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Kalisch R, Russo SJ, Müller MB. Neurobiology and systems biology of stress resilience. Physiol Rev 2024; 104:1205-1263. [PMID: 38483288 DOI: 10.1152/physrev.00042.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 05/16/2024] Open
Abstract
Stress resilience is the phenomenon that some people maintain their mental health despite exposure to adversity or show only temporary impairments followed by quick recovery. Resilience research attempts to unravel the factors and mechanisms that make resilience possible and to harness its insights for the development of preventative interventions in individuals at risk for acquiring stress-related dysfunctions. Biological resilience research has been lagging behind the psychological and social sciences but has seen a massive surge in recent years. At the same time, progress in this field has been hampered by methodological challenges related to finding suitable operationalizations and study designs, replicating findings, and modeling resilience in animals. We embed a review of behavioral, neuroimaging, neurobiological, and systems biological findings in adults in a critical methods discussion. We find preliminary evidence that hippocampus-based pattern separation and prefrontal-based cognitive control functions protect against the development of pathological fears in the aftermath of singular, event-type stressors [as found in fear-related disorders, including simpler forms of posttraumatic stress disorder (PTSD)] by facilitating the perception of safety. Reward system-based pursuit and savoring of positive reinforcers appear to protect against the development of more generalized dysfunctions of the anxious-depressive spectrum resulting from more severe or longer-lasting stressors (as in depression, generalized or comorbid anxiety, or severe PTSD). Links between preserved functioning of these neural systems under stress and neuroplasticity, immunoregulation, gut microbiome composition, and integrity of the gut barrier and the blood-brain barrier are beginning to emerge. On this basis, avenues for biological interventions are pointed out.
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Affiliation(s)
- Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Scott J Russo
- Nash Family Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Brain and Body Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Marianne B Müller
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center, Mainz, Germany
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2
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Sep MSC, Geuze E, Joëls M. Impaired learning, memory, and extinction in posttraumatic stress disorder: translational meta-analysis of clinical and preclinical studies. Transl Psychiatry 2023; 13:376. [PMID: 38062029 PMCID: PMC10703817 DOI: 10.1038/s41398-023-02660-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/28/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
Current evidence-based treatments for post-traumatic stress disorder (PTSD) are efficacious in only part of PTSD patients. Therefore, novel neurobiologically informed approaches are urgently needed. Clinical and translational neuroscience point to altered learning and memory processes as key in (models of) PTSD psychopathology. We extended this notion by clarifying at a meta-level (i) the role of information valence, i.e. neutral versus emotional/fearful, and (ii) comparability, as far as applicable, between clinical and preclinical phenotypes. We hypothesized that cross-species, neutral versus emotional/fearful information processing is, respectively, impaired and enhanced in PTSD. This preregistered meta-analysis involved a literature search on PTSD+Learning/Memory+Behavior, performed in PubMed. First, the effect of information valence was estimated with a random-effects meta-regression. The sources of variation were explored with a random forest-based analysis. The analyses included 92 clinical (N = 6732 humans) and 182 preclinical (N = 6834 animals) studies. A general impairment of learning, memory and extinction processes was observed in PTSD patients, regardless of information valence. Impaired neutral learning/memory and fear extinction were also present in animal models of PTSD. Yet, PTSD models enhanced fear/trauma memory in preclinical studies and PTSD impaired emotional memory in patients. Clinical data on fear/trauma memory was limited. Mnemonic phase and valence explained most variation in rodents but not humans. Impaired neutral learning/memory and fear extinction show stable cross-species PTSD phenotypes. These could be targeted for novel PTSD treatments, using information gained from neurobiological animal studies. We argue that apparent cross-species discrepancies in emotional/fearful memory deserve further in-depth study; until then, animal models targeting this phenotype should be applied with utmost care.
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Affiliation(s)
- Milou S C Sep
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands.
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.
- GGZ inGeest Mental Health Care, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands.
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands.
- Department of Psychiatry, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, The Netherlands.
| | - Elbert Geuze
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Marian Joëls
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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3
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Vasterling JJ, Franz MR, Lee LO, Kaiser AP, Proctor SP, Marx BP, Schnurr PP, Ko J, Concato J, Aslan M. Early predictors of chronic posttraumatic stress disorder symptom trajectories in U.S. Army soldiers deployed to the Iraq war zone. J Trauma Stress 2023; 36:955-967. [PMID: 37608526 DOI: 10.1002/jts.22964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 08/24/2023]
Abstract
The course of posttraumatic stress disorder (PTSD) symptoms varies among veterans of war zones, but sources of variation in long-term symptom course remain poorly understood. Modeling of symptom growth trajectories facilitates the understanding of predictors of individual outcomes over time. Although growth mixture modeling (GMM) has been applied to military populations, few studies have incorporated both predeployment and follow-up measurements over an extended time. In this prospective study, 1,087 U.S. Army soldiers with varying military occupational specialties and geographic locations were assessed before and after deployment to the Iraq war zone, with long-term follow-up assessment occurring at least 5 years after return from deployment. The primary outcome variable was the PTSD Checklist-Civilian Version summary score. GMM yielded four latent profiles, characterized as primarily asymptomatic (n = 194, 17.8%); postdeployment worsening symptoms (n = 84, 7.7%); mild symptoms (n = 320, 29.4%); and preexisting, with a chronic postdeployment elevation of symptoms (n = 489, 45.0%). Regression models comparing the primarily asymptomatic class to the symptomatic classes revealed that chronic symptom classes were associated with higher degrees of stress exposure, less predeployment social support, military reservist or veteran status at the most recent assessment, and poorer predeployment visual memory, ORs = 0.98-2.90. PTSD symptom course varies considerably over time after military deployment and is associated with potentially modifiable biopsychosocial factors that occur early in its course in addition to exposures and military status.
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Affiliation(s)
- Jennifer J Vasterling
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Molly R Franz
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Lewina O Lee
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Susan P Proctor
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
- Research Service, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Brian P Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Paula P Schnurr
- National Center for PTSD, White River Junction, Vermont, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - John Ko
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA
| | - John Concato
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Mihaela Aslan
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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4
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Günak MM, Ebrahimi OV, Pietrzak RH, Fried EI. Using network models to explore the associations between posttraumatic stress disorder symptoms and subjective cognitive functioning. J Anxiety Disord 2023; 99:102768. [PMID: 37716026 DOI: 10.1016/j.janxdis.2023.102768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 06/24/2023] [Accepted: 09/03/2023] [Indexed: 09/18/2023]
Abstract
Several studies have identified relationships between posttraumatic stress disorder (PTSD) and cognitive functioning. Here, we aimed to elucidate the nature of this relationship by investigating cross-sectional associations between subjective cognitive functioning (SCF) and 1) the PTSD sum score, 2) symptom domains, and 3) individual symptoms. We also investigated temporal stability by testing whether results replicated over a 3-year period. We estimated partial correlation networks of DSM-5 PTSD symptoms (at baseline) and SCF (at baseline and follow-up, respectively), using data from the National Health and Resilience in Veterans Study (NHRVS; N = 1484; Mdn = 65 years). The PTSD sum score was negatively associated with SCF. SCF was consistently negatively associated with the PTSD symptom domains 'marked alterations in arousal and reactivity' and 'negative alterations in cognitions and mood', and showed robust relations with the specific symptoms 'having difficulty concentrating' and 'trouble experiencing positive feelings'. Results largely replicated at the 3-year follow-up, suggesting that some PTSD symptoms both temporally precede and are statistically associated with the development or maintenance of reduced SCF. We discuss the importance of examining links between specific PTSD domains and symptoms with SCF-relations obfuscated by focusing on PTSD diagnoses or sum scores-as well as investigating mechanisms underlying these relations. Registration Number: 37069 (https://aspredicted.org/n5sw7.pdf).
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Affiliation(s)
- Mia Maria Günak
- Department of Clinical Psychology, Leiden University, Pieter de la Court Building, Wassernaarseweg 52, 2333 AK Leiden, the Netherlands; Department of Psychology, LMU Munich, Leopoldstr. 13, 80802 Munich, Germany
| | - Omid V Ebrahimi
- Department of Clinical Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway; Department of Psychology, University of Amsterdam, Roeterseiland Campus, Nieuwe Achtergracht 129-B, 1018 WS Amsterdam, the Netherlands
| | - Robert H Pietrzak
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, West Haven, CT 06516, USA; Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, P.O. Box 208034, 60 College Street, New Haven, CT 06520-0834, USA
| | - Eiko I Fried
- Department of Clinical Psychology, Leiden University, Pieter de la Court Building, Wassernaarseweg 52, 2333 AK Leiden, the Netherlands.
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Lawrence KA, Garcia-Willingham NE, Slade E, DeBeer BB, Meyer EC, Morissette SB. Associations Among PTSD, Cognitive Functioning, and Health-Promoting Behavior in Post-9/11 Veterans. Mil Med 2023; 188:e2284-e2291. [PMID: 36825299 PMCID: PMC10362999 DOI: 10.1093/milmed/usad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/09/2023] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION PTSD is associated with negative health behaviors that increase chronic disease risk, yet health behaviors and their determinants are not well investigated in this context. One understudied mechanism of health behaviors is cognitive functioning. Deficits in cognitive functioning may undermine engagement in health-promoting behavior, thereby increasing the negative impact of PTSD. We tested three hypotheses: (1) Greater PTSD symptom severity is associated with less health-promoting behavior; (2) greater PTSD symptom severity is associated with poorer cognitive functioning across verbal memory, processing speed, attention, and executive functioning domains; and (3) verbal memory and executive functioning exhibit indirect effects on the relationship between PTSD and health-promoting behavior. MATERIALS AND METHODS We examined associations between PTSD symptom severity (Clinician-Administered PTSD Scale for DSM-IV), cognitive functioning, and health-promoting behavior (Health-Promoting Lifestyle Profile II) in 124 post-9/11 veterans (average age = 37.82; 85.5% male; 63.7% White; 18.5% Black; 26.6% Hispanic). Cognitive domains examined included verbal memory (California Verbal Learning Test), processing speed (Digit Symbol Coding), attention and working memory (Digit Span), and executive functions (Trail Making Test and Stroop Interference). RESULTS Regression analyses indicated that greater PTSD symptom severity was associated with less health-promoting behavior (B = -.0101, SE = 0.0016, P < .0001; R2 = 0.3052). Path analyses revealed that verbal learning and memory partially accounted for this relationship (R2 = 0.037- 0.043; P < .05). CONCLUSIONS Therapeutic targeting of these relationships may have implications for the prevention of long-term disease impact in veterans; longitudinal research is needed to elucidate the potential impact on chronic disease.
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Affiliation(s)
- Karen A Lawrence
- College of Social Work, University of Kentucky, Lexington, KY 40506, USA
| | | | - Emily Slade
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40506, USA
| | - Bryann B DeBeer
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Eric C Meyer
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Sandra B Morissette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX 78249, USA
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6
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Domitrovic Spudic S, Nikolac Perkovic M, Uzun S, Nedic Erjavec G, Kozumplik O, Svob Strac D, Mimica N, Pivac N. Reduced plasma BDNF concentration and cognitive decline in veterans with PTSD. Psychiatry Res 2022; 316:114772. [PMID: 35961151 DOI: 10.1016/j.psychres.2022.114772] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/15/2022] [Accepted: 08/04/2022] [Indexed: 12/22/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a trauma and stress related disorder frequently associated with cognitive decline. War veterans with PTSD have a higher risk of developing dementia than healthy subjects. Brain derived neurotrophic factor (BDNF) is an important protein that modulates plasticity, memory consolidation and cognitive processes. Lower circulating BDNF levels were related to memory impairment and cognitive deterioration. The aim of this study was to evaluate cognitive deterioration and plasma BDNF concentration in 120 veterans with combat related PTSD, 120 healthy controls, 47 subjects with mild cognitive impairment (MCI) and 76 patients with Alzheimer's disease (AD), and to assess if plasma BDNF concentration might be used as biomarker of cognitive deterioration. Veterans with PTSD had significantly decreased plasma BDNF concentration and worse cognitive performances (assessed using the Mini Mental State Examination, Clock Drawing test and Montreal Cognitive Assessment scores/categories) than healthy subjects, and similarly reduced plasma BDNF and cognitive decline as MCI subjects. Reduced plasma BDNF was found in cognitively impaired subjects. These results suggest that veterans with PTSD should be closely monitored in order to early detect and predict cognitive worsening and promote interventions that might help restore blood BDNF levels and cognitive functions.
