1
|
Granger SJ, May V, Hammack SE, Akman E, Jobson SA, Olson EA, Pernia CD, Daskalakis NP, Ravichandran C, Carlezon WA, Ressler KJ, Rauch SL, Rosso IM. Circulating PACAP levels are associated with altered imaging measures of entorhinal cortex neurite density in posttraumatic stress disorder. Eur J Psychotraumatol 2024; 15:2335793. [PMID: 38590134 PMCID: PMC11005872 DOI: 10.1080/20008066.2024.2335793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction: Pituitary adenylate cyclase-activating polypeptide (PACAP) regulates plasticity in brain systems underlying arousal and memory and is associated with posttraumatic stress disorder (PTSD). Research in animal models suggests that PACAP modulates entorhinal cortex (EC) input to the hippocampus, contributing to impaired contextual fear conditioning. In PTSD, PACAP is associated with higher activity of the amygdala to threat stimuli and lower functional connectivity of the amygdala and hippocampus. However, PACAP-affiliated structural alterations of these regions have not been investigated in PTSD. Here, we examined whether peripheral PACAP levels were associated with neuronal morphology of the amygdala and hippocampus (primary analyses), and EC (secondary) using Neurite Orientation Dispersion and Density Imaging.Methods: Sixty-four (44 female) adults (19 to 54 years old) with DSM-5 Criterion A trauma exposure completed the Clinician-Administered PTSD Scale (CAPS-5), a blood draw, and magnetic resonance imaging. PACAP38 radioimmunoassay was performed and T1-weighted and multi-shell diffusion-weighted images were acquired. Neurite Density Index (NDI) and Orientation Dispersion Index (ODI) were quantified in the amygdala, hippocampus, and EC. CAPS-5 total score and anxious arousal score were used to test for clinical associations with brain structure.Results: Higher PACAP levels were associated with greater EC NDI (β = 0.0099, q = 0.032) and lower EC ODI (β = -0.0073, q = 0.047), and not hippocampal or amygdala measures. Neither EC NDI nor ODI was associated with clinical measures.Conclusions: Circulating PACAP levels were associated with altered neuronal density of the EC but not the hippocampus or amygdala. These findings strengthen evidence that PACAP may impact arousal-associated memory circuits in PTSD.
Collapse
Affiliation(s)
- Steven J. Granger
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Victor May
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Eylül Akman
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Sydney A. Jobson
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Elizabeth A. Olson
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Cameron D. Pernia
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Basic Neuroscience Division, McLean Hospital, Belmont, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Nikos P. Daskalakis
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Basic Neuroscience Division, McLean Hospital, Belmont, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Caitlin Ravichandran
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - William A. Carlezon
- Basic Neuroscience Division, McLean Hospital, Belmont, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kerry J. Ressler
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Scott L. Rauch
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle M. Rosso
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Borst B, Jovanovic T, House SL, Bruce SE, Harnett NG, Roeckner AR, Ely TD, Lebois LAM, Young D, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Peak DA, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Harte SE, Koenen KC, Kessler RC, McLean SA, Ressler KJ, Stevens JS, van Rooij SJH. Sex differences in response inhibition-related neural predictors of PTSD in recent trauma-exposed civilians. Biol Psychiatry Cogn Neurosci Neuroimaging 2024:S2451-9022(24)00080-6. [PMID: 38522649 DOI: 10.1016/j.bpsc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Females are more likely to develop posttraumatic stress disorder (PTSD) than males. Impaired inhibition has been identified as mechanism for PTSD development, but studies on the potential sex differences of this neurobiological mechanism and how it relates to PTSD severity and progression are sparse. Here we examined sex differences in neural activation during response inhibition and PTSD following recent trauma. METHODS Participants (N= 205, 138 female sex assigned at birth) were recruited from emergency departments within 72 hours of a traumatic event. PTSD symptoms were assessed 2-weeks and 6-months post-trauma. A Go/NoGo task was performed 2-weeks post-trauma in a 3T MRI scanner to measure neural activity during response inhibition in the ventromedial prefrontal cortex (vmPFC), right inferior frontal gyrus (rIFG), and the bilateral hippocampus. General Linear models were used to examine the interaction effect of sex on the relationship between our regions of interest (ROIs) and the whole brain, and PTSD symptoms at 6-months, and symptom progression between 2-weeks and 6-months. RESULTS Lower response-inhibition-related vmPFC activation 2-weeks post-trauma predicted more PTSD symptoms at 6-months in females but not in males, while greater response-inhibition-related rIFG activation predicted lower PTSD symptom progression in males but not females. Whole brain interaction effects were observed in the medial temporal gyrus and left precentral gyrus. CONCLUSIONS There are sex differences in the relationship between inhibition-related brain activation and PTSD symptom severity and progression. These findings suggest that sex differences should be assessed in future PTSD studies and reveal potential targets for sex-specific interventions.
Collapse
Affiliation(s)
- Bibian Borst
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Alyssa R Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Dmitri Young
- University of California San Francisco, San Francisco, CA, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, USA; Department of Emergency Medicine, Brown University, Providence, RI
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA; The Many Brains Project, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA; Ohio State University College of Nursing, Columbus, OH, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Jefferson Einstein hospital, Jefferson Health, Philadelphia, PA, USA; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
3
|
Garrison-Desany HM, Meyers JL, Linnstaedt SD, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Jovanovic T, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, Gentile NT, Hudak LA, Pascual JL, Seamon MJ, Harris E, Pearson C, Peak DA, Domeier RM, Rathlev NK, O’Neil BJ, Sergot P, Sanchez LD, Bruce SE, Joormann J, Harte SE, McLean SA, Koenen KC, Denckla CA. Post-traumatic stress and future substance use outcomes: leveraging antecedent factors to stratify risk. Front Psychiatry 2024; 15:1249382. [PMID: 38525258 PMCID: PMC10957776 DOI: 10.3389/fpsyt.2024.1249382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/10/2024] [Indexed: 03/26/2024] Open
Abstract
Background Post-traumatic stress disorder (PTSD) and substance use (tobacco, alcohol, and cannabis) are highly comorbid. Many factors affect this relationship, including sociodemographic and psychosocial characteristics, other prior traumas, and physical health. However, few prior studies have investigated this prospectively, examining new substance use and the extent to which a wide range of factors may modify the relationship to PTSD. Methods The Advancing Understanding of RecOvery afteR traumA (AURORA) study is a prospective cohort of adults presenting at emergency departments (N = 2,943). Participants self-reported PTSD symptoms and the frequency and quantity of tobacco, alcohol, and cannabis use at six total timepoints. We assessed the associations of PTSD and future substance use, lagged by one timepoint, using the Poisson generalized estimating equations. We also stratified by incident and prevalent substance use and generated causal forests to identify the most important effect modifiers of this relationship out of 128 potential variables. Results At baseline, 37.3% (N = 1,099) of participants reported likely PTSD. PTSD was associated with tobacco frequency (incidence rate ratio (IRR): 1.003, 95% CI: 1.00, 1.01, p = 0.02) and quantity (IRR: 1.01, 95% CI: 1.001, 1.01, p = 0.01), and alcohol frequency (IRR: 1.002, 95% CI: 1.00, 1.004, p = 0.03) and quantity (IRR: 1.003, 95% CI: 1.001, 1.01, p = 0.001), but not with cannabis use. There were slight differences in incident compared to prevalent tobacco frequency and quantity of use; prevalent tobacco frequency and quantity were associated with PTSD symptoms, while incident tobacco frequency and quantity were not. Using causal forests, lifetime worst use of cigarettes, overall self-rated physical health, and prior childhood trauma were major moderators of the relationship between PTSD symptoms and the three substances investigated. Conclusion PTSD symptoms were highly associated with tobacco and alcohol use, while the association with prospective cannabis use is not clear. Findings suggest that understanding the different risk stratification that occurs can aid in tailoring interventions to populations at greatest risk to best mitigate the comorbidity between PTSD symptoms and future substance use outcomes. We demonstrate that this is particularly salient for tobacco use and, to some extent, alcohol use, while cannabis is less likely to be impacted by PTSD symptoms across the strata.
Collapse
Affiliation(s)
- Henri M. Garrison-Desany
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jacquelyn L. Meyers
- Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, New York City, NY, United States
| | - Sarah D. Linnstaedt
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Francesca L. Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, United States
- Department of Emergency Medicine, Brown University, Providence, RI, United States
| | - Xinming An
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Thomas C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Laura T. Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- The Many Brains Project, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kenneth A. Bollen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Scott L. Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, McLean Hospital, Belmont, MA, United States
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Brittany E. Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, United States
| | - Robert A. Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, United States
| | - Nina T. Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Jose L. Pascual
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Erica Harris
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, United States
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Robert M. Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, United States
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States
| | - Brian J. O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, United States
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center, Houston, TX, United States
| | - Leon D. Sanchez
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, United States
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Samuel A. McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Christy A. Denckla
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| |
Collapse
|
4
|
Lewis MW, Bradford DE, Akman E, Frederiks K, Rauch SL, Rosso IM. Unconditioned response to a naturally aversive stimulus is associated with sensitized defensive responding and self-reported fearful traits in a PTSD sample. Psychophysiology 2024; 61:e14473. [PMID: 37919832 DOI: 10.1111/psyp.14473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023]
Abstract
Unconditioned responding (UCR) to a naturally aversive stimulus is associated with defensive responding to a conditioned threat cue (CS+) and a conditioned safety cue (CS-) in trauma-exposed individuals during fear acquisition. However, the relationships of UCR with defensive responses during extinction training, posttraumatic stress disorder (PTSD) symptom severity, and fearful traits in trauma-exposed individuals are not known. In a sample of 100 trauma-exposed adults with a continuum of PTSD severity, we recorded startle responses and skin conductance responses (SCR) during fear acquisition and extinction training using a 140 psi, 250-ms air blast to the larynx as the unconditioned stimulus. We explored dimensional associations of two different measures of UCR (unconditioned startle and unconditioned SCR) with conditioned defensive responding to CS+ and CS-, conditioned fear (CS+ minus CS-), PTSD symptom severity, and a measure of fearful traits (composite of fear survey schedule, anxiety sensitivity index, and Connor-Davidson resilience scale). Unconditioned startle was positively associated with startle potentiation to the threat cue and the safety cue across both learning phases (CS+ Acquisition, CS- Acquisition, CS+ Extinction Training, CS- Extinction Training) and with fearful traits. Unconditioned SCR was positively associated with SCR to the CS+ and CS- and SCR difference score during Acquisition. Neither type of UCR was associated with PTSD symptom severity. Our findings suggest that UCR, particularly unconditioned startle to a naturally aversive stimulus, may inform research on biomarkers and treatment targets for symptoms of pervasive and persistent fear in trauma-exposed individuals.
Collapse
Affiliation(s)
- Michael W Lewis
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel E Bradford
- School of Psychological Science, Oregon State University, Oregon, USA
| | - Eylül Akman
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Kevin Frederiks
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Scott L Rauch
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Shen FX, Baum ML, Martinez-Martin N, Miner AS, Abraham M, Brownstein CA, Cortez N, Evans BJ, Germine LT, Glahn DC, Grady C, Holm IA, Hurley EA, Kimble S, Lázaro-Muñoz G, Leary K, Marks M, Monette PJ, Jukka-Pekka O, O’Rourke PP, Rauch SL, Shachar C, Sen S, Vahia I, Vassy JL, Baker JT, Bierer BE, Silverman BC. Returning Individual Research Results from Digital Phenotyping in Psychiatry. Am J Bioeth 2024; 24:69-90. [PMID: 37155651 PMCID: PMC10630534 DOI: 10.1080/15265161.2023.2180109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants' locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant's real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas.
Collapse
Affiliation(s)
- Francis X. Shen
- Harvard Medical School
- Massachusetts General Hospital
- Harvard Law School
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mason Marks
- Harvard Law School
- Florida State University College of Law
- Yale Law School
| | | | | | | | - Scott L. Rauch
- Harvard Medical School
- McLean Hospital
- Mass General Brigham
| | | | | | | | - Jason L. Vassy
- Harvard Medical School
- Brigham and Women’s Hospital
- VA Boston Healthcare System
| | | | - Barbara E. Bierer
- Harvard Medical School
- Brigham and Women’s Hospital
- Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard
| | | |
Collapse
|
6
|
Hinojosa CA, Liew A, An X, Stevens JS, Basu A, van Rooij SJH, House SL, Beaudoin FL, Zeng D, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Swor RA, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, Sergot P, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Pizzagalli DA, Sheridan JF, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Ressler KJ, Fani N. Associations of alcohol and cannabis use with change in posttraumatic stress disorder and depression symptoms over time in recently trauma-exposed individuals. Psychol Med 2024; 54:338-349. [PMID: 37309917 PMCID: PMC10716364 DOI: 10.1017/s0033291723001642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians. METHODS In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance. RESULTS Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12. CONCLUSIONS Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.
Collapse
Affiliation(s)
- Cecilia A. Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Amanda Liew
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Archana Basu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Sanne J H. van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L. Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Sarah D. Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T. Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- The Many Brains Project, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Scott L. Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E. Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA
- Ohio State University College of Nursing, Columbus, OH, USA
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A. Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L. Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth M. Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anna M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C. Merchant
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Robert M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Leon D. Sanchez
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Mark W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - John F. Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, OH, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M. Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Samuel A. McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
7
|
Wong SA, Lebois LAM, Ely TD, van Rooij SJH, Bruce SE, Murty VP, Jovanovic T, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Swor RA, Hudak LA, Pascual JL, Seamon MJ, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Ressler KJ, Stevens JS, Harnett NG. Internal capsule microstructure mediates the relationship between childhood maltreatment and PTSD following adulthood trauma exposure. Mol Psychiatry 2023; 28:5140-5149. [PMID: 36932158 PMCID: PMC10505244 DOI: 10.1038/s41380-023-02012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/19/2023]
Abstract
Childhood trauma is a known risk factor for trauma and stress-related disorders in adulthood. However, limited research has investigated the impact of childhood trauma on brain structure linked to later posttraumatic dysfunction. We investigated the effect of childhood trauma on white matter microstructure after recent trauma and its relationship with future posttraumatic dysfunction among trauma-exposed adult participants (n = 202) recruited from emergency departments as part of the AURORA Study. Participants completed self-report scales assessing prior childhood maltreatment within 2-weeks in addition to assessments of PTSD, depression, anxiety, and dissociation symptoms within 6-months of their traumatic event. Fractional anisotropy (FA) obtained from diffusion tensor imaging (DTI) collected at 2-weeks and 6-months was used to index white matter microstructure. Childhood maltreatment load predicted 6-month PTSD symptoms (b = 1.75, SE = 0.78, 95% CI = [0.20, 3.29]) and inversely varied with FA in the bilateral internal capsule (IC) at 2-weeks (p = 0.0294, FDR corrected) and 6-months (p = 0.0238, FDR corrected). We observed a significant indirect effect of childhood maltreatment load on 6-month PTSD symptoms through 2-week IC microstructure (b = 0.37, Boot SE = 0.18, 95% CI = [0.05, 0.76]) that fully mediated the effect of childhood maltreatment load on PCL-5 scores (b = 1.37, SE = 0.79, 95% CI = [-0.18, 2.93]). IC microstructure did not mediate relationships between childhood maltreatment and depressive, anxiety, or dissociative symptomatology. Our findings suggest a unique role for IC microstructure as a stable neural pathway between childhood trauma and future PTSD symptoms following recent trauma. Notably, our work did not support roles of white matter tracts previously found to vary with PTSD symptoms and childhood trauma exposure, including the cingulum bundle, uncinate fasciculus, and corpus callosum. Given the IC contains sensory fibers linked to perception and motor control, childhood maltreatment might impact the neural circuits that relay and process threat-related inputs and responses to trauma.
