Absence Of Posttraumatic Stress Disorder Research Articles

Co-Occurring Mental and Physical Health Conditions Among Older Adults With and Without Post-traumatic Stress Disorder: A Case Control Study.

Rates of post-traumatic stress disorder (PTSD) among older adults range from 0.4%-4.5%. Research examining PTSD in adults has demonstrated numerous associations between physical and mental health conditions; however, these are less well characterized in older adults. The current study aimed to identify base rates of such conditions among older adults with and without a history of PTSD. In a case control design using the National Alzheimer's Coordinating Center Uniform Data Set, adults 65 years or older from the United States who endorsed either the presence or absence of PTSD were matched by age to assess between-group differences (N = 472; 236 pairs). We examined differences across self-reported sociodemographics and physical health, mental health, and substance use histories. More participants with a history of PTSD identified as Hispanic, non-white, non-married, and functionally independent. Compared to individuals without a history of PTSD, significantly more individuals with a history of PTSD had histories of depression, anxiety, substance abuse, Parkinson's disease, seizures, insomnia, and TBI. Among participants without PTSD history, only 14.7% reported a history of TBI, compared to 41.1% of individuals with PTSD history. Findings showed expected trends toward worse physical and mental health among older adults with self-reported PTSD. There was a striking difference in the frequency of TBI history between participants with and without PTSD. These findings underscore a need to assess for PTSD among older adults, particularly those reporting a history of TBI.

Identifying PTSD sex-based patterns through explainable artificial intelligence in biometric data

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that arises from exposure to traumatic events, affecting various aspects of human well-being. The complexity and variability of symptoms pose challenges for accurate diagnosis and monitoring, exacerbated by accessibility barriers. In response, alternative methodologies leveraging biometric data have emerged, such as facial movements, speech, or voice-to-text transcriptions, and analyzing them using Explainable Artificial Intelligence (XAI) techniques. Numerous studies have explored the presence or absence of PTSD, yet few have concentrated on either explicable indicators or distinctions among these indicators, such as the patient’s sex. This research used an XAI algorithm to identify patterns related to PTSD in three biometric data sets: facial movements, speech, and voice-to-text transcriptions. Such biometric data are grouped by sex. Utilizing the DAIC-WOZ database, this study involves feature selection and characterization. Experiment configurations addressed participant segmentation, feature reduction, and standardization. Training phases employed machine-learning classification algorithms with their corresponding performance evaluation. The interpretability stage explored the relationship between input features and class output. The findings reveal that among the three biometric data sets evaluated in this work (facial movements, speech, and voice-to-text transcriptions), speech characterization is the most effective in identifying PTSD indicators, suggesting a uniform speech pattern associated with breathy and tense voice and weak phonation in PTSD patients. Sex-specific analysis enhances prediction performance, revealing distinctions in the associated speech features. The Women’s model prioritizes tense voice and vocal volume variations, reduced glottal closure, and interrupted phonation. Conversely, the Speech-Men model reflects reduced resonance, making the voice thinner and weaker, indicating altered vocal quality. As for facial movements, sex-specific characteristics are not evident, but some features focused on lips are associated with PTSD. Similarly, PTSD is related to alertness, determination, and anxiety in both women and men. In conclusion, using an XAI algorithm to differentiate sex-based patterns in biometric data contributes to a better understanding of PTSD indicators, offering potential advancements in personalized diagnostic strategies.

Phenotyping Depression After Mild Traumatic Brain Injury: Evaluating the Impact of Multiple Injury, Gender, and Injury Context.

