Baseline Posttraumatic Stress Disorder Symptoms Research Articles

Investigating the bed nucleus of the stria terminalis as a predictor of posttraumatic stress disorder in Black Americans and the moderating effects of racial discrimination

Altered functioning of the bed nucleus of the stria terminalis (BNST) may play a critical role in the etiology of posttraumatic stress disorder (PTSD). Chronic stressors such as racial discrimination and lifetime trauma are associated with an increased risk for PTSD, but it is unknown whether they influence the relationship between BNST functioning and PTSD. We investigated acute post-trauma BNST resting-state functional connectivity (rsFC) as a predictor of future PTSD symptoms in Black trauma survivors. We also examined whether racial discrimination and lifetime trauma moderated the relationship between BNST rsFC and PTSD symptoms. Black adults (N = 95; 54.7% female; mean age = 34.04) were recruited from an emergency department after experiencing a traumatic injury (72.6% were motor vehicle accidents). Two-weeks post-injury, participants underwent a resting-state fMRI scan and completed questionnaires evaluating their PTSD symptoms as well as lifetime exposure to racial discrimination and trauma. Six-months post-injury, PTSD symptoms were reassessed. Whole brain seed-to-voxel analyses were conducted to examine BNST rsFC patterns. Greater rsFC between the BNST and the posterior cingulate cortex, precuneus, left angular gyrus, and hippocampus prospectively predicted six-month PTSD symptoms after adjusting for sex, age, education, and baseline PTSD symptoms. Acute BNST rsFC was a stronger predictor of PTSD symptoms in individuals who experienced more racial discrimination and lifetime trauma. Thus, in the acute aftermath of a traumatic event, the BNST could be a key biomarker of risk for PTSD in Black Americans, particularly for individuals with a greater history of racial discrimination or previous trauma exposure.

Alcohol Use Predicts Longer But More Fragmented Sleep: A Daily Diary Study of Alcohol, Sleep, and PTSD in Nurses.

Due to the demanding nature of their profession, nurses are at risk of experiencing irregular sleep patterns, substance use, and fatigue. Evidence supports a reciprocal relationship between alcohol use and sleep disturbances; however, no research has examined such a link in a sample of nurses. One factor that may further impact the dynamic between alcohol and sleep patterns is posttraumatic stress disorder (PTSD) symptoms. We investigated the daily bidirectional associations between alcohol use and several sleep domains (i.e., self-report and actigraphy-determined sleep), and moderation by baseline PTSD symptom severity. Over a 14-day period, 392 nurses (92% female; 78% White) completed sleep diaries and actigraphy to assess alcohol use and sleep patterns. Within-person bidirectional associations between alcohol and sleep were examined using multilevel models, with symptoms of PTSD as a cross-level moderator. Daily alcohol use (i.e., ≥ 1 alcoholic beverage; 25.76%) was associated with shorter self-reported sleep onset latency (b = -4.21, p = .003) but longer self-reported wake after sleep onset (b = 2.36, p = .009). Additionally, days with any alcohol use were associated with longer self-reported sleep duration (b = 15.60, p = .006) and actigraphy-determined sleep duration (b = 10.06, p = .037). No sleep variables were associated with next-day alcohol use. Bidirectional associations between alcohol consumption and sleep were similar regardless of baseline PTSD symptoms. Our results suggested that on days when nurses drank alcohol, they experienced longer but also more fragmented sleep.

Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans

Chronic pain is common and disabling in older adults, and psychological interventions are indicated. However, the gold standard approach, cognitive-behavioral therapy (CBT), produces only modest benefits, and more powerful options are needed. To evaluate whether emotional awareness and expression therapy (EAET) is superior to CBT for treatment of chronic pain among predominantly male older veterans and whether higher baseline depression, anxiety, or posttraumatic stress disorder (PTSD) symptoms-key targets of EAET-moderate treatment response. This 2-arm randomized clinical trial was conducted from May 16, 2019, to September 14, 2023, in the US Department of Veterans Affairs Greater Los Angeles Healthcare System. The trial included a racially and ethnically diverse group of veterans aged 60 to 95 years with at least 3 months of musculoskeletal pain. Emotional awareness and expression therapy or CBT, conducted concurrently, each presented as one 90-minute individual session followed by eight 90-minute group sessions. The primary outcome was Brief Pain Inventory pain severity (range, 0 to 10) from baseline to posttreatment (week 10, primary end point) and 6-month follow-up. Secondary outcomes included Patient Reported Outcomes Institute Measurement System Anxiety, Depression, Fatigue, General Life Satisfaction (NIH Toolbox), Pain Interference, and Sleep Disturbance Short Forms, Patient Global Impression of Change (PGIC), and Satisfaction with Therapy and Therapist Scale-Revised. A subset of participants completed the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). All analyses were for the intention-to-treat population and included all randomized participants. Among 126 randomized participants (66 in the EAET group and 60 in the CBT group; mean [SD] age, 71.9 [5.9] years; 116 [92%] male), 111 (88%) completed posttreatment, and 104 (82%) completed the 6-month follow-up. The EAET was superior to CBT for the primary outcome of reduction in pain severity at posttreatment (estimate, -1.59 [95% CI, -2.35 to -0.83]; P < .001) and follow-up (estimate, -1.01 [95% CI, -1.78 to -0.24]; P = .01). A greater percentage of participants in EAET vs CBT had clinically significant (at least 30%) pain reduction (63% vs 17%; odds ratio, 21.54 [95% CI, 4.66-99.56]; P < .001) at posttreatment. In addition, EAET was superior to CBT on 50% pain reduction (35% vs 7%; odds ratio, 11.77 [95% CI, 2.38-58.25]; P = .002), anxiety (estimate, -2.49 [95% CI, -4.30 to -0.68]; P = .006), depression (estimate, -3.06 [95% CI, -5.88 to -0.25]; P = .03), general life satisfaction (estimate, 1.23 [95% CI, 0.36-2.10]; P = .005), PTSD symptoms (estimate, -4.39 [95% CI, -8.44 to -0.34]; P = .03), PGIC score (estimate, 1.46 [95% CI, 0.77-2.15]; P < .001), and global treatment satisfaction (estimate, 0.28 [95% CI, 0.12-0.45]; P < .001) at posttreatment. Higher baseline depression (estimate, -1.55 [95% CI, -0.37 to 2.73]; P < .001), anxiety (estimate, -1.53 [95% CI, -2.19 to -0.88]; P < .001), and PTSD symptoms (estimate, -1.69 [95% CI, -2.96 to -0.42]; P = .009) moderated greater reduction in pain severity after EAET but not CBT. The results of this randomized clinical trial suggest that EAET may be a preferred intervention for medically and psychiatrically complex patients with pain. The societal burden of chronic pain could be improved by further incorporating the principles of EAET into mainstream clinical pain medicine. ClinicalTrials.gov Identifier: NCT03918642.

Trajectories of patient-reported outcomes after prolonged stays for hematopoietic cell transplant.

6553 Background: Patients hospitalized for hematopoietic cell transplantation (HCT) may have prolonged length of stay (PLOS). The longitudinal effect of PLOS in this population on quality of life (QOL) and psychological distress is unknown. Methods: We conducted secondary analyses of data from three prospective studies of patients undergoing HCT (2011-2022) at three academic centers. We defined PLOS as ≥30 days for allogeneic and ≥21 days for autologous HCT from date of admission. We collected patient-reported outcomes (PROs) for QOL, anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms at baseline, 2 weeks, 3 and 6 months post-HCT. We used multivariate logistic regression to assess the effect of change in PROs from baseline to week 2 on PLOS adjusting for age, transplant type, donor, and diagnosis. We then fit linear mixed effects models to characterize the trajectory of PROs by PLOS over time. Results: 593 patients (mean age 56 years) were included, the majority of whom were male (57%), white (82%), and underwent allogeneic HCT (52%). The most common diagnosis was acute leukemia (28%). Patients with PLOS (26%) were younger (57 [range 18-78 yrs], 53 [19-75 yrs], p = 0.002), had acute leukemia (26%, 34%, p = 0.001), received myeloablative conditioning (21%, 41%, p &lt; 0.001), and underwent allogeneic HCT (50%, 60%, p &lt; 0.001). At baseline, patients with PLOS had lower QOL (108, 102, p = 0.001) and more depression symptoms (4.4, 5.3, p = 0.02). There was no difference in baseline anxiety or PTSD symptoms. An increase in depression symptoms from baseline to week 2 was associated with greater odds of PLOS (adjusted OR = 1.08, p = 0.04). The table depicts longitudinal differences in PROs by PLOS. Compared to those without PLOS, patients with PLOS reported lower QOL (time*PLOS interaction, ∆ = -6.6, SE = 2.1, p = 0.001) and greater increase in depression symptoms (time*PLOS interaction, ∆ = 1.9, SE = 0.6, p &lt; 0.001) at week 2. Lower QOL in those with PLOS persisted through 6 months (Table). PLOS was associated with more re-admissions (0.8, 1.1, p = 0.02) and mortality (9%, 19%, p = 0.001) within 1 year of HCT. No difference was seen in rate of relapse and severe acute or chronic graft- versus-host disease. Conclusions: Patients with PLOS experienced worse QOL and increased psychological distress. Increase in depression symptoms from admission to week 2 may be an early indicator of PLOS and supports mental health screening during the index HCT hospitalization. Patients with PLOS may benefit from enhanced supportive care during and after HCT.[Table: see text]

Childhood Maltreatment and Amygdala-Mediated Anxiety and Posttraumatic Stress Following Adult Trauma

BackgroundChildhood abuse (physical, emotional, and sexual) is associated with aberrant connectivity of the amygdala, a key threat-processing region. Heightened amygdala activity also predicts adult anxiety and posttraumatic stress disorder (PTSD) symptoms, as do experiences of childhood abuse. The current study explored whether amygdala resting-state functional connectivity may explain the relationship between childhood abuse and anxiety and PTSD symptoms following trauma exposure in adults. MethodsTwo weeks posttrauma, adult trauma survivors (n = 152, mean age [SD] = 32.61 [10.35] years; women = 57.2%) completed the Childhood Trauma Questionnaire and underwent resting-state functional magnetic resonance imaging. PTSD and anxiety symptoms were assessed 6 months posttrauma. Seed-to-voxel analyses evaluated the association between childhood abuse and amygdala resting-state functional connectivity. A mediation model evaluated the potential mediating role of amygdala connectivity in the relationship between childhood abuse and posttrauma anxiety and PTSD. ResultsChildhood abuse was associated with increased amygdala connectivity with the precuneus while covarying for age, gender, childhood neglect, and baseline PTSD symptoms. Amygdala-precuneus resting-state functional connectivity was a significant mediator of the effect of childhood abuse on anxiety symptoms 6 months posttrauma (B = 0.065; 95% CI, 0.013–0.130; SE = 0.030), but not PTSD. A secondary mediation analysis investigating depression as an outcome was not significant. ConclusionsAmygdala-precuneus connectivity may be an underlying neural mechanism by which childhood abuse increases risk for anxiety following adult trauma. Specifically, this heightened connectivity may reflect attentional vigilance for threat or a tendency toward negative self-referential thoughts. Findings suggest that childhood abuse may contribute to longstanding upregulation of attentional vigilance circuits, which makes one vulnerable to anxiety-related symptoms in adulthood.

Fear generalization predicts post-traumatic stress symptoms: A two-year follow-up study in Dutch fire fighters

IntroductionExcessive fear generalization has been associated with pathological anxiety, including posttraumatic stress disorder (PTSD). However, studies investigating the longitudinal relationship between generalization and the development of anxiety symptomatology are scarce. This study aims to test the predictive value of fear generalization for PTSD symptoms in a high-risk profession sample and to explore the relationship between generalization and neuroticism, which are both linked to PTSD. MethodLongitudinal data from a multi-wave study in 529 Dutch fire-fighters were used. Fear generalization, PTSD symptoms and neuroticism were assessed at baseline. PTSD symptoms were reevaluated at six, 12, 18, and 24 months. Generalization was assessed in a differential conditioning paradigm by measuring expectancies of an aversive outcome when presented with stimuli similar to previously conditioned stimuli. ResultsHigher expectancy ratings towards stimuli most similar to safety signals predicted PTSD symptoms at follow-up after controlling for baseline PTSD symptoms, whereas higher expectancy ratings towards stimuli most similar to danger signals was associated with neuroticism. Neuroticism weakened the predictive power of fear generalization when considered simultaneously. DiscussionThese findings suggest that heightened fear generalization is associated with the development of anxiety and trauma-related symptoms. Targeting problematic fear generalization may be a promising intervention approach.

Prospective measurement of skin conductance response during trauma interview predicts future PTSD severity in trauma exposed children

Previous cross-sectional studies have shown that sympathetic nervous system (SNS) arousal is positively associated with posttraumatic stress disorder (PTSD) symptoms in children with trauma exposure. One of the ways that SNS activity is measured is through skin conductance response (SCR), which has been shown to predict future PTSD severity in adults. In this study, we explored the utility of a novel, low-cost mobile SCR device, eSense, to predict future PTSD symptom severity in trauma exposed children. We recruited children (N = 43, age 9 years at initial visit) for a longitudinal study in which SCR was recorded at baseline visit, and PTSD symptoms were assessed two years later. Results indicated an interaction between SCR and trauma exposure, such that children with lower trauma exposure who demonstrated greater SCR reported higher PTSD severity two years later. This association remained significant even after controlling for baseline PTSD symptoms. Children with higher levels of trauma exposure did not show this association, potentially due to ceiling effects of PTSD symptoms. Together these findings suggest the utility of SCR as a biomarker for predicting trauma related disorders in children, and that it may be a valuable tool in clinical interventions targeting sympathetic arousal.

Associations among posttraumatic stress disorder symptoms, life satisfaction, and well-being comparisons: A longitudinal investigation.

Many individuals who encounter potentially traumatic events go on to develop symptoms of posttraumatic stress disorder (PTSD). Research suggests that survivors of traumatic events frequently compare their current well-being to different standards; yet, knowledge regarding the role of comparative thinking in well-being is limited to a few cross-sectional studies. We therefore examined the temporal associations among aversive well-being comparisons (i.e., comparisons threatening self-motives), PTSD symptoms, and life satisfaction in individuals exposed to traumatic events. Participants (N = 518) with a trauma history completed measures of PTSD symptoms and life satisfaction, as well as the Comparison Standards Scale for Well-being (CSS-W), at assessment points 3 months apart. The CSS-W assesses the frequency, perceived discrepancy, and affective impact of aversive social, temporal, counterfactual, and criteria-based comparisons related to well-being. All participants reported having engaged in aversive well-being comparisons during the last 3 weeks. Comparison frequency emerged as a significant predictor of PTSD symptoms, β = .24, beyond baseline PTSD symptom severity. Life satisfaction contributed unique variance to the comparison process by predicting comparison frequency, β = -.18; discrepancy, β = -.24; and affective impact, β = .20. The findings suggest that frequent aversive comparisons may lead to a persistent focus on negative aspects of well-being, thereby exacerbating PTSD symptoms, and further indicate that comparison frequency, discrepancy, and affective impact are significantly influenced by life satisfaction. Taken together, the findings support the need for a thorough examination of the role of comparative thinking in clinical populations, which may ultimately help improve clinical care.

Coping styles in refugees with PTSD: Results from a randomized trial comparing EMDR therapy and stabilization.

While treatment of posttraumatic stress disorder (PTSD) in refugees is generally effective, many refugees remain symptomatic after treatment. Coping styles could be relevant to PTSD treatment response and as such may be a potential focus of PTSD treatment. The study aims to examine 1) if baseline coping styles are related to treatment response after EMDR therapy or stabilization, and 2) if coping styles change during these treatments. Seventy-two refugees with PTSD were randomly allocated to 12 hours of EMDR therapy or stabilization. A coping questionnaire (COPE-easy) and clinical interview for PTSD (CAPS-IV) were administered before and after treatment and at three-month follow-up. The association between baseline coping styles and PTSD symptom change was examined using regression analysis and a t-test. Changes in coping styles were analyzed using mixed design ANOVA. No significant relations between baseline coping style levels and PTSD symptom changes were found. Additionally, coping style levels did not change significantly after either treatment. Contrary to the hypothesis, we did not find any evidence that treatment was related to (changes in) coping style. Addressing pre-treatment coping styles among refugees receiving short-term therapy, may not be required for reducing PTSD. Changing coping styles may need a longer or different type of treatment.

Self-rated personality disorder symptoms do not predict treatment outcome for posttraumatic stress disorder in routine clinical care.

To test the hypothesis that self-rated personality disorder (PD) symptoms are a significant and clinically relevant predictor of treatment outcomes in a naturalistic treatment setting specialized in trauma-focused treatment using a single-group pretest-posttest design. Treatment-seeking patients reporting clinical levels of posttraumatic stress disorder (PTSD) symptoms filled out questionnaires at intake and after treatment. The primary outcome was change in PTSD severity after treatment, measured by the PTSD Checklist for DSM-5 (PCL-5). PD symptoms were measured with the Structured Clinical Interview for DSM-5 Screening Personality Questionnaire (SCID-5-SPQ). Secondary outcomes were general mental health problems, treatment response, number of sessions and dropout. N =1174 patients (59% female, baseline PCL-5 score M [SD] = 53.0 [10.8]) were included for the primary analysis. Regression analysis revealed that PD symptoms explained 0.4% of variance in PTSD symptom change (p = .066). After controlling for baseline PTSD symptoms, PD symptoms explained 0.0% of variance (p = .311). The fully adjusted model including baseline PTSD symptom severity, age, gender, cumulative exposure to potentially traumatic experiences, PD symptoms, and number of sessions together explained 5% of the observed variance in PTSD symptom change. Baseline PTSD severity was the only significant predictor and negatively predicted outcome. Sensitivity analyses with imputed data from N = 2694 cases yielded comparable results. Finally, secondary analyses showed that PD symptoms did not predict significant or clinically relevant changes in treatment response status, general mental health problems, dropout rates or number of sessions. The findings provide no evidence that self-rated PD symptoms predict treatment outcomes for patients suffering from clinical levels of PTSD symptoms in a naturalistic treatment setting specializing in trauma-focused treatment. Self-report screening for these symptoms to inform clinicians about expected effects of PTSD treatment is not supported by the evidence.

Neural processes of emotional conflict detection and prediction of posttraumatic stress disorder symptom clusters in traumatic injury survivors.

Given the prevalence and significant burden of posttraumatic stress disorder (PTSD), identifying early predictors of symptom development following trauma is critical. PTSD is a heterogeneous disorder comprised of distinct symptom clusters-reexperiencing, avoidance, negative mood, and hyperarousal-that contribute to the broad range of possible symptom profiles. Affective and attentional regulation processes, such as emotional conflict detection, are impaired in individuals with PTSD; however, the neural mechanisms underlying these alterations and their predictive utility for the development of PTSD symptoms remain unclear. Traumatic injury survivors (N = 49) without traumatic brain injury were recruited from the emergency department of an urban, Level-1 trauma center. Within 1 month of trauma exposure, participants completed a well-characterized emotional conflict task during a functional magnetic resonance imaging scan. Participants returned 6-month later for a clinical assessment of PTSD symptoms. Using a region-of-interest mask derived from whole-brain voxelwise analyses during emotional conflict detection (vs. no emotional conflict detection) we examined whether differential neural activity predicted 6-month PTSD symptom cluster severity. Greater activation of the right middle frontal gyrus during emotional conflict detection prospectively predicted lower PTSD avoidance symptom severity 6 months later (above and beyond the effects of self-reported baseline PTSD and depressive symptoms, previous traumatic life events, racial discrimination, age, sex, and injury severity). Neural processes of emotion conflict detection measured in the early aftermath of a potentially traumatic event are useful as predictors for the development of PTSD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Neighborhood Poverty Prospectively Predicts PTSD Symptoms Six-Months Following Trauma Exposure.

Individuals living in areas with high rates of poverty are disproportionately affected by posttraumatic stress disorder (PTSD). Despite this association, little is known about how neighborhood poverty rates impact risk for PTSD development. In the current prospective study, we determined the relationship between neighborhood poverty rate and PTSD symptoms six-months after experiencing a traumatic event in a sample of varied race, gender, and socioeconomic status. Participants (N=252) were enrolled in a hospital emergency department after experiencing a traumatic event. Demographic information (including zip code of residence), baseline PTSD symptoms, and baseline trauma history was assessed in the emergency department. PTSD symptoms were again assessed six-months post-trauma. Neighborhood poverty rate was determined using the American Community Survey. Correlation analyses revealed that neighborhood poverty was significantly associated with baseline PTSD symptoms (r=.181, p=.004) and PTSD symptoms six-months post-trauma (r=.163, p=.009). A regression analysis controlling for baseline trauma exposure, clinician-rated trauma severity, and individual socioeconomic status demonstrated that neighborhood poverty predicted PTSD symptoms six-months post-trauma (R2= 0.099, B= 0.15, p=0.04), but this relationship was no longer significant when baseline PTSD symptoms was added as an additional covariate (R2=.304, B= 0.07, p>0.05). Overall, results suggest that neighborhood poverty generally increases PTSD symptom severity, and the context in which an individual lives should be considered when conceptualizing risk for PTSD.

Implicit trauma identity associations in treatment-seeking U.S. military personnel do not predict or change in response to cognitive processing therapy for PTSD.

This study evaluated implicit associations (i.e., associations in memory that are automatically activated and difficult to control consciously) related to trauma and one's self in the context of a clinical trial for active duty service members seeking treatment for posttraumatic stress disorder (PTSD). Previous studies with nontreatment-seeking community samples found that implicit trauma identity associations were associated with PTSD symptoms even after controlling for amount of trauma exposure and self-reported negative cognitions about the self. This study extended prior work by evaluating whether trauma-related implicit associations were associated with PTSD and depressive symptoms in a clinical sample seeking treatment for PTSD, predicted PTSD treatment response, or changed over the course of treatment. This secondary analysis examined implicit trauma identity associations using data from a clinical trial evaluating a variable-length adaptation of cognitive processing therapy for military personnel. Participants were 127 active duty U.S. military personnel (13.4% women) seeking PTSD treatment. Implicit trauma identity associations were evaluated at baseline and posttreatment. Study hypotheses and data analysis plan were preregistered. Contrary to predictions, baseline implicit trauma identity associations were not significantly associated with baseline PTSD or depressive symptoms and did not predict treatment response. Implicit trauma identity associations did not change significantly in response to treatment. More tailoring of implicit trauma measures for military personnel and/or treatment-seeking patients may be needed. The measure may lack sensitivity to change in response to treatment and have reduced utility in treatment-seeking samples with high symptom burden and less variability in symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examination of PTSD symptom networks over the course of cognitive processing therapy.

Cognitive processing therapy (CPT) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD); however, little is known about how interrelationships between PTSD symptoms change over the course of treatment. The current study examined baseline, midtreatment, and posttreatment PTSD symptom networks during CPT for PTSD. Adults with PTSD (n = 107) received 12 sessions of CPT as part of a randomized trial. Self-reported PTSD symptoms were assessed at pretreatment, midtreatment, and posttreatment, and network analysis was used to examine the interrelationships between symptoms at these three timepoints. Linear regression was conducted to examine whether any baseline symptoms or midpoint symptoms predicted overall treatment change. In the baseline PTSD network, feelings of detachment and feeling upset at reminders of the trauma were central to the symptom network. These symptoms were no longer central at midtreatment, possibly suggesting that CPT quickly reduces the importance of these symptoms. These findings were consistent with regression results that, after accounting for multiple comparisons, high baseline scores of feeling upset at trauma reminders predicted later treatment change. At the conclusion of treatment, strong negative emotions were the most central symptom and may be most important in maintaining or lowering other PTSD symptoms at the conclusion of treatment. Though replication is necessary, these findings offer insights into identifying which symptoms may be most predictive of treatment outcomes and the course by which CPT reduces PTSD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Longitudinal Patient-Reported Outcomes in Patients Receiving Chimeric Antigen Receptor (CAR) T-Cell Therapy

Background: CAR T-cell therapy is a novel treatment for patients with hematologic malignancies that carries risk of unique toxicities such as cytokine release syndrome (CRS) and immune effector cell-associated neurologic toxicity (ICANS). Patients are at risk for quality of life (QOL) deterioration and immense physical and psychological symptom burden given these toxicities, their illness, and the need for a prolonged hospitalization. Yet, data that comprehensively depict the longitudinal patient-reported outcomes (PROs) of patients receiving CAR T-cell therapy are limited. Methods: We conducted a longitudinal cohort study of 100 consecutive adult patients with hematologic malignancies receiving CAR T-cell therapy at Massachusetts General Hospital (MGH) between 4/2019 and 11/2021. Patients completed baseline questionnaires prior to receipt of CAR T-cell therapy about sociodemographic data, QOL (Functional Assessment of Cancer Therapy-General), physical symptoms (Edmonton Symptom Assessment Survey-revised [ESAS-r]), and psychological distress (Hospital Anxiety and Depression Scale and Post-Traumatic Stress Checklist) and completed PRO questionnaires at 1 week, 1 month, 3 months, and 6 months after CAR T-cell infusion. We used descriptive statistics to summarize patient characteristics and PROs at each timepoint and rates of clinically significant depression, anxiety, and post-traumatic stress disorder (PTSD) based on establish cutoffs. We conducted paired t-tests analyzing changes in QOL, physical, and psychological symptoms from baseline to 1 week, 3 months, and 6 months. We used multivariable linear regression models to examine factors associated with QOL at three months after CAR T-cell infusion. Results: We enrolled 71.4% (100/140) of eligible patients (median age 66 years; 63% male sex; 77% married/living with partner). The most common diagnosis was lymphoma (71%) followed by multiple myeloma (28%); A plurality (34%) received tisagenlecleucel, followed by lisocabtagene maraleucel (16%), axicabtagene ciloleucel (13%), and idecabtagene vicleucel (12%). The overall response rate was 80%, and with a median follow up of 14 months after CAR T-cell infusion, 38% died. CRS and ICANS occurred in 76% and 33% of patients, respectively. At baseline, median QOL score was 77.9 (range: 34-107), and was 70.0 (35-107) at 1 week, 76.0 (46-106) at 1 month, 83.5 (29-108) at 3 months, and 83.7 (34-107) at 6 months. Severe physical symptoms (ESAS-r score >=7) were reported by 47%, 52%, 35%, 28%, and 28% of patients at baseline, 1 week, 1 month, 3 months, and 6 months, respectively. The rates of clinically significant anxiety, depression, and PTSD symptoms at each time point are depicted in figure 1. Patient's QOL decreased at 1 week (mean difference [md]=5.1, p=0.04), but increased at 3 months (md -5.2, p=0.04) and 6 months (md=-5.3, p=0.07) compared to baseline. Patient's physical symptoms increased at 1 week, but decreased at 3 months (md 5.1, p=0.03) and 6 months (md=4.5, p=0.07), compared to baseline. There was no significant difference in anxiety symptoms from baseline to 1 week, 1 month, or 3 months. Anxiety symptoms improved at 6 months compared to baseline. There was no significant difference in depression or PTSD symptoms across all time points compared to baseline. In univariate linear regression, older age (β=0.4; p=0.01) and undergraduate or graduate degree (β=7.53, p=0.04) were associated with better QOL, whereas baseline anxiety symptoms (β=-14.3, p<0.01), baseline depression symptoms (β=-16.6, p<0.01), and baseline PTSD symptoms (β=-18.8, p<0.01) were associated with worse QOL at 3 months. In separate multivariable models including age, sex, education, marital status, and Eastern Cooperative Oncology Group performance status given collinearity among baseline PROs, anxiety (β=-10.6, p<0.01), depression (β=-12.6, p<0.01), and PTSD symptoms (β=-16.2, p<0.01) were the only factors associated with QOL at 3 months. Conclusion: Patients receiving CAR T-cell therapy experience significant QOL impairment and physical and psychological symptom burden, which peaks 1 week after cell infusion and improves by 6 months post-infusion. Given high rates of persistent severe symptoms and clinically significant psychological distress, interventions to improve the QOL of these patients are warranted. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Moving toward precision PTSD treatment: predicting veterans' intensive PTSD treatment response using continuously updating machine learning models.