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Affiliation(s)
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapce, 10090 Zagreb, Croatia; School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia
| | - Oliver Kozumplik
- Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapce, 10090 Zagreb, Croatia
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia
| | - Ninoslav Mimica
- Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapce, 10090 Zagreb, Croatia; School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia.
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Bardeen JR, Gorday JY, Weathers FW. Executive functioning deficits exacerbate posttraumatic stress symptoms: A longitudinal mediation model. J Anxiety Disord 2022; 87:102556. [PMID: 35276509 PMCID: PMC8996315 DOI: 10.1016/j.janxdis.2022.102556] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/16/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
Executive functioning (EF) consists of a set of related, but distinct, higher-level cognitive abilities that are used to organize and integrate lower-level processes in the service of engaging in goal-direct behavior. Evidence suggests that deficits in EF are a vulnerability factor for the development of posttraumatic stress (PTS) symptoms. Less understood, however, is the role that EF plays in symptom maintenance and exacerbation following trauma exposure. As such, the primary purpose of the present study was to determine whether EF deficits exacerbate PTS symptoms over the course of one year. A secondary aim of this study was to use a cross-lagged design to determine the directional relations among EF deficits and PTS. Trauma-exposed adults (N = 98) completed a clinical interview and self-report measures at an initial assessment session (Time 1 [T1]). Participants also completed self-report measures at 6- (Time 2 [T2]; n = 92) and 12-month (Time 3 [T3]; n = 91) follow-up sessions. As predicted, EF deficits at T2 mediated the relationship between PTS symptoms from T1 to T3, thus suggesting that EF deficits exacerbate PTS symptoms following trauma exposure. Results from a cross-lagged path analysis from T2 to T3 suggest that deficits in EF exert a stronger influence on the maintenance of PTS symptoms than vice versa. These results have implications for (a) identifying individuals that are at elevated risk for developing PTS symptoms, (b) developing precision medicine-based approaches for alleviating PTS symptoms, and (c) improving well-established PTSD treatments for those with relative deficits in EF.
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O’Neil ME, Agyemang A, Walker WC, Pogoda TK, Klyce DW, Perrin PB, Hsu NH, Nguyen H, Presson AP, Cifu DX. Demographic, military, and health comorbidity variables by mild TBI and PTSD status in the LIMBIC-CENC cohort. Brain Inj 2022; 36:598-606. [DOI: 10.1080/02699052.2022.2033847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Maya E. O’Neil
- VA Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Amma Agyemang
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - William C. Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
- Central Virginia VA Healthcare System, Richmond, Virginia, USA
| | - Terri K. Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Daniel W. Klyce
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
- Central Virginia VA Healthcare System, Richmond, Virginia, USA
- Sheltering Arms Institute, Richmond, Virginia, USA
| | - Paul B. Perrin
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
- Central Virginia VA Healthcare System, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nancy H. Hsu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Huong Nguyen
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Angela P. Presson
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David X. Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
- Innovation and System Integration, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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9
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Zhang J, Buchanan GJR, Monn AR, Gewirtz AH. Inhibitory Control Moderates the Intervention Effects of a Preventive Parenting Program on Posttraumatic Stress Disorder Symptoms Among Male Service Members. J Trauma Stress 2022; 35:235-245. [PMID: 34388288 PMCID: PMC9707609 DOI: 10.1002/jts.22724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/11/2021] [Accepted: 06/13/2021] [Indexed: 02/03/2023]
Abstract
Military servicemembers face substantial challenges due to war-related trauma exposure, including posttraumatic stress disorder (PTSD). Individuals with deficits in inhibitory control (IC) may have an increased risk of developing PTSD due to a reduced ability to regulate their cognitive responses to and disengage from trauma-related stimuli. After Deployment, Adaptive Parenting Tools (ADAPT) is a mindfulness-infused parenting program for military families that has also been found to have crossover effects on parental mental health. The present study examined whether fathers' IC at baseline affected their response to this emotional skills-focused intervention and further influenced their PTSD symptoms 1 year later. The sample included 282 male National Guard and Reserve (NG/R) service members who had recently been deployed to Iraq or Afghanistan. Fathers were randomly assigned to either the ADAPT program or a control condition, with IC measured at baseline and PTSD symptoms measured at baseline and 1-year follow-up. Intent-to-treat analyses revealed no significant main effect of the intervention on fathers' PTSD symptoms. However, fathers' IC moderated intervention effects on PTSD symptoms, f2 = 0.03. The intervention had more beneficial effects on reducing fathers' PTSD symptoms for participants with low IC at baseline. These findings are consistent with compensatory effects in the risk moderation hypothesis, which suggests that prevention or intervention programs are more effective for high-risk subgroups.
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Affiliation(s)
- Jingchen Zhang
- Department of Family Social Science, University of Minnesota – Twin Cities, Minneapolis, Minnesota, USA
| | - Gretchen J. R. Buchanan
- Department of Family Social Science, University of Minnesota – Twin Cities, Minneapolis, Minnesota, USA
| | - Amy R. Monn
- Green Hills Family Psych, Nashville, Tennessee, USA
| | - Abigail H. Gewirtz
- Department of Family Social Science and Institute of Child Development, University of Minnesota – Twin Cities, Minneapolis, Minnesota, USA
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Van Praag DLG, Van Den Eede F, Wouters K, Wilson L, Maas AIR. The Impact of Neurocognitive Functioning on the Course of Posttraumatic Stress Symptoms following Civilian Traumatic Brain Injury. J Clin Med 2021; 10:jcm10215109. [PMID: 34768628 PMCID: PMC8584567 DOI: 10.3390/jcm10215109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/15/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background: One out of seven individuals who have suffered a traumatic brain injury (TBI) develops a posttraumatic stress disorder (PTSD), which is often associated with neurocognitive impairment. The present study explores the impact of neurocognitive functioning after mild, moderate, and severe TBI on the course of PTSD symptoms. Methods: The data of 671 adults admitted to hospital for a TBI was drawn from the Collaborative European Neurotrauma Effectiveness Research (CENTER-TBI) study. After six- and 12-months post-injury, participants completed the PTSD Checklist-5 (PCL-5), from which change scores were calculated. At six months, participants also completed a neurocognitive assessment including the Rey Auditory Verbal Learning Test, the Trail Making Test, and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Linear regressions were performed to identify associations between cognitive functioning and PCL-5 change scores. Results: Overall, mean PCL-5 change scores showed no clear change (−0.20 ± 9.88), but 87 improved and 80 deteriorated by a change score of 10 or more. CANTAB Rapid Visual Information Processing scores were significantly associated with PCL-5 change scores. Conclusions: Strong sustained attention was associated with improvement in PTSD symptoms. Assessing cognitive performance may help identify individuals at risk of developing (persisting) PTSD post-TBI and offer opportunities for informing treatment strategies.
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Affiliation(s)
- Dominique L. G. Van Praag
- Department of Psychology, Antwerp University Hospital, 2650 Edegem, Belgium
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, 2610 Wilrijk, Belgium
- Correspondence: ; Tel.: +32-3-821-56-14
| | - Filip Van Den Eede
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, 2610 Wilrijk, Belgium
- Department of Psychiatry, Antwerp University Hospital, 2650 Edegem, Belgium;
| | - Kristien Wouters
- Clinical Trial Center, Clinical Research Center Antwerp, Antwerp University Hospital, 2650 Edegem, Belgium;
- Antwerp Research Center, Faculty of Medicine, University of Antwerp, 2610 Wilrijk, Belgium
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling FK9 4LA, UK;
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital, 2650 Edegem, Belgium;
- Translational Neurosciences, University of Antwerp, 2610 Wilrijk, Belgium
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11
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Schultebraucks K, Qian M, Abu-Amara D, Dean K, Laska E, Siegel C, Gautam A, Guffanti G, Hammamieh R, Misganaw B, Mellon SH, Wolkowitz OM, Blessing EM, Etkin A, Ressler KJ, Doyle FJ, Jett M, Marmar CR. Pre-deployment risk factors for PTSD in active-duty personnel deployed to Afghanistan: a machine-learning approach for analyzing multivariate predictors. Mol Psychiatry 2021; 26:5011-5022. [PMID: 32488126 PMCID: PMC8589682 DOI: 10.1038/s41380-020-0789-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022]
Abstract
Active-duty Army personnel can be exposed to traumatic warzone events and are at increased risk for developing post-traumatic stress disorder (PTSD) compared with the general population. PTSD is associated with high individual and societal costs, but identification of predictive markers to determine deployment readiness and risk mitigation strategies is not well understood. This prospective longitudinal naturalistic cohort study-the Fort Campbell Cohort study-examined the value of using a large multidimensional dataset collected from soldiers prior to deployment to Afghanistan for predicting post-deployment PTSD status. The dataset consisted of polygenic, epigenetic, metabolomic, endocrine, inflammatory and routine clinical lab markers, computerized neurocognitive testing, and symptom self-reports. The analysis was computed on active-duty Army personnel (N = 473) of the 101st Airborne at Fort Campbell, Kentucky. Machine-learning models predicted provisional PTSD diagnosis 90-180 days post deployment (random forest: AUC = 0.78, 95% CI = 0.67-0.89, sensitivity = 0.78, specificity = 0.71; SVM: AUC = 0.88, 95% CI = 0.78-0.98, sensitivity = 0.89, specificity = 0.79) and longitudinal PTSD symptom trajectories identified with latent growth mixture modeling (random forest: AUC = 0.85, 95% CI = 0.75-0.96, sensitivity = 0.88, specificity = 0.69; SVM: AUC = 0.87, 95% CI = 0.79-0.96, sensitivity = 0.80, specificity = 0.85). Among the highest-ranked predictive features were pre-deployment sleep quality, anxiety, depression, sustained attention, and cognitive flexibility. Blood-based biomarkers including metabolites, epigenomic, immune, inflammatory, and liver function markers complemented the most important predictors. The clinical prediction of post-deployment symptom trajectories and provisional PTSD diagnosis based on pre-deployment data achieved high discriminatory power. The predictive models may be used to determine deployment readiness and to determine novel pre-deployment interventions to mitigate the risk for deployment-related PTSD.
