Greater Posttraumatic Stress Disorder Symptoms Research Articles

PTSD Symptoms Among College Students: Linkages with Familial Risk, Borderline Personality, and Sexual Assault

ABSTRACT College students have high rates of post-traumatic stress disorder (PTSD) symptoms as well as high rates of sexual assault. What is less clear, however, is whether different sexual assault types (e.g. coercive, physically forced, and incapacitation) are associated with greater PTSD symptoms. Moreover, understanding early familial and mental health histories of college students is important for explaining PTSD symptoms. As such, we use a social stress framework to examine the relationships between early familial risk (i.e. child abuse, perceived maternal rejection), borderline personality (BP) symptoms, and three sexual assault types with PTSD symptoms among college students. A total of 783 undergraduate students (65.4% female) completed paper and pencil surveys in fall 2019 and spring 2020 at a large public university. Results revealed that females were more likely to experience child sexual abuse and all three forms of sexual assault, while males experienced higher rates of child physical abuse. OLS regression results showed positive associations between child sexual abuse, perceived maternal rejection, BP symptoms and all three types of sexual assault with PTSD symptoms. Females also experienced more PTSD symptoms compared to males. Findings have implications for targeted interventions to improve mental health outcomes.

Examining relationships between posttraumatic stress disorder severity and types of media/technology usage.

Psychopathology, cyberpsychology, and mass media theories link psychological symptoms, such as posttraumatic stress disorder (PTSD), to increased media and technology usage (MTU). Given limited research in this area, we uniquely examined if specific MTU facets were associated with PTSD symptom severity. A sample of 404 socioeconomically diverse adults (Mage = 35.89; 57.4% female) was recruited from Amazon's Mechanical Turk and completed the Life Events Checklist for DSM-5, Posttraumatic Stress Disorder Checklist for DSM-5, Media and Technology Usage and Attitudes Scale, and Patient Health Questionnaire-9. Hierarchical multiple regression analyses indicated that, controlling for depression severity, greater frequency of TV viewing (p = .004) and media sharing (p = .040) and greater quantity of online friendships (p = .006) were associated with greater PTSD symptom severity. Study findings suggest that the extent of MTU behaviors (especially extent of TV use, media sharing, and online friendships) are important to examine in trauma-exposed individuals with PTSD symptoms. Results generalize to trauma-exposed community members and are considered within the context of current MTU theories. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sexual Objectification Racial Microaggressions Amplify the Positive Relation Between Sexual Assault and Posttraumatic Stress Among Black Women

Black women report higher rates of adult sexual assault (ASA) and sexual objectification compared to White women. Sexual objectification serves as a reminder that Black women's bodies are viewed as sexual objects based on racist/sexist ideologies, though trauma research rarely includes race-specific stressors. In this study, we examined sexual objectification racial microaggressions as a moderator of the relation between ASA severity and posttraumatic stress disorder (PTSD) symptoms among Black women. Data were collected from 129 Black college and community women ( Mage = 33.84). ASA severity was associated with greater overall PTSD symptoms and symptom clusters. The interaction between ASA severity and sexual objectification microaggressions was associated with greater PTSD symptoms and the PTSD symptom cluster, negative alterations in cognition and mood. ASA severity was associated with PTSD at mean and high sexual objectification racial microaggressions but not low levels. Associations with other PTSD symptom clusters were not significant. Findings suggest sexual objectification racial microaggressions amplify the positive relation between ASA and PTSD symptoms, specifically symptoms related to cognition and mood. It is essential that clinicians assess for race-specific stressors during trauma interventions to help reduce mental health disparities. Post-assault interventions should be tailored with multiculturally sensitive practices to address the ways racial discrimination can exacerbate trauma symptoms.

Time doesn't heal all: PTSD symptoms exacerbate the relationship between age and pain intensity.

Posttraumatic stress disorder (PTSD) symptoms and pain interfere with daily functioning and quality of life for many combat Veterans. As individuals age, pain symptoms tend to increase whereas PTSD symptoms tend to decrease. PTSD symptoms exacerbate pain, but the nature of this relationship across the aging process is unclear. The purpose of this study was to determine how PTSD symptoms affect the association between age and pain intensity. Participants in this cross-sectional study included 450 Veterans (80% male) who served after September 11, 2001. PTSD and pain intensity ratings were assessed by the PTSD Checklist for DSM-5 (PCL-5) and the Brief Pain Inventory (BPI), respectively. Hierarchical multiple linear regression evaluated main and interaction effects between age, PTSD symptoms, and pain intensity. Age (B = 0.04, p < 0.001) and PTSD symptoms (B = 0.05, p < 0.001) were positively associated with pain intensity. Age and PTSD symptoms were inversely correlated (r = -0.16, p < 0.001). PTSD symptoms exacerbated the relationship between age and pain intensity (ΔR2 = 0.01, p = 0.036). Specifically, when greater PTSD symptoms were reported at older ages, pain intensity was significantly higher. Results of these analyses suggests that age is important when considering the effects of PTSD symptoms on pain intensity ratings. Specifically, pain intensity ratings are higher in older Veterans with PTSD symptoms. These findings underscore the importance for clinical providers to evaluate trauma history and PTSD symptoms in older Veterans reporting pain symptoms.