Considerable heterogeneity exists in treatment response to first-line posttraumatic stress disorder (PTSD) treatments, such as Cognitive Processing Therapy (CPT). Relatively little is known about the timing of when during a course of care the treatment response becomes apparent. Novel machine learning methods, especially continuously updating prediction models, have the potential to address these gaps in our understanding of response and optimize PTSD treatment. Using data from a 3-week (n = 362) CPT-based intensive PTSD treatment program (ITP), we explored three methods for generating continuously updating prediction models to predict endpoint PTSD severity. These included Mixed Effects Bayesian Additive Regression Trees (MixedBART), Mixed Effects Random Forest (MERF) machine learning models, and Linear Mixed Effects models (LMM). Models used baseline and self-reported PTSD symptom severity data collected every other day during treatment. We then validated our findings by examining model performances in a separate, equally established, 2-week CPT-based ITP (n = 108). Results across approaches were very similar and indicated modest prediction accuracy at baseline (R2 ~ 0.18), with increasing accuracy of predictions of final PTSD severity across program timepoints (e.g. mid-program R2 ~ 0.62). Similar findings were obtained when the models were applied to the 2-week ITP. Neither the MERF nor the MixedBART machine learning approach outperformed LMM prediction, though benefits of each may differ based on the application. Utilizing continuously updating models in PTSD treatments may be beneficial for clinicians in determining whether an individual is responding, and when this determination can be made.

Comparative Effectiveness of Direct-Acting Antivirals for Posttraumatic Stress Disorder in Veterans Affairs Patients With Hepatitis C Virus Infection.

We recently conducted an exploratory study that indicated that several direct-acting antivirals (DAAs), highly effective medications for hepatitis C virus (HCV) infection, were also associated with improvement in posttraumatic stress disorder (PTSD) among a national cohort of US Department of Veterans Affairs (VA) patients treated between October 1, 1999, and September 30, 2019. Limiting the same cohort to patients with PTSD and HCV, we compared the associations of individual DAAs with PTSD symptom improvement using propensity score weighting. After identifying patients who had available baseline and endpoint PTSD symptom data as measured with the PTSD Checklist (PCL), we compared changes over the 8-12 weeks of DAA treatment. The DAAs most prescribed in conjunction with PCL measurement were glecaprevir/pibrentasvir (GLE/PIB; n= 54), sofosbuvir/velpatasvir (SOF/VEL; n= 54), and ledipasvir/sofosbuvir (LDV/SOF; n= 145). GLE/PIB was superior to LDV/SOF, with a mean difference in improvement of 7.3 points on the PCL (95% confidence interval (CI): 1.1, 13.6). The mean differences in improvement on the PCL were smaller between GLE/PIB and SOF/VEL (3.0, 95% CI: -6.3, 12.2) and between SOF/VEL and LDV/SOF (4.4, 95% CI: -2.4, 11.2). While almost all patients were cured of HCV (92.5%) regardless of the agent received, PTSD outcomes were superior for those receiving GLE/PIB compared with those receiving LDV/SOF, indicating that GLE/PIB may merit further investigation as a potential PTSD treatment.

P661. Greater Hippocampal Subfield Volume Predicts Increasing PTSD Symptoms Over Time

Posttraumatic stress disorder (PTSD) is a highly heterogenous and complex disorder that can vary considerably over time. The neurobiological factors that predict PTSD symptoms in individuals diagnosed with PTSD remain unclear. This study investigated whether the structural integrity of the hippocampus and hippocampal subfields predicts 1) baseline PTSD symptoms and 2) PTSD symptom changes over a 2-year period.

Trauma involving violation of trust and mental health help seeking among homeless adults

ABSTRACT Objective Lack of trust in others is a barrier to mental health help seeking and may be a consequence of trauma exposure, which is highly prevalent among people who experience homelessness. This study examined the association between trauma involving violation of trust and mental health help seeking. Method This study was a secondary analysis of data collected for a randomised controlled trial comparing a 3-year homelessness intervention with standard service provision. The sample included trauma-exposed adults with a history of chronic homelessness in Melbourne (N = 73). Participants identified their worst lifetime trauma and indicated whether someone they knew and trusted was responsible for that event. The primary outcome was 12-month formal mental health help seeking. Results Controlling for randomisation and baseline posttraumatic stress disorder symptom severity, participants whose worst trauma involved violation of trust reported, on average, 4.34 times as many visits to an outpatient service (e.g., hospital, mental health facility, alcohol and other drug service) as those whose worst trauma did not involve a violation of trust, p = .002. Conclusions Contrary to expectation, chronically homeless adults whose worst trauma involved violation of trust sought outpatient care more than those whose worst trauma did not involve violation of trust. Mental health professionals should adopt a trauma-informed approach and be aware that trauma exposure may influence help seeking among people who experience chronic homelessness. Key Points What is already known about this topic: Chronically homeless adults have high rates of trauma exposure, trauma-related mental health disorders, and unmet mental health care needs. People experiencing homelessness face multiple barriers to accessing mental health care, and qualitative studies have found feelings of mistrust may be one such barrier. In the general population, interpersonal trauma, particularly trauma involving betrayal, is associated with reduced trust in others, including physicians and health care systems. What this topic adds: Over 12 months, greater outpatient service use was reported by chronically homeless adults whose worst trauma involved violation of trust compared to those whose worst trauma did not involve violation of trust. The violation of trust group included a higher percentage of Aboriginal persons, and a higher percentage of participants whose worst trauma occurred in childhood compared to the no violation of trust group. Mental health professionals, such as psychologists, should apply trauma-informed care principles when providing mental health care for chronically homeless adults.

Worse sleep, worsening post-traumatic stress disorder (PTSD): Poor sleep quality associated with increases in PTSD symptoms amongst those experiencing high threat of the COVID-19 pandemic.

SummaryThe coronavirus disease 2019 (COVID‐19) pandemic is a global health crisis with the potential to elicit and worsen psychiatric symptoms, particularly post‐traumatic stress disorder (PTSD) symptoms. Identifying modifiable protective factors is critical for preventing and treating PTSD symptoms both during and following the COVID‐19 pandemic. The present study examined associations of self‐reported sleep quality and anticipatory threat appraisals of the pandemic with PTSD symptoms 6 months later in a sample enriched for pre‐pandemic trauma exposure and PTSD. The sample included 590 adults (mean age 38.2 years) who completed a baseline survey in August/September 2020 and follow‐up survey in March/April 2021. The sample was recruited from a pool of participants interested in a prior study about traumatic stress. Participants self‐reported sleep quality and pandemic‐related anticipatory threat appraisals at baseline. PTSD symptoms were assessed at baseline and follow‐up. Baseline sleep quality was associated with PTSD symptoms at follow‐up controlling for baseline PTSD symptoms (B = −2.49, p = 0.001). Perceived anticipatory threat of the pandemic moderated this association such that worse sleep quality was related to more severe PTSD symptoms at follow‐up for participants with higher (B = −4.07, p < 0.001) but not lower (B = −0.43, p = 0.679) anticipatory threat about the COVID‐19 pandemic. These findings suggest that poor sleep quality may enhance vulnerability to later PTSD symptoms during the pandemic, particularly among those individuals who perceived the pandemic as threatening for their future. Treatments that address sleep problems may be beneficial for reducing trauma‐related symptoms during and following the global health crisis.