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Affiliation(s)
- Katharina Schultebraucks
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Emergency Medicine, Vagelos School of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
- Data Science Institute, Columbia University, New York, NY, USA.
| | - Meng Qian
- Department of Psychiatry, Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY, USA
| | - Duna Abu-Amara
- Department of Psychiatry, Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY, USA
| | - Kelsey Dean
- Harvard Paulson School of Engineering & Applied Sciences, Boston, MA, USA
| | - Eugene Laska
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, Biostatistics Division, New York University Grossman School of Medicine, New York, NY, USA
| | - Carole Siegel
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, Biostatistics Division, New York University Grossman School of Medicine, New York, NY, USA
| | - Aarti Gautam
- Integrative Systems Biology, US Army Center for Environmental Health Research, USACEHR, Fort Detrick, Frederick, MD, USA
| | - Guia Guffanti
- McLean Hospital, Harvard University, Boston, MA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Rasha Hammamieh
- Integrative Systems Biology, US Army Center for Environmental Health Research, USACEHR, Fort Detrick, Frederick, MD, USA
| | - Burook Misganaw
- Harvard Paulson School of Engineering & Applied Sciences, Boston, MA, USA
| | - Synthia H Mellon
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Owen M Wolkowitz
- Department of Psychiatry/Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Esther M Blessing
- Department of Psychiatry, Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY, USA
| | - Amit Etkin
- Alto Neuroscience, Inc., Los Altos, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Kerry J Ressler
- McLean Hospital, Harvard University, Boston, MA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Francis J Doyle
- Harvard Paulson School of Engineering & Applied Sciences, Boston, MA, USA
| | - Marti Jett
- Integrative Systems Biology, US Army Center for Environmental Health Research, USACEHR, Fort Detrick, Frederick, MD, USA
| | - Charles R Marmar
- Department of Psychiatry, Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY, USA
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13
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ADHD symptoms as risk factor for PTSD in inpatients treated for alcohol use disorder. Psychiatry Res 2021; 300:113904. [PMID: 33872853 DOI: 10.1016/j.psychres.2021.113904] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/27/2021] [Indexed: 12/24/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD) are more common in alcohol use disorder (AUD) patients than in the general population. Still, there is a lack of knowledge about the relationship between the two conditions in these patients. The main objective of this study was to examine the prevalence of ADHD symptoms, and the relationship between ADHD symptoms and PTSD in AUD inpatients in treatment. Data from 85 AUD patients were collected. The Adult ADHD Self-Report Scale (ASRS) was used to measure ADHD symptoms in all patients. Differences between groups split by PTSD diagnosis and by ASRS clinical cut-off were described, and the relationship between ADHD symptom level and PTSD was tested in a multiple regression model. Almost half the patients scored above ASRS cut-off and 14% had PTSD. Of the patients whose score was above cut-off on the ASRS 23% had PTSD, versus 7% among those below cut-off. Higher ASRS score was associated with PTSD even when age, sex and trauma were adjusted for. This study confirms the high level of ADHD symptoms in AUD patients in treatment. Diagnostic evaluation of PTSD is recommended in patients with ADHD attending inpatient treatment programs for AUD.
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14
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Denckla CA, Lee SY, Kim R, Spies G, Vasterling JJ, Subramanian SV, Seedat S. Patterning of individual variability in neurocognitive health among South African women exposed to childhood maltreatment. Sci Rep 2021; 11:6669. [PMID: 33758246 PMCID: PMC7988062 DOI: 10.1038/s41598-021-85979-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/09/2021] [Indexed: 11/08/2022] Open
Abstract
There are individual differences in health outcomes following exposure to childhood maltreatment, yet constant individual variance is often assumed in analyses. Among 286 Black, South African women, the association between childhood maltreatment and neurocognitive health, defined here as neurocognitive performance (NP), was first estimated assuming constant variance. Then, without assuming constant variance, we applied Goldstein's method (Encyclopedia of statistics in behavioral science, Wiley, 2005) to model "complex level-1 variation" in NP as a function of childhood maltreatment. Mean performance in some tests of information processing speed (Digit-symbol, Stroop Word, and Stroop Color) lowered with increasing severity of childhood maltreatment, without evidence of significant individual variation. Conversely, we found significant individual variation by severity of childhood maltreatment in tests of information processing speed (Trail Making Test) and executive function (Color Trails 2 and Stroop Color-Word), in the absence of mean differences. Exploratory results suggest that the presence of individual-level heterogeneity in neurocognitive performance among women exposed to childhood maltreatment warrants further exploration. The methods presented here may be used in a person-centered framework to better understand vulnerability to the toxic neurocognitive effects of childhood maltreatment at the individual level, ultimately informing personalized prevention and treatment.
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Affiliation(s)
- Christy A Denckla
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Sun Yeop Lee
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Georgina Spies
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
| | | | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Harvard Center for Population and Development Studies, Cambridge, MA, 02138, USA
| | - Soraya Seedat
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
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15
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Bisson Desrochers A, Rouleau I, Angehrn A, Vasiliadis HM, Saumier D, Brunet A. Trauma on duty: cognitive functioning in police officers with and without posttraumatic stress disorder (PTSD). Eur J Psychotraumatol 2021; 12:1959117. [PMID: 34721819 PMCID: PMC8555514 DOI: 10.1080/20008198.2021.1959117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Neuropsychological alterations co-occur with Posttraumatic Stress Disorder (PTSD); yet, the nature and magnitude of such alterations in police officers remains unknown despite their high level of trauma exposure. OBJECTIVE The current research sought to examine (1) cognitive functioning among police officers with and without PTSD; (2) the clinical significance of their cognitive performance; and (3) the relationship between PTSD symptoms and cognition. METHOD Thirty-one police officers with PTSD were compared to thirty age- and sex-matched trauma-exposed officers without PTSD. Clinical assessment and self-report questionnaires established PTSD status. All participants underwent a neuropsychological evaluation. RESULTS Police officers with PTSD displayed lower cognitive performance across several domains, notably executive functioning, verbal learning and memory, and lexical access, compared to controls. The neuropsychological decrements in the PTSD group were mild compared to normative data, with average performances falling within normal limits. Among officers with PTSD, higher levels of intrusion symptoms were associated with reduced efficacy in executive functioning, as well as attention and working memory. Moreover, increased intrusion and avoidance symptoms were associated with slower information processing speed. CONCLUSION Considering that even mild subclinical cognitive difficulties may affect their social and occupational functioning, it appears important to integrate neuropsychological assessments in the clinical management of police officers diagnosed with PTSD.
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Affiliation(s)
- Alexandra Bisson Desrochers
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada.,Psychosocial Research Division, Douglas Mental Health University Institute Research Center, Montréal, QC, Canada
| | - Isabelle Rouleau
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Andréanne Angehrn
- Department of Psychology, Université du Québec àTrois-Rivières, Trois-Rivières, QC, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Science, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Daniel Saumier
- Psychosocial Research Division, Douglas Mental Health University Institute Research Center, Montréal, QC, Canada
| | - Alain Brunet
- Psychosocial Research Division, Douglas Mental Health University Institute Research Center, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
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16
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Esterman M, Stumps A, Jagger-Rickels A, Rothlein D, DeGutis J, Fortenbaugh F, Romer A, Milberg W, Marx BP, McGlinchey R. Evaluating the evidence for a neuroimaging subtype of posttraumatic stress disorder. Sci Transl Med 2020; 12:12/568/eaaz9343. [DOI: 10.1126/scitranslmed.aaz9343] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/24/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Michael Esterman
- National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA 02130, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Anna Stumps
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Audreyana Jagger-Rickels
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
| | - David Rothlein
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Joseph DeGutis
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Francesca Fortenbaugh
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Adrienne Romer
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA 02478, USA
| | - William Milberg
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA 02130, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Geriatric Research, Education and Clinical Center (GRECC) and Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
| | - Brian P. Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Regina McGlinchey
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA 02130, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Geriatric Research, Education and Clinical Center (GRECC) and Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
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17
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Camacho-Conde JA. Cognitive Function Assessment of a Patient With PTSD Before and After EMDR Treatment. JOURNAL OF EMDR PRACTICE AND RESEARCH 2020. [DOI: 10.1891/emdr-d-20-00022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The current case study investigates whether successful psychotherapy for posttraumatic stress disorder (PTSD) symptoms will also ameliorate cognitive deficits. We describe the treatment response of a 37-year-old woman diagnosed with PTSD who received eight weekly EMDR sessions. At pre-treatment, the patient reported emotional disturbance on the Beck Depression Inventory-II, and problems with anxiety and sleep. Testing showed high scores on the State-Trait Anxiety Inventory and the Symptoms Scale of Post-traumatic Stress Disorder Scale-Revised. An evaluation of her attention profile and other executive functions was conducted with dual execution tasks using a virtual reality program, Nesplora Aquarium. The attention testing data indicated attention-deficit disorder. At the end of the therapy, testing showed improvements in sleep problems and in emotional disturbance and anxiety symptoms on all measures. The attention testing revealed normal scores for her age range in the Nesplora Aquarium test. A follow-up assessment was carried out at 1 month, and it was observed that the patient maintained the improvement achieved. We discuss the relationship between PTSD and cognitive impairment and the value of the Nesplora Aquarium test for cognitive assessments. Our results suggest attentional deficits in this case when performing a continuous execution test with dual execution components that involve the participation of the central executive system of working memory.
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18
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Kuan PF, Clouston S, Yang X, Kotov R, Bromet E, Luft BJ. Molecular linkage between post-traumatic stress disorder and cognitive impairment: a targeted proteomics study of World Trade Center responders. Transl Psychiatry 2020; 10:269. [PMID: 32753605 PMCID: PMC7403297 DOI: 10.1038/s41398-020-00958-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022] Open
Abstract
Existing work on proteomics has found common biomarkers that are altered in individuals with post-traumatic stress disorder (PTSD) and mild cognitive impairment (MCI). The current study expands our understanding of these biomarkers by profiling 276 plasma proteins with known involvement in neurobiological processes using the Olink Proseek Multiplex Platform in individuals with both PTSD and MCI compared to either disorder alone and with unaffected controls. Participants were World Trade Center (WTC) responders recruited through the Stony Brook WTC Health Program. PTSD and MCI were measured with the PTSD Checklist (PCL) and the Montreal Cognitive Assessment, respectively. Compared with unaffected controls, we identified 16 proteins associated with comorbid PTSD-MCI at P < 0.05 (six at FDR < 0.1), 20 proteins associated with PTSD only (two at FDR < 0.1), and 24 proteins associated with MCI only (one at FDR < 0.1), for a total of 50 proteins. The multiprotein composite score achieved AUCs of 0.84, 0.77, and 0.83 for PTSD-MCI, PTSD only, and MCI only versus unaffected controls, respectively. To our knowledge, the current study is the largest to profile a large set of proteins involved in neurobiological processes. The significant associations across the three case-group analyses suggest that shared biological mechanisms may be involved in the two disorders. If findings from the multiprotein composite score are replicated in independent samples, it has the potential to add a new tool to help classify both PTSD and MCI.
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Affiliation(s)
- Pei-Fen Kuan
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Sean Clouston
- Department of Family and Preventive Medicine, Stony Book University, Stony Brook, NY, USA
| | - Xiaohua Yang
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Book University, Stony Brook, NY, USA
| | - Evelyn Bromet
- Department of Psychiatry, Stony Book University, Stony Brook, NY, USA
| | - Benjamin J Luft
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
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Malta LS, Giosan C, Szkodny LE, Altemus MM, Rizzo AA, Silbersweig DA, Difede J. Predictors of involuntary and voluntary emotional episodic memories of virtual reality scenarios in Veterans with and without PTSD. Memory 2020; 28:724-740. [PMID: 32462992 DOI: 10.1080/09658211.2020.1770289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study investigated predictors of involuntary and voluntary memories of stressful virtual reality scenarios. Thirty-two veterans of the two Persian Gulf Wars completed verbal memory tests and diagnostic assessments. They were randomly assigned to a Recounting (16) or a Suppression (16) condition. After immersion in the VR scenarios, the Recounting group described the scenarios and the Suppression group suppressed thoughts of the scenarios. One week later, participants completed surprise voluntary memory tests and another thought suppression task. The best predictors of voluntary memory were verbal memory ability, dissociation, and to a lesser extent, physiological arousal before and after scenarios. Dissociation and physiological stress responses selectively affected memory for neutral elements. Higher distress during scenarios impaired voluntary memory but increased the frequency of involuntary memories. Physiological stress responses promoted more frequent involuntary memories immediately after the scenarios. More frequent initial involuntary memories, tonic physiological arousal, and stronger emotional responses to dangerous events predicted difficulty inhibiting involuntary memories at follow-up. The effects of thought suppression were transient and weaker than those of other variables. The findings suggest that posttraumatic amnesia and involuntary memories of adverse events are more related to memory ability and emotional and physiological stress responses than to post-exposure suppression.