Relationship of social determinants of health with symptom severity among Veterans and non-Veterans with probable posttraumatic stress disorder or depression.

Social determinants of health (SDoH) refer to the conditions in the environments in which people live that affect health outcomes and risks. SDoH may provide proximal, actionable targets for interventions. This study examined how SDoH are associated with posttraumatic stress disorder (PTSD) and depression symptoms among Veterans and non-Veterans with probable PTSD or depression. Four multiple regressions were conducted. Two multiple regressions with Veterans examined the impact of SDoH on PTSD symptoms and on depression symptoms. Two multiple regressions with non-Veterans examined the impact of SDoH on PTSD symptoms and on depression symptoms. Independent variables included demographic characteristics, adverse experiences (in childhood and adulthood), and SDoH (discrimination, education, employment, economic instability, homelessness, justice involvement, and social support). Correlates that were statistically significant (p < 0.05) and clinically meaningful (rpart >|0.10|) were interpreted. For Veterans, lower social support (rpart = -0.14) and unemployment (rpart = 0.12) were associated with greater PTSD symptoms. Among non-Veterans, greater economic instability (rpart = 0.19) was associated with greater PTSD symptoms. In the depression models, lower social support (rpart = -0.23) and greater economic instability (rpart = 0.12) were associated with greater depression for Veterans, while only lower social support was associated with greater depression for non-Veterans (rpart = -0.14). Among Veterans and non-Veterans with probable PTSD or depression, SDoH were associated with PTSD and depression symptoms, particularly social support, economic instability, and employment. Beyond direct treatment of mental health symptoms, addressing social support and economic factors such as instability and employment in the context of PTSD and depression are potential intervention targets that would benefit from future research.

The Role of Unit and Interpersonal Support in Military Sexual Trauma and Posttraumatic Stress Disorder Symptoms.

Military sexual trauma (MST) is strongly associated with posttraumatic stress disorder (PTSD). Among many potential factors explaining this association are unit and interpersonal support, which have been explored in few studies with veterans who have experienced MST. This project examines unit and interpersonal support as moderators and/or mediators of PTSD symptoms among post-9/11 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans who experienced MST. MST, unit support, and interpersonal support variables were collected at Time 1 (T1; N = 1,150, 51.4% women), and PTSD symptoms 1 year later at Time 2 (T2; N = 825; 52.3% women). Given gender differences in endorsed MST, models with the full sample (men and women) and women only were examined, while controlling for covariates related to PTSD, and a path model was examined among women veterans. Mediation was supported in the full model and women-only models, with the combination of both mediators demonstrating the strongest mediation effects (full-model: β = .06, 95% confidence interval [CI] [0.03, 0.10], p < .001; women-only model: β = .07, [0.03, 0.14], p = .002). Among the women-only model, MST was negatively associated with unit support (β = -.23, [-0.33, -0.13], p < .001) and interpersonal support (β = -.16, [-0.27, -0.06], p = .002) and both support types were negatively associated with PTSD symptoms (unit support: β = -.13, [-0.24, -0.03], p = .014; interpersonal support: β = -.25, [-0.35, -0.15], p < .001). Moderation was not supported in the full model nor in the women-only model. Experiencing MST is associated with receiving less unit and/or interpersonal support, which in turn is associated with greater PTSD symptoms. More work is needed to understand and improve the impact of unit and community responses to MST on service members who experience MST.