The chronic mental health consequences of mild traumatic brain injury (TBI) are a leading cause of disability. This is surprising given the expectation of significant recovery after mild TBI, which suggests that other injury-related factors may contribute to long-term adverse outcomes. The objective of this study was to determine how number of prior injuries, gender, and environment/context of injury may contribute to depressive symptoms after mild TBI among deployed United States service members and veterans (SMVs). Data from the Long-term Impact of Military-Relevant Brain Injury Consortium Prospective Longitudinal Study was used to assess TBI injury characteristics and depression scores previously measured on the Patient Health Questionnaire-9 (PHQ-9) among a sample of 1456 deployed SMVs. Clinical diagnosis of mild TBI was defined via a multi-step process centered on a structured face-to-face interview. Logistical and linear regressions stratified by gender and environment of injury were used to model depressive symptoms controlling for sociodemographic and combat deployment covariates. Relative to controls with no history of mild TBI (n = 280), the odds ratios (OR) for moderate/severe depression (PHQ-9 ≥ 10) were higher for SMVs with one mild TBI (n = 358) OR: 1.62 (95% confidence interval [CI] 1.09-2.40, p = 0.016) and two or more mild TBIs (n = 818) OR: 1.84 (95% CI 1.31-2.59, p < 0.001). Risk differences across groups were assessed in stratified linear models, which found that depression symptoms were elevated in those with a history of multiple mild TBIs compared with those who had a single mild TBI (p < 0.001). Combat deployment-related injuries were also associated with higher depression scores than injuries occurring in non-combat or civilian settings (p < 0.001). Increased rates of depression after mild TBI persisted in the absence of post-traumatic stress disorder. Both men and women SMVs separately exhibited significantly increased depressive symptom scores if they had had combat-related mild TBI. These results suggest that contextual information, gender, and prior injury history may influence long-term mental health outcomes among SMVs with mild TBI exposure.

Disentangling the effects of PTSD from Gulf War Illness in male veterans via a systems-wide analysis of immune cell, cytokine, and symptom measures

BackgroundOne-third of veterans returning from the 1990–1991 Gulf War reported a myriad of symptoms including cognitive dysfunction, skin rashes, musculoskeletal discomfort, and fatigue. This symptom cluster is now referred to as Gulf War Illness (GWI). As the underlying mechanisms of GWI have yet to be fully elucidated, diagnosis and treatment are based on symptomatic presentation. One confounding factor tied to the illness is the high presence of post-traumatic stress disorder (PTSD). Previous research efforts have demonstrated that both GWI and PTSD are associated with immunological dysfunction. As such, this research endeavor aimed to provide insight into the complex relationship between GWI symptoms, cytokine presence, and immune cell populations to pinpoint the impact of PTSD on these measures in GWI.MethodsSymptom measures were gathered through the Multidimensional fatigue inventory (MFI) and 36-item short form health survey (SF-36) scales and biological measures were obtained through cytokine & cytometry analysis. Subgrouping was conducted using Davidson Trauma Scale scores and the Structured Clinical Interview for Diagnostic and statistical manual of mental disorders (DSM)-5, into GWI with high probability of PTSD symptoms (GWIH) and GWI with low probability of PTSD symptoms (GWIL). Data was analyzed using Analysis of variance (ANOVA) statistical analysis along with correlation graph analysis. We mapped correlations between immune cells and cytokine signaling measures, hormones and GWI symptom measures to identify patterns in regulation between the GWIH, GWIL, and healthy control groups.ResultsGWI with comorbid PTSD symptoms resulted in poorer health outcomes compared with both Healthy control (HC) and the GWIL subgroup. Significant differences were found in basophil levels of GWI compared with HC at peak exercise regardless of PTSD symptom comorbidity (ANOVA F = 4.7, P = 0.01,) indicating its potential usage as a biomarker for general GWI from control. While the unique identification of GWI with PTSD symptoms was less clear, the GWIL subgroup was found to be delineated from both GWIH and HC on measures of IL-15 across an exercise challenge (ANOVA F > 3.75, P < 0.03). Additional differences in natural killer (NK) cell numbers and function highlight IL-15 as a potential biomarker of GWI in the absence of PTSD symptoms.ConclusionWe conclude that disentangling GWI and PTSD by defining trauma-based subgroups may aid in the identification of unique GWI biosignatures that can help to improve diagnosis and target treatment of GWI more effectively.