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Affiliation(s)
- Loretta S Malta
- Weill Medical College of Cornell University, 1300 York Ave, New York, NY 10065
| | - Cezar Giosan
- Weill Medical College of Cornell University, 1300 York Ave, New York, NY 10065.,Department of Psychology, University of Bucharest, Panduri 90, Bucharest, Romania, 032075
| | - Lauren E Szkodny
- Weill Medical College of Cornell University, 1300 York Ave, New York, NY 10065
| | - Margaret M Altemus
- Weill Medical College of Cornell University, 1300 York Ave, New York, NY 10065
| | - Albert A Rizzo
- Weill Medical College of Cornell University, 1300 York Ave, New York, NY 10065.,Institute for Creative Technologies, University of Southern California, 12015 Waterfront Drive, Playa Vista, CA 90094-2536
| | - David A Silbersweig
- Weill Medical College of Cornell University, 1300 York Ave, New York, NY 10065
| | - JoAnn Difede
- Weill Medical College of Cornell University, 1300 York Ave, New York, NY 10065
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20
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Merritt VC, Clark AL, Evangelista ND, Sorg SF, Schiehser DM, Delano-Wood L. Dissociation of BDNF Val66Met polymorphism on neurocognitive functioning in military veterans with and without a history of remote mild traumatic brain injury. Clin Neuropsychol 2020; 34:1226-1247. [PMID: 32204647 DOI: 10.1080/13854046.2020.1740324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Since neurocognitive functioning following mild traumatic brain injury (mTBI) may be influenced by genetic factors that mediate synaptic survival and repair, we examined the influence of a common brain-derived neurotrophic factor (BDNF) polymorphism (Val66Met) on cognition using a well-defined sample of military Veterans with and without a history of mTBI. METHOD Participants included 138 Veterans (mTBI = 75; military controls [MCs] = 63) who underwent neuropsychological testing, including completion of self-report measures assessing psychiatric distress, and BDNF genotyping. The mTBI group was tested roughly 66.7 months following their most recent mTBI. Veterans were divided into two groups-Met+ (Met/Met and Met/Val; n = 49) and Met- (Val/Val; n = 89) and compared on domain-specific cognitive composite scores representing memory, executive functioning, and visuospatial speed. RESULTS ANCOVAs adjusting for psychiatric distress, sex, years of education, and ethnicity/race revealed a significant group (mTBI vs. MC) by BDNF genotype (Met + vs. Met-) interaction for the memory (p = .024; ηp 2 = .039) and executive functioning (p = .010; ηp 2 = .050) composites, such that Met+ mTBI Veterans demonstrated better performance than Met- mTBI Veterans on the cognitive measures, whereas Met+ MCs demonstrated worse performance relative to Met- MCs on the cognitive measures. No significant interaction was observed for the visuospatial speed composite (p = .938; ηp 2 < .001). CONCLUSIONS These findings offer preliminary evidence to suggest that the Met allele may be protective in the context of remote mTBI. Findings need to be replicated using larger samples, and future studies are necessary to elucidate the precise mechanisms and neural underpinnings of this interaction.
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Affiliation(s)
- Victoria C Merritt
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA, USA
| | - Alexandra L Clark
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA, USA
| | - Nicole D Evangelista
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Scott F Sorg
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA, USA
| | - Dawn M Schiehser
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Lisa Delano-Wood
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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21
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22
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Jacob SN, Dodge CP, Vasterling JJ. Posttraumatic stress disorder and neurocognition: A bidirectional relationship? Clin Psychol Rev 2019; 72:101747. [DOI: 10.1016/j.cpr.2019.101747] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/25/2019] [Accepted: 06/11/2019] [Indexed: 12/20/2022]
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23
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Stout DM, Buchsbaum MS, Spadoni AD, Risbrough VB, Strigo IA, Matthews SC, Simmons AN. Multimodal canonical correlation reveals converging neural circuitry across trauma-related disorders of affect and cognition. Neurobiol Stress 2018; 9:241-250. [PMID: 30450388 PMCID: PMC6234282 DOI: 10.1016/j.ynstr.2018.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/02/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022] Open
Abstract
Trauma-related disorders of affect and cognition (TRACs) are associated with a high degree of diagnostic comorbidity, which may suggest that these disorders share a set of underlying neural mechanisms. TRACs are characterized by aberrations in functional and structural circuits subserving verbal memory and affective anticipation. Yet, it remains unknown how the neural circuitry underlying these multiple mechanisms contribute to TRACs. Here, in a sample of 47 combat Veterans, we measured affective anticipation using functional magnetic resonance imaging (fMRI), verbal memory with fluorodeoxyglucose positron emission tomography (FDG-PET), and grey matter volume with structural magnetic resonance imaging (sMRI). Using a voxel-based multimodal canonical correlation analysis (mCCA), the set of neural measures were statistically integrated, or fused, with a set of TRAC symptom measures including mild traumatic brain injury (mTBI), posttraumatic stress, and depression severity. The first canonical correlation pair revealed neural convergence in clusters encompassing the middle frontal gyrus and supplemental motor area, regions implicated in top-down cognitive control and affect regulation. These results highlight the potential of leveraging multivariate neuroimaging analysis for linking neurobiological mechanisms associated with TRACs, paving the way for transdiagnostic biomarkers and targets for treatment.
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Affiliation(s)
- Daniel M Stout
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Monte S Buchsbaum
- Department of Psychiatry, University of California, San Diego, USA.,Department of Radiology, University of California, San Diego, USA
| | - Andrea D Spadoni
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Victoria B Risbrough
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Irina A Strigo
- Department of Psychiatry, University of California, San Francisco, & San Francisco VA Health Care System, USA
| | - Scott C Matthews
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
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Abstract
PURPOSE OF REVIEW We review recent research addressing neurocognitive and information processing abnormalities in posttraumatic stress disorder (PTSD), including studies informing direction of causality. We additionally consider neurocognition in the context of co-morbid mild traumatic brain injury (TBI) and psychosocial treatments for PTSD. RECENT FINDINGS Learning, memory, attention, inhibitory functions, and information processing biases frequently accompany PTSD, reflecting potential bi-directional relationships with PTSD. Although mild TBI is associated with increased risk of PTSD development and maintenance, TBI does not typically contribute significantly to sustained neurocognitive deficits in individuals with PTSD. Whereas better learning and memory is associated with mildly enhanced response to psychosocial interventions, such interventions may also improve neurocognitive performance and can be effectively provided to patients with TBI history. PTSD is associated with cognitive abnormalities in processing both emotionally relevant and emotionally neutral information and, although mild, may underlie some PTSD symptom expression.
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Affiliation(s)
- Jennifer J Vasterling
- Psychology (116B), National Center for PTSD at VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA, 02130, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | - Kimberly A Arditte Hall
- Psychology (116B), National Center for PTSD at VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA, 02130, USA
- Boston University School of Medicine, Boston, MA, USA
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Bøg M, Filges T, Jørgensen AMK. Deployment of personnel to military operations: impact on mental health and social functioning. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-127. [PMID: 37131363 PMCID: PMC8427986 DOI: 10.4073/csr.2018.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This Campbell systematic review examines the effects of deployment on mental health. The review summarizes evidence from 185 studies. All studies used observational data to quantify the effect of deployment. This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment). Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. Plain language summary Deployment to military operations negatively affects the mental health functioning of deployed military personnel: While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel.What is this review about?: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health.The primary condition under consideration is deployment to an international military operation. Deployment to a military operation is not a uniform condition; rather, it covers a range of scenarios. Military deployment is defined as performing military service in an operation at a location outside the home country for a limited time period, pursuant to orders.The review included studies that reported outcomes for individuals who had been deployed. This review looked at the effect of deployment on mental health outcomes. The mental health outcomes are: post-traumatic stress disorder (PTSD), major depressive disorder (MDD), common mental disorders (depression, anxiety and somatisation disorders) and substance-related disorders.By identifying the major effects of deployment on mental health and quantifying these effects, the review can inform policy development on deployment and military activity as well as post-deployment support for veterans. In this way the review enables decision-makers to prioritise key areas.What are the main findings of this review?: What studies are included?: This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment).Does deployment have an effect on mental health?: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive.What do the findings of this review mean?: The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long-lasting.Overall the risk of bias in the majority of included studies was high. While it is difficult to imagine a randomised study design to understand how deployment affects mental health, other matters such as changes to personnel policy, or unanticipated shocks to the demand for military personnel, could potentially be a rich source of quasi-experimental variation.How up-to-date is this review?: The review authors searched for studies up to 2017. This Campbell systematic review was published in March 2018. Executive summary BACKGROUND: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health. Research suggests that the increased risk to mental health is mainly due to the hazards of war, combat exposure: firing weapons, road side bombs, seeing fellow soldiers, friends, civilians, and enemies being injured, maimed or killed. These experiences may lead to severe mental stress. The adverse impact on mental health is the psychological cost of war, and it is of interest to policymakers to learn the magnitude of these effects. This review sets out to synthesise available evidence about the consequences of deployment for deployed military personnel in the mental health and social functioning domains.OBJECTIVES: The objective of this review isto synthesise the consequences of deployment to military operation on the mental health and social functioning of deployed military personnel.SEARCH METHODS: We searched electronic databases, grey literature, and references from primary studies and related reviews. No language or date restrictions were applied to the searches. We searched the following electronic databases: Academic Search Elite, Cochrane Library, EMBASE, ERIC, MEDLINE, PsycINFO, Science Citation Index, Social Science Citation Index, SocINDEX, as well as the Nordic platforms: bibliotek.dk, BIBSYS, and LIBRIS. The conclusions of this review are based on the most recent searches performed. The last search was performed in April 2017.SELECTION CRITERIA: Primary studies had to meet the following inclusion criteria: Participants: The participants should be military personnel.Intervention: The condition should be deployment to a military operation.Comparison: The relevant comparisons were either comparing a) deployed military personnel to non-deployed military personnel, b) deployed military personnel to military personnel deployed elsewhere, for example personnel deployed to non-combat operations, c) military personnel deployed to the same operation but stratified by combat exposure.Outcomes: The study should report on one or more mental health outcomes, and/or social functioning for the deployed participants. In particular studies should report on one or more of the following mental health outcomes: PTSD, major depression, substance abuse or dependence (including alcohol), and common mental disorders (depression and anxiety disorders). The following social functioning outcomes were relevant: employment, and homelessness.Study Designs: Both experimental and quasi-experimental designs with a comparison group were eligible for inclusion in the review. Studies were excluded if they: Reported on deployments taking place before 1989.Used a within group pre-post study design.Did not report on at least one of the mental health or social functioning outcomes. DATA COLLECTION AND ANALYSIS: The total number of potentially relevant studies constituted31,049records. A total of 185 studies met the inclusion criteria and were critically appraised by the review authors. The final selection of 185 studies was from 13 different countries.Forty eight of the 185 studies did not report effect estimates or provide data that would allow the calculation of an effect size and standard error. Fifty four studies were excluded because of overlapping samples. The majority of those studies were from USA but the main reason for not using studies from USA in the synthesis was lack of information to calculate an effect size. Nearly half the studies from the UK could not be used in the synthesis due to overlap of data samples. Forty three studies were judged to have a very high risk of bias (5 on the scale) and, in accordance with the protocol, we excluded these from the data synthesis on the basis that they would be more likely to mislead than inform., Thus a total of 40 studies, from five different countries, were included in the data synthesis.Random effects models were used to pool data across the studies. We used the odds ratio. Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were calculated. The meta-analyses were carried out by time since exposure (short, medium, long, and other time since exposure) and by type of comparison (deployed versus non-deployed, all deployed but stratified by either combat operations versus non-combat operations, or stratified by combat exposure). We performed single factor subgroup analysis. The assessment of any difference between subgroups was based on 95% confidence intervals. Funnel plots were used to assess the possibility of publication bias. Sensitivity analysis was used to evaluate whether the pooled effect sizes were robust across components of methodological quality.MAIN RESULTS: The findings were mixed, depending on the outcome, the time since exposure and the approach (deployed versus non-deployed termed absolute or stratified by extent of combat termed relative) used to investigate the effect. It was not possible to analyse the outcomes homelessness and employment. All studies that could be used in the data synthesis reported on the impact of deployment on mental health; PTSD, depression, substance use or common mental disorder.For assessments taken less than 24 months since exposure the evidence was inconclusive either because too few studies reported results in the short and medium term and/or the degree of heterogeneity between studies was large.For assessments taken at other time points (a variable number of months since exposure) the evidence was inconclusive for the relative comparisons due to either too few studies or a substantial degree of heterogeneity between studies. For the absolute comparison the analysis of common mental disorder was inconclusive, whereas the average effects of PTSD and depression were positive and statistically significant (PTSD odds ratio (OR) was 1.91 (95% confidence interval (CI): 1.28 to 2.85) and OR=1.98 (95% CI: 1.05 to 3.70) for depression). The analysis concerning substance use indicated that deployed participants did not have higher odds of screening positive for substance use compared to non-deployed participants (OR=1.15 (95% CI: 0.98 to 1.36)).For assessments taken more than 24 months post exposure, meta-analyses indicated that the odds of screening positive for PTSD, depression, substance use and common mental disorder were higher for participants in the deployed group compared to participants in the group that were not deployed (PTSD OR=3.31 (95% CI: 2.69 to 4.07), OR=2.19 (95% CI: 1.58 to 3.03) for depression, OR=1.27 (95% CI: 1.15 to 1.39) for substance use, and OR=1.64 (95% CI: 1.38 to 1.96) for common mental disorder). Likewise, participants reporting high combat exposure had higher odds of screening positive for PTSD and depression than participants reporting lower exposure for long term assessments (PTSD OR=3.05 (95% CI: 1.94 to 4.80) and OR=1.81 (95% CI: 1.28 to 2.56) for depression). The analyses of substance use and common mental disorder were inconclusive due to too few studies.On the basis of the prevalence of mental health problems in pre-deployed or non-deployed population based comparison sampleswe would therefore expect the long term prevalence of PTSD in post-deployed samples to be in the range 6.1 - 14.9%, the long term prevalence of depression to be in the range from 7.6% to 18%, the long term prevalence of substance use to be in the range from 2.4% to 17.5% and the prevalence of common mental disorder to be in the range from 10% to 23%.Sensitivity analyses resulted in no appreciable change in effect size, suggesting that the results are robust.It was only possible to assess the impact of two types of personnel characteristics (branch of service and duty/enlistment status) on the mental health outcomes. We found no evidence to suggest that the effect of deployment on any outcomes differ between these two types of personnel characteristics.AUTHORS' CONCLUSIONS: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. We focused on the effect of deployment on PTSD (post-traumatic stress disorder), depression, substance abuse/dependence, and common mental disorders (depression and anxiety disorders). For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all domains, particularly on PTSD. There is increased political awareness of the need to address post deployment mental health problems. The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long lasting. Mental illness is of particular concern in the military for operational reasons, but they may be hard to detect in the military setting because a military career is intimately linked with mental and physical strength.It was not possible to examine a number of factors which we had reason to expect would impact on the magnitude of the effect. This would have been particularly relevant from a policy perspective because these are direct parameters that one could use to optimally "organize" deployment in order to minimize impacts on mental health functioning.While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel. The next step is to begin to examine preventive measures and policies for organizing deployment, in order to minimize the effects on mental health.
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Wright WG, Handy JD, Avcu P, Ortiz A, Haran FJ, Doria M, Servatius RJ. Healthy Active Duty Military with Lifetime Experience of Mild Traumatic Brain Injury Exhibits Subtle Deficits in Sensory Reactivity and Sensory Integration During Static Balance. Mil Med 2018; 183:313-320. [DOI: 10.1093/milmed/usx182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- W Geoffrey Wright
- Neuromotor Sciences Program, College of Public Health, Temple University, 1800 N. Broad St., Philadelphia, PA
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY
| | - Justin D Handy
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY
| | - Pelin Avcu
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers University, 65 Bergen St., Newark, NJ
| | - Alejandro Ortiz
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY
| | - F Jay Haran
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD
| | - Michael Doria
- U.S. Coast Guard Headquarters, 2701 Martin Luther King Jr Ave SE, Washington DC
| | - Richard J Servatius
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers University, 65 Bergen St., Newark, NJ
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Longitudinal Associations among Posttraumatic Stress Disorder Symptoms, Traumatic Brain Injury, and Neurocognitive Functioning in Army Soldiers Deployed to the Iraq War. J Int Neuropsychol Soc 2018; 24:311-323. [PMID: 29199924 PMCID: PMC6103787 DOI: 10.1017/s1355617717001059] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Military deployment is associated with increased risk of adverse emotional and cognitive outcomes. Longitudinal associations involving posttraumatic stress disorder (PTSD), relatively mild traumatic brain injury (TBI), and neurocognitive compromise are poorly understood, especially with regard to long-term outcomes, and rigorous research is necessary to better understand the corresponding relationships. The objective of this study was to examine short-term and long-term (>5 years) longitudinal associations among PTSD, neurocognitive performance, and TBI following military deployment. METHODS In this prospective study, N=315 U.S. Army soldiers were assessed at military installations before (2003-2005) and after (2004-2006) an index deployment to the Iraq War, and again an average of 7.6 years later (2010-2014) as a nationally dispersed cohort of active duty soldiers, reservists, and veterans. Thus, the study design allowed for two measurement intervals over which to examine changes. All assessments included the PTSD Checklist, civilian version, and individually-administered performance-based neurocognitive tests. TBI history was derived from clinical interview. RESULTS Autoregressive analyses indicated that visual reproduction scores were inversely related to subsequent PTSD symptom severity at subsequent assessments. Conversely, increases in PTSD symptom severity over each measurement interval were associated with poorer verbal and/or visual recall at the end of each interval, and less efficient reaction time at post-deployment. TBI, primarily mild in this sample, was associated with adverse PTSD symptom outcomes at both post-deployment and long-term follow-up. CONCLUSIONS These results suggest longitudinal relationships among PTSD symptoms, TBI, and neurocognitive decrements may contribute to sustained emotional and neurocognitive symptoms over time. (JINS, 2018, 24, 311-323).
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Servatius RJ, Handy JD, Doria MJ, Myers CE, Marx CE, Lipsky R, Ko N, Avcu P, Wright WG, Tsao JW. Stress-Related Mental Health Symptoms in Coast Guard: Incidence, Vulnerability, and Neurocognitive Performance. Front Psychol 2017; 8:1513. [PMID: 28959220 PMCID: PMC5603677 DOI: 10.3389/fpsyg.2017.01513] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/21/2017] [Indexed: 11/17/2022] Open
Abstract
U.S. Coast Guard (CG) personnel face occupational stressors (e.g., search and rescue) which compound daily life stressors encountered by civilians. However, the degree CG personnel express stress-related mental health symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) is understudied as a military branch, and little is known concerning the interplay of vulnerabilities and neurocognitive outcomes in CG personnel. The current study addressed this knowledge gap, recruiting 241 active duty CG personnel (22% female) to assess mental health, personality, and neurocognitive function. Participants completed a battery of scales: PTSD Checklist with military and non-military prompts to screen for PTSD, Psychological Health Questionnaire 8 for MDD, and scales for behaviorally inhibited (BI) temperament, and distressed (Type D) personality. Neurocognitive performance was assessed with the Defense Automated Neurobehavioral Assessment (DANA) battery. Cluster scoring yielded an overall rate of PTSD of 15% (95% CI: 11–20%) and 8% (95% CI: 3–9%) for MDD. Non-military trauma was endorsed twice that of military trauma in those meeting criteria for PTSD. Individual vulnerabilities were predictive of stress-related mental health symptoms in active duty military personnel; specifically, BI temperament predicted PTSD whereas gender and Type D personality predicted MDD. Stress-related mental health symptoms were also associated with poorer reaction time and response inhibition. These results suggest rates of PTSD and MDD are comparable among CG personnel serving Boat Stations to those of larger military services after combat deployment. Further, vulnerabilities distinguished between PTSD and MDD, which have a high degree of co-occurrence in military samples. To what degree stress-related mental healthy symptoms and attendant neurocognitive deficits affect operational effectiveness remains unknown and warrant future study.
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Affiliation(s)
- Richard J Servatius
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical CenterSyracuse, NY, United States.,Department of Psychiatry, State University of New York Upstate Medical UniversitySyracuse, NY, United States.,Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers UniversityNewark, NJ, United States
| | - Justin D Handy
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical CenterSyracuse, NY, United States.,Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers UniversityNewark, NJ, United States
| | | | - Catherine E Myers
- Department of Veterans Affairs, VA New Jersey Health Care SystemEast Orange, NJ, United States.,Department of Pharmacology, Physiology & Neuroscience, Rutgers Biomedical Health Sciences, Rutgers UniversityNewark, NJ, United States
| | - Christine E Marx
- Veterans Affairs Mid-Atlantic Mental Illness, Research Education and Clinical Center, Durham Veterans Affairs Medical CenterDurham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, United States
| | - Robert Lipsky
- Department of Neurosciences, INOVA Health SystemFairfax, VA, United States
| | - Nora Ko
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers UniversityNewark, NJ, United States.,Program of Neuroscience, Graduate School of Biomedical Sciences, Rutgers UniversityNewark, NJ, United States
| | - Pelin Avcu
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers UniversityNewark, NJ, United States.,Program of Neuroscience, Graduate School of Biomedical Sciences, Rutgers UniversityNewark, NJ, United States
| | - W Geoffrey Wright
- Neuromotor Sciences Program, Temple UniversityPhiladelphia, PA, United States
| | - Jack W Tsao
- Department of Neurology, University of Tennessee Health Science CenterMemphis, TN, United States.,Department of Neurology, Memphis Veteran Affairs Administration Medical CenterMemphis, TN, United States.,Children's Foundation Research Institute, Le Bonheur Children's HospitalMemphis, TN, United States
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Jha AP, Witkin JE, Morrison AB, Rostrup N, Stanley E. Short-Form Mindfulness Training Protects Against Working Memory Degradation over High-Demand Intervals. JOURNAL OF COGNITIVE ENHANCEMENT 2017. [DOI: 10.1007/s41465-017-0035-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Sumner JA, Hagan K, Grodstein F, Roberts AL, Harel B, Koenen KC. Posttraumatic stress disorder symptoms and cognitive function in a large cohort of middle-aged women. Depress Anxiety 2017; 34:356-366. [PMID: 28072503 PMCID: PMC5378624 DOI: 10.1002/da.22600] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 12/13/2016] [Accepted: 12/17/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) has been linked to cognitive decline, but research in women is generally lacking. We examined whether trauma and elevated PTSD symptoms were associated with worse cognitive function in middle-aged civilian women. A secondary objective was to investigate the possible role of depression in the relation of PTSD symptoms to cognitive function. METHODS The sample comprised 14,029 middle-aged women in the Nurses' Health Study II. Lifetime trauma exposure, lifetime PTSD symptoms, and past-week depressive symptoms were measured in 2008. Cognitive function was measured in 2014-2016 using the Cogstate Brief Battery, a self-administered online cognitive battery that assesses psychomotor speed, attention, learning, and working memory. We used linear regression models to estimate mean differences in cognition across PTSD symptom levels. RESULTS Compared to no trauma, elevated PTSD symptoms consistent with probable PTSD (i.e., 4+ symptoms on a screening questionnaire) were associated with worse performance on psychomotor speed/attention (b = -0.08 standard units, p = .001) and learning/working memory (b = -0.09, p < .001) composites, after adjusting for sociodemographics. Although attenuated, associations remained significant when adjusted for depressive symptoms and other cognitive risk factors. We found the strongest associations among women with comorbid probable PTSD and depression. CONCLUSIONS PTSD symptoms were negatively related to measures of psychomotor speed/attention and learning/working memory in middle-aged women. Our study adds to a growing literature that suggests that mental disorders are associated with worse cognitive function over the life course.
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Affiliation(s)
- Jennifer A. Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Corresponding author: Jennifer A. Sumner, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 St, PH 9-315, New York, NY 10032 USA. Tel: 212-342-3133; Fax: 212-342-3431;
| | - Kaitlin Hagan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Fran Grodstein
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Andrea L. Roberts
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA,Psychiatric and Neurodevelopmental Genetics Unit and Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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31
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Swick D, Cayton J, Ashley V, Turken AU. Dissociation between working memory performance and proactive interference control in post-traumatic stress disorder. Neuropsychologia 2017; 96:111-121. [PMID: 28077328 DOI: 10.1016/j.neuropsychologia.2017.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 01/06/2017] [Accepted: 01/06/2017] [Indexed: 12/20/2022]
Abstract
Deficits in working memory (WM) and cognitive control processes have been reported in post-traumatic stress disorder (PTSD), in addition to clinical symptoms such as hypervigilance, re-experiencing, and avoidance of trauma reminders. Given the uncontrollable nature of intrusive memories, an important question is whether PTSD is associated with altered control of interference in WM. Some studies also suggest that episodic memory shows a material-specific dissociation in PTSD, with greater impairments in verbal memory and relative sparing of nonverbal memory. It is unclear whether this dissociation applies to WM, as no studies have used identical task parameters across material. Here we tested 29 combat Veterans with PTSD and 29 age-matched control Veterans on a recent probes WM task with words and visual patterns in separate blocks. Participants studied four-item sets, followed by a probe stimulus that had been presented in the previous set (recent probe) or not (nonrecent probe). Participants with PTSD made more errors than controls, and this decrement was similar for verbal and visual stimuli. Proactive interference from items recently presented, but no longer relevant, was not significantly different in the PTSD group and showed no relationship to re-experiencing symptom severity. These results demonstrate that PTSD is not reliably associated with increased intrusions of irrelevant representations into WM when non-emotional stimuli are used. Future studies that use trauma-related material may provide insight into the flashbacks and intrusive thoughts that plague those with PTSD.
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Affiliation(s)
- Diane Swick
- VA Northern California Health Care System, Martinez, CA, USA; University of California, Davis, USA.
| | - Julien Cayton
- VA Northern California Health Care System, Martinez, CA, USA.
| | - Victoria Ashley
- VA Northern California Health Care System, Martinez, CA, USA.
| | - And U Turken
- VA Northern California Health Care System, Martinez, CA, USA.
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Stricker NH, Lippa SM, Green DL, McGlynn SM, Grande LJ, Milberg WP, McGlinchey RE. Elevated rates of memory impairment in military service-members and veterans with posttraumatic stress disorder. J Clin Exp Neuropsychol 2016; 39:768-785. [PMID: 27976973 DOI: 10.1080/13803395.2016.1264575] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Studies investigating the neurocognitive effects of posttraumatic stress disorder (PTSD) routinely find "deficits" in various cognitive domains. However, the rate of cognitive impairment in individuals with PTSD remains unclear, as studies have focused on null hypothesis testing (NHT) and inferring patterns of impairment rather than empirically determining the rate of cognitive impairment in this sample. METHOD This study examined rates of cognitive impairment using a domain-specific approach in non-treatment-seeking Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn service members and veterans with (n = 92) and without (n = 79) PTSD and without substance abuse/dependence who passed a performance validity measure and were matched on age, education, estimated IQ, and ethnicity. Chi-square analyses were used to compare the rate of cognitive impairment across groups based on normative scores using three cutoffs (-1, -1.5, and -2 SDs). NHT was also used to compare performances across groups. RESULTS Individuals with PTSD showed higher rates of impairment in memory (-1-SD cutoff) than controls, but equivalent rates of impairment in attention, processing speed, and executive functioning; no significant differences were found on NHT. Impairment in any domain was also more prevalent in PTSD (-1-, -1.5-, and -2-SD cutoffs). No differences were found on NHT or rates of impairment in individuals with PTSD with (n = 34) and without (n = 58) depression. CONCLUSIONS Patients with PTSD were more likely to meet criteria for memory impairment and to show impairment in any domain than controls. Patients with PTSD and comorbid depression were no more likely to be impaired in any cognitive domain or to have lower scores on individual cognitive tasks than patients with PTSD alone. Clinicians noting cognitive impairment in individuals with PTSD should exercise caution before ascribing that impairment to another etiology if deficits are limited to memory.
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Affiliation(s)
- Nikki H Stricker
- a VA Boston Healthcare System , Boston , MA , USA.,b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA.,c Department of Psychiatry and Psychology , Mayo Clinic , Rochester , MN , USA
| | - Sara M Lippa
- d Defense and Veterans Brain Injury Center , Bethesda , MD , USA
| | | | - Susan M McGlynn
- a VA Boston Healthcare System , Boston , MA , USA.,b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA
| | - Laura J Grande
- b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA
| | - William P Milberg
- e Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric; Research, Education and Clinical Center (GRECC) , Boston , MA , USA.,f Department of Psychiatry , Harvard Medical School , Boston , MA , USA
| | - Regina E McGlinchey
- e Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric; Research, Education and Clinical Center (GRECC) , Boston , MA , USA.,f Department of Psychiatry , Harvard Medical School , Boston , MA , USA
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Mendoza C, Barreto GE, Ávila-Rodriguez M, Echeverria V. Role of neuroinflammation and sex hormones in war-related PTSD. Mol Cell Endocrinol 2016; 434:266-77. [PMID: 27216917 DOI: 10.1016/j.mce.2016.05.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/16/2016] [Accepted: 05/19/2016] [Indexed: 11/17/2022]
Abstract
The susceptibility to develop posttraumatic stress disorder (PTSD) is greatly influenced by both innate and environmental risk factors. One of these factors is gender, with women showing higher incidence of trauma-related mental health disorders than their male counterparts. The evidence so far links these differences in susceptibility or resilience to trauma to the neuroprotective actions of sex hormones in reducing neuroinflammation after severe stress exposure. In this review, we discuss the impact of war-related trauma on the incidence of PTSD in civilian and military populations as well as differences associated to gender in the incidence and recovery from PTSD. In addition, the mutually influencing role of inflammation, genetic, and sex hormones in modulating the consequences derived from exposure to traumatic events are discussed in light of current evidence.
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Affiliation(s)
- Cristhian Mendoza
- Neurobiology Laboratory, Facultad Ciencias de la Salud, Universidad San Sebastian, Lientur 1457, Concepción, 4080871, Chile
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia; Center for Biomedical Research, Universidad Autónoma de Chile, Carlos Antúnez 1920, Providencia, Santiago, Chile
| | | | - Valentina Echeverria
- Neurobiology Laboratory, Facultad Ciencias de la Salud, Universidad San Sebastian, Lientur 1457, Concepción, 4080871, Chile; Research and Development, Bay Pines VA Healthcare System, Bay Pines, FL, USA.
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Martínez L, Prada E, Satler C, Tavares MCH, Tomaz C. Executive Dysfunctions: The Role in Attention Deficit Hyperactivity and Post-traumatic Stress Neuropsychiatric Disorders. Front Psychol 2016; 7:1230. [PMID: 27602003 PMCID: PMC4993788 DOI: 10.3389/fpsyg.2016.01230] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/02/2016] [Indexed: 11/13/2022] Open
Abstract
Executive functions (EFs) is an umbrella term for various cognitive processes controlled by a complex neural activity, which allow the production of different types of behaviors seeking to achieve specific objectives, one of them being inhibitory control. There is a wide consensus that clinical and behavioral alterations associated with EF, such as inhibitory control, are present in various neuropsychiatric disorders. This paper reviews the research literature on the relationship between executive dysfunction, frontal-subcortical neural circuit changes, and the psychopathological processes associated with attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD). A revision on the role of frontal-subcortical neural circuits and their presumable abnormal functioning and the high frequency of neuropsychiatric symptoms could explain the difficulties with putting effector mechanisms into action, giving individuals the necessary tools to act efficiently in their environment. Although, neuronal substrate data about ADHD and PTSD has been reported in the literature, it is isolated. Therefore, this review highlights the overlapping of neural substrates in the symptomatology of ADHD and PTSD disorders concerning EFs, especially in the inhibitory component. Thus, the changes related to impaired EF that accompany disorders like ADHD and PTSD could be explained by disturbances that have a direct or indirect impact on the functioning of these loops. Initially, the theoretical model of EF according to current neuropsychology will be presented, focusing on the inhibitory component. In a second stage, this component will be analyzed for each of the disorders of interest, considering the clinical aspects, the etiology and the neurobiological basis. Additionally, commonalities between the two neuropsychiatric conditions will be taken into consideration from the perspectives of cognitive and emotional inhibition. Finally, the implications and future prospects for research and interventions in the area will be outlined, with the intention of contributing scientific reference information that encompasses the knowledge and understanding of executive dysfunction and its relationship with these treated disorders.
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Affiliation(s)
- Lía Martínez
- Laboratory of Neurosciences and Behavior, Department of Physiological Sciences, University of Brasilia Brasilia, Brazil
| | - Edward Prada
- Laboratory of Neurosciences and Behavior, Department of Physiological Sciences, University of BrasiliaBrasilia, Brazil; Faculty of Psychology, Social Sciences Department, Universidad Pontificia Bolivariana Seccional BucaramangaBucaramanga, Colombia
| | - Corina Satler
- Faculty of Ceilandia, University of Brasilia Brasilia, Brazil
| | - Maria C H Tavares
- Laboratory of Neurosciences and Behavior, Department of Physiological Sciences, University of Brasilia Brasilia, Brazil
| | - Carlos Tomaz
- Laboratory of Neurosciences and Behavior, Department of Physiological Sciences, University of BrasiliaBrasilia, Brazil; Neuroscience Research Program, University CEUMASão Luis, Brazil
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Abstract
OBJECTIVES Neuropsychological studies of posttraumatic stress disorder (PTSD) have revealed deficits in attention/working memory, processing speed, executive functioning, and retrospective memory. However, little is known about prospective memory (PM) in PTSD, a clinically relevant aspect of episodic memory that supports the encoding and retrieval of intentions for future actions. METHODS Here we examined PM performance in 40 veterans with PTSD compared to 38 trauma comparison (TC) veterans who were exposed to combat but did not develop PTSD. All participants were administered the Memory for Intentions Test (MIST; Raskin, Buckheit, & Sherrod, 2010), a standardized and validated measure of PM, alongside a comprehensive neurocognitive battery, structured diagnostic interviews for psychiatric conditions, and behavioral questionnaires. RESULTS Veterans with PTSD performed moderately lower than TC on time-based PM, with errors primarily characterized as PM failure errors (i.e., omissions). However, groups did not differ in event-based PM, ongoing task performance, or post-test recognition of PM intentions for each trial. Lower time-based PM performance was specifically related to hyperarousal symptoms of PTSD. Time-based-performance was also associated with neuropsychological measures of retrospective memory and executive functions in the PTSD group. Nevertheless, PTSD was significantly associated with poorer PM above and beyond age and performance in retrospective memory and executive functions. DISCUSSION Results provide initial evidence of PM dysfunction in PTSD, especially in strategic monitoring during time-based PM tasks. Findings have potential implications for everyday functioning and health behaviors in persons with PTSD, and deserve replication and future study. (JINS, 2016, 22, 724-734).
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Zuj DV, Palmer MA, Lommen MJJ, Felmingham KL. The centrality of fear extinction in linking risk factors to PTSD: A narrative review. Neurosci Biobehav Rev 2016; 69:15-35. [PMID: 27461912 DOI: 10.1016/j.neubiorev.2016.07.014] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 02/08/2023]
Abstract
Recent prospective studies in emergency services have identified impaired fear extinction learning and memory to be a significant predictor of Posttraumatic Stress Disorder (PTSD), complementing a wealth of cross-sectional evidence of extinction deficits associated with the disorder. Additional fields of research show specific risk factors and biomarkers of the disorder, including candidate genotypes, stress and sex hormones, cognitive factors, and sleep disturbances. Studies in mostly nonclinical populations also reveal that the aforementioned factors are involved in fear extinction learning and memory. Here, we provide a comprehensive narrative review of the literature linking PTSD to these risk factors, and linking these risk factors to impaired fear extinction. On balance, the evidence suggests that fear extinction may play a role in the relationship between risk factors and PTSD. Should this notion hold true, this review carries important implications for the improvement of exposure-based treatments, as well as strategies for the implementation of treatment.
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Affiliation(s)
- Daniel V Zuj
- Division of Psychology, School of Medicine, University of Tasmania, Tasmania, Australia.
| | - Matthew A Palmer
- Division of Psychology, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Miriam J J Lommen
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - Kim L Felmingham
- Division of Psychology, School of Medicine, University of Tasmania, Tasmania, Australia
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Sørensen HJ, Andersen SB, Karstoft KI, Madsen T. The influence of pre-deployment cognitive ability on post-traumatic stress disorder symptoms and trajectories: The Danish USPER follow-up study of Afghanistan veterans. J Affect Disord 2016; 196:148-53. [PMID: 26921867 DOI: 10.1016/j.jad.2016.02.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 02/02/2016] [Accepted: 02/12/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE New trajectories of PTSD symptoms have recently been identified in war exposed army veterans. The aim of this army veterans study was to examine whether pre-deployment cognitive ability is associated with the risk of developing PTSD symptoms or non-resilient PTSD trajectories. METHOD Follow up study in 428 Danish soldiers, deployed to Afghanistan in 2009, who were assessed at six occasions from pre-deployment to three years post-deployment. Pre-deployment vulnerabilities, deployment and homecoming stressors were measured. Pre-deployment cognitive test scores on Børge Priens Prøve (based on logical, verbal, numerical and spatial reasoning) were converted to a mean of 100 and with a standard deviation of 15. RESULTS Higher pre-deployment cognitive ability scores were associated with lower risk of PTSD symptoms as assessed by the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C) 2.5 years post-deployment (OR=0.97; 95% CI 0.95-1.00) after adjustment for educational length, baseline PCL-C score and perceived war-zone stress. Compared to a resilient trajectory, a non-resilient relieved-worsening trajectory (high baseline mental symptoms, being symptom free during deployment and a drastic increase in PTSD symptoms at the final assessments of PTSD symptoms) had significantly lower cognitive scores by a mean difference of 14.5 (95% CI 4.7-24.3). This trajectory (n=9) comprised 26.5% of soldiers with moderate-severe PTSD symptoms 2.5 years post-deployment. CONCLUSION We confirmed an inverse association between pre-deployment cognitive ability and risk of PTSD symptoms, and observed significantly lower mean pre-deployment cognitive scores in one non-resilient PTSD trajectory. If replicated, this might inform relevant prevention efforts for soldiers at pre-deployment.
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Affiliation(s)
- Holger J Sørensen
- Mental Health center Copenhagen, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark.
| | - Søren B Andersen
- Research and Knowledge Center, The Danish Veteran Center, Garnisonen 1, 4100 Ringsted, Denmark
| | - Karen-Inge Karstoft
- Research and Knowledge Center, The Danish Veteran Center, Garnisonen 1, 4100 Ringsted, Denmark
| | - Trine Madsen
- Mental Health center Copenhagen, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark; Research and Knowledge Center, The Danish Veteran Center, Garnisonen 1, 4100 Ringsted, Denmark
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Neuropsychological Functioning in Veterans with Posttraumatic Stress Disorder: Associations with Performance Validity, Comorbidities, and Functional Outcomes. J Int Neuropsychol Soc 2016; 22:399-411. [PMID: 26892753 DOI: 10.1017/s1355617716000059] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Numerous studies have shown that individuals with posttraumatic stress disorder (PTSD) display reduced performances on neuropsychological tests, although most prior research has not adequately accounted for comorbidities or performance validity concerns that are common in this population and could partially account for the observed neurocognitive findings. Moreover, few studies have examined the functional implications of neuropsychological results in PTSD. METHODS We examined neuropsychological functioning in 44 veterans with PTSD and 40 veteran trauma comparison (TC) participants with combat exposure and no PTSD. RESULTS After excluding four veterans with PTSD for performance validity concerns, multivariate analyses of variance by neurocognitive domain revealed significantly worse performance by the PTSD group in the domains of speed of information processing (p=.035) and executive functions (p=.017), but no group differences in attention/working memory, verbal/language functioning, visuoconstruction, or episodic memory. Group differences by PTSD status were still present after covarying for depression, a history of head injuries, and substance use disorders. Executive functioning performance was associated with poorer self-reported occupational functioning and physical health-related quality of life, while speed of information processing performance was associated with poorer physical health-related quality of life. DISCUSSION These results are generally consistent with a fronto-limbic conceptualization of PTSD-associated neuropsychological dysfunction and show that cognitive functioning may be associated with critical functional outcomes. Taken together, results suggest that consideration of neurocognitive functioning may enhance the clinical management of individuals with PTSD.
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Dretsch MN, Williams K, Emmerich T, Crynen G, Ait-Ghezala G, Chaytow H, Mathura V, Crawford FC, Iverson GL. Brain-derived neurotropic factor polymorphisms, traumatic stress, mild traumatic brain injury, and combat exposure contribute to postdeployment traumatic stress. Brain Behav 2016; 6:e00392. [PMID: 27110438 PMCID: PMC4834940 DOI: 10.1002/brb3.392] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/22/2015] [Accepted: 08/16/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In addition to experiencing traumatic events while deployed in a combat environment, there are other factors that contribute to the development of posttraumatic stress disorder (PTSD) in military service members. This study explored the contribution of genetics, childhood environment, prior trauma, psychological, cognitive, and deployment factors to the development of traumatic stress following deployment. METHODS Both pre- and postdeployment data on 231 of 458 soldiers were analyzed. Postdeployment assessments occurred within 30 days from returning stateside and included a battery of psychological health, medical history, and demographic questionnaires; neurocognitive tests; and blood serum for the D2 dopamine receptor (DRD2), apolipoprotein E (APOE), and brain-derived neurotropic factor (BDNF) genes. RESULTS Soldiers who screened positive for traumatic stress at postdeployment had significantly higher scores in depression (d = 1.91), anxiety (d = 1.61), poor sleep quality (d = 0.92), postconcussion symptoms (d = 2.21), alcohol use (d = 0.63), traumatic life events (d = 0.42), and combat exposure (d = 0.91). BDNF Val66 Met genotype was significantly associated with risk for sustaining a mild traumatic brain injury (mTBI) and screening positive for traumatic stress. Predeployment traumatic stress, greater combat exposure and sustaining an mTBI while deployed, and the BDNF Met/Met genotype accounted for 22% of the variance of postdeployment PTSD scores (R (2) = 0.22, P < 0.001). However, predeployment traumatic stress, alone, accounted for 17% of the postdeployment PTSD scores. CONCLUSION These findings suggest predeployment traumatic stress, genetic, and environmental factors have unique contributions to the development of combat-related traumatic stress in military service members.
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Affiliation(s)
- Michael N Dretsch
- U.S. Army Aeromedical Research Laboratory 6901 Farrel Road Fort Rucker Alabama 22206; National Intrepid Center of Excellence Walter Reed National Military Medical Center 4860 South Palmer Road Bethesda Maryland 20889; Human Dimension Division (HDD) Headquarters Army Training and Doctrine Command (HQ TRADOC) 950 Jefferson Ave Fort Eustis Virginia 23604
| | - Kathy Williams
- National Intrepid Center of Excellence Walter Reed National Military Medical Center 4860 South Palmer Road Bethesda Maryland 20889
| | - Tanja Emmerich
- Roskamp Institute 2040 Whitfield Ave Sarasota Florida 34243
| | - Gogce Crynen
- Roskamp Institute 2040 Whitfield Ave Sarasota Florida 34243
| | | | - Helena Chaytow
- Roskamp Institute 2040 Whitfield Ave Sarasota Florida 34243
| | - Venkat Mathura
- Roskamp Institute 2040 Whitfield Ave Sarasota Florida 34243
| | | | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation Harvard Medical School Boston Massachusetts; Spaulding Rehabilitation Hospital Boston Massachusetts; Red Sox Foundation and Massachusetts General Hospital Home Base Program Boston Massachusetts; Defense and Veterans Brain Injury Center Bethesda Maryland; Center for Health and Rehabilitation Department of Physical Medicine & Rehabilitation Harvard Medical School 79/96 Thirteenth Street Charlestown Navy Yard Charlestown Massachusetts 02129
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40
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Gilbert KS, Kark SM, Gehrman P, Bogdanova Y. Sleep disturbances, TBI and PTSD: Implications for treatment and recovery. Clin Psychol Rev 2015; 40:195-212. [PMID: 26164549 DOI: 10.1016/j.cpr.2015.05.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 04/27/2015] [Accepted: 05/13/2015] [Indexed: 12/26/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD), traumatic brain injury (TBI), and sleep problems significantly affect recovery and functional status in military personnel and Veterans returning from combat. Despite recent attention, sleep is understudied in the Veteran population. Few treatments and rehabilitation protocols target sleep, although poor sleep remains at clinical levels and continues to adversely impact functioning even after the resolution of PTSD or mild TBI symptoms. Recent developments in non-pharmacologic sleep treatments have proven efficacious as stand-alone interventions and have potential to improve treatment outcomes by augmenting traditional behavioral and cognitive therapies. This review discusses the extensive scope of work in the area of sleep as it relates to TBI and PTSD, including pathophysiology and neurobiology of sleep; existing and emerging treatment options; as well as methodological issues in sleep measurements for TBI and PTSD. Understanding sleep problems and their role in the development and maintenance of PTSD and TBI symptoms may lead to improvement in overall treatment outcomes while offering a non-stigmatizing entry in mental health services and make current treatments more comprehensive by helping to address a broader spectrum of difficulties.
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Affiliation(s)
- Karina Stavitsky Gilbert
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Sarah M Kark
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States
| | - Philip Gehrman
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States; Philadelphia VA Medical Center, Philadelphia, PA, United States
| | - Yelena Bogdanova
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States.
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Scott JC, Matt GE, Wrocklage KM, Crnich C, Jordan J, Southwick SM, Krystal JH, Schweinsburg BC. A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder. Psychol Bull 2015. [PMID: 25365762 DOI: 10.1037/a00389039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Posttraumatic stress disorder (PTSD) is associated with regional alterations in brain structure and function that are hypothesized to contribute to symptoms and cognitive deficits associated with the disorder. We present here the first systematic meta-analysis of neurocognitive outcomes associated with PTSD to examine a broad range of cognitive domains and describe the profile of cognitive deficits, as well as modifying clinical factors and study characteristics. This report is based on data from 60 studies totaling 4,108 participants, including 1,779 with PTSD, 1,446 trauma-exposed comparison participants, and 895 healthy comparison participants without trauma exposure. Effect-size estimates were calculated using a mixed-effects meta-analysis for 9 cognitive domains: attention/working memory, executive functions, verbal learning, verbal memory, visual learning, visual memory, language, speed of information processing, and visuospatial abilities. Analyses revealed significant neurocognitive effects associated with PTSD, although these ranged widely in magnitude, with the largest effect sizes in verbal learning (d = -.62), speed of information processing (d = -.59), attention/working memory (d = -.50), and verbal memory (d =-.46). Effect-size estimates were significantly larger in treatment-seeking than community samples and in studies that did not exclude participants with attention-deficit/hyperactivity disorder, and effect sizes were affected by between-group IQ discrepancies and the gender composition of the PTSD groups. Our findings indicate that consideration of neuropsychological functioning in attention, verbal memory, and speed of information processing may have important implications for the effective clinical management of persons with PTSD. Results are further discussed in the context of cognitive models of PTSD and the limitations of this literature.
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Affiliation(s)
- J Cobb Scott
- VISN4 Mental Illness Research, Education, and Clinical Center, Philadelphia VA Medical Center
| | - Georg E Matt
- Department of Psychology, San Diego State University
| | | | | | - Jessica Jordan
- National Center for PTSD, VA Connecticut Healthcare System
| | | | - John H Krystal
- National Center for PTSD, VA Connecticut Healthcare System
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Neuropsychological and Physiological Outcomes Pre- and Post-EMDR Therapy for a Woman With PTSD: A Case Study. JOURNAL OF EMDR PRACTICE AND RESEARCH 2015. [DOI: 10.1891/1933-3196.9.4.174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article provides a comprehensive review of the literature on the neurocognitive impact of posttraumatic stress disorder (PTSD) and reports on a quantitative single-case study, which investigated whether eye movement desensitization and reprocessing (EMDR) therapy would change the neuropsychological and physiological responses of an 18-year-old female client diagnosed with comorbid PTSD and major depressive disorder. Eleven 90-minute weekly sessions of EMDR therapy were provided. We used biofeedback equipment (ProComp5 Infiniti System) to obtain records of heart rate and conductance while the participant was in the desensitization and reprocessing phases of EMDR therapy. Results showed a heart rate decrease between baselines at the beginning and end of treatment. Neuropsychological evaluations of attention, memory, and brain executive functions showed pretreatment impairments in attentional processes, information processing speed, and working memory and posttreatment improvement of these cognitive functions, with significant differences on the Paced Auditory Serial Addition Test. We found a substantial posttreatment decrease in mean scores on the Beck Depression Inventory-II and the Dissociative Experiences Scale. Furthermore, the patient showed no signs of PTSD after the intervention, based on the Posttraumatic Stress Global Scale. At 1-year follow-up, the participant reported maintenance of treatment effects. We discuss how amelioration of PTSD symptoms was associated with improved neurocognitive outcomes.
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Scott JC, Matt GE, Wrocklage KM, Crnich C, Jordan J, Southwick SM, Krystal JH, Schweinsburg BC. A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder. Psychol Bull 2015; 141:105-140. [PMID: 25365762 PMCID: PMC4293317 DOI: 10.1037/a0038039] [Citation(s) in RCA: 317] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with regional alterations in brain structure and function that are hypothesized to contribute to symptoms and cognitive deficits associated with the disorder. We present here the first systematic meta-analysis of neurocognitive outcomes associated with PTSD to examine a broad range of cognitive domains and describe the profile of cognitive deficits, as well as modifying clinical factors and study characteristics. This report is based on data from 60 studies totaling 4,108 participants, including 1,779 with PTSD, 1,446 trauma-exposed comparison participants, and 895 healthy comparison participants without trauma exposure. Effect-size estimates were calculated using a mixed-effects meta-analysis for 9 cognitive domains: attention/working memory, executive functions, verbal learning, verbal memory, visual learning, visual memory, language, speed of information processing, and visuospatial abilities. Analyses revealed significant neurocognitive effects associated with PTSD, although these ranged widely in magnitude, with the largest effect sizes in verbal learning (d = -.62), speed of information processing (d = -.59), attention/working memory (d = -.50), and verbal memory (d =-.46). Effect-size estimates were significantly larger in treatment-seeking than community samples and in studies that did not exclude participants with attention-deficit/hyperactivity disorder, and effect sizes were affected by between-group IQ discrepancies and the gender composition of the PTSD groups. Our findings indicate that consideration of neuropsychological functioning in attention, verbal memory, and speed of information processing may have important implications for the effective clinical management of persons with PTSD. Results are further discussed in the context of cognitive models of PTSD and the limitations of this literature.
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Affiliation(s)
- J. Cobb Scott
- VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Georg E. Matt
- Department of Psychology, San Diego State University, San Diego, CA, 92182, USA
| | | | | | - Jessica Jordan
- VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Steven M. Southwick
- VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA
| | - John H. Krystal
- VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA
- Department of Neurobiology, Yale University School of Medicine, New Haven, CT 06510 USA
- Psychiatry Services, Yale-New Haven Hospital, New Haven, CT 06510
| | - Brian C. Schweinsburg
- VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA
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King PR, Donnelly KT, Wade M, Donnelly JP, Dunnam M, Warner G, Kittleson CJ, Bradshaw CB, Alt M. The Relationships Among Premilitary Vocational Aptitude Assessment, Traumatic Brain Injury, and Postdeployment Cognitive Functioning in Combat Veterans. Arch Clin Neuropsychol 2014; 29:391-402. [DOI: 10.1093/arclin/acu011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wisdom NM, Pastorek NJ, Miller BI, Booth JE, Romesser JM, Linck JF, Sim AH. PTSD and Cognitive Functioning: Importance of Including Performance Validity Testing. Clin Neuropsychol 2013; 28:128-45. [DOI: 10.1080/13854046.2013.863977] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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46
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Hoyt T, Renshaw K, Pasupathi M. Disclosure of Combat Events by Afghanistan and Iraq War Veterans. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/21635781.2013.827960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cavalcanti-Ribeiro P, Andrade-Nascimento M, Morais-de-Jesus M, de Medeiros GM, Daltro-Oliveira R, Conceição JO, Rocha MF, Miranda-Scippa Â, Koenen KC, Quarantini LC. Post-traumatic stress disorder as a comorbidity: impact on disease outcomes. Expert Rev Neurother 2013; 12:1023-37. [PMID: 23002944 DOI: 10.1586/ern.12.77] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Post-traumatic stress disorder (PTSD) is associated with many psychiatric and nonpsychiatric comorbidities. Growing evidence suggests that PTSD as a comorbidity may impair drug adherence, quality of life and sleep quality, as well as increase rehospitalization rates, disease relapses, intensity of symptoms, morbidity and mortality. The aim of this article is to examine the literature regarding the effects of PTSD comorbidity on physical and mental health.
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48
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Impact of Posttraumatic Stress Disorder and Depression on Neuropsychological Functioning in Electrical Injury Survivors. J Burn Care Res 2013; 34:659-65. [DOI: 10.1097/bcr.0b013e31827e5062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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49
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Bomyea J, Risbrough V, Lang AJ. A consideration of select pre-trauma factors as key vulnerabilities in PTSD. Clin Psychol Rev 2012; 32:630-41. [PMID: 22917742 PMCID: PMC3444146 DOI: 10.1016/j.cpr.2012.06.008] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 05/07/2012] [Accepted: 06/25/2012] [Indexed: 02/02/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a pathological response to a traumatic event. A number of risk and vulnerability factors predicting PTSD development have been identified in the literature. Many of these variables are specific factors occurring during and after exposure to a traumatic event or are not measured prospectively to assess temporal sequence. Recent research, however, has begun to focus on pre-trauma individual differences that could contribute to risk for developing PTSD. The present review proposes that a number of biological and cognitive vulnerability factors place individuals at risk for PTSD development prior to the actual experience of trauma. Accordingly, this review provides a summary of evidence for a select number of these factors as pre-trauma vulnerabilities to PTSD. Included is a discussion of biological factors, including molecular genetic studies of systems regulating serotonin, catecholamines, and glucocorticoids as well as aspects of the neuroendocrine system. Specific cognitive factors are also considered, including intelligence, neuropsychological functioning and cognitive biases such as negative attributional style and appraisals. For each factor, the present review summarizes evidence to date regarding PTSD vulnerability and highlights directions for future research in this area.
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Affiliation(s)
- Jessica Bomyea
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, La Jolla, CA, USA.
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Betts KS, Williams GM, Najman JM, Bor W, Alati R. Pre-trauma verbal ability at five years of age and the risk of post-traumatic stress disorder in adult males and females. J Psychiatr Res 2012; 46:933-9. [PMID: 22575335 DOI: 10.1016/j.jpsychires.2012.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/07/2012] [Accepted: 04/03/2012] [Indexed: 11/16/2022]
Abstract
Previous studies have shown that high cognitive ability, measured in childhood and prior to the experience of traumatic events, is protective of PTSD development. Our aim was to test if the association between pre-trauma verbal ability ascertained at 5 years with DSM-IV lifetime post-traumatic stress disorder (PTSD) at 21 years was subject to effect modification by gender, trauma type or prior behaviour problems. Using a prospective birth cohort of young Australians, we found that both trauma type and behaviour problems did not change the association between cognitive ability and PTSD. During multivariate analysis, testing for the interactive effect of gender revealed that verbal ability was linearly and inversely associated with PTSD in females only, with those in the lowest verbal ability quintile having strongly increased odds of PTSD (OR=3.89: 95% CI; 1.50, 10.10) compared with those in the highest quintile. A graph of the interaction revealed lower verbal ability placed females, but not males, at an increased risk of PTSD. Our results indicate that lower verbal ability in early childhood is a vulnerability factor for PTSD in females but not in males, and may constitute a gender-specific risk factor responsible for part of the increased risk of PTSD found in females compared with males.
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Affiliation(s)
- Kim Steven Betts
- School of Population Health, University of Queensland, Brisbane, Australia.
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