Repetitive Transcranial Magnetic Stimulation for Depression and Posttraumatic Stress Disorder in Veterans With Mild Traumatic Brain Injury

ObjectivesMild traumatic brain injury (mTBI) is a signature injury of military conflicts and is prevalent in veterans with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Although therapeutic transcranial magnetic stimulation (TMS) can reduce symptoms of depression and PTSD, whether traumatic brain injury (TBI) affects TMS responsiveness is not yet known. We hypothesized mTBI would be associated with higher pretreatment symptom burden and poorer TMS response. Materials and MethodsWe investigated a registry of veterans (N = 770) who received TMS for depression across the US Veterans Affairs system. Of these, 665 (86.4%) had data on TBI and lifetime number of head injuries while 658 had complete data related to depression outcomes. Depression symptoms were assessed using the nine-item Patient Health Questionnaire and PTSD symptoms using the PTSD Checklist for DSM-5. Linear mixed effects models and t-tests evaluated whether head injuries predicted symptom severity before treatment, and how TBI status affected clinical TMS outcomes. ResultsOf the 658 veterans included, 337 (50.7%) reported previous mTBI, with a mean of three head injuries (range 1–20). TBI status did not predict depressive symptom severity or TMS-associated changes in depression (all p’s > 0.1). TBI status was associated with a modest attenuation of TMS-associated improvement in PTSD (in patients with PTSD Checklist for DSM-5 scores > 33). There was no correlation between the number of head injuries and TMS response (p > 0.1). ConclusionsContrary to our hypothesis, presence of mTBI did not meaningfully change TMS outcomes. Veterans with mTBI had greater PTSD symptoms, yet neither TBI status nor cumulative head injuries reduced TMS effectiveness. Limitations include those inherent to retrospective registry studies and self-reporting. Although these findings are contrary to our hypotheses, they support the safety and effectiveness of TMS for MDD and PTSD in patients who have comorbid mTBI.

Intolerance of uncertainty, posttraumatic stress, depression, and fears for the future among displaced refugees

IntroductionThe vast majority of the 100 million forcibly displaced persons worldwide live in a state of prolonged uncertainty with limited resettlement prospects and access to resources. Little is known, however, regarding how refugees and asylum-seekers cope with this uncertainty. MethodsIn this study, we investigated the longitudinal association between a measure of how people cope with uncertainty (intolerance of uncertainty (IU)), fears for the future, posttraumatic stress disorder (PTSD) symptoms and depression symptoms. A sample of 1,237 refugees displaced in Indonesia completed an online survey in Arabic, Farsi, Dari, Somali or English at two time-points six-months apart. ResultsResults indicated that greater IU-inhibitory anxiety (IU-IA or impairment related to uncertainty) was associated with subsequent increases in PTSD and depression symptoms and fears for the future. Greater PTSD symptoms and fears for the future were associated with increases in IU-prospective anxiety (IU-PA or distress related to uncertainty), and greater depression symptoms were associated with increases in IU-IA. DiscussionThese findings provide evidence for the mechanistic role of IU in psychological symptoms amongst displaced refugees. Results underscore the importance of policies to reduce uncertainty in displacement environments, and highlight IU as a potential intervention target to help refugees cope with protracted displacement.

Prepandemic Social Integration: Protection or Risk for Older Adults in the Time of COVID-19?

To examine the association between prepandemic social integration and posttraumatic stress disorder (PTSD) symptoms during the coronavirus disease 2019 (COVID-19) pandemic and test whether the association is mediated by social support received and social events missed during the pandemic. We also explored age, race, gender, and socioeconomic differences in the association. We adopted a prospective design. Path analysis was conducted using data from the COVID-19 supplement (2020) and the 2019 wave of the National Health and Aging Trends Study (NHATS). The sample represents Medicare beneficiaries aged 70 years and older (N = 2,694). Social integration was measured using a six-item index. A standardized scale assessed PTSD symptoms. Both social support received and social events missed were single-item measures. The analysis controlled for sociodemographic characteristics, prepandemic physical and mental health, and coronavirus exposure during the pandemic. Prepandemic social integration was positively associated with PTSD symptoms during the pandemic. The association was primarily mediated by social events missed-high levels of prepandemic social integration were associated with missing more social events during the pandemic resulting in more PTSD symptoms. Social support received was also a mediator-social integration was positively associated with social support received during the pandemic, with more received support associated with greater PTSD symptoms. Prepandemic social integration had no significant direct effect on PTSD symptoms. The direct, indirect, and total effects of social integration on PTSD symptoms did not significantly differ by age, race, gender, education, or poverty status. Social integration may carry mental health risks in times of infectious disease outbreaks.

Trauma Coping Self-Efficacy Mediates Associations Between Adult Attachment and Posttraumatic Stress Symptoms.