Nightmares: An Independent Risk Factor for Cardiovascular Disease?

Prior work has established associations between post-traumatic stress disorder (PTSD), disrupted sleep, and cardiovascular disease (CVD), but few studies have examined health correlates of nightmares beyond risks conferred by PTSD. This study examined associations between nightmares and CVD in military veterans. Participants were veterans (N=3468; 77% male) serving since September 11, 2001, aged 38 years (SD=10.4); approximately 30% were diagnosed with PTSD. Nightmare frequency and severity was assessed using the Davidson Trauma Scale (DTS). Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study Self-report Medical Questionnaire. Mental health disorders were established using the Structured Clinical Interview for DSM-IV. The sample was stratified by the presence or absence of PTSD. Within-group associations between nightmare frequency and severity and self-reported CVD conditions, adjusting for age, sex, race, current smoking, depression, and sleep duration. Frequent and severe nightmares during the past week were endorsed by 32% and 35% of participants, respectively. Those endorsing nightmares that were frequent, severe, and the combination thereof were more likely to also evidence high blood pressure (ORs 1.42, OR 1.56, and OR 1.47, respectively) and heart problems (OR 1.43, OR 1.48, and OR 1.59, respectively) after adjusting for PTSD diagnosis and other covariates. Nightmare frequency and severity among veterans are associated with cardiovascular conditions, even after controlling for PTSD diagnosis. Study findings suggest that nightmares may be an independent risk factor for CVD. Additional research is needed to validate these findings using confirmed diagnoses and explore potential mechanisms.

Clinical utility of PTSD, resilience, sleep, and blast as risk factors to predict poor neurobehavioral functioning following traumatic brain injury: A longitudinal study in U.S. military service members.

This study examined the clinical utility of post-traumatic stress disorder (PTSD), low resilience, poor sleep, and lifetime blast exposure as risk factors for predicting future neurobehavioral outcome following traumatic brain injury (TBI). Participants were 591 U.S. military service members and veterans who had sustained a TBI (n = 419) or orthopedic injury without TBI (n = 172). Participants completed the Neurobehavioral Symptom Inventory, PTSD Checklist, and the TBI-Quality of Life (TBI-QOL) scale at baseline and follow-up. Using the four risk factors at baseline, 15 risk factor combinations were examined by calculating odds ratios to predict poor neurobehavioral outcome at follow-up (i.e., number of abnormal scores across five TBI-QOL scales [e.g., Fatigue, Depression]). The vast majority of risk factor combinations resulted in odds ratios that were considered to be clinically meaningful (i.e., ≥ 2.5) for predicting poor outcome. The risk factor combinations with the highest odds ratios included PTSD singularly, or in combination with poor sleep and/or low resilience (odds ratios = 4.3-72.4). However, poor sleep and low resilience were also strong predictors in the absence of PTSD (odds ratios = 3.1-29.8). PTSD, poor sleep, and low resilience, singularly or in combination, may be valuable risk factors that can be used clinically for targeted early interventions.

Neurobiology of emotional trauma.

An emotional trauma may induce a cascade of neurobiological events that have long-lasting consequences even altered gene expression. Early abuse and neglect can deregulate the child's developing neurobiological system by reducing its resistance to stressful events, leading to later problems of emotional regulation. Children who have been subjected to physical or emotional abuse tend to pay more attention to signs that contain anger and are hypersensitive to threat. Scar hypothesis and the theories of behavioural sensitization or electrophysiological kindling suggest that emotional traumas may leave traces that persist even after remission of depression, and render individuals vulnerable to the onset of new episodes, even under the influence of only moderate psychosocial stress. Unfavorable early social experiences, such as emotional abuse or institutionalization can affect the structure and function of the prefrontal cortex. Exposure to repeated emotional stressors, even in the absence of post-traumatic stress disorder (PTSD) diagnoses, has been shown to produce increased synapse formation and dendritic growth in basolateral amygdala, dendritic retraction in the hippocampus, and anxiety-like behavior against specific triggers, such as phobia of open spaces. During the narration of an emotionally traumatic event, there is activation of the limbic system, the right amygdale, the orbitofrontal cortex and the anterior cingulate gyrus. In addition, there is an activation of the anterior insula, which records the physical impact of negative emotions, and the anterior and medial temporal cortex, which are involved in negative emotions. Neuroimaging studies in PTSD patients have found hypoactivity in the frontal lobe, anterior cingulate and thalamic areas, indicating the effects of PTSD on executive function, attention and cognitive, memorial, and affective and somatosensory integration. One of the most replicated findings in studies involving PTSD patients is the decreased activation of the dorsolateral prefrontal cortex. Studies have also found a negative correlation between the dorsolateral prefrontal cortex and amygdala activation. A recent meta-analysis revealed structural brain abnormalities associated with PTSD and emotional trauma and suggested that global brain volume reductions can distinguish PTSD from major depression. Neuroimaging studies of successful eye movement desensitization and reprocessing (EMDR) treatment have consistently shown that patients exhibited increased frontal lobe activation. Moving beyond diagnostic boundaries, focusing on the causal interplay between specific traumatic processes and using standardized measures, are useful directions for future research in memory, emotion and emotional trauma.

Differential relationships of PTSD and childhood trauma with the course of substance use disorders

A large body of research documents the link between Posttraumatic Stress Disorder (PTSD) and the course of Substance Use Disorders (SUD). Similar relationships have been reported between Childhood Trauma (CT) and the course of illness in patients with SUD even in the absence of PTSD, but few studies have examined differential effects of PTSD and CT (independent of PTSD) in this population.We used the International Diagnostic Checklist (IDCL) and the Posttraumatic Diagnostic Scale (PDS) to diagnose PTSD in a sample of patients with SUD (N = 459). The Childhood Trauma Questionnaire (CTQ) and the European Addiction Severity Index (EuropASI) were administered to assess childhood trauma and addiction related problems including comorbid psychopathological symptoms. The sample was divided into three groups: patients with experiences of CT and PTSD (CT-PTSD), experiences of CT without PTSD (CT-only), and neither experiences of CT nor PTSD (No trauma) to examine their differential associations with the course and severity of SUD.Patients of both the CT-PTSD (n = 95) and the CT-only group (n = 134) reported significantly higher levels of anxiety and depression as well as more suicidal thoughts and suicide attempts during their lifetime than the No trauma group (n = 209). Regarding most variables a graded association became apparent, with the highest level of symptoms in the CT-PTSD group, an intermediate level in the CT-only group and the lowest level in the No trauma group. The CT-PTSD group also differed in almost all substance use variables significantly from the No trauma group, including a younger age at first use of alcohol and cannabis, more cannabis use in the last month, and more lifetime drug overdoses.Our results confirm the relationships of both CT and PTSD with psychiatric symptoms in patients with SUD. Thus, it seems important to include both domains into the routine assessment of SUD patients. Specific treatments for comorbid PTSD but also for other consequences of childhood trauma should be integrated into SUD treatment programs.

The Double-Edged Sword - Outward and Inward Directed Aggression among War Combatants

Inspired by the two-stage model of countervailing forces, we explored the mechanism underlining inward and outward aggression among ex-combatants. Israeli veterans (N = 230) reported their partner’s violence (outward aggression), suicidal ideation (inward aggression), aggressive impulses, posttraumatic stress disorder (PTSD), paranoid ideation and guilt. Suicidal ideation was related to aggressive impulses only in the presence of PTSD, or under high guilt; whereas paranoid ideation buffered these effects. Violence towards the partner, on the other hand, was related to aggressive impulses under low guilt and in the absence of PTSD. Aggressive impulses underline both suicidal ideation and partner violence. The inter-relations between PTSD, guilt, and paranoid ideation influence the manifestation of aggression and the direction it takes.