Collapse
Affiliation(s)
- Samantha A Wong
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, USA
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- The Many Brains Project, Belmont, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA
- Ohio State University College of Nursing, Columbus, OH, USA
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- Kolling Institute, University of Sydney, St Leonards, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, Camperdown, NSW, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
8
|
Zeamer AL, Salive MC, An X, Beaudoin FL, House SL, Stevens JS, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Rauch SL, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, Hudak LA, Pascual JL, Seamon MJ, Harris E, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Kessler RC, Koenen KC, McLean SA, Bucci V, Haran JP. Association between microbiome and the development of adverse posttraumatic neuropsychiatric sequelae after traumatic stress exposure. Transl Psychiatry 2023; 13:354. [PMID: 37980332 PMCID: PMC10657470 DOI: 10.1038/s41398-023-02643-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023] Open
Abstract
Patients exposed to trauma often experience high rates of adverse post-traumatic neuropsychiatric sequelae (APNS). The biological mechanisms promoting APNS are currently unknown, but the microbiota-gut-brain axis offers an avenue to understanding mechanisms as well as possibilities for intervention. Microbiome composition after trauma exposure has been poorly examined regarding neuropsychiatric outcomes. We aimed to determine whether the gut microbiomes of trauma-exposed emergency department patients who develop APNS have dysfunctional gut microbiome profiles and discover potential associated mechanisms. We performed metagenomic analysis on stool samples (n = 51) from a subset of adults enrolled in the Advancing Understanding of RecOvery afteR traumA (AURORA) study. Two-, eight- and twelve-week post-trauma outcomes for post-traumatic stress disorder (PTSD) (PTSD checklist for DSM-5), normalized depression scores (PROMIS Depression Short Form 8b) and somatic symptom counts were collected. Generalized linear models were created for each outcome using microbial abundances and relevant demographics. Mixed-effect random forest machine learning models were used to identify associations between APNS outcomes and microbial features and encoded metabolic pathways from stool metagenomics. Microbial species, including Flavonifractor plautii, Ruminococcus gnavus and, Bifidobacterium species, which are prevalent commensal gut microbes, were found to be important in predicting worse APNS outcomes from microbial abundance data. Notably, through APNS outcome modeling using microbial metabolic pathways, worse APNS outcomes were highly predicted by decreased L-arginine related pathway genes and increased citrulline and ornithine pathways. Common commensal microbial species are enriched in individuals who develop APNS. More notably, we identified a biological mechanism through which the gut microbiome reduces global arginine bioavailability, a metabolic change that has also been demonstrated in the plasma of patients with PTSD.
Collapse
Affiliation(s)
- Abigail L Zeamer
- Department of Microbiology and Physiologic Systems, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Marie-Claire Salive
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Xinming An
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, USA
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- The Many Brains Project, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA
- Ohio State University College of Nursing, Columbus, OH, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erica Harris
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | | | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vanni Bucci
- Department of Microbiology and Physiologic Systems, University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Program in Microbiome Dynamics, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - John P Haran
- Department of Microbiology and Physiologic Systems, University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Program in Microbiome Dynamics, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| |
Collapse
|
9
|
Rowland GE, Roeckner A, Ely TD, Lebois LAM, van Rooij SJH, Bruce SE, Jovanovic T, House SL, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Gentile NT, Hudak LA, Pascual JL, Seamon MJ, Harris E, Pearson C, Merchant RC, Domeier RM, Rathlev NK, Sergot P, Sanchez LD, Miller MW, Pietrzak RH, Joormann J, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Ressler KJ, Stevens JS, Harnett NG. Prior Sexual Trauma Exposure Impacts Posttraumatic Dysfunction and Neural Circuitry Following a Recent Traumatic Event in the AURORA Study. Biol Psychiatry Glob Open Sci 2023; 3:705-715. [PMID: 37881578 PMCID: PMC10593890 DOI: 10.1016/j.bpsgos.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
Background Prior sexual trauma (ST) is associated with greater risk for posttraumatic stress disorder after a subsequent traumatic event; however, the underlying neurobiological mechanisms remain opaque. We investigated longitudinal posttraumatic dysfunction and amygdala functional dynamics following admission to an emergency department for new primarily nonsexual trauma in participants with and without previous ST. Methods Participants (N = 2178) were recruited following acute trauma exposure (primarily motor vehicle collision). A subset (n = 242) completed magnetic resonance imaging that included a fearful faces task and a resting-state scan 2 weeks after the trauma. We investigated associations between prior ST and several dimensions of posttraumatic symptoms over 6 months. We further assessed amygdala activation and connectivity differences between groups with or without prior ST. Results Prior ST was associated with greater posttraumatic depression (F1,1120 = 28.35, p = 1.22 × 10-7, ηp2 = 0.06), anxiety (F1,1113 = 17.43, p = 3.21 × 10-5, ηp2 = 0.05), and posttraumatic stress disorder (F1,1027 = 11.34, p = 7.85 × 10-4, ηp2 = 0.04) severity and more maladaptive beliefs about pain (F1,1113 = 8.51, p = .004, ηp2 = 0.02) but was not related to amygdala reactivity to fearful versus neutral faces (all ps > .05). A secondary analysis revealed an interaction between ST and lifetime trauma load on the left amygdala to visual cortex connectivity (peak Z value: -4.41, corrected p < .02). Conclusions Findings suggest that prior ST is associated with heightened posttraumatic dysfunction following a new trauma exposure but not increased amygdala activity. In addition, ST may interact with lifetime trauma load to alter neural circuitry in visual processing regions following acute trauma exposure. Further research should probe the relationship between trauma type and visual circuitry in the acute aftermath of trauma.
Collapse
Affiliation(s)
- Grace E Rowland
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - Alyssa Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, Missouri
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, Rhode Island
- Department of Emergency Medicine, Brown University, Providence, Rhode Island
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
- Department of Neurology, University of California, San Francisco, San Francisco, California
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts
- TheMany Brains Project, Belmont, Massachusetts
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, Ohio
- Ohio State University College of Nursing, Columbus, Ohio
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama
- Division of Acute Care Surgery, Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nina T Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jose L Pascual
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Traumatology, Department of Surgery, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica Harris
- Einstein Medical Center, Philadelphia, Pennsylvania
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, Michigan
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - John F Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, Ohio
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, Ohio
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - James M Elliott
- Kolling Institute, University of Sydney, St. Leonards, New South Wales, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Sydney, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Karestan C Koenen
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
10
|
Valeri L, Rahimi-Eichi H, Liebenthal E, Rauch SL, Schutt RK, Öngür D, Dixon LB, Onnela JP, Baker JT. Intensive longitudinal assessment of mobility, social activity and loneliness in individuals with severe mental illness during COVID-19. Schizophrenia (Heidelb) 2023; 9:62. [PMID: 37730830 PMCID: PMC10511540 DOI: 10.1038/s41537-023-00383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/20/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Linda Valeri
- Department of Biostatistics, Columbia University, New York, NY, USA.
| | | | - Einat Liebenthal
- Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Scott L Rauch
- Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Russell K Schutt
- University Of Massachusetts, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dost Öngür
- Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Lisa B Dixon
- Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | | | - Justin T Baker
- Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| |
Collapse
|
11
|
Webb EK, Ely TD, Rowland GE, Lebois LAM, van Rooij SJH, Bruce SE, Jovanovic T, House SL, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, Sergot P, Sanchez LD, Kessler RC, Koenen KC, McLean SA, Stevens JS, Ressler KJ, Harnett NG. Neighborhood Disadvantage and Neural Correlates of Threat and Reward Processing in Survivors of Recent Trauma. JAMA Netw Open 2023; 6:e2334483. [PMID: 37721751 PMCID: PMC10507487 DOI: 10.1001/jamanetworkopen.2023.34483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
Importance Differences in neighborhood socioeconomic characteristics are important considerations in understanding differences in risk vs resilience in mental health. Neighborhood disadvantage is associated with alterations in the function and structure of threat neurocircuitry. Objective To investigate associations of neighborhood disadvantage with white and gray matter and neural reactivity to positive and negative stimuli in the context of trauma exposure. Design, Setting, and Participants In this cross-sectional study, survivors of trauma who completed sociodemographic and posttraumatic symptom assessments and neuroimaging were recruited as part of the Advancing Understanding of Recovery After Trauma (AURORA) study between September 2017 and June 2021. Data analysis was performed from October 25, 2022, to February 15, 2023. Exposure Neighborhood disadvantage was measured with the Area Deprivation Index (ADI) for each participant home address. Main Outcomes and Measures Participants completed separate threat and reward tasks during functional magnetic resonance imaging. Diffusion-weighted and high-resolution structural images were also collected. Linear models assessed the association of ADI with reactivity, microstructure, and macrostructure of a priori regions of interest after adjusting for income, lifetime trauma, sex at birth, and age. A moderated-mediation model tested whether ADI was associated with neural activity via microstructural changes and if this was modulated by PTSD symptoms. Results A total of 280 participants (183 females [65.4%]; mean [SD] age, 35.39 [13.29] years) completed the threat task and 244 participants (156 females [63.9%]; mean [SD] age, 35.10 [13.26] years) completed the reward task. Higher ADI (per 1-unit increase) was associated with greater insula (t274 = 3.20; β = 0.20; corrected P = .008) and anterior cingulate cortex (ACC; t274 = 2.56; β = 0.16; corrected P = .04) threat-related activity after considering covariates, but ADI was not associated with reward reactivity. Greater disadvantage was also associated with altered microstructure of the cingulum bundle (t274 = 3.48; β = 0.21; corrected P = .001) and gray matter morphology of the ACC (cortical thickness: t273 = -2.29; β = -0.13; corrected P = .02; surface area: t273 = 2.53; β = 0.13; corrected P = .02). The moderated-mediation model revealed that ADI was associated with ACC threat reactivity via cingulum microstructural changes (index of moderated mediation = -0.02). However, this mediation was only present in individuals with greater PTSD symptom severity (at the mean: β = -0.17; standard error = 0.06, t= -2.28; P = .007; at 1 SD above the mean: β = -0.28; standard error = 0.08; t = -3.35; P < .001). Conclusions and Relevance In this study, neighborhood disadvantage was associated with neurobiology that supports threat processing, revealing associations of neighborhood disadvantage with neural susceptibility for PTSD and suggesting how altered structure-function associations may complicate symptoms. Future work should investigate specific components of neighborhood disadvantage that may be associated with these outcomes.
Collapse
Affiliation(s)
- E Kate Webb
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Grace E Rowland
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri-St Louis
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, Rhode Island
- Department of Emergency Medicine, Brown University, Providence, Rhode Island
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco
- Department Neurology, University of California, San Francisco
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- The Many Brains Project, Belmont, Massachusetts
- Institute for Technology in Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
- Department of Sociology, University of North Carolina at Chapel Hill
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Institute for Technology in Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus
- College of Nursing, Ohio State University, Columbus
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Jose L Pascual
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Mark J Seamon
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St John Hospital, Detroit, Michigan
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert M Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, Michigan
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Karestan C Koenen
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
12
|
Granger SJ, May V, Hammack SE, Akman E, Jobson SA, Olson EA, Pernia CD, Daskalakis NP, Ravichandran C, Carlezon WA, Ressler KJ, Rauch SL, Rosso IM. Circulating PACAP levels are associated with altered imaging measures of entorhinal cortex neurite density in posttraumatic stress disorder. medRxiv 2023:2023.08.31.23294894. [PMID: 37693514 PMCID: PMC10491384 DOI: 10.1101/2023.08.31.23294894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Pituitary adenylate cyclase-activating polypeptide (PACAP) regulates plasticity in brain systems underlying arousal and memory and is associated with posttraumatic stress disorder (PTSD). Research in animal models suggests that PACAP modulates entorhinal cortex (EC) input to the hippocampus, contributing to impaired contextual fear conditioning. In PTSD, PACAP is associated with higher activity of the amygdala to threat stimuli and lower functional connectivity of the amygdala and hippocampus. However, PACAP-affiliated structural alterations of these regions have not been reported. Here, we examined whether peripheral PACAP levels were associated with neuronal morphology of the amygdala and hippocampus (primary analysis), and EC (secondary analysis) using Neurite Orientation Dispersion and Density Imaging. Methods Sixty-four (44 female) adults (19 to 54 years old) with DSM-5 Criterion A trauma exposure completed the Clinician-Administered PTSD Scale (CAPS-5), a blood draw, and magnetic resonance imaging. PACAP38 radioimmunoassay was performed and T1-weighted and multi-shell diffusion- weighted images were acquired. Neurite Density Index (NDI) and Orientation Dispersion Index (ODI) were quantified in the amygdala, hippocampus, and EC. CAPS-5 total score and anxious arousal score were used to test for clinical associations with brain structure. Results Higher PACAP levels in blood were associated with greater EC NDI (β=0.31, q=0.034) and lower EC ODI (β=-0.30, q=0.042) and not hippocampal or amygdala measures. Neither EC NDI nor ODI was associated with clinical measures. Conclusions Circulating PACAP levels were associated with altered neuronal density of the EC but not hippocampus or amygdala. These findings strengthen evidence that PACAP may impact arousal- associated memory circuits.
Collapse
|
13
|
Hinojosa CA, VanElzakker MB, Kaur N, Felicione JM, Charney ME, Bui E, Marques L, Summergrad P, Rauch SL, Simon NM, Shin LM. Pre-treatment amygdala activation and habituation predict symptom change in post-traumatic stress disorder. Front Behav Neurosci 2023; 17:1198244. [PMID: 37492481 PMCID: PMC10363634 DOI: 10.3389/fnbeh.2023.1198244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/13/2023] [Indexed: 07/27/2023] Open
Abstract
Trauma-focused psychotherapy approaches are the first-line treatment option for post-traumatic stress disorder (PTSD); however, up to a third of patients remain symptomatic even after completion of the treatment. Predicting which patients will respond to a given treatment option would support personalized treatments and improve the efficiency of healthcare systems. Although previous neuroimaging studies have examined possible pre-treatment predictors of response to treatment, the findings have been somewhat inconsistent, and no other study has examined habituation to stimuli as a predictor. In this study, 16 treatment-seeking adults (MAge = 43.63, n = 10 women) with a primary diagnosis of PTSD passively viewed pictures of emotional facial expressions during functional magnetic resonance imaging (fMRI). After scanning, participants rated facial expressions on both valence and arousal. Participants then completed eight weekly sessions of prolonged exposure (PE) therapy. PTSD symptom severity was measured before and after treatment. Overall, participants showed symptomatic improvement with PE. Consistent with hypotheses, lesser activation in the amygdala and greater activation in the ventromedial prefrontal cortex during the presentation of fearful vs. happy facial expressions, as well as a greater decline in amygdala activation across blocks of fearful facial expressions at baseline, were associated with greater reduction of PTSD symptoms. Given that the repeated presentation of emotional material underlies PE, changes in brain responses with repeated stimulus presentations warrant further studies as potential predictors of response to exposure therapies.
Collapse
Affiliation(s)
- Cecilia A. Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael B. VanElzakker
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Navneet Kaur
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Julia M. Felicione
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Psychology, Tufts University, Medford, MA, United States
| | - Meredith E. Charney
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Eric Bui
- Normandie Univ, University of Caen Normandy (UNICAEN), L'Institut national de la santé et de la recherche médicale (INSERM), U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), GIP Cyceron, Caen, France
- Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Center for Anxiety and Traumatic Stress Disorders, Boston, MA, United States
| | - Paul Summergrad
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, United States
| | - Scott L. Rauch
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Naomi M. Simon
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Lisa M. Shin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Psychology, Tufts University, Medford, MA, United States
| |
Collapse
|
14
|
Harnett NG, Fani N, Carter S, Sanchez LD, Rowland GE, Davie WM, Guzman C, Lebois LAM, Ely TD, van Rooij SJH, Seligowski AV, Winters S, Grasser LR, Musey PI, Seamon MJ, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, Hudak LA, Pascual JL, Harris E, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Jovanovic T, Stevens JS, Ressler KJ. Structural inequities contribute to racial/ethnic differences in neurophysiological tone, but not threat reactivity, after trauma exposure. Mol Psychiatry 2023; 28:2975-2984. [PMID: 36725899 PMCID: PMC10615735 DOI: 10.1038/s41380-023-01971-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/03/2023]
Abstract
Considerable racial/ethnic disparities persist in exposure to life stressors and socioeconomic resources that can directly affect threat neurocircuitry, particularly the amygdala, that partially mediates susceptibility to adverse posttraumatic outcomes. Limited work to date, however, has investigated potential racial/ethnic variability in amygdala reactivity or connectivity that may in turn be related to outcomes such as post-traumatic stress disorder (PTSD). Participants from the AURORA study (n = 283), a multisite longitudinal study of trauma outcomes, completed functional magnetic resonance imaging and psychophysiology within approximately two-weeks of trauma exposure. Seed-based amygdala connectivity and amygdala reactivity during passive viewing of fearful and neutral faces were assessed during fMRI. Physiological activity was assessed during Pavlovian threat conditioning. Participants also reported the severity of posttraumatic symptoms 3 and 6 months after trauma. Black individuals showed lower baseline skin conductance levels and startle compared to White individuals, but no differences were observed in physiological reactions to threat. Further, Hispanic and Black participants showed greater amygdala connectivity to regions including the dorsolateral prefrontal cortex (PFC), dorsal anterior cingulate cortex, insula, and cerebellum compared to White participants. No differences were observed in amygdala reactivity to threat. Amygdala connectivity was associated with 3-month PTSD symptoms, but the associations differed by racial/ethnic group and were partly driven by group differences in structural inequities. The present findings suggest variability in tonic neurophysiological arousal in the early aftermath of trauma between racial/ethnic groups, driven by structural inequality, impacts neural processes that mediate susceptibility to later PTSD symptoms.