Attachment orientations reflect individuals’ expectations for interpersonal relationships and influence emotion regulation strategies and coping. Previous research has documented that anxious and avoidant attachment orientations have deleterious effects on the trauma recovery process leaving these survivors vulnerable to posttraumatic stress disorder (PTSD) symptoms. However, avoidant attachment may be more complicated. Prior work has also found those high in avoidant attachment but also low in anxious attachment (i.e., dismissing) may not experience such vulnerabilities. Further, avoidant attachment individuals often report higher self-efficacy than their anxiously attached counterparts. The present study examined trauma coping self-efficacy (CSE-T) as a previously unexamined mechanism of action between adult attachment and PTSD symptoms. Structural equation modeling results showed that anxious attachment was associated with lower CSE-T and greater PTSD symptoms six weeks later. Further, a significant indirect effect of anxious attachment on PTSD symptoms through CSE-T was found. Contrary to hypotheses, avoidant attachment also exhibited an indirect effect on PTSD symptoms through CSE-T, such that avoidant attachment was associated with lower CSE-T, which in turn, was associated with greater PTSD symptoms. Also contrary to hypotheses, the interaction between anxious and avoidant attachment was not significantly associated with either CSE-T or PTSD symptoms. Results suggest that both anxious and avoidant attachment orientations contribute to poor self-regulation following trauma, as they undermine perceptions of trauma coping self-efficacy.

Veteran Suicide Exposure: Associations with Guilt, PTSD, and Suicidality

Veterans commit suicide at a rate 1.5 times greater than their non-veteran civilian counterparts. Not only is this a public health concern due to the substantial loss of life, but because of the impact on suicide survivors. Research indicates exposure to suicide by others is related to posttraumatic stress disorder (PTSD) symptoms, depression, anxiety, non-suicidal self-injury, and suicidality (in the form of suicidal thoughts and behaviors). The present study uses self-report survey data from 186 Post-9/11 veterans of Iraq and/or Afghanistan, who were recruited as part of a larger study, to expand on this research to evaluate whether there is a cumulative effect such that knowing more others who have died by suicide increases veterans’ guilt, PTSD symptoms, and suicidality. A series of hierarchical multiple regression analyses revealed that, as hypothesized, the more comrades a veteran or active service member has lost to suicide, the greater PTSD symptoms and suicidal thoughts and behaviors they reported, above and beyond that predicted by combat casualty experiences. Further, no evidence of habituation to suicide exposure was found. The results illustrate that the alarming rise in veteran suicide in the Post-9/11 era may be a self-compounding problem that needs greater attention, such as addressing PTSD and guilt, to reverse the trend.

Hippocampal volume and volume asymmetry prospectively predict PTSD symptom emergence among Iraq-deployed soldiers.

Evidence suggests a link between smaller hippocampal volume (HV) and post-traumatic stress disorder (PTSD). However, there has been little prospective research testing this question directly and it remains unclear whether smaller HV confers risk or is a consequence of traumatization and PTSD. U.S. soldiers (N = 107) completed a battery of clinical assessments, including structural magnetic resonance imaging pre-deployment. Once deployed they completed monthly assessments of traumatic-stressors and symptoms. We hypothesized that smaller HV would potentiate the effects of traumatic stressors on PTSD symptoms in theater. Analyses evaluated whether total HV, lateral (right v. left) HV, or HV asymmetry (right - left) moderated the effects of stressor-exposure during deployment on PTSD symptoms. Findings revealed no interaction between total HV and average monthly traumatic-stressors on PTSD symptoms b = -0.028, p = 0.681 [95% confidence interval (CI) -0.167 to 0.100]. However, in the context of greater exposure to average monthly traumatic stressors, greater right HV was associated with fewer PTSD symptoms b = -0.467, p = 0.023 (95% CI -0.786 to -0.013), whereas greater left HV was unexpectedly associated with greater PTSD symptoms b = 0.435, p = 0.024 (95% CI 0.028-0.715). Our findings highlight the importance of considering the complex role of HV, in particular HV asymmetry, in predicting the emergence of PTSD symptoms in response to war-zone trauma.

Rape Myth Acceptance Buffers the Association Between Sexual Assault and Posttraumatic Stress Disorder Symptoms Among College Students.

Rape myths are cultural beliefs that invalidate, blame, and stigmatize rape survivors, thereby perpetuating sexual violence. Few studies have explored associations between rape myth acceptance (RMA) and mental health outcomes, but evidence suggests that RMA can buffer the mental health impact of some forms of sexual assault. The current study examined the buffering effect of RMA on depression and posttraumatic stress disorder (PTSD) symptoms using self-report data from an online survey of 500 female college students. Findings provided support for the buffering effect of RMA on the association between any sexual assault and PTSD symptoms. Experiencing any sexual assault was significantly associated with greater PTSD symptoms among participants with low RMA, whereas this association was only marginally significant among those with high RMA. Findings demonstrate that there are some contexts in which high RMA might lessen the mental health impact of sexual assault. Thus, it is possible that as progress is made to dismantle rape myths in society, mental health symptoms amongst some survivors may exacerbate, thereby increasing the demand for mental health services.

Latino/a adolescents facing neighborhood dