present review summarizes the current state of genetic research on PTSD. First, we outline information regarding genetic influences provided by family investigations and by twin studies. Second, we propose the fear-conditioning model of PTSD as a framework for the nomination of candidate genes that may be related to the disorder. Third, we review lines of evidence from three neurobiological systems involved in fear conditioning, and we summarize published investigations of genetic variants studied in association with PTSD in these three systems. Finally, we review gene-by-environment interaction research, a promising novel approach to genetic research in PTSD.
Collapse
Affiliation(s)
- Ananda B Amstadter
- Departments of Psychiatry and Behavioral Science, Medical University of South Carolina
| | | | | |
Collapse
|
23
|
Albright DL, Thyer B. Does EMDR reduce post-traumatic stress disorder symptomatology in combat veterans? BEHAVIORAL INTERVENTIONS 2009. [DOI: 10.1002/bin.295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
24
|
Gale CR, Deary IJ, Boyle SH, Barefoot J, Mortensen LH, Batty GD. Cognitive ability in early adulthood and risk of 5 specific psychiatric disorders in middle age: the Vietnam experience study. ARCHIVES OF GENERAL PSYCHIATRY 2008; 65:1410-8. [PMID: 19047528 PMCID: PMC3634571 DOI: 10.1001/archpsyc.65.12.1410] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Lower cognitive ability is a risk factor for some forms of psychopathology, but much of the evidence for risk is based on individuals who required specialist care. It is unclear whether lower ability influences the risk of particular patterns of comorbidity. OBJECTIVE To examine the relation between premorbid cognitive ability in early adulthood and the risk of major depression, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), alcohol and other drug abuse or dependence, and comorbid forms of these conditions in midlife. DESIGN Prospective cohort study in which cognitive ability was measured on enlistment into military service at a mean age of 20.4 years and psychiatric disorder was assessed by structured diagnostic interview at a mean age of 38.3 years. SETTING The United States. PARTICIPANTS A total of 3258 male veterans, participants in the Vietnam Experience Study. MAIN OUTCOME MEASURES Major depression, GAD, PTSD, and alcohol or other drug abuse or dependence since enlistment and currently, diagnosed according to the DSM-III. RESULTS Lower cognitive ability was associated with an increased risk of depression, GAD, alcohol abuse or dependence, and PTSD and with some patterns of comorbidity. For a 1-SD decrease in cognitive ability, unadjusted odds ratios (95% confidence interval) for having these disorders currently were 1.32 (1.12-1.56) for depression, 1.43 (1.27-1.64) for GAD, 1.20 (1.08-1.35) for alcohol abuse or dependence, 1.39 (1.18-1.67) for PTSD, 2.50 (1.41-4.55) for PTSD plus GAD, 2.17 (1.47-3.22) for PTSD plus GAD plus depression, and 2.77 (1.12-6.66) for all 4 disorders. Most associations remained statistically significant after adjustment for confounders. CONCLUSIONS Lower cognitive ability is a risk factor for several specific psychiatric disorders, including some forms of comorbidity. Understanding the mechanisms whereby ability is linked to individual patterns of psychopathology may inform intervention.
Collapse
Affiliation(s)
- Catharine R Gale
- Medical Research Council Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, England.
| | | | | | | | | | | |
Collapse
|
25
|
Nugent NR, Amstadter AB, Koenen KC. Genetics of post-traumatic stress disorder: informing clinical conceptualizations and promoting future research. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2008; 148C:127-32. [PMID: 18412098 DOI: 10.1002/ajmg.c.30169] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this article is to provide an overview of genetic research involving post-traumatic stress disorder (PTSD). First, we summarize evidence for genetic influences on PTSD from family investigations. Second, we discuss the distinct contributions to our understanding of the genetics of PTSD permitted by twin studies. Finally, we summarize findings from molecular genetic studies, which have the potential to inform our understanding of underlying biological mechanisms for the development of PTSD.
Collapse
Affiliation(s)
- Nicole R Nugent
- Brown Medical School and Bradley/ Hasbro Children's Research Center, USA
| | | | | |
Collapse
|
26
|
Koenen KC, Nugent NR, Amstadter AB. Gene-environment interaction in posttraumatic stress disorder: review, strategy and new directions for future research. Eur Arch Psychiatry Clin Neurosci 2008; 258:82-96. [PMID: 18297420 PMCID: PMC2736096 DOI: 10.1007/s00406-007-0787-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The purpose of this article is to encourage research investigating the role of measured gene-environment interaction (G x E) in the etiology of posttraumatic stress disorder (PTSD). PTSD is uniquely suited to the study of G x E as the diagnosis requires exposure to a potentially-traumatic life event. PTSD is also moderately heritable; however, the role of genetic factors in PTSD etiology has been largely neglected both by trauma researchers and psychiatric geneticists. First, we summarize evidence for genetic influences on PTSD from family, twin, and molecular genetic studies. Second, we discuss the key challenges in G x E studies of PTSD and offer practical strategies for addressing these challenges and for discovering replicable G x E for PTSD. Finally, we propose some promising new directions for PTSD G x E research. We suggest that G x E research in PTSD is essential to understanding vulnerability and resilience following exposure to a traumatic event.
Collapse
Affiliation(s)
- Karestan C. Koenen
- Department of Society, Human Development, and Health and Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Kresge 613, Boston, MA 02115, USA, Tel.: 617/4324622. Fax: 617/4323755 E-Mail: ,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Nicole R. Nugent
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA,Department of Psychology, Kent State University, Kent, OH, USA
| | - Ananda B. Amstadter
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA,Department of Psychology, Auburn University, Auburn, AL, USA
| |
Collapse
|
27
|
Scherrer JF, Xian H, Lyons MJ, Goldberg J, Eisen SA, True W, Tsuang M, Bucholz KK, Koenen KC. Posttraumatic stress disorder; combat exposure; and nicotine dependence, alcohol dependence, and major depression in male twins. Compr Psychiatry 2008; 49:297-304. [PMID: 18396190 PMCID: PMC2375042 DOI: 10.1016/j.comppsych.2007.11.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 11/06/2007] [Accepted: 11/08/2007] [Indexed: 11/28/2022] Open
Abstract
Combat exposure is associated with increased risk of psychiatric and substance use disorders in veterans. However, it is not known whether combat exposure independently increases risk for these disorders or whether this association is accounted for by genetic vulnerability common to posttraumatic stress disorder (PTSD). This article tests competing explanations for the association of combat exposure and PTSD with nicotine dependence (ND), alcohol dependence (AD), and major depression (MD). Data were obtained from 6099 members of the Vietnam Era Twin Registry, a national registry of male-male twin pairs who served in the military during the Vietnam era. Twin models were fit to estimate the genetic and environmental variance common and specific to Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, lifetime diagnoses of PTSD, combat trauma, and 3 comorbid conditions: ND, AD, and MD. Variance specific to ND, AD, and MD was due to genetic factors (48%, 36%, and 12%, respectively) and unique environmental factors (36%, 42%, and 58%, respectively). After accounting for variance common to PTSD, no residual genetic and environmental variance overlapped between combat and ND, combat and AD, and combat and MD. Combat exposure is not independently associated with lifetime ND, AD, and MD. The association of combat exposure with these 3 disorders is due to genetic and unique environmental contributions in common with PTSD. These findings suggest comorbid PTSD may represent a genetically mediated vulnerability to psychopathology after trauma.
Collapse
Affiliation(s)
- Jeffrey F. Scherrer
- St. Louis Veterans Affairs Medical Center, Research Service, St. Louis, MO,Washington University School of Medicine, Midwest Alcoholism Research Center, Department of Psychiatry, St. Louis, MO
| | - Hong Xian
- St. Louis Veterans Affairs Medical Center, Research Service, St. Louis, MO,Washington University School of Medicine, Department of Internal Medicine, Division of General Medical Sciences, St.Louis, MO
| | - Michael J. Lyons
- Department of Psychology, Boston University, Boston, MA,Harvard Institute of Psychiatric Epidemiology and Genetics, Department of Epidemiology, Harvard School of Public Health, Boston, MA,Harvard Medical School Department of Psychiatry at Massachusetts, Mental Health Center, Boston, MA
| | - Jack Goldberg
- Seattle VA ERIC/Vietnam Era Twin Registry, Seattle, WA,University of Washington, Department of Epidemiology, Seattle, WA
| | - Seth A. Eisen
- St. Louis Veterans Affairs Medical Center, Research Service, St. Louis, MO,Washington University School of Medicine, Department of Internal Medicine, Division of General Medical Sciences, St.Louis, MO,St. Louis Veterans Affairs Medical Center, Medical Service, St. Louis, MO
| | - William True
- St. Louis Veterans Affairs Medical Center, Research Service, St. Louis, MO,Saint Louis University Medical Center, School of Public Health, St. Louis, MO
| | - Ming Tsuang
- Harvard Institute of Psychiatric Epidemiology and Genetics, Department of Epidemiology, Harvard School of Public Health, Boston, MA,Harvard Medical School Department of Psychiatry at Massachusetts, Mental Health Center, Boston, MA,Institute of Human Behavioral Genomics, Departments of Psychiatry, University of California, San Diego and VA San Diego Health Care System, San Diego, CA
| | - Kathleen K. Bucholz
- Washington University School of Medicine, Department of Internal Medicine, Division of General Medical Sciences, St.Louis, MO
| | - Karestan C. Koenen
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA
| |
Collapse
|