Collapse
Affiliation(s)
- Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Grace E Rowland
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - William M Davie
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Camilo Guzman
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
- Department of Psychiatry, Henry Ford Health System, Detroit, MI, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Antonia V Seligowski
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sterling Winters
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Lana R Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark J Seamon
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- The Many Brains Project, Belmont, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA
- Ohio State University College of Nursing, Columbus, OH, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
15
|
Hanuka S, Olson EA, Admon R, Webb CA, Killgore WDS, Rauch SL, Rosso IM, Pizzagalli DA. Reduced anhedonia following internet-based cognitive-behavioral therapy for depression is mediated by enhanced reward circuit activation. Psychol Med 2023; 53:4345-4354. [PMID: 35713110 DOI: 10.1017/s0033291722001106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a highly prevalent psychiatric condition, yet many patients do not receive adequate treatment. Novel and highly scalable interventions such as internet-based cognitive-behavioral-therapy (iCBT) may help to address this treatment gap. Anhedonia, a hallmark symptom of MDD that refers to diminished interest and ability to experience pleasure, has been associated with reduced reactivity in a neural reward circuit that includes medial prefrontal and striatal brain regions. Whether iCBT can reduce anhedonia severity in MDD patients, and whether these therapeutic effects are accompanied by enhanced reward circuit reactivity has yet to be examined. METHODS Fifty-two MDD patients were randomly assigned to either 10-week iCBT (n = 26) or monitored attention control (MAC, n = 26) programs. All patients completed pre- and post-treatment assessments of anhedonia (Snaith-Hamilton Pleasure Scale; SHAPS) and reward circuit reactivity [monetary incentive delay (MID) task during functional magnetic resonance imaging (fMRI)]. Healthy control participants (n = 42) also underwent two fMRI scans while completing the MID task 10 weeks apart. RESULTS Both iCBT and MAC groups exhibited a reduction in anhedonia severity post-treatment. Nevertheless, only the iCBT group exhibited enhanced nucleus accumbens (Nacc) and subgenual anterior cingulate cortex (sgACC) activation and functional connectivity from pre- to post-treatment in response to reward feedback. Enhanced Nacc and sgACC activations were associated with reduced anhedonia severity following iCBT treatment, with enhanced Nacc activation also mediating the reduction in anhedonia severity post-treatment. CONCLUSIONS These findings suggest that increased reward circuit reactivity may contribute to a reduction in anhedonia severity following iCBT treatment for depression.
Collapse
Affiliation(s)
- Shir Hanuka
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Elizabeth A Olson
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Roee Admon
- School of Psychological Sciences, University of Haifa, Haifa, Israel
- The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel
| | - Christian A Webb
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Scott L Rauch
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
16
|
Clancy KJ, Devignes Q, Kumar P, May V, Hammack SE, Akman E, Casteen EJ, Pernia CD, Jobson SA, Lewis MW, Daskalakis NP, Carlezon WA, Ressler KJ, Rauch SL, Rosso IM. Circulating PACAP levels are associated with increased amygdala-default mode network resting-state connectivity in posttraumatic stress disorder. Neuropsychopharmacology 2023:10.1038/s41386-023-01593-5. [PMID: 37161077 PMCID: PMC10267202 DOI: 10.1038/s41386-023-01593-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
The pituitary adenylate cyclase-activating polypeptide (PACAP) system is implicated in posttraumatic stress disorder (PTSD) and related amygdala-mediated arousal and threat reactivity. PTSD is characterized by increased amygdala reactivity to threat and, more recently, aberrant intrinsic connectivity of the amygdala with large-scale resting state networks, specifically the default mode network (DMN). While the influence of PACAP on amygdala reactivity has been described, its association with intrinsic amygdala connectivity remains unknown. To fill this gap, we examined functional connectivity of resting-state functional magnetic resonance imaging (fMRI) in eighty-nine trauma-exposed adults (69 female) screened for PTSD symptoms to examine the association between blood-borne (circulating) PACAP levels and amygdala-DMN connectivity. Higher circulating PACAP levels were associated with increased amygdala connectivity with posterior DMN regions, including the posterior cingulate cortex/precuneus (PCC/Precun) and left angular gyrus (lANG). Consistent with prior work, this effect was seen in female, but not male, participants and the centromedial, but not basolateral, subregions of the amygdala. Clinical association analyses linked amygdala-PCC/Precun connectivity to anxious arousal symptoms, specifically exaggerated startle response. Taken together, our findings converge with previously demonstrated effects of PACAP on amygdala activity in PTSD-related processes and offer novel evidence for an association between PACAP and intrinsic amygdala connectivity patterns in PTSD. Moreover, these data provide preliminary evidence to motivate future work ascertaining the sex- and subregion-specificity of these effects. Such findings may enable novel mechanistic insights into neural circuit dysfunction in PTSD and how the PACAP system confers risk through a disruption of intrinsic resting-state network dynamics.
Collapse
Affiliation(s)
- Kevin J Clancy
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Quentin Devignes
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Poornima Kumar
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Victor May
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Eylül Akman
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Emily J Casteen
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Cameron D Pernia
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sydney A Jobson
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Michael W Lewis
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Nikolaos P Daskalakis
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - William A Carlezon
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Scott L Rauch
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
17
|
Jones CW, An X, Ji Y, Liu M, Zeng D, House SL, Beaudoin FL, Stevens JS, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Punches BE, Lyons MS, Kurz MC, Swor RA, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Harris E, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Koenen KC, Ressler KJ, Kessler RC, McLean SA. Derivation and Validation of a Brief Emergency Department-Based Prediction Tool for Posttraumatic Stress After Motor Vehicle Collision. Ann Emerg Med 2023; 81:249-261. [PMID: 36328855 DOI: 10.1016/j.annemergmed.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
STUDY OBJECTIVE To derive and initially validate a brief bedside clinical decision support tool that identifies emergency department (ED) patients at high risk of substantial, persistent posttraumatic stress symptoms after a motor vehicle collision. METHODS Derivation (n=1,282, 19 ED sites) and validation (n=282, 11 separate ED sites) data were obtained from adults prospectively enrolled in the Advancing Understanding of RecOvery afteR traumA study who were discharged from the ED after motor vehicle collision-related trauma. The primary outcome was substantial posttraumatic stress symptoms at 3 months (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders-5 ≥38). Logistic regression derivation models were evaluated for discriminative ability using the area under the curve and the accuracy of predicted risk probabilities (Brier score). Candidate posttraumatic stress predictors assessed in these models (n=265) spanned a range of sociodemographic, baseline health, peritraumatic, and mechanistic domains. The final model selection was based on performance and ease of administration. RESULTS Significant 3-month posttraumatic stress symptoms were common in the derivation (27%) and validation (26%) cohort. The area under the curve and Brier score of the final 8-question tool were 0.82 and 0.14 in the derivation cohort and 0.76 and 0.17 in the validation cohort. CONCLUSION This simple 8-question tool demonstrates promise to risk-stratify individuals with substantial posttraumatic stress symptoms who are discharged to home after a motor vehicle collision. Both external validation of this instrument, and work to further develop more accurate tools, are needed. Such tools might benefit public health by enabling the conduct of preventive intervention trials and assisting the growing number of EDs that provide services to trauma survivors aimed at promoting psychological recovery.
Collapse
Affiliation(s)
- Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ
| | - Xinming An
- Department of Anesthesiology, Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yinyao Ji
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Mochuan Liu
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO
| | - Francesca L Beaudoin
- Department of Emergency Medicine and Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Thomas C Neylan
- Department of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine and Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI
| | - Sarah D Linnstaedt
- Department of Anesthesiology, Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA; The Many Brains Project, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience and Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, McLean Hospital, Belmont, MA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Phyllis L Hendry
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL; Department of Emergency Medicine, University of Cincinnati College of Medicine, and College of Nursing, University of Cincinnati, Cincinnati, OH
| | - Brittany E Punches
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL
| | - Michael S Lyons
- College of Nursing, University of Cincinnati, Cincinnati, OH
| | - Michael C Kurz
- Department of Emergency Medicine, Division of Acute Care Surgery, Department of Surgery, University of Alabama School of Medicine, and Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA; Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA
| | - Mark J Seamon
- Division of Traumatology, Department of Surgery, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, and the Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA
| | | | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St John Hospital, Detroit, MI
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX
| | - Leon D Sanchez
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St Louis, St Louis, MO
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston, MA; Clinical Neurosciences Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT
| | | | - Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, MO
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA
| | - John F Sheridan
- Department of Biosciences, and the Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, and Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA
| | - Steven E Harte
- Department of Anesthesiology, and Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI
| | - James M Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, and Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia, and Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, MO
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Samuel A McLean
- Departments of Emergency Medicine and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| |
Collapse
|
18
|
Lewis MW, Bradford DE, Pace-Schott EF, Rauch SL, Rosso IM. Multiverse analyses of fear acquisition and extinction retention in posttraumatic stress disorder. Psychophysiology 2023:e14265. [PMID: 36786400 DOI: 10.1111/psyp.14265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/13/2022] [Accepted: 01/14/2023] [Indexed: 02/15/2023]
Abstract
Persistent fear is a cardinal feature of posttraumatic stress disorder (PTSD), and deficient fear extinction retention is a proposed illness mechanism and target of exposure-based therapy. However, evidence for deficient fear extinction in PTSD has been mixed using laboratory paradigms, which may relate to underidentified methodological variation across studies. We reviewed the literature to identify parameters that differ across studies of fear extinction retention in PTSD. We then performed Multiverse Analysis in a new sample, to quantify the impact of those methodological parameters on statistical findings. In 25 PTSD patients (15 female) and 36 trauma-exposed non-PTSD controls (TENC) (20 female), we recorded skin conductance response (SCR) during fear acquisition and extinction learning (day 1) and extinction recall (day 2). A first Multiverse Analysis examined the effects of methodological parameters identified by the literature review on comparisons of SCR-based fear extinction retention in PTSD versus TENC. A second Multiverse Analysis examined the effects of those methodological parameters on comparisons of SCR to a danger cue (CS+) versus safety cue (CS-) during fear acquisition. Both the literature review and the Multiverse Analysis yielded inconsistent findings for fear extinction retention in PTSD versus TENC, and most analyses found no statistically significant group difference. By contrast, significantly elevated SCR to CS+ versus CS- was consistently found across all analyses in the literature review and the Multiverse Analysis of new data. We discuss methodological parameters that may most contribute to inconsistent findings of fear extinction retention deficit in PTSD and implications for future clinical research.
Collapse
Affiliation(s)
- Michael W Lewis
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel E Bradford
- School of Psychological Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Edward F Pace-Schott
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Scott L Rauch
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
19
|
Chow SM, Nahum-Shani I, Baker JT, Spruijt-Metz D, Allen NB, Auerbach RP, Dunton GF, Friedman NP, Intille SS, Klasnja P, Marlin B, Nock MK, Rauch SL, Pavel M, Vrieze S, Wetter DW, Kleiman EM, Brick TR, Perry H, Wolff-Hughes DL. The ILHBN: challenges, opportunities, and solutions from harmonizing data under heterogeneous study designs, target populations, and measurement protocols. Transl Behav Med 2023; 13:7-16. [PMID: 36416389 PMCID: PMC9853092 DOI: 10.1093/tbm/ibac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The ILHBN is funded by the National Institutes of Health to collaboratively study the interactive dynamics of behavior, health, and the environment using Intensive Longitudinal Data (ILD) to (a) understand and intervene on behavior and health and (b) develop new analytic methods to innovate behavioral theories and interventions. The heterogenous study designs, populations, and measurement protocols adopted by the seven studies within the ILHBN created practical challenges, but also unprecedented opportunities to capitalize on data harmonization to provide comparable views of data from different studies, enhance the quality and utility of expensive and hard-won ILD, and amplify scientific yield. The purpose of this article is to provide a brief report of the challenges, opportunities, and solutions from some of the ILHBN's cross-study data harmonization efforts. We review the process through which harmonization challenges and opportunities motivated the development of tools and collection of metadata within the ILHBN. A variety of strategies have been adopted within the ILHBN to facilitate harmonization of ecological momentary assessment, location, accelerometer, and participant engagement data while preserving theory-driven heterogeneity and data privacy considerations. Several tools have been developed by the ILHBN to resolve challenges in integrating ILD across multiple data streams and time scales both within and across studies. Harmonization of distinct longitudinal measures, measurement tools, and sampling rates across studies is challenging, but also opens up new opportunities to address cross-cutting scientific themes of interest.
Collapse
Affiliation(s)
- Sy-Miin Chow
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Justin T Baker
- Department of Psychiatry, McLean Hospital, Boson, MA, USA
- Department of Psychiatry, Harvard Medical School, Boson, MA, USA
| | - Donna Spruijt-Metz
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | | | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Genevieve F Dunton
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Naomi P Friedman
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Stephen S Intille
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin Marlin
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Franciscan Children’s, Boston, MA, USA
- Children’s Hospital, Boston, MA, USA
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Boson, MA, USA
- Department of Psychiatry, Harvard Medical School, Boson, MA, USA
| | - Misha Pavel
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Scott Vrieze
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Evan M Kleiman
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Timothy R Brick
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802, USA
- Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Heather Perry
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802, USA
| | | |
Collapse
|
20
|
Beaudoin FL, An X, Basu A, Ji Y, Liu M, Kessler RC, Doughtery RF, Zeng D, Bollen KA, House SL, Stevens JS, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Swor RA, Murty VP, McGrath ME, Hudak LA, Pascual JL, Datner EM, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, Neil BJO, Sergot P, Sanchez LD, Bruce SE, Baker JT, Joormann J, Miller MW, Pietrzak RH, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Koenen KC, Ressler KJ, McLean SA. Use of serial smartphone-based assessments to characterize diverse neuropsychiatric symptom trajectories in a large trauma survivor cohort. Transl Psychiatry 2023; 13:4. [PMID: 36609484 PMCID: PMC9823011 DOI: 10.1038/s41398-022-02289-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/25/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023] Open
Abstract
The authors sought to characterize adverse posttraumatic neuropsychiatric sequelae (APNS) symptom trajectories across ten symptom domains (pain, depression, sleep, nightmares, avoidance, re-experiencing, anxiety, hyperarousal, somatic, and mental/fatigue symptoms) in a large, diverse, understudied sample of motor vehicle collision (MVC) survivors. More than two thousand MVC survivors were enrolled in the emergency department (ED) and completed a rotating battery of brief smartphone-based surveys over a 2-month period. Measurement models developed from survey item responses were used in latent growth curve/mixture modeling to characterize homogeneous symptom trajectories. Associations between individual trajectories and pre-trauma and peritraumatic characteristics and traditional outcomes were compared, along with associations within and between trajectories. APNS across all ten symptom domains were common in the first two months after trauma. Many risk factors and associations with high symptom burden trajectories were shared across domains. Both across and within traditional diagnostic boundaries, APNS trajectory intercepts, and slopes were substantially correlated. Across all domains, symptom severity in the immediate aftermath of trauma (trajectory intercepts) had the greatest influence on the outcome. An interactive data visualization tool was developed to allow readers to explore relationships of interest between individual characteristics, symptom trajectories, and traditional outcomes ( http://itr.med.unc.edu/aurora/parcoord/ ). Individuals presenting to the ED after MVC commonly experience a broad constellation of adverse posttraumatic symptoms. Many risk factors for diverse APNS are shared. Individuals diagnosed with a single traditional outcome should be screened for others. The utility of multidimensional categorizations that characterize individuals across traditional diagnostic domains should be explored.
Collapse
Affiliation(s)
- Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, USA
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Archana Basu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Yinyao Ji
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mochuan Liu
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | | | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- The Many Brains Project, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O' Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | | | - Jutta Joormann
- Department of Psychology, Yale University, West Haven, CT, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - John F Sheridan
- Department of Biosciences, OSU Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local, Health District, NSW, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
21
|
Hinojosa CA, VanElzakker MB, Hughes KC, Offringa R, Sangermano LM, Spaulding IG, Staples-Bradley LK, Whitman ET, Lasko NB, Rauch SL, Orr SP, Pitman RK, Shin LM. Exaggerated amygdala activation to ambiguous facial expressions is a familial vulnerability factor for posttraumatic stress disorder. J Psychiatr Res 2022; 156:451-459. [PMID: 36332360 PMCID: PMC9742331 DOI: 10.1016/j.jpsychires.2022.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous research has reported hyperresponsivity in the amygdala and hyporesponsivity in ventral portions of the medial prefrontal cortex to threat-related stimuli in posttraumatic stress disorder (PTSD). Whether such findings generalize to more ambiguous stimuli and whether such brain activation abnormalities reflect familial vulnerabilities, trauma-exposure, or acquired characteristics of PTSD remain unclear. In this study, we measured brain responses to emotionally ambiguous stimuli (i.e., surprised facial expressions) in identical twin pairs discordant for trauma exposure to elucidate the origin of brain activation abnormalities. METHODS Participants with PTSD (n = 12) and their trauma-unexposed identical cotwins (n = 12), as well as trauma-exposed participants without PTSD (n = 15) and their trauma-unexposed identical cotwins (n = 15), passively viewed surprised and neutral facial expressions during functional magnetic resonance imaging (fMRI). Afterward, participants labeled and rated each facial expression on valence and arousal. RESULTS Amygdala activation to Surprised and Neutral facial expressions (versus Fixation) was greater in the participants with PTSD and their trauma-unexposed identical cotwins without PTSD, compared to the control twin pairs. In contrast, medial frontal gyrus (MFG) activation to Surprised facial expressions (versus Fixation) was diminished in the PTSD group relative to the other three groups. CONCLUSIONS Amygdala hyperresponsivity to emotionally ambiguous facial expressions may be a familial vulnerability factor that increases the likelihood of developing PTSD after experiencing a traumatic event. In contrast, MFG hyporesponsivity may be an acquired characteristic of the disorder.
Collapse
Affiliation(s)
- Cecilia A Hinojosa
- Department of Psychology, Tufts University, Medford, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Michael B VanElzakker
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Katherine C Hughes
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Reid Offringa
- Department of Psychology, Tufts University, Medford, MA, USA
| | - Lisa M Sangermano
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Isabella G Spaulding
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Lindsay K Staples-Bradley
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Ethan T Whitman
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Natasha B Lasko
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Lisa M Shin
- Department of Psychology, Tufts University, Medford, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA.
| |
Collapse
|
22
|
Short NA, van Rooij SJH, Murty VP, Stevens JS, An X, Ji Y, McLean SA, House SL, Beaudoin FL, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Kessler RC, Koenen KC, Jovanovic T. Anxiety sensitivity as a transdiagnostic risk factor for trajectories of adverse posttraumatic neuropsychiatric sequelae in the AURORA study. J Psychiatr Res 2022; 156:45-54. [PMID: 36242943 PMCID: PMC10960961 DOI: 10.1016/j.jpsychires.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/16/2022] [Accepted: 09/16/2022] [Indexed: 01/20/2023]
Abstract
Anxiety sensitivity, or fear of anxious arousal, is cross-sectionally associated with a wide array of adverse posttraumatic neuropsychiatric sequelae, including symptoms of posttraumatic stress disorder, depression, anxiety, sleep disturbance, pain, and somatization. The current study utilizes a large-scale, multi-site, prospective study of trauma survivors presenting to emergency departments. Hypotheses tested whether elevated anxiety sensitivity in the immediate posttrauma period is associated with more severe and persistent trajectories of common adverse posttraumatic neuropsychiatric sequelae in the eight weeks posttrauma. Participants from the AURORA study (n = 2,269 recruited from 23 emergency departments) completed self-report assessments over eight weeks posttrauma. Associations between heightened anxiety sensitivity and more severe and/or persistent trajectories of trauma-related symptoms identified by growth mixture modeling were analyzed. Anxiety sensitivity assessed two weeks posttrauma was associated with severe and/or persistent posttraumatic stress, depression, anxiety, sleep disturbance, pain, and somatic symptoms in the eight weeks posttrauma. Effect sizes were in the small to medium range in multivariate models accounting for various demographic, trauma-related, pre-trauma mental health-related, and personality-related factors. Anxiety sensitivity may be a useful transdiagnostic risk factor in the immediate posttraumatic period identifying individuals at risk for the development of adverse posttraumatic neuropsychiatric sequelae. Further, considering anxiety sensitivity is malleable via brief intervention, it could be a useful secondary prevention target. Future research should continue to evaluate associations between anxiety sensitivity and trauma-related pathology.
Collapse
Affiliation(s)
- Nicole A Short
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA; Department of Psychology, University of Nevada, Las Vegas, NV, 89154, USA.
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, 19121, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Yinyao Ji
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA; Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, The Brown University School of Public Health, Providence, RI, 02930, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27559, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA; The Many Brains Project, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, 01655, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, 43210, USA; Ohio State University College of Nursing, Columbus, OH, 43210, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, 48309, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, 19141, USA; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, 48202, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, 48202, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, 77030, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, 06510, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - John F Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, OH, 43210, USA; Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA; Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, 02142, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James M Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, 2065, Australia; Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, 2006, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, 48202, USA
| |
Collapse
|
23
|
Punches BE, Stolz U, Freiermuth CE, Ancona RM, McLean SA, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Kurz MC, Gentile NT, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Harris E, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O’Neil BJ, Sanchez LD, Bruce SE, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Smoller JW, Luna B, Harte SE, Elliott JM, Kessler RC, Ressler KJ, Koenen KC, Lyons MS. Predicting at-risk opioid use three months after ed visit for trauma: Results from the AURORA study. PLoS One 2022; 17:e0273378. [PMID: 36149896 PMCID: PMC9506640 DOI: 10.1371/journal.pone.0273378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/07/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use. Methods Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed for euphoria) in the 30 days before enrollment, and missing or incomplete data regarding opioid exposure or pain. We used multivariable logistic regression to assess the relationship between ED opioid exposure and at-risk opioid use, defined as any self-reported non-medical opioid use after initial ED encounter or prescription opioid use at 3-months. Results Of 1441 subjects completing 3-month follow-up, 872 participants were included for analysis. At-risk opioid use occurred within 3 months in 33/620 (5.3%, CI: 3.7,7.4) participants without ED opioid analgesic exposure; 4/16 (25.0%, CI: 8.3, 52.6) with ED opioid prescription only; 17/146 (11.6%, CI: 7.1, 18.3) with ED opioid administration only; 12/90 (13.3%, CI: 7.4, 22.5) with both. Controlling for clinical factors, adjusted odds ratios (aORs) for at-risk opioid use after ED opioid exposure were: ED prescription only: 4.9 (95% CI 1.4, 17.4); ED administration for analgesia only: 2.0 (CI 1.0, 3.8); both: 2.8 (CI 1.2, 6.5). Conclusions ED opioids were associated with subsequent at-risk opioid use within three months in a geographically diverse cohort of adult trauma patients. This supports need for prospective studies focused on the long-term consequences of ED opioid analgesic exposure to estimate individual risk and guide therapeutic decision-making.
Collapse
Affiliation(s)
- Brittany E. Punches
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
- Department of Emergency Medicine College of Medicine, The Ohio State University, Columbus, OH, United States of America
- * E-mail:
| | - Uwe Stolz
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States of America
| | - Caroline E. Freiermuth
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States of America
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Rachel M. Ancona
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Samuel A. McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Francesca L. Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, United States of America
| | - Xinming An
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Thomas C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, United States of America
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States of America
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, United States of America
| | - Sarah D. Linnstaedt
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Laura T. Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States of America
- The Many Brains Project, Belmont, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Kenneth A. Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Scott L. Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Department of Psychiatry, McLean Hospital, Belmont, MA, United States of America
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Christopher Lewandowski
- Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, United States of America
| | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States of America
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States of America
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, United States of America
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States of America
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, United States of America
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Nina T. Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States of America
| | - Meghan E. McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Jose L. Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, United States of America
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, United States of America
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, United States of America
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, United States of America
| | - Erica Harris
- Department of Emergency Medicine, Einstein Healthcare Network, Pennsylvania, PA, United States of America
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA, United States of America
| | - Anna M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, United States of America
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, United States of America
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Roland C. Merchant
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Robert M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, United States of America
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States of America
| | - Brian J. O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, United States of America
| | - Leon D. Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri—St. Louis, St. Louis, MO, United States of America
| | - Robert H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT, United States of America
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, MO, United States of America
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, United States of America
| | - Jordan W. Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, United States of America
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - James M. Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, United States of America
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
| | - Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States of America
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| |
Collapse
|
24
|
Lebois LAM, Harnett NG, van Rooij SJH, Ely TD, Jovanovic T, Bruce SE, House SL, Ravichandran C, Dumornay NM, Finegold KE, Hill SB, Merker JB, Phillips KA, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Chang AM, Pearson C, Domeier RM, Rathlev NK, O’Neil BJ, Sergot P, Sanchez LD, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Luna B, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Stevens JS, Ressler KJ. Persistent Dissociation and Its Neural Correlates in Predicting Outcomes After Trauma Exposure. Am J Psychiatry 2022; 179:661-672. [PMID: 35730162 PMCID: PMC9444876 DOI: 10.1176/appi.ajp.21090911] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Dissociation, a disruption or discontinuity in psychological functioning, is often linked with worse psychiatric symptoms; however, the prognostic value of dissociation after trauma is inconsistent. Determining whether trauma-related dissociation is uniquely predictive of later outcomes would enable early identification of at-risk trauma populations. The authors conducted the largest prospective longitudinal biomarker study of persistent dissociation to date to determine its predictive capacity for adverse psychiatric outcomes following acute trauma. METHODS All data were part of the Freeze 2 data release from the Advancing Understanding of Recovery After Trauma (AURORA) study. Study participants provided self-report data about persistent derealization (N=1,464), a severe type of dissociation, and completed a functional MRI emotion reactivity task and resting-state scan 2 weeks posttrauma (N=145). Three-month follow-up reports were collected of posttraumatic stress, depression, pain, anxiety symptoms, and functional impairment. RESULTS Derealization was associated with increased ventromedial prefrontal cortex (vmPFC) activation in the emotion reactivity task and decreased resting-state vmPFC connectivity with the cerebellum and orbitofrontal cortex. In separate analyses, brain-based and self-report measures of persistent derealization at 2 weeks predicted worse 3-month posttraumatic stress symptoms, distinct from the effects of childhood maltreatment history and current posttraumatic stress symptoms. CONCLUSIONS The findings suggest that persistent derealization is both an early psychological and biological marker of worse later psychiatric outcomes. The neural correlates of trauma-related dissociation may serve as potential targets for treatment engagement to prevent posttraumatic stress disorder. These results underscore dissociation assessment as crucial following trauma exposure to identify at-risk individuals, and they highlight an unmet clinical need for tailored early interventions.
Collapse
Affiliation(s)
- Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Caitlin Ravichandran
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA
| | - Nathalie M Dumornay
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | | | - Sarah B Hill
- Department of Psychology, Northern Illinois University, DeKalb, IL, 60115, USA
| | - Julia B Merker
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - Karlye A Phillips
- McLean Hospital, Belmont, MA, 02478, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, 02930, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- The Many Brains Project, Belmont, MA, 02478, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- College of Nursing, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, 48309, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Pennsylvania, PA, 19141, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA, 19107, USA
| | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, 77030, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - John F Sheridan
- Department of Biosciences, OSU Wexner Medical Center, Columbus, OH, 43210, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, 02142, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James M Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, 2006, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| |
Collapse
|
25
|
Tanriverdi B, Gregory DF, Olino TM, Ely TD, Harnett NG, van Rooij SJH, Lebois LAM, Seligowski AV, Jovanovic T, Ressler KJ, House SL, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Domeier RM, Rathlev NK, O'Neil BJ, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, McLean SA, Kessler RC, Koenen KC, Stevens JS, Murty VP. Hippocampal Threat Reactivity Interacts with Physiological Arousal to Predict PTSD Symptoms. J Neurosci 2022; 42:6593-6604. [PMID: 35879096 PMCID: PMC9410748 DOI: 10.1523/jneurosci.0911-21.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/21/2022] Open
Abstract
Hippo campal impairments are reliably associated with post-traumatic stress disorder (PTSD); however, little research has characterized how increased threat sensitivity may interact with arousal responses to alter hippocampal reactivity, and further how these interactions relate to the sequelae of trauma-related symptoms. In a sample of individuals recently exposed to trauma (N = 116, 76 female), we found that PTSD symptoms at 2 weeks were associated with decreased hippocampal responses to threat as assessed with fMRI. Further, the relationship between hippocampal threat sensitivity and PTSD symptomology only emerged in individuals who showed transient, high threat-related arousal, as assayed by an independently collected measure of fear potentiated startle. Collectively, our finding suggests that development of PTSD is associated with threat-related decreases in hippocampal function because of increases in fear-potentiated arousal.SIGNIFICANCE STATEMENT Alterations in hippocampal function linked to threat-related arousal are reliably associated with post-traumatic stress disorder (PTSD); however, how these alterations relate to the sequelae of trauma-related symptoms is unknown. Prior models based on nontrauma samples suggest that arousal may impact hippocampal neurophysiology leading to maladaptive behavior. Here we show that decreased hippocampal threat sensitivity interacts with fear-potentiated startle to predict PTSD symptoms. Specifically, individuals with high fear-potentiated startle and low, transient hippocampal threat sensitivity showed the greatest PTSD symptomology. These findings bridge literatures of threat-related arousal and hippocampal function to better understand PTSD risk.
Collapse
Affiliation(s)
- Büşra Tanriverdi
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania 19121
| | - David F Gregory
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania 19121
| | - Thomas M Olino
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania 19121
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30329
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts 02478
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30329
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts 02478
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
| | - Antonia V Seligowski
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts 02478
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan 48202
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts 02478
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri 63110
| | - Francesca L Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and Miriam Hospital, Providence, Rhode Island 02930
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27559
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, California 94143
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia 30332
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia 30332
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27559
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts 02478
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27559
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
- Institute for Technology in Psychiatry/Department of Psychiatry, McLean Hospital, Belmont, Massachusetts 02478
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida 32209
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida 32209
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey 08103
| | - Brittany E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
- College of Nursing, University of Cincinnati, Cincinnati, Ohio 45221
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama 35294
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, Alabama 35294
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama 35294
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts 02118
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia 30329
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania 19141
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan 48202
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan 48197
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts 01107
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan 48202
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts 02115
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, Missouri 63121
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts 02130
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts 02118
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut 06516
- Department of Psychiatry, Yale School of Medicine, West Haven, Connecticut 06510
| | - Jutta Joormann
- Department of Psychology, Yale University, West Haven, Connecticut 06520
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri 63130
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts 02478
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
| | - John F Sheridan
- Department of Biosciences, Ohio State University Wexner Medical Center, Columbus, Ohio 43210
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, Ohio 43211
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts 02114
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts 02142
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan 48109
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - James M Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales 2006, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60208
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27559
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27559
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30329
| | - Vishnu P Murty
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania 19121
| |
Collapse
|
26
|
Harnett NG, Finegold KE, Lebois LAM, van Rooij SJH, Ely TD, Murty VP, Jovanovic T, Bruce SE, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Swor RA, Hudak LA, Pascual JL, Seamon MJ, Harris E, Chang AM, Pearson C, Peak DA, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Nickerson LD, Ressler KJ, Stevens JS. Structural covariance of the ventral visual stream predicts posttraumatic intrusion and nightmare symptoms: a multivariate data fusion analysis. Transl Psychiatry 2022; 12:321. [PMID: 35941117 PMCID: PMC9360028 DOI: 10.1038/s41398-022-02085-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 01/16/2023] Open
Abstract
Visual components of trauma memories are often vividly re-experienced by survivors with deleterious consequences for normal function. Neuroimaging research on trauma has primarily focused on threat-processing circuitry as core to trauma-related dysfunction. Conversely, limited attention has been given to visual circuitry which may be particularly relevant to posttraumatic stress disorder (PTSD). Prior work suggests that the ventral visual stream is directly related to the cognitive and affective disturbances observed in PTSD and may be predictive of later symptom expression. The present study used multimodal magnetic resonance imaging data (n = 278) collected two weeks after trauma exposure from the AURORA study, a longitudinal, multisite investigation of adverse posttraumatic neuropsychiatric sequelae. Indices of gray and white matter were combined using data fusion to identify a structural covariance network (SCN) of the ventral visual stream 2 weeks after trauma. Participant's loadings on the SCN were positively associated with both intrusion symptoms and intensity of nightmares. Further, SCN loadings moderated connectivity between a previously observed amygdala-hippocampal functional covariance network and the inferior temporal gyrus. Follow-up MRI data at 6 months showed an inverse relationship between SCN loadings and negative alterations in cognition in mood. Further, individuals who showed decreased strength of the SCN between 2 weeks and 6 months had generally higher PTSD symptom severity over time. The present findings highlight a role for structural integrity of the ventral visual stream in the development of PTSD. The ventral visual stream may be particularly important for the consolidation or retrieval of trauma memories and may contribute to efficient reactivation of visual components of the trauma memory, thereby exacerbating PTSD symptoms. Potentially chronic engagement of the network may lead to reduced structural integrity which becomes a risk factor for lasting PTSD symptoms.
Collapse
Affiliation(s)
- Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | | | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- The Many Brains Project, Belmont, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA
- Ohio State University College of Nursing, Columbus, OH, USA
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John F Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, OH, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa D Nickerson
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Imaging Center, McLean Hospital, Belmont, MA, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
27
|
Ressler KJ, Berretta S, Bolshakov VY, Rosso IM, Meloni EG, Rauch SL, Carlezon WA. Post-traumatic stress disorder: clinical and translational neuroscience from cells to circuits. Nat Rev Neurol 2022; 18:273-288. [PMID: 35352034 PMCID: PMC9682920 DOI: 10.1038/s41582-022-00635-8] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 01/16/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a maladaptive and debilitating psychiatric disorder, characterized by re-experiencing, avoidance, negative emotions and thoughts, and hyperarousal in the months and years following exposure to severe trauma. PTSD has a prevalence of approximately 6-8% in the general population, although this can increase to 25% among groups who have experienced severe psychological trauma, such as combat veterans, refugees and victims of assault. The risk of developing PTSD in the aftermath of severe trauma is determined by multiple factors, including genetics - at least 30-40% of the risk of PTSD is heritable - and past history, for example, prior adult and childhood trauma. Many of the primary symptoms of PTSD, including hyperarousal and sleep dysregulation, are increasingly understood through translational neuroscience. In addition, a large amount of evidence suggests that PTSD can be viewed, at least in part, as a disorder that involves dysregulation of normal fear processes. The neural circuitry underlying fear and threat-related behaviour and learning in mammals, including the amygdala-hippocampus-medial prefrontal cortex circuit, is among the most well-understood in behavioural neuroscience. Furthermore, the study of threat-responding and its underlying circuitry has led to rapid progress in understanding learning and memory processes. By combining molecular-genetic approaches with a translational, mechanistic knowledge of fear circuitry, transformational advances in the conceptual framework, diagnosis and treatment of PTSD are possible. In this Review, we describe the clinical features and current treatments for PTSD, examine the neurobiology of symptom domains, highlight genomic advances and discuss translational approaches to understanding mechanisms and identifying new treatments and interventions for this devastating syndrome.
Collapse
Affiliation(s)
- Kerry J Ressler
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sabina Berretta
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Vadim Y Bolshakov
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward G Meloni
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott L Rauch
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - William A Carlezon
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
28
|
Shen FX, Silverman BC, Monette P, Kimble S, Rauch SL, Baker JT. An Ethics Checklist for Digital Health Research in Psychiatry: Viewpoint. J Med Internet Res 2022; 24:e31146. [PMID: 35138261 PMCID: PMC8867294 DOI: 10.2196/31146] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/23/2021] [Accepted: 10/29/2021] [Indexed: 01/23/2023] Open
Abstract
Background Psychiatry has long needed a better and more scalable way to capture the dynamics of behavior and its disturbances, quantitatively across multiple data channels, at high temporal resolution in real time. By combining 24/7 data—on location, movement, email and text communications, and social media—with brain scans, genetics, genomics, neuropsychological batteries, and clinical interviews, researchers will have an unprecedented amount of objective, individual-level data. Analyzing these data with ever-evolving artificial intelligence could one day include bringing interventions to patients where they are in the real world in a convenient, efficient, effective, and timely way. Yet, the road to this innovative future is fraught with ethical dilemmas as well as ethical, legal, and social implications (ELSI). Objective The goal of the Ethics Checklist is to promote careful design and execution of research. It is not meant to mandate particular research designs; indeed, at this early stage and without consensus guidance, there are a range of reasonable choices researchers may make. However, the checklist is meant to make those ethical choices explicit, and to require researchers to give reasons for their decisions related to ELSI issues. The Ethics Checklist is primarily focused on procedural safeguards, such as consulting with experts outside the research group and documenting standard operating procedures for clearly actionable data (eg, expressed suicidality) within written research protocols. Methods We explored the ELSI of digital health research in psychiatry, with a particular focus on what we label “deep phenotyping” psychiatric research, which combines the potential for virtually boundless data collection and increasingly sophisticated techniques to analyze those data. We convened an interdisciplinary expert stakeholder workshop in May 2020, and this checklist emerges out of that dialogue. Results Consistent with recent ELSI analyses, we find that existing ethical guidance and legal regulations are not sufficient for deep phenotyping research in psychiatry. At present, there are regulatory gaps, inconsistencies across research teams in ethics protocols, and a lack of consensus among institutional review boards on when and how deep phenotyping research should proceed. We thus developed a new instrument, an Ethics Checklist for Digital Health Research in Psychiatry (“the Ethics Checklist”). The Ethics Checklist is composed of 20 key questions, subdivided into 6 interrelated domains: (1) informed consent; (2) equity, diversity, and access; (3) privacy and partnerships; (4) regulation and law; (5) return of results; and (6) duty to warn and duty to report. Conclusions Deep phenotyping research offers a vision for vastly more effective care for people with, or at risk for, psychiatric disease. The potential perils en route to realizing this vision are significant; however, and researchers must be willing to address the questions in the Ethics Checklist before embarking on each leg of the journey.
Collapse
Affiliation(s)
- Francis X Shen
- Harvard Medical School, Boston, MA, United States.,Law School, University of Minnesota, Minneapolis, MN, United States
| | - Benjamin C Silverman
- Harvard Medical School, Boston, MA, United States.,Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Patrick Monette
- Harvard Medical School, Boston, MA, United States.,Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Sara Kimble
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Scott L Rauch
- Harvard Medical School, Boston, MA, United States.,Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Justin T Baker
- Harvard Medical School, Boston, MA, United States.,Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
| |
Collapse
|
29
|
Germine LT, Joormann J, Passell E, Rutter LA, Scheuer L, Martini P, Hwang I, Lee S, Sampson N, Barch DM, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Linnstaedt SD, Jovanovic T, Clifford GD, Neylan TC, Rauch SL, Lewandowski C, Hendry PL, Sheikh S, Storrow AB, Musey PI, Jones CW, Punches BE, McGrath ME, Pascual JL, Mohiuddin K, Pearson C, Peak DA, Domeier RM, Bruce SE, Rathlev NK, Sanchez LD, Pietrzak RH, Pizzagalli DA, Harte SE, Elliott JM, Koenen KC, Ressler KJ, McLean SA, Kessler RC. Neurocognition after motor vehicle collision and adverse post-traumatic neuropsychiatric sequelae within 8 weeks: Initial findings from the AURORA study. J Affect Disord 2022; 298:57-67. [PMID: 34800569 PMCID: PMC10878171 DOI: 10.1016/j.jad.2021.10.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/14/2021] [Accepted: 10/23/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous work has indicated that differences in neurocognitive functioning may predict the development of adverse post-traumatic neuropsychiatric sequelae (APNS). Such differences may be vulnerability factors or simply correlates of APNS-related symptoms. Longitudinal studies that measure neurocognitive functioning at the time of trauma are needed to determine whether such differences precede the development of APNS. METHODS Here, we present findings from a subsample of 666 ambulatory patients from the AURORA (Advancing Understanding of RecOvery afteR trumA) study. All patients presented to EDs after a motor vehicle collision (MVC). We examined associations of neurocognitive test performance shortly after MVC with peritraumatic symptoms in the ED and APNS (depression, post-traumatic stress, post-concussive symptoms, and pain) 2 weeks and 8 weeks later. Neurocognitive tests assessed processing speed, attention, verbal reasoning, memory, and social perception. RESULTS Distress in the ED was associated with poorer processing speed and short-term memory. Poorer short-term memory was also associated with depression at 2 weeks post-MVC, even after controlling for peritraumatic distress. Finally, higher vocabulary scores were associated with pain 2 weeks post-MVC. LIMITATIONS Self-selection biases among those who present to the ED and enroll in the study limit generalizability. Also, it is not clear whether observed neurocognitive differences predate MVC exposure or arise in the immediate aftermath of MVC exposure. CONCLUSIONS Our results suggest that processing speed and short-term memory may be useful predictors of trauma-related characteristics and the development of some APNS, making such measures clinically-relevant for identifying at-risk individuals.
Collapse
Affiliation(s)
- Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; The Many Brains Project, Belmont, MA, USA.
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Eliza Passell
- Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA
| | - Lauren A Rutter
- Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Luke Scheuer
- Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA
| | | | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Sue Lee
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine and Health Services, Policy, and Practice, The Alpert Medical School of Brown University, USA; Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA; Department of Emergency Medicine, The Miriam Hospital, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, USA; Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Thomas C Neylan
- San Francisco VA Healthcare System, San Francisco, CA, USA; Departments of Psychiatry, University of California, San Francisco, CA, USA; Departments of Neurology, University of California, San Francisco, CA, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | | | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittney E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
| | - Jose L Pascual
- Department of Surgery and Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kamran Mohiuddin
- Dept. of Emergency Medicine/Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Departments of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA; Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- The Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karesten C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety Disorders, McLean hospital, Belmont, MA, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
30
|
Abstract
Obsessive Compulsive Disorder (OCD) is a highly prevalent and severe neuropsychiatric disorder, with an incidence of 1.5-3% worldwide. However, despite the clear public health burden of OCD and relatively well-defined symptom criteria, effective treatments are still limited, spotlighting the need for investigation of the neural substrates of the disorder. Human neuroimaging studies have consistently highlighted abnormal activity patterns in prefrontal cortex (PFC) regions and connected circuits in OCD during both symptom provocation and performance of neurocognitive tasks. Because of recent technical advances, these findings can now be leveraged to develop novel targeted interventions. Here we will highlight current theories regarding the role of the prefrontal cortex in the generation of OCD symptoms, discuss ways in which this knowledge can be used to improve treatments for this often disabling illness, and lay out challenges in the field for future study.
Collapse
Affiliation(s)
- Susanne E Ahmari
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
31
|
Joormann J, Ziobrowski HN, King A, Gildea SM, Lee S, Sampson NA, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Chang AM, Pearson C, Peak DA, Domeier RM, Rathlev NK, O’Neil BJ, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Barch DM, Pizzagalli DA, Harte SE, Elliott JM, Koenen KC, McLean SA, Kessler RC. Prior histories of posttraumatic stress disorder and major depression and their onset and course in the three months after a motor vehicle collision in the AURORA study. Depress Anxiety 2022; 39:56-70. [PMID: 34783142 PMCID: PMC8732322 DOI: 10.1002/da.23223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/17/2021] [Accepted: 10/26/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A better understanding of the extent to which prior occurrences of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) predict psychopathological reactions to subsequent traumas might be useful in targeting posttraumatic preventive interventions. METHODS Data come from 1306 patients presenting to 29 U.S. emergency departments (EDs) after a motor vehicle collision (MVC) in the advancing understanding of recovery after trauma study. Patients completed self-reports in the ED and 2-weeks, 8-weeks, and 3-months post-MVC. Associations of pre-MVC probable PTSD and probable MDE histories with subsequent 3-months post-MVC probable PTSD and probable MDE were examined along with mediation through intervening peritraumatic, 2-, and 8-week disorders. RESULTS 27.6% of patients had 3-month post-MVC probable PTSD and/or MDE. Pre-MVC lifetime histories of these disorders were not only significant (relative risk = 2.6-7.4) but were dominant (63.1% population attributable risk proportion [PARP]) predictors of this 3-month outcome, with 46.6% prevalence of the outcome among patients with pre-MVC disorder histories versus 9.9% among those without such histories. The associations of pre-MVC lifetime disorders with the 3-month outcome were mediated largely by 2- and 8-week probable PTSD and MDE (PARP decreasing to 22.8% with controls for these intervening disorders). Decomposition showed that pre-MVC lifetime histories predicted both onset and persistence of these intervening disorders as well as the higher conditional prevalence of the 3-month outcome in the presence of these intervening disorders. CONCLUSIONS Assessments of pre-MVC PTSD and MDE histories and follow-ups at 2 and 8 weeks could help target early interventions for psychopathological reactions to MVCs.
Collapse
Affiliation(s)
- Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Hannah N. Ziobrowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrew King
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Sarah M. Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Sue Lee
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Francesca L. Beaudoin
- Department of Emergency Medicine, The Alpert Medical School of Brown University, Providence, RI, 02930, USA
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Providence, RI, 02930, USA
- Rhode Island Hospital, Providence, RI, 02930, USA
- The Miriam Hospital, Providence, RI, 02930, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27559, USA
| | - Thomas C. Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, 94143, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Sarah D. Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T. Germine
- Department of Biomedical Engineering, Emory University, Atlanta, GA, 30332, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- The Many Brains Project, Belmont, MA, 02478, USA
| | - Kenneth A. Bollen
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Scott L. Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E. Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- College of Nursing, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Meghan E. McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Jose L. Pascual
- Department of Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Anna M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Robert M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J. O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - Leon D. Sanchez
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Mark W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Robert H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James M. Elliott
- Kolling Institute of Medical Research, University of Sydney, St. Leonards, New South Wales, 2065, Australia
- Faculty of Medicine and Health, University of Sydney, New South Wales, 2006, Australia
- Northern Sydney Local Health District, New South Wales, 2006, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Samuel A. McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| |
Collapse
|
32
|
Ziobrowski HN, Kennedy CJ, Ustun B, House SL, Beaudoin FL, An X, Zeng D, Bollen KA, Petukhova M, Sampson NA, Puac-Polanco V, Lee S, Koenen KC, Ressler KJ, McLean SA, Kessler RC, Stevens JS, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Lyons MS, Murty VP, McGrath ME, Pascual JL, Seamon MJ, Datner EM, Chang AM, Pearson C, Peak DA, Jambaulikar G, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Harte SE, Elliott JM, van Rooij SJH. Development and Validation of a Model to Predict Posttraumatic Stress Disorder and Major Depression After a Motor Vehicle Collision. JAMA Psychiatry 2021; 78:1228-1237. [PMID: 34468741 PMCID: PMC8411364 DOI: 10.1001/jamapsychiatry.2021.2427] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE A substantial proportion of the 40 million people in the US who present to emergency departments (EDs) each year after traumatic events develop posttraumatic stress disorder (PTSD) or major depressive episode (MDE). Accurately identifying patients at high risk in the ED would facilitate the targeting of preventive interventions. OBJECTIVES To develop and validate a prediction tool based on ED reports after a motor vehicle collision to predict PTSD or MDE 3 months later. DESIGN, SETTING, AND PARTICIPANTS The Advancing Understanding of Recovery After Trauma (AURORA) study is a longitudinal study that examined adverse posttraumatic neuropsychiatric sequalae among patients who presented to 28 US urban EDs in the immediate aftermath of a traumatic experience. Enrollment began on September 25, 2017. The 1003 patients considered in this diagnostic/prognostic report completed 3-month assessments by January 31, 2020. Each patient received a baseline ED assessment along with follow-up self-report surveys 2 weeks, 8 weeks, and 3 months later. An ensemble machine learning method was used to predict 3-month PTSD or MDE from baseline information. Data analysis was performed from November 1, 2020, to May 31, 2021. MAIN OUTCOMES AND MEASURES The PTSD Checklist for DSM-5 was used to assess PTSD and the Patient Reported Outcomes Measurement Information System Depression Short-Form 8b to assess MDE. RESULTS A total of 1003 patients (median [interquartile range] age, 34.5 [24-43] years; 715 [weighted 67.9%] female; 100 [weighted 10.7%] Hispanic, 537 [weighted 52.7%] non-Hispanic Black, 324 [weighted 32.2%] non-Hispanic White, and 42 [weighted 4.4%] of non-Hispanic other race or ethnicity were included in this study. A total of 274 patients (weighted 26.6%) met criteria for 3-month PTSD or MDE. An ensemble machine learning model restricted to 30 predictors estimated in a training sample (patients from the Northeast or Midwest) had good prediction accuracy (mean [SE] area under the curve [AUC], 0.815 [0.031]) and calibration (mean [SE] integrated calibration index, 0.040 [0.002]; mean [SE] expected calibration error, 0.039 [0.002]) in an independent test sample (patients from the South). Patients in the top 30% of predicted risk accounted for 65% of all 3-month PTSD or MDE, with a mean (SE) positive predictive value of 58.2% (6.4%) among these patients at high risk. The model had good consistency across regions of the country in terms of both AUC (mean [SE], 0.789 [0.025] using the Northeast as the test sample and 0.809 [0.023] using the Midwest as the test sample) and calibration (mean [SE] integrated calibration index, 0.048 [0.003] using the Northeast as the test sample and 0.024 [0.001] using the Midwest as the test sample; mean [SE] expected calibration error, 0.034 [0.003] using the Northeast as the test sample and 0.025 [0.001] using the Midwest as the test sample). The most important predictors in terms of Shapley Additive Explanations values were symptoms of anxiety sensitivity and depressive disposition, psychological distress in the 30 days before motor vehicle collision, and peritraumatic psychosomatic symptoms. CONCLUSIONS AND RELEVANCE The results of this study suggest that a short set of questions feasible to administer in an ED can predict 3-month PTSD or MDE with good AUC, calibration, and geographic consistency. Patients at high risk can be identified in the ED for targeting if cost-effective preventive interventions are developed.
Collapse
Affiliation(s)
| | - Chris J. Kennedy
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Berk Ustun
- Halıcıoğlu Data Science Institute, University of California, San Diego
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Francesca L. Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Kenneth A. Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Victor Puac-Polanco
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Sue Lee
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts,Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts
| | - Samuel A. McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill,Department of Emergency Medicine, University of North Carolina at Chapel Hill
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California, San Francisco
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia.,Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts.,The Many Brains Project, Belmont, Massachusetts
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Brittany E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.,College of Nursing, University of Cincinnati, Cincinnati, Ohio.,Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael S Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
| | - Jose L Pascual
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mark J Seamon
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania.,Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | | | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan
| | - Paulina Sergot
- McGovern Medical School, University of Texas Health Science Center, Houston
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri, St Louis
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, Veterans Affairs Connecticut Healthcare System, West Haven.,Department of Psychiatry, Yale School of Medicine, West Haven, Connecticut
| | - Jutta Joormann
- Department of Psychology, Yale University, West Haven, Connecticut
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University, St Louis, Missouri
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts.,Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - John F Sheridan
- Department of Biosciences and Neuroscience, Wexner Medical Center, The Ohio State University, Columbus.,Institute for Behavioral Medicine Research, Wexner Medical Center, The Ohio State University, Columbus
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor.,Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor
| | - James M Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia.,Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
33
|
Seligowski AV, Steuber ER, Hinrichs R, Reda MH, Wiltshire CN, Wanna CP, Winters SJ, Phillips KA, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Guffanti G, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Murty VP, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Luna B, Harte SE, Elliott JM, Koenen KC, Kessler RC, McLean SA, Ressler KJ, Jovanovic T. A prospective examination of sex differences in posttraumatic autonomic functioning. Neurobiol Stress 2021; 15:100384. [PMID: 34485632 PMCID: PMC8397921 DOI: 10.1016/j.ynstr.2021.100384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cross-sectional studies have found that individuals with posttraumatic stress disorder (PTSD) exhibit deficits in autonomic functioning. While PTSD rates are twice as high in women compared to men, sex differences in autonomic functioning are relatively unknown among trauma-exposed populations. The current study used a prospective design to examine sex differences in posttraumatic autonomic functioning. METHODS 192 participants were recruited from emergency departments following trauma exposure (Mean age = 35.88, 68.2% female). Skin conductance was measured in the emergency department; fear conditioning was completed two weeks later and included measures of blood pressure (BP), heart rate (HR), and high frequency heart rate variability (HF-HRV). PTSD symptoms were assessed 8 weeks after trauma. RESULTS 2-week systolic BP was significantly higher in men, while 2-week HR was significantly higher in women, and a sex by PTSD interaction suggested that women who developed PTSD demonstrated the highest HR levels. Two-week HF-HRV was significantly lower in women, and a sex by PTSD interaction suggested that women with PTSD demonstrated the lowest HF-HRV levels. Skin conductance response in the emergency department was associated with 2-week HR and HF-HRV only among women who developed PTSD. CONCLUSIONS Our results indicate that there are notable sex differences in autonomic functioning among trauma-exposed individuals. Differences in sympathetic biomarkers (BP and HR) may have implications for cardiovascular disease risk given that sympathetic arousal is a mechanism implicated in this risk among PTSD populations. Future research examining differential pathways between PTSD and cardiovascular risk among men versus women is warranted.
Collapse
Affiliation(s)
- Antonia V. Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | | | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Mariam H. Reda
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
| | | | - Cassandra P. Wanna
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
| | - Sterling J. Winters
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
| | - Karlye A. Phillips
- McLean Hospital, Belmont, MA, 02478, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Francesca L. Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and the Miriam Hospital, Providence, RI, 02930, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27559, USA
| | - Thomas C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
| | - Sarah D. Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T. Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- The Many Brains Project, Belmont, MA, 02478, USA
| | - Kenneth A. Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Guia Guffanti
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - Scott L. Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | | | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E. Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- College of Nursing, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, 35294, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, 35294, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Vishnu P. Murty
- Department of Psychology, Temple University, Philadelphia, PA, 19121, USA
| | - Meghan E. McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Jose L. Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Elizabeth M. Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Pennsylvania, PA, 19141, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA, 19107, USA
| | - Anna M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Roland C. Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Robert M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J. O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - Leon D. Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Mark W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Robert H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - John F. Sheridan
- Department of Biosciences, OSU Wexner Medical Center, Columbus, OH, 43210, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James M. Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, 2006, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Samuel A. McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
| |
Collapse
|
34
|
Stevens JS, Harnett NG, Lebois LAM, van Rooij SJH, Ely TD, Roeckner A, Vincent N, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Rauch SL, Lewandowski C, Storrow AB, Hendry PL, Sheikh S, Musey PI, Haran JP, Jones CW, Punches BE, Lyons MS, Kurz MC, McGrath ME, Pascual JL, Datner EM, Chang AM, Pearson C, Peak DA, Domeier RM, O'Neil BJ, Rathlev NK, Sanchez LD, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Luna B, Harte SE, Elliott JM, Murty VP, Jovanovic T, Bruce SE, House SL, Kessler RC, Koenen KC, McLean SA, Ressler KJ. Brain-Based Biotypes of Psychiatric Vulnerability in the Acute Aftermath of Trauma. Am J Psychiatry 2021; 178:1037-1049. [PMID: 34645277 PMCID: PMC9069566 DOI: 10.1176/appi.ajp.2021.20101526] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Major negative life events, such as trauma exposure, can play a key role in igniting or exacerbating psychopathology. However, few disorders are diagnosed with respect to precipitating events, and the role of these events in the unfolding of new psychopathology is not well understood. The authors conducted a multisite transdiagnostic longitudinal study of trauma exposure and related mental health outcomes to identify neurobiological predictors of risk, resilience, and different symptom presentations. METHODS A total of 146 participants (discovery cohort: N=69; internal replication cohort: N=77) were recruited from emergency departments within 72 hours of a trauma and followed for the next 6 months with a survey, MRI, and physiological assessments. RESULTS Task-based functional MRI 2 weeks after a motor vehicle collision identified four clusters of individuals based on profiles of neural activity reflecting threat reactivity, reward reactivity, and inhibitory engagement. Three clusters were replicated in an independent sample with a variety of trauma types. The clusters showed different longitudinal patterns of posttrauma symptoms. CONCLUSIONS These findings provide a novel characterization of heterogeneous stress responses shortly after trauma exposure, identifying potential neuroimaging-based biotypes of trauma resilience and psychopathology.
Collapse
Affiliation(s)
- Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Nathaniel G Harnett
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Lauren A M Lebois
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Alyssa Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Nico Vincent
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Francesca L Beaudoin
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Xinming An
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Donglin Zeng
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Thomas C Neylan
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Gari D Clifford
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Sarah D Linnstaedt
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Laura T Germine
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Scott L Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Christopher Lewandowski
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Alan B Storrow
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Phyllis L Hendry
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Sophia Sheikh
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Paul I Musey
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - John P Haran
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Christopher W Jones
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Brittany E Punches
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Michael S Lyons
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Michael C Kurz
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Meghan E McGrath
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Jose L Pascual
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Elizabeth M Datner
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Anna M Chang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Claire Pearson
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - David A Peak
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Robert M Domeier
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Brian J O'Neil
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Niels K Rathlev
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Leon D Sanchez
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Robert H Pietrzak
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Jutta Joormann
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Deanna M Barch
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Diego A Pizzagalli
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - John F Sheridan
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Beatriz Luna
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Steven E Harte
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - James M Elliott
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Vishnu P Murty
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Steven E Bruce
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Stacey L House
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Ronald C Kessler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Karestan C Koenen
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Samuel A McLean
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean)
| |
Collapse
|
35
|
Steuber ER, Seligowski AV, Roeckner AR, Reda M, Lebois LAM, van Rooij SJH, Murty VP, Ely TD, Bruce SE, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Rauch SL, Lewandowski C, Sheikh S, Jones CW, Punches BE, Swor RA, McGrath ME, Hudak LA, Pascual JL, Chang AM, Pearson C, Peak DA, Domeier RM, O'Neil BJ, Rathlev NK, Sanchez LD, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Elliott JM, Kessler RC, Koenen KC, McLean SA, Ressler KJ, Jovanovic T, Harnett NG, Stevens JS. Thalamic volume and fear extinction interact to predict acute posttraumatic stress severity. J Psychiatr Res 2021; 141:325-332. [PMID: 34304036 PMCID: PMC8513112 DOI: 10.1016/j.jpsychires.2021.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/04/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with lower gray matter volume (GMV) in brain regions critical for extinction of learned threat. However, relationships among volume, extinction learning, and PTSD symptom development remain unclear. We investigated subcortical brain volumes in regions supporting extinction learning and fear-potentiated startle (FPS) to understand brain-behavior interactions that may impact PTSD symptom development in recently traumatized individuals. Participants (N = 99) completed magnetic resonance imaging and threat conditioning two weeks following trauma exposure as part of a multisite observational study to understand the neuropsychiatric effects of trauma (AURORA Study). Participants completed self-assessments of PTSD (PTSD Checklist for DSM-5; PCL-5), dissociation, and depression symptoms two- and eight-weeks post-trauma. We completed multiple regressions to investigate relationships between FPS during late extinction, GMV, and PTSD symptom development. The interaction between thalamic GMV and FPS during late extinction at two weeks post-trauma predicted PCL-5 scores eight weeks (t (75) = 2.49, β = 0.28, p = 0.015) post-trauma. Higher FPS predicted higher PCL-5 scores in the setting of increased thalamic GMV. Meanwhile, lower FPS also predicted higher PCL-5 scores in the setting of decreased thalamic GMV. Thalamic GMV and FPS interactions also predicted posttraumatic dissociative and depressive symptoms. Amygdala and hippocampus GMV by FPS interactions were not associated with posttraumatic symptom development. Taken together, thalamic GMV and FPS during late extinction interact to contribute to adverse posttraumatic neuropsychiatric outcomes. Multimodal assessments soon after trauma have the potential to distinguish key phenotypes vulnerable to posttraumatic neuropsychiatric outcomes.
Collapse
Affiliation(s)
| | - Antonia V Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Alyssa R Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mariam Reda
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Lauren A M Lebois
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Vishnu P Murty
- Department of Psychology, College of Liberal Arts, Temple University, Philadelphia, PA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine & Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA
| | - Xinming An
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C Neylan
- San Francisco VA Healthcare System and Departments of Psychiatry and Neurology, University of California, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine and Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA; The Many Brains Project, Acton, MA, USA
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | | | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine & University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery and Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA & Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, College of Arts & Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | | | - James M Elliott
- The Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samuel A McLean
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nathaniel G Harnett
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
36
|
Salvi JD, Rauch SL, Baker JT. Behavior as Physiology: How Dynamical-Systems Theory Could Advance Psychiatry. Am J Psychiatry 2021; 178:791-792. [PMID: 34516231 PMCID: PMC8442738 DOI: 10.1176/appi.ajp.2020.20081151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Joshua D. Salvi
- Harvard Medical School, Boston, Massachusetts,MGH / McLean Adult Psychiatry Residency Program, Boston, Massachusetts,Correspondence: Joshua D. Salvi, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114,
| | | | | |
Collapse
|
37
|
Cakmak AS, Alday EAP, Da Poian G, Rad AB, Metzler TJ, Neylan TC, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Linnstaedt SD, Jovanovic T, Germine LT, Bollen KA, Rauch SL, Lewandowski CA, Hendry PL, Sheikh S, Storrow AB, Musey PI, Haran JP, Jones CW, Punches BE, Swor RA, Gentile NT, McGrath ME, Seamon MJ, Mohiuddin K, Chang AM, Pearson C, Domeier RM, Bruce SE, O'Neil BJ, Rathlev NK, Sanchez LD, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Harte SE, Elliott JM, Kessler RC, Koenen KC, Ressler KJ, Mclean SA, Li Q, Clifford GD. Classification and Prediction of Post-Trauma Outcomes Related to PTSD Using Circadian Rhythm Changes Measured via Wrist-Worn Research Watch in a Large Longitudinal Cohort. IEEE J Biomed Health Inform 2021; 25:2866-2876. [PMID: 33481725 PMCID: PMC8395207 DOI: 10.1109/jbhi.2021.3053909] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition resulting from threatening or horrifying events. We hypothesized that circadian rhythm changes, measured by a wrist-worn research watch are predictive of post-trauma outcomes. APPROACH 1618 post-trauma patients were enrolled after admission to emergency departments (ED). Three standardized questionnaires were administered at week eight to measure post-trauma outcomes related to PTSD, sleep disturbance, and pain interference with daily life. Pulse activity and movement data were captured from a research watch for eight weeks. Standard and novel movement and cardiovascular metrics that reflect circadian rhythms were derived using this data. These features were used to train different classifiers to predict the three outcomes derived from week-eight surveys. Clinical surveys administered at ED were also used as features in the baseline models. RESULTS The highest cross-validated performance of research watch-based features was achieved for classifying participants with pain interference by a logistic regression model, with an area under the receiver operating characteristic curve (AUC) of 0.70. The ED survey-based model achieved an AUC of 0.77, and the fusion of research watch and ED survey metrics improved the AUC to 0.79. SIGNIFICANCE This work represents the first attempt to predict and classify post-trauma symptoms from passive wearable data using machine learning approaches that leverage the circadian desynchrony in a potential PTSD population.
Collapse
|
38
|
McLean SA, Ressler K, Koenen KC, Neylan T, Germine L, Jovanovic T, Clifford GD, Zeng D, An X, Linnstaedt S, Beaudoin F, House S, Bollen KA, Musey P, Hendry P, Jones CW, Lewandowski C, Swor R, Datner E, Mohiuddin K, Stevens JS, Storrow A, Kurz MC, McGrath ME, Fermann GJ, Hudak LA, Gentile N, Chang AM, Peak DA, Pascual JL, Seamon MJ, Sergot P, Peacock WF, Diercks D, Sanchez LD, Rathlev N, Domeier R, Haran JP, Pearson C, Murty VP, Insel TR, Dagum P, Onnela JP, Bruce SE, Gaynes BN, Joormann J, Miller MW, Pietrzak RH, Buysse DJ, Pizzagalli DA, Rauch SL, Harte SE, Young LJ, Barch DM, Lebois LAM, van Rooij SJH, Luna B, Smoller JW, Dougherty RF, Pace TWW, Binder E, Sheridan JF, Elliott JM, Basu A, Fromer M, Parlikar T, Zaslavsky AM, Kessler R. Correction: The AURORA Study: a longitudinal, multimodal library of brain biology and function after traumatic stress exposure. Mol Psychiatry 2021; 26:3658. [PMID: 32989243 PMCID: PMC10853881 DOI: 10.1038/s41380-020-00897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Samuel A McLean
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA.
| | - Kerry Ressler
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | | | - Thomas Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Laura Germine
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | - Tanja Jovanovic
- Department of Psychiatry & Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, MI, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Donglin Zeng
- Department of Biostatistics, UNC Gillings School of Public Health, Chapel Hill, NC, USA
| | - Xinming An
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Sarah Linnstaedt
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Francesca Beaudoin
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Stacey House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Kenneth A Bollen
- Department of Statistics and Operational Research, University of North Carolina, Chapel Hill, NC, USA
| | - Paul Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper University Health Care, Camden, NJ, USA
| | | | - Robert Swor
- Department of Emergency Medicine, William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Elizabeth Datner
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kamran Mohiuddin
- Department of Emergency Medicine, Einstein Health Medical Center, Philadelphia, PA, USA
| | - Jennifer S Stevens
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Alan Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Christopher Kurz
- Department of Emergency Medicine, School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston University Medical Center, Boston, MA, USA
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Nina Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jose L Pascual
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas, Houston, TX, USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Deborah Diercks
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Niels Rathlev
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Robert Domeier
- Department of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, USA
| | - John Patrick Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Vishnu P Murty
- Department of Psychology, College of Liberal Arts, Temple University, Philadelphia, PA, USA
| | | | - Paul Dagum
- Mindstrong Health, Mountain View, CA, USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA
| | - Bradley N Gaynes
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Mark W Miller
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Larry J Young
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Sanne J H van Rooij
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Thaddeus W W Pace
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Elisabeth Binder
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - John F Sheridan
- College of Dentistry, Ohio State University School of Medicine, Columbus, OH, USA
| | - James M Elliott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Archana Basu
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | | | | | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronald Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
39
|
Sugarman DE, Meyer LE, Reilly ME, Rauch SL, Greenfield SF. Exploring Technology-Based Enhancements to Inpatient and Residential Treatment for Young Adult Women with Co-Occurring Substance Use. J Dual Diagn 2021; 17:236-247. [PMID: 34261413 PMCID: PMC8892261 DOI: 10.1080/15504263.2021.1940412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Young adults have the highest rates of substance use of any age group. Although men historically have higher rates of substance use disorders (SUDs) than women, research shows this gender gap is narrowing. Young adults with comorbid psychiatric disorders are at increased risk for developing a SUD. Co-occurring psychiatric disorders such as depression, anxiety, eating and post-traumatic stress disorders are more prevalent in women than men with SUDs, yet mental health treatment often does not adequately address substance use in patients receiving care for a comorbid psychiatric disorder. Tailored gender-responsive interventions for women with psychiatric disorders and co-occurring SUD have gained empirical support. Digital interventions tailored to young adult women with co-occurring disorders have the potential to overcome barriers to addressing substance use for young adult women in a psychiatric treatment setting. This study utilized a user-centered design process to better understand how technology could be used to address substance use in young adult women receiving inpatient and residential psychiatric care. Methods: Women (N = 15; age 18-25 years), recruited from five psychiatric treatment programs, engaged in a qualitative interview and completed self-report surveys on technology use and acceptability. Qualitative interviews were coded for salient themes. Results: Results showed that few participants were currently using mental health web-based applications (i.e., "apps"), but most participants expressed an interest in using apps as part of their mental health treatment. Participants identified several important topics salient to women their age including substance use and sexual assault, stigma and shame, difficulties abstaining from substance use while maintaining social relationships with peers, and negative emotions as a trigger for use. Conclusions: These data provide preliminary evidence that a digital intervention may be a feasible way to address co-occurring substance use problems in young adult women receiving care in a psychiatric setting.
Collapse
Affiliation(s)
- Dawn E Sugarman
- McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Laurel E Meyer
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | | | - Scott L Rauch
- McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Shelly F Greenfield
- McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
40
|
Furukawa TA, Suganuma A, Ostinelli EG, Andersson G, Beevers CG, Shumake J, Berger T, Boele FW, Buntrock C, Carlbring P, Choi I, Christensen H, Mackinnon A, Dahne J, Huibers MJH, Ebert DD, Farrer L, Forand NR, Strunk DR, Ezawa ID, Forsell E, Kaldo V, Geraedts A, Gilbody S, Littlewood E, Brabyn S, Hadjistavropoulos HD, Schneider LH, Johansson R, Kenter R, Kivi M, Björkelund C, Kleiboer A, Riper H, Klein JP, Schröder J, Meyer B, Moritz S, Bücker L, Lintvedt O, Johansson P, Lundgren J, Milgrom J, Gemmill AW, Mohr DC, Montero-Marin J, Garcia-Campayo J, Nobis S, Zarski AC, O'Moore K, Williams AD, Newby JM, Perini S, Phillips R, Schneider J, Pots W, Pugh NE, Richards D, Rosso IM, Rauch SL, Sheeber LB, Smith J, Spek V, Pop VJ, Ünlü B, van Bastelaar KMP, van Luenen S, Garnefski N, Kraaij V, Vernmark K, Warmerdam L, van Straten A, Zagorscak P, Knaevelsrud C, Heinrich M, Miguel C, Cipriani A, Efthimiou O, Karyotaki E, Cuijpers P. Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data. Lancet Psychiatry 2021; 8:500-511. [PMID: 33957075 PMCID: PMC8838916 DOI: 10.1016/s2215-0366(21)00077-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Internet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom. METHODS We did a systematic review and individual participant data component network meta-analysis (cNMA) of iCBT trials for depression. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomised controlled trials (RCTs) published from database inception to Jan 1, 2019, that compared any form of iCBT against another or a control condition in the acute treatment of adults (aged ≥18 years) with depression. Studies with inpatients or patients with bipolar depression were excluded. We sought individual participant data from the original authors. When these data were unavailable, we used aggregate data. Two independent researchers identified the included components. The primary outcome was depression severity, expressed as incremental mean difference (iMD) in the Patient Health Questionnaire-9 (PHQ-9) scores when a component is added to a treatment. We developed a web app that estimates relative efficacies between any two combinations of components, given baseline patient characteristics. This study is registered in PROSPERO, CRD42018104683. FINDINGS We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42·0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1·83 [95% credible interval (CrI) -2·90 to -0·80]) and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0·32 [95% CrI 0·13 to 0·93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components. INTERPRETATION The individual patient data cNMA revealed potentially helpful, less helpful, or harmful components and delivery formats for iCBT packages. iCBT packages aiming to be effective and efficient might choose to include beneficial components and exclude ones that are potentially detrimental. Our web app can facilitate shared decision making by therapist and patient in choosing their preferred iCBT package. FUNDING Japan Society for the Promotion of Science.
Collapse
Affiliation(s)
- Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
| | - Aya Suganuma
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Edoardo G Ostinelli
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Christopher G Beevers
- Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
| | - Jason Shumake
- Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Florien Willemijn Boele
- Patient Centred Outcomes Research Group, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Isabella Choi
- Central Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Andrew Mackinnon
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Marcus J H Huibers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - David D Ebert
- Department for Sport and Health Sciences, Chair for Psychology & Digital Mental Health Care, Technical University Munich, Germany
| | - Louise Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Nicholas R Forand
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Daniel R Strunk
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Iony D Ezawa
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Erik Forsell
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Viktor Kaldo
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | | | - Sally Brabyn
- Department of Health Sciences, University of York, York, UK
| | | | - Luke H Schneider
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Robert Johansson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Robin Kenter
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Marie Kivi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Johanna Schröder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Björn Meyer
- Research Department, GAIA AG, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ove Lintvedt
- Norwegian Center for E-health research, Tromsø, Norway
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Jeannette Milgrom
- Parent-Infant Research Institute and Austin Health, Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia
| | - Alan W Gemmill
- Parent-Infant Research Institute and Austin Health, Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Javier Garcia-Campayo
- Aragon Institute for Health Research, Miguel Servet University Hospital, Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | | | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kathleen O'Moore
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Alishia D Williams
- Department of Psychology, Faculty of Science, The University of New South Wales, Sydney, NSW, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales at the Black Dog Institute, Sydney, NSW, Australia
| | - Sarah Perini
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Rachel Phillips
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Justine Schneider
- School of Sociology & Social Policy and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Wendy Pots
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | | | - Derek Richards
- University of Dublin, Trinity College, School of Psychology, E-mental Health Research Group, Dublin, Ireland; SilverCloud Health, Clinical Research & Innovation, Dublin, Ireland
| | | | | | | | - Jessica Smith
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Viola Spek
- School of Applied Psychology, Fontys University of Applied Science, Eindhoven, Netherlands
| | - Victor J Pop
- Department of Medical & Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | | | | | - Sanne van Luenen
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Nadia Garnefski
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Vivian Kraaij
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Kristofer Vernmark
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pavle Zagorscak
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Manuel Heinrich
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Andrea Cipriani
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Orestis Efthimiou
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Eirini Karyotaki
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
41
|
Harnett NG, van Rooij SJH, Ely TD, Lebois LAM, Murty VP, Jovanovic T, Hill SB, Dumornay NM, Merker JB, Bruce SE, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Lewandowski C, Hendry PL, Sheikh S, Storrow AB, Musey PI, Haran JP, Jones CW, Punches BE, Swor RA, McGrath ME, Pascual JL, Seamon MJ, Mohiuddin K, Chang AM, Pearson C, Peak DA, Domeier RM, Rathlev NK, Sanchez LD, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Harte SE, Elliott JM, Kessler RC, Koenen KC, Mclean S, Ressler KJ, Stevens JS. Prognostic neuroimaging biomarkers of trauma-related psychopathology: resting-state fMRI shortly after trauma predicts future PTSD and depression symptoms in the AURORA study. Neuropsychopharmacology 2021; 46:1263-1271. [PMID: 33479509 PMCID: PMC8134491 DOI: 10.1038/s41386-020-00946-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 01/30/2023]
Abstract
Neurobiological markers of future susceptibility to posttraumatic stress disorder (PTSD) may facilitate identification of vulnerable individuals in the early aftermath of trauma. Variability in resting-state networks (RSNs), patterns of intrinsic functional connectivity across the brain, has previously been linked to PTSD, and may thus be informative of PTSD susceptibility. The present data are part of an initial analysis from the AURORA study, a longitudinal, multisite study of adverse neuropsychiatric sequalae. Magnetic resonance imaging (MRI) data from 109 recently (i.e., ~2 weeks) traumatized individuals were collected and PTSD and depression symptoms were assessed at 3 months post trauma. We assessed commonly reported RSNs including the default mode network (DMN), central executive network (CEN), and salience network (SN). We also identified a proposed arousal network (AN) composed of a priori brain regions important for PTSD: the amygdala, hippocampus, mamillary bodies, midbrain, and pons. Primary analyses assessed whether variability in functional connectivity at the 2-week imaging timepoint predicted 3-month PTSD symptom severity. Left dorsolateral prefrontal cortex (DLPFC) to AN connectivity at 2 weeks post trauma was negatively related to 3-month PTSD symptoms. Further, right inferior temporal gyrus (ITG) to DMN connectivity was positively related to 3-month PTSD symptoms. Both DLPFC-AN and ITG-DMN connectivity also predicted depression symptoms at 3 months. Our results suggest that, following trauma exposure, acutely assessed variability in RSN connectivity was associated with PTSD symptom severity approximately two and a half months later. However, these patterns may reflect general susceptibility to posttraumatic dysfunction as the imaging patterns were not linked to specific disorder symptoms, at least in the subacute/early chronic phase. The present data suggest that assessment of RSNs in the early aftermath of trauma may be informative of susceptibility to posttraumatic dysfunction, with future work needed to understand neural markers of long-term (e.g., 12 months post trauma) dysfunction. Furthermore, these findings are consistent with neural models suggesting that decreased top-down cortico-limbic regulation and increased network-mediated fear generalization may contribute to ongoing dysfunction in the aftermath of trauma.
Collapse
Affiliation(s)
- Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Sarah B Hill
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | | | - Julia B Merker
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Steve E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, Springfield, MO, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine & Health Services, Policy, and Practice, Rhode Island Hospital and The Miriam Hospital, The Alpert Medical School of Brown University, Providence, RI, USA
| | - Xinming An
- Institute of Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute of Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience, Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | | | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, College of Medicine & College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
| | - Jose L Pascual
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Kamran Mohiuddin
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MO, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John F Sheridan
- Department of Biosciences and Neuroscience, OSU Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- The Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samuel Mclean
- Institute of Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.
| |
Collapse
|
42
|
Dougherty DD, Chou T, Buhlmann U, Rauch SL, Deckersbach T. Early Amygdala Activation and Later Ventromedial Prefrontal Cortex Activation During Anger Induction and Imagery. ACTA ACUST UNITED AC 2020. [DOI: 10.3233/jmp-160002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Neurobiological studies implicate the amygdala and related limbic/paralimbic structures, such as the ventromedial prefrontal cortex (VMPFC), in anger and aggression. Previous studies of self-generated anger using Positron Emission Tomography (PET) have consistently documented a lack of amygdala activation during anger. Objective: We investigated the hypothesis that a lack of amygdala activation during anger is due to differences in the time course of amygdala and VMPFC activation. Specifically, we explored whether the amygdala is involved in the early phases of anger experience which is later followed by increased VMPFC activation. Methods: Eighteen healthy control participants underwent fMRI. We adapted an anger induction paradigm previously used in our PET study, in which neutral and angry states were induced using autobiographical scripts. The hypothesized time course of amygdala and VMPFC activation during acute anger induction and imagery were modeled. Region of interest (ROI) analyses were used to identify significant a priori region activation, and correlations were run between signal values and VAS anger ratings. Results: Amygdala activation increased during the acute phase of anger induction and decreased during the later phase of anger imagery, whereas VMPFC activation decreased during anger induction and increased during anger imagery, compared to the neutral conditions. In addition, negative correlations were found between self-ratings of anger and bilateral VMPFC activation. Conclusions: Overall, our results suggest that the amygdala may be active at the initial onset of anger while the VMPFC is activated over time as the individual sustains and perhaps regulates that emotional state.
Collapse
Affiliation(s)
| | - Tina Chou
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
- Harvard University, Cambridge, MA, USA
| | - Ulrike Buhlmann
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Scott L. Rauch
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| |
Collapse
|
43
|
McLean SA, Ressler K, Koenen KC, Neylan T, Germine L, Jovanovic T, Clifford GD, Zeng D, An X, Linnstaedt S, Beaudoin F, House S, Bollen KA, Musey P, Hendry P, Jones CW, Lewandowski C, Swor R, Datner E, Mohiuddin K, Stevens JS, Storrow A, Kurz MC, McGrath ME, Fermann GJ, Hudak LA, Gentile N, Chang AM, Peak DA, Pascual JL, Seamon MJ, Sergot P, Peacock WF, Diercks D, Sanchez LD, Rathlev N, Domeier R, Haran JP, Pearson C, Murty VP, Insel TR, Dagum P, Onnela JP, Bruce SE, Gaynes BN, Joormann J, Miller MW, Pietrzak RH, Buysse DJ, Pizzagalli DA, Rauch SL, Harte SE, Young LJ, Barch DM, Lebois LAM, van Rooij SJH, Luna B, Smoller JW, Dougherty RF, Pace TWW, Binder E, Sheridan JF, Elliott JM, Basu A, Fromer M, Parlikar T, Zaslavsky AM, Kessler R. The AURORA Study: a longitudinal, multimodal library of brain biology and function after traumatic stress exposure. Mol Psychiatry 2020; 25:283-296. [PMID: 31745239 PMCID: PMC6981025 DOI: 10.1038/s41380-019-0581-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/26/2019] [Indexed: 11/08/2022]
Abstract
Adverse posttraumatic neuropsychiatric sequelae (APNS) are common among civilian trauma survivors and military veterans. These APNS, as traditionally classified, include posttraumatic stress, postconcussion syndrome, depression, and regional or widespread pain. Traditional classifications have come to hamper scientific progress because they artificially fragment APNS into siloed, syndromic diagnoses unmoored to discrete components of brain functioning and studied in isolation. These limitations in classification and ontology slow the discovery of pathophysiologic mechanisms, biobehavioral markers, risk prediction tools, and preventive/treatment interventions. Progress in overcoming these limitations has been challenging because such progress would require studies that both evaluate a broad spectrum of posttraumatic sequelae (to overcome fragmentation) and also perform in-depth biobehavioral evaluation (to index sequelae to domains of brain function). This article summarizes the methods of the Advancing Understanding of RecOvery afteR traumA (AURORA) Study. AURORA conducts a large-scale (n = 5000 target sample) in-depth assessment of APNS development using a state-of-the-art battery of self-report, neurocognitive, physiologic, digital phenotyping, psychophysical, neuroimaging, and genomic assessments, beginning in the early aftermath of trauma and continuing for 1 year. The goals of AURORA are to achieve improved phenotypes, prediction tools, and understanding of molecular mechanisms to inform the future development and testing of preventive and treatment interventions.
Collapse
Affiliation(s)
- Samuel A McLean
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA.
| | - Kerry Ressler
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | | | - Thomas Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Laura Germine
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | - Tanja Jovanovic
- Department of Psychiatry & Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, MI, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Donglin Zeng
- Department of Biostatistics, UNC Gillings School of Public Health, Chapel Hill, NC, USA
| | - Xinming An
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Sarah Linnstaedt
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Francesca Beaudoin
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Stacey House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Kenneth A Bollen
- Department of Statistics and Operational Research, University of North Carolina, Chapel Hill, NC, USA
| | - Paul Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper University Health Care, Camden, NJ, USA
| | | | - Robert Swor
- Department of Emergency Medicine, William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Elizabeth Datner
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kamran Mohiuddin
- Department of Emergency Medicine, Einstein Health Medical Center, Philadelphia, PA, USA
| | - Jennifer S Stevens
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Alan Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Christopher Kurz
- Department of Emergency Medicine, School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston University Medical Center, Boston, MA, USA
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Nina Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jose L Pascual
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas, Houston, TX, USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Deborah Diercks
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Niels Rathlev
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Robert Domeier
- Department of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, USA
| | - John Patrick Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Vishnu P Murty
- Department of Psychology, College of Liberal Arts, Temple University, Philadelphia, PA, USA
| | | | - Paul Dagum
- Mindstrong Health, Mountain View, CA, USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA
| | - Bradley N Gaynes
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Mark W Miller
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Larry J Young
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Sanne J H van Rooij
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Thaddeus W W Pace
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Elisabeth Binder
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - John F Sheridan
- College of Dentistry, Ohio State University School of Medicine, Columbus, OH, USA
| | - James M Elliott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Archana Basu
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | | | | | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronald Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
44
|
Olson EA, Overbey TA, Ostrand CG, Pizzagalli DA, Rauch SL, Rosso IM. Childhood maltreatment experiences are associated with altered diffusion in occipito-temporal white matter pathways. Brain Behav 2020; 10:e01485. [PMID: 31773917 PMCID: PMC6955831 DOI: 10.1002/brb3.1485] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/27/2019] [Accepted: 11/09/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Childhood maltreatment may contribute to brain alterations in posttraumatic stress disorder (PTSD). We previously found that PTSD was associated with white matter compromise, or lower fractional anisotropy (FA), in the left inferior longitudinal fasciculus (ILF). In this study, including non-PTSD controls, we examined whether ILF FA was associated with maltreatment exposures, including those that meet DSM-IV criterion A (physical abuse, sexual abuse) and those that typically do not (emotional abuse, emotional neglect, physical neglect). We hypothesized that lower FA would be associated with PTSD diagnosis and with both categories of maltreatment. METHODS Ninety-three participants (51 female), ages 20-50, were enrolled, including 32 with lifetime DSM-IV PTSD, 27 trauma-exposed non-PTSD controls, and 34 healthy controls. Participants completed structured interviews, the Childhood Trauma Questionnaire (CTQ), and diffusion-weighted imaging (36 directions). Probabilistic tractography (using FreeSurfer's TRACULA) was used to assess diffusion metrics in the ILF. RESULTS Contrary to our hypothesis, there was no significant effect of diagnostic group on FA. In contrast, higher CTQ scores were significantly associated with lower FA in the ILF bilaterally. This association of maltreatment with lower FA remained statistically significant after controlling for diagnostic group, and it was significant for both criterion-A-type and noncriterion-A-type maltreatment categories. CONCLUSIONS This work contributes to a growing body of literature indicating that different forms of childhood maltreatment are associated with altered white matter microstructure in the ILF, an association pathway involved in integrating visual information from occipital regions with emotion processing functions of the anterior temporal lobe.
Collapse
Affiliation(s)
- Elizabeth A Olson
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Tate A Overbey
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - Caroline G Ostrand
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,McLean Imaging Center, McLean Hospital, Belmont, Massachusetts
| | - Scott L Rauch
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
45
|
Gerstenblith TA, Jaramillo-Huff A, Ruutiainen T, Nestadt PS, Samuels JF, Grados MA, Cullen BA, Riddle MA, Liang KY, Greenberg BD, Rasmussen SA, Rauch SL, McCracken JT, Piacentini J, Knowles JA, Nestadt G, Bienvenu OJ. Trichotillomania comorbidity in a sample enriched for familial obsessive-compulsive disorder. Compr Psychiatry 2019; 94:152123. [PMID: 31518848 PMCID: PMC6980465 DOI: 10.1016/j.comppsych.2019.152123] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/24/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND This study addresses the strength of associations between trichotillomania (TTM) and other DSM-IV Axis I conditions in a large sample (n = 2606) enriched for familial obsessive-compulsive disorder (OCD), to inform TTM classification. METHODS We identified participants with TTM in the Johns Hopkins OCD Family Study (153 families) and the OCD Collaborative Genetics Study, a six-site genetic linkage study of OCD (487 families). We used logistic regression (with generalized estimating equations) to assess the strength of associations between TTM and other DSM-IV disorders. RESULTS TTM had excess comorbidity with a number of conditions from different DSM-IV chapters, including tic disorders, alcohol dependence, mood disorders, anxiety disorders, impulse-control disorders, and bulimia nervosa. However, association strengths (odds ratios) were highest for kleptomania (6.6), pyromania (5.8), OCD (5.6), skin picking disorder (4.4), bulimia nervosa (3.5), and pathological nail biting (3.4). CONCLUSIONS TTM is comorbid with a number of psychiatric conditions besides OCD, and it is strongly associated with other conditions involving impaired impulse control. Though DSM-5 includes TTM as an OCD-related disorder, its comorbidity pattern also emphasizes the impulsive, appetitive aspects of this condition that may be relevant to classification.
Collapse
Affiliation(s)
- Ted Avi Gerstenblith
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Ashley Jaramillo-Huff
- University of New Mexico School of Medicine, Department of Obstetrics and Gynecology, United States of America
| | - Tuua Ruutiainen
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, United States of America
| | - Paul S Nestadt
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Jack F Samuels
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Marco A Grados
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Bernadette A Cullen
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Mark A Riddle
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | | | - Benjamin D Greenberg
- Brown Medical School, Department of Psychiatry and Human Behavior, United States of America
| | - Steven A Rasmussen
- Brown Medical School, Department of Psychiatry and Human Behavior, United States of America
| | - Scott L Rauch
- Harvard Medical School, Department of Psychiatry, United States of America
| | - James T McCracken
- University of California, Los Angeles School of Medicine, Department of Psychiatry and Biobehavioral Sciences, United States of America
| | - John Piacentini
- University of California, Los Angeles School of Medicine, Department of Psychiatry and Biobehavioral Sciences, United States of America
| | - James A Knowles
- SUNY Downstate Medical Center College of Medicine, Department of Cell Biology, United States of America
| | - Gerald Nestadt
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - O Joseph Bienvenu
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America.
| |
Collapse
|
46
|
Hobbs KW, Monette PJ, Owoyemi P, Beard C, Rauch SL, Ressler KJ, Vahia IV. Incorporating Information From Electronic and Social Media Into Psychiatric and Psychotherapeutic Patient Care: Survey Among Clinicians. J Med Internet Res 2019; 21:e13218. [PMID: 31301127 PMCID: PMC6659389 DOI: 10.2196/13218] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/26/2019] [Accepted: 05/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obtaining collateral information from a patient is an essential component of providing effective psychiatric and psychotherapeutic care. Research indicates that patients' social and electronic media contains information relevant to their psychotherapy and clinical care. However, it remains unclear to what degree this content is being actively utilized by clinicians as a part of diagnosis or therapy. Moreover, clinicians' attitudes around this practice have not been well characterized. OBJECTIVE This survey aimed to establish the current attitudes and behaviors of outpatient clinicians regarding the incorporation of patients' social and electronic media into psychotherapy. METHODS A Web-based survey was sent to outpatient psychotherapists associated with McLean Hospital in Belmont, Massachusetts. The survey asked clinicians to indicate to what extent and with which patients they reviewed patients' social and electronic media content as part of their clinical practice, as well as their reasons for or against doing so. RESULTS Of the total 115 respondents, 71 (61.7%) indicated that they had viewed at least one patient's social or electronic media as part of psychotherapy, and 65 of those 71 (92%) endorsed being able to provide more effective treatment as a result of this information. The use of either short message service text messages or email was significantly greater than the use of other electronic media platforms (χ21=24.1, n=115, P<.001). Moreover, the analysis of survey responses found patterns of use associated with clinicians' years of experience and patient demographics, including age and primary diagnosis. CONCLUSIONS The incorporation of patients' social and electronic media into therapy is currently common practice among clinicians at a large psychiatric teaching hospital. The results of this survey have informed further questions about whether reviewing patient's media impacts the quality and efficacy of clinical care.
Collapse
Affiliation(s)
| | | | | | - Courtney Beard
- McLean Hospital, Belmont, MA, United States.,Harvard Medical School, Cambridge, MA, United States
| | - Scott L Rauch
- McLean Hospital, Belmont, MA, United States.,Harvard Medical School, Cambridge, MA, United States
| | - Kerry J Ressler
- McLean Hospital, Belmont, MA, United States.,Harvard Medical School, Cambridge, MA, United States
| | - Ipsit V Vahia
- McLean Hospital, Belmont, MA, United States.,Harvard Medical School, Cambridge, MA, United States
| |
Collapse
|
47
|
Olson EA, Kaiser RH, Pizzagalli DA, Rauch SL, Rosso IM. Regional Prefrontal Resting-State Functional Connectivity in Posttraumatic Stress Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2018; 4:390-398. [PMID: 30449518 DOI: 10.1016/j.bpsc.2018.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Prefrontal subregions, including the ventromedial prefrontal cortex (PFC), dorsomedial PFC, and dorsolateral PFC (DLPFC), are differentially implicated in the pathophysiology of posttraumatic stress disorder (PTSD), though few existing studies have examined subregional differences in resting-state functional connectivity (rsFC). We hypothesized that PTSD would involve weaker positive rsFC between ventromedial PFC, dorsomedial PFC, and other default mode network regions and increased negative rsFC between DLPFC and posterior default mode network regions. Additionally, we hypothesized that prefrontal regions exhibiting group differences in rsFC would be characterized by alterations in cortical thickness. METHODS Participants included 36 healthy control subjects, 30 trauma-exposed control subjects, and 21 individuals with current DSM-IV PTSD resulting from community-acquired trauma. Participants completed the Clinician Administered PTSD Scale, questionnaires (Childhood Trauma Questionnaire, Adverse Childhood Events, Life Events Checklist, Beck Depression Inventory), structural neuroimaging, and resting-state functional magnetic resonance imaging. rsFC of DLPFC, ventromedial PFC, and dorsomedial PFC seeds was evaluated in SPM12 and CONN. Cortical thickness for regions with significant rsFC findings was assessed using FreeSurfer. RESULTS Relative to both healthy control and trauma-exposed control subjects, individuals with PTSD showed increased negative rsFC between the DLPFC and a region of precuneus. This finding was associated with increased overall symptom severity but not with trauma load or childhood trauma exposure. Greater negative DLPFC-precuneus connectivity was associated with greater bilateral precuneus thickness. CONCLUSIONS Given participation of precuneus subregions in the central executive network, increased anticorrelation between right DLPFC and precuneus in this sample may reflect increased opposition between anterior and posterior central executive network hubs in PTSD.
Collapse
Affiliation(s)
- Elizabeth A Olson
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| | - Roselinde H Kaiser
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; McLean Imaging Center, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Scott L Rauch
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
48
|
Dougherty DD, Brennan BP, Stewart SE, Wilhelm S, Widge AS, Rauch SL. Neuroscientifically Informed Formulation and Treatment Planning for Patients With Obsessive-Compulsive Disorder: A Review. JAMA Psychiatry 2018; 75:1081-1087. [PMID: 30140845 DOI: 10.1001/jamapsychiatry.2018.0930] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Obsessive-compulsive disorder (OCD) is a common and often debilitating psychiatric illness. Recent advances in the understanding of the neuroscience of OCD have provided valuable insights that have begun to transform the way we think about the management of this disorder. This educational review provides an integrated neuroscience perspective on formulation and treatment planning for patients with OCD. The article is organized around key neuroscience themes most relevant for OCD. OBSERVATIONS An integrated neuroscience formulation of OCD is predicated on a fundamental understanding of phenomenology and symptom dimensions, fear conditioning and extinction, neurochemistry, genetics and animal models, as well as neurocircuitry and neurotherapeutics. Symptom dimensions provide a means to better understand the phenotypic heterogeneity within OCD with an eye toward more personalized treatments. The concept of abnormal fear extinction is central to OCD and to the underlying therapeutic mechanism of exposure and response prevention. A framework for understanding the neurochemistry of OCD focuses on both traditional monoaminergic systems and more recent evidence of glutamatergic and γ-aminobutyric acid-ergic dysfunction. Obsessive-compulsive disorder is highly heritable, and future work is needed to understand the contribution of genes to underlying pathophysiology. A circuit dysregulation framework focuses on cortico-striato-thalamo-cortical circuit dysfunction and the development of neurotherapeutic approaches targeting this circuit. The impact of these concepts on how we think about OCD diagnosis and treatment is discussed. Suggestions for future investigations that have the potential to further enhance the clinical management of OCD are presented. CONCLUSIONS AND RELEVANCE These key neuroscience themes collectively inform formulation and treatment planning for patients with OCD. The ultimate goal is to increase crosstalk between clinicians and researchers in an effort to facilitate translation of advances in neuroscience research to improved care for patients with OCD.
Collapse
Affiliation(s)
- Darin D Dougherty
- Division of Neurotherapeutics, Massachusetts General Hospital, Boston.,Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, Massachusetts.,Obsessive-Compulsive and Related Disorders Program, Massachusetts General Hospital, Boston.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Brian P Brennan
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts
| | - S Evelyn Stewart
- BC Mental Health & Addictions Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabine Wilhelm
- Obsessive-Compulsive and Related Disorders Program, Massachusetts General Hospital, Boston.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Alik S Widge
- Division of Neurotherapeutics, Massachusetts General Hospital, Boston.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Picower Institute for Learning and Memory, Massachusetts Institute for Technology, Cambridge
| | - Scott L Rauch
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
49
|
Rasmussen SA, Noren G, Greenberg BD, Marsland R, McLaughlin NC, Malloy PJ, Salloway SP, Strong DR, Eisen JL, Jenike MA, Rauch SL, Baer L, Lindquist C. Gamma Ventral Capsulotomy in Intractable Obsessive-Compulsive Disorder. Biol Psychiatry 2018; 84:355-364. [PMID: 29361268 DOI: 10.1016/j.biopsych.2017.11.034] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 09/26/2017] [Accepted: 11/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite the development of effective pharmacologic and cognitive behavioral treatments for obsessive-compulsive disorder (OCD), some patients continue to be treatment-refractory and severely impaired. Fiber tracts connecting orbitofrontal and dorsal anterior cingulate cortex with subcortical nuclei have been the target of neurosurgical lesions as well as deep brain stimulation in these patients. We report on the safety and efficacy of ventral gamma capsulotomy for patients with intractable OCD. METHODS Fifty-five patients with severely disabling, treatment-refractory OCD received bilateral lesions in the ventral portion of the anterior limb of the internal capsule over a 20-year period using the Leksell Gamma Knife. The patients were prospectively followed over 3 years with psychiatric, neurologic, and neuropsychological assessments of safety and efficacy, as well as structural neuroimaging. RESULTS Thirty-one of 55 patients (56%) had an improvement in the primary efficacy measure, the Yale-Brown Obsessive Compulsive Scale, of ≥35% over the 3-year follow-up period. Patients had significant improvements in depression, anxiety, quality of life, and global functioning. Patients tolerated the procedure well without significant acute adverse events. Five patients (9%) developed transient edema that required short courses of dexamethasone. Three patients (5%) developed cysts at long-term follow-up, 1 of whom developed radionecrosis resulting in an ongoing minimally conscious state. CONCLUSIONS Gamma Knife ventral capsulotomy is an effective radiosurgical procedure for many treatment-refractory OCD patients. A minority of patients developed cysts at long-term follow-up, 1 of whom had permanent neurological sequelae.
Collapse
Affiliation(s)
- Steven A Rasmussen
- Department of Psychiatry and Human Behavior, Butler Hospital, Brown University School of Medicine, Providence, Rhode Island.
| | - Georg Noren
- Department of Neurosurgery, Rhode Island Hospital, Brown University School of Medicine, Providence, Rhode Island
| | - Benjamin D Greenberg
- Department of Psychiatry and Human Behavior, Butler Hospital, Brown University School of Medicine, Providence, Rhode Island
| | - Richard Marsland
- Department of Psychiatry and Human Behavior, Butler Hospital, Brown University School of Medicine, Providence, Rhode Island
| | - Nicole C McLaughlin
- Department of Psychiatry and Human Behavior, Butler Hospital, Brown University School of Medicine, Providence, Rhode Island
| | - Paul J Malloy
- Department of Psychiatry and Human Behavior, Butler Hospital, Brown University School of Medicine, Providence, Rhode Island
| | - Stephen P Salloway
- Department of Psychiatry and Human Behavior, Butler Hospital, Brown University School of Medicine, Providence, Rhode Island
| | - David R Strong
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jane L Eisen
- Department of Psychiatry and Human Behavior, Butler Hospital, Brown University School of Medicine, Providence, Rhode Island
| | - Michael A Jenike
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Scott L Rauch
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lee Baer
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Christer Lindquist
- Department of Stereotactic Neurosurgery, Cromwell Hospital, London, United Kingdom
| |
Collapse
|
50
|
Brennan BP, Wang D, Li M, Perriello C, Ren J, Elias JA, Van Kirk NP, Krompinger JW, Pope HG, Haber SN, Rauch SL, Baker JT, Liu H. Use of an Individual-Level Approach to Identify Cortical Connectivity Biomarkers in Obsessive-Compulsive Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2018; 4:27-38. [PMID: 30262337 DOI: 10.1016/j.bpsc.2018.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Existing functional connectivity studies of obsessive-compulsive disorder (OCD) support a model of circuit dysfunction. However, these group-level observations have failed to yield neuroimaging biomarkers sufficient to serve as a test for the OCD diagnosis, predict current or future symptoms, or predict treatment response, perhaps because these studies failed to account for the substantial intersubject variability in structural and functional brain organization. METHODS We used functional regions, localized in each of 41 individual OCD patients, to identify cortical connectivity biomarkers of both global and dimension-specific symptom severity and to detect functional connections that track changes in symptom severity following intensive residential treatment. RESULTS Global OCD symptom severity was directly linked to dysconnectivity between large-scale intrinsic brain networks-particularly among the dorsal attention, default, and frontoparietal networks. Changes within a subset of connections among these networks were associated with symptom resolution. Additionally, distinct and nonoverlapping cortical connectivity biomarkers were identified that were significantly associated with the severity of contamination/washing and responsibility for harm/checking symptoms, highlighting the contribution of dissociable neural networks to specific OCD symptom dimensions. By contrast, when we defined functional regions conventionally, using a population-level brain atlas, we could no longer identify connectivity biomarkers of severity or improvement for any of the symptom dimensions. CONCLUSIONS Our findings would seem to encourage the use of individual-level approaches to connectivity analyses to better delineate the cortical and subcortical networks underlying symptom severity and improvement at the dimensional level in OCD patients.
Collapse
Affiliation(s)
- Brian P Brennan
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts; Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| | - Danhong Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meiling Li
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu
| | - Chris Perriello
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts
| | - Jianxun Ren
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jason A Elias
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Nathaniel P Van Kirk
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jason W Krompinger
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Harrison G Pope
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Suzanne N Haber
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Justin T Baker
- Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Hesheng Liu
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China; Institute for Research and Medical Consultations, Imam Abdulahman Bin Faisal University, Dammam, Saudi Arabia.
| |
Collapse
|