“Heroes' invisible wounds of war:” constructions of posttraumatic stress disorder in the text of US federal legislation

Public policies contribute to the social construction of mental health problems. In this study, I use social constructivist theories of policy design and the methodology of ethnographic content analysis to qualitatively explore how posttraumatic stress disorder (PTSD) has been constructed as a problem in US federal legislation. I analyzed the text of 166 bills introduced between 1989 and 2009 and found that PTSD has been constructed as a problem unique to combat exposures and military populations. These constructions were produced through combat-related language and imagery (e.g., wounds, war, heroism), narratives describing PTSD as a military-specific phenomenon, and reinforced by the absence of PTSD in trauma-focused legislation targeting civilians. These constructions do not reflect the epidemiology of PTSD—the vast majority of people who develop the disorder have not experienced combat and many non-combat traumas (e.g., sexual assault) carry higher PTSD risk—and might constrain public and political discourse about the disorder and reify sociocultural barriers to the access of mental health services.

Assessing traumatic experiences in screening for PTSD in substance use disorder patients: What is the gain in addition to PTSD symptoms?

Traumatic experiences have been linked with substance use disorders (SUD) and may be an important factor in the perpetuation of SUD, even in the absence of posttraumatic stress disorder (PTSD) symptoms. The purpose of the current study was to examine the relationship between childhood trauma and substance use severity in 192 SUD inpatients. Childhood trauma was assessed using the Traumatic Experiences Checklist (TEC). With variables derived from this measure in addition to PTSD symptoms, two regression models were created with alcohol use or drug use severity as dependent variables. Alcohol severity was explained by PTSD symptoms as well as the age of trauma. Drug severity was explained solely by PTSD symptoms. The clinical value of assessing childhood trauma in determining the addiction severity appears to be limited in comparison with PTSD symptoms.

Invasive coronary procedure use and outcomes among veterans with posttraumatic stress disorder: Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

Posttraumatic stress disorder (PTSD) is prevalent in the general population and US veterans in particular and is associated with an increased risk of developing coronary artery disease (CAD). We compared the patient characteristics and postprocedural outcomes of veterans with and without PTSD undergoing coronary angiography. This is a multicenter observational study of patients who underwent coronary angiography in Veterans Affairs hospitals nationally from October 2007 to September 2011. We described patient characteristics at angiography, angiographic results, and after coronary angiography, we compared risk-adjusted 1-year rates of all-cause mortality, myocardial infarction (MI), and revascularization by the presence or absence of PTSD. Overall, of 116,488 patients undergoing angiography, 14,918 (12.8%) had PTSD. Compared with those without PTSD, patients with PTSD were younger (median age 61.9 vs 63.7; P < .001), had higher rates of cardiovascular risk factors, and were more likely to have had a prior MI (26.4% vs 24.7%; P < .001). Patients with PTSD were more likely to present for stable angina (22.4% vs 17.0%) or atypical chest pain (58.5% vs 48.6%) and less likely to have obstructive CAD identified at angiography (55.9% vs 62.2%; P < .001). After coronary angiography, PTSD was associated with lower unadjusted 1-year rates of MI (hazard ratio (HR), 0.86; 95% CI [0.75-1.00]; P = 0.04), revascularization (HR, 0.88; 95% CI [0.83-0.93]; P < .001), and all-cause mortality (HR, 0.66; 95% CI [0.60-0.71]; P < .001). After adjustment for cardiovascular risk, PTSD was no longer associated with 1-year rates of MI or revascularization but remained associated with lower 1-year all-cause mortality (HR, 0.91; 95% CI [0.84-0.99]; P = .03). Findings were similar after further adjustment for depression, anxiety, alcohol or substance use disorders, and frequency of outpatient follow-up. Among veterans undergoing coronary angiography in the Veterans Affairs, those with PTSD were more likely to present with elective indications and less likely to have obstructive CAD. After coronary angiography, PTSD was not associated with adverse 1-year outcomes of MI, revascularization, or all-cause mortality.

Rehabilitation outcome following war-related transtibial amputation in Kosovo

Previous literature has suggested that age, level of amputation, residual limb length, comorbidities, mental disorders, and cause of amputation can affect the ability to successfully ambulate with prosthesis. The objective of this study was to analyze the predictors that affect the rehabilitation outcome of war-related transtibial amputees and the relationship of these factors with ambulation ability after prosthetic fitting. Retrospective observational study. We reviewed the records of 69 war-related transtibial amputees. The rehabilitation outcome was analyzed according to the grade of rehabilitation summarized in three grades. Multiple logistic regression analysis was used to determine the odds of achieving the first rehabilitation grade. The majority of patients with transtibial amputations achieved the first grade of rehabilitation (59.4%). The factors that significantly influenced the achievement of the first grade of rehabilitation were age and absence of posttraumatic stress disorder. For every 1-year increase in patient age, the odds of achieving first grade of rehabilitation decreased by a factor of 0.9. Patients without posttraumatic stress disorder had 12.9 greater odds of achieving the first rehabilitation grade compared to patients with posttraumatic stress disorder. Achievement of the first grade of rehabilitation among war-related transtibial amputees is dependent on patient age and the absence of posttraumatic stress disorder. Understanding the factors that may affect the rehabilitation outcome of war-related amputees could lead to a more specific organization of the rehabilitation, especially in a country that has recently been involved in war. This is the first study to focus on determinants of prosthetic rehabilitation in these patients.

EMDR and CBT for Cancer Patients: Comparative Study of Effects on PTSD, Anxiety, and Depression

This pilot study examined the efficacy of eye movement desensitization and reprocessing (EMDR) treatment compared with cognitive behavioral therapy (CBT) in treating posttraumatic stress disorder (PTSD) in oncology patients in the follow-up phase of the disease. The secondary aim of this study was to assess whether EMDR treatment has a different impact on PTSD in the active treatment or during the follow-up stages of disease. Twenty-one patients in follow-up care were randomly assigned to EMDR or CBT groups, and 10 patients in the active treatment phase were assigned to EMDR group. The Impact of Event Scale—Revised (IES-R) and Clinician-Administered PTSD Scale (CAPS) were used to assess PTSD at pretreatment and 1 month posttreatment. Anxiety, depression, and psychophysiological symptoms were also evaluated. For cancer patients in the follow-up stage, the absence of PTSD after the treatment was associated with a significantly higher likelihood of receiving EMDR rather than CBT. EMDR was significantly more effective than CBT in reducing scores on the IES-R and the CAPS intrusive symptom subscale, whereas anxiety and depression improved equally in both treatment groups. Furthermore, EMDR showed the same efficacy both in the active cancer treatment and during the follow-up of the disease.

Changes in personality after mild traumatic brain injury from primary blast vs. blunt forces

Introduction: Injuries from explosive devices can cause blast-force injuries, including mild traumatic brain injury (mTBI).Objective: This study investigated changes in personality from blast-force mTBI in comparison to blunt-force mTBI.Methods: Clinicians and significant others assessed US veterans who sustained pure blast-force mTBI (n = 12), as compared to those who sustained pure blunt-force mTBI (n = 12). Inclusion criteria included absence of any mixed blast–blunt trauma and absence of post-traumatic stress disorder. Measures included the Interpersonal Measure of Psychopathy (IM-P), the Big Five Inventory (BFI), the Interpersonal Adjectives Scale (IAS) and the Frontal Systems Behaviour Scale (FrSBe).Results: There were no group differences on demographic or TBI-related variables. Compared to the Blunt Group, the Blast Group had more psychopathy on the IM-P, with anger, frustration, toughness and boundary violations and tended to more neuroticism on the BFI. When pre-TBI and post-TBI assessments were compared on the IAS and FrSBe, only the patients with blast force mTBI had become more cold-hearted, aloof–introverted and apathetic.Conclusion: These results suggest that blast forces alone can cause negativistic behavioural changes when evaluated with selected measures of personality. Further research on isolated blast-force mTBI should focus on these personality changes and their relationship to blast over-pressure.

Lifetime trauma exposure and posttraumatic stress disorder in women sentenced to drug court

The aims of this study were to characterize trauma exposure and posttraumatic stress disorder (PTSD) in female drug court participants and test for differences in socioeconomic status and familial status between women with: (i) no trauma exposure, (ii) trauma exposure without PTSD, and (iii) trauma exposure resulting in PTSD. Three hundred and nineteen women were recruited from drug courts. Rates of exposure and likelihood of traumatic events leading to PTSD were examined, sociodemographic characteristics were compared across groups, and a logistic regression analysis was conducted to test for differences in PTSD risk for assaultive vs. non-assaultive events. Twenty percent of participants met PTSD criteria, 71% had trauma exposure without PTSD, and 9% did not endorse any traumatic events. Prostitution and homelessness were more prevalent in women with vs. without a history of trauma, but among trauma-exposed women prevalences did not vary by PTSD status. No differences in risk for PTSD were found between assaultive and non-assaultive events (OR=0.91; 95%CI: 0.48–1.75). Women sentenced to drug court represent a heavily trauma-exposed population, for whom risk for PTSD is not limited to assaultive events. Within this high-risk population, trauma is associated with elevated rates of homelessness and prostitution, even in the absence of PTSD.

Mild Traumatic Brain Injury from Primary Blast vs. Blunt Forces: Post-Concussion Consequences and Functional Neuroimaging (P01.178)

Objective: This study investigated changes in functional health and well-being, cognition, and functional neuroimaging among Iraq/Afghanistan veterans who sustained pure blast-force mild traumatic brain injury (mTBI), as compared to those who sustained pure blunt-force mTBI. The aim was to document post-concussion consequences and associated changes in cerebral metabolism from mTBI due to blast forces. Background Injuries from blast forces are a hallmark of the conflicts in Iraq and Afghanistan and may cause undetected neurological dysfunction from mTBI. The effects of primary blast overpressure on the brain have been difficult to clarify because of complications, such as secondary and tertiary blast effects and comorbid post-traumatic stress disorder (PTSD). Design/Methods: Inclusion criteria included presence of pure blast or blunt injury, absence of PTSD, and between 6-36 months post-trauma. The Blast Group (n=12) and the Blunt Group (n=12) underwent assessments of well-being, cognition, and resting fluorodeoxyglucose positron emission tomography (PET). Results: There were no group differences on mTBI-related variables, the Rivermead Post-Concussion Questionnaire (RPQ), or the SF36-V Health Survey. Both groups, however, did worse than published norms on the RPQ and SF36-V, and the Blast Group had additional worse SF36-V subscale scores on Bodily Pain and Social Functioning. Compared to the Blunt Group, the Blast Group had poorer scores on the Paced Auditory Serial Addition Test (PASAT) and greater PET hypometabolism in the right superior parietal region. Only the Blast Group had significant correlations of their RPQ, SF36-V Mental Composite Score, and PASAT scores with specific regional metabolic changes. Conclusions: Together these results suggest that pure blast force mTBI has post-concussion consequences. Blast mTBI may cause deficits in well-being, possibly from an altered bodily self-image, and in attentional control. These changes are associated with regional changes in cerebral metabolism, particularly hypometabolism in the right hemisphere. Supported by: Department of Veteran9s Affairs Grant. Disclosure: Dr. Mendez has nothing to disclose. Dr. Licht has nothing to disclose. Dr. Berenji has nothing to disclose. Dr. Peppers has nothing to disclose.

Screening for posttraumatic stress disorder using verbal features in self narratives: A text mining approach

Much evidence has shown that people's physical and mental health can be predicted by the words they use. However, such verbal information is seldom used in the screening and diagnosis process probably because the procedure to handle these words is rather difficult with traditional quantitative methods. The first challenge would be to extract robust information from diversified expression patterns, the second to transform unstructured text into a structuralized dataset. The present study developed a new textual assessment method to screen the posttraumatic stress disorder (PTSD) patients using lexical features in the self narratives with text mining techniques. Using 300 self narratives collected online, we extracted highly discriminative keywords with the Chi-square algorithm and constructed a textual assessment model to classify individuals with the presence or absence of PTSD. This resulted in a high agreement between computer and psychiatrists' diagnoses for PTSD and revealed some expressive characteristics in the writings of PTSD patients. Although the results of text analysis are not completely analogous to the results of structured interviews in PTSD diagnosis, the application of text mining is a promising addition to assessing PTSD in clinical and research settings.

Posttraumatic growth and posttraumatic distress: A longitudinal study.

This longitudinal study examined the course and bidirectional relation between posttraumatic distress and posttraumatic growth (PTG). A sample of Israeli ex-prisoners of war and matched controls were followed over 17 years. Participants’ posttraumatic stress disorder (PTSD), depression, and anxiety symptoms were measured at three time-points. PTG was assessed twice. Applying an autoregressive cross-lagged modeling strategy, initial PTSD predicted subsequent PTG above and beyond PTG stability, but not vice versa. Cross-lagged relations of PTG to depression and anxiety were not significant. Moreover, analysis of PTG trajectory revealed that individuals with PTSD reported higher PTG levels across times than those without PTSD. Thus, growth is facilitated and maintained by endorsement rather than absence of PTSD. The findings are discussed in the context of the illusionary versus adaptive notion of PTG.

Outcome Evaluation of the Veterans Affairs Salt Lake City Integrative Health Clinic for Chronic Pain and Stress-Related Depression, Anxiety, and Post-Traumatic Stress Disorder

The purpose of this longitudinal outcome research study was to determine the effectiveness of the Integrative Health Clinic and Program (IHCP) and to perform a subgroup analysis investigating patient benefit. The IHCP is an innovative clinical service within the Veterans Affairs Health Care System designed for nonpharmacologic biopsychosocial management of chronic nonmalignant pain and stress-related depression, anxiety, and symptoms of post-traumatic stress disorder (PTSD) utilizing complementary and alternative medicine and mind-body skills. A post-hoc quasi-experimental design was used and combined with subgroup analysis to determine who benefited the most from the program. Data were collected at intake and up to four follow-up visits over a 2-year time period. Hierarchical linear modeling was used for the statistical analysis. The outcome measures included: Health-Related Quality of Life (SF-36), the Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Subgroup comparisons included low anxiety (BAI < 19, n = 82), low depression (BDI < 19, n = 93), and absence of PTSD (n = 102) compared to veterans with high anxiety (BAI > or = 19, n = 77), high depression (BDI > 19, n = 67), and presence of PTSD (n = 63). All of the comparison groups demonstrated an improvement in depression and anxiety scores, as well as in some SF-36 categories. The subgroups with the greatest improvement, seen at 6 months, were found in the high anxiety group (Cohen's d = 0.52), the high-depression group (Cohen's d = 0.46), and the PTSD group (Cohen's d = 0.41). The results suggest IHCP is an effective program, improving chronic pain and stress-related depression, anxiety, and health-related quality of life. Of particular interest was a significant improvement in anxiety in the PTSD group. The IHCP model offers innovative treatment options that are low risk, low cost, and acceptable to patients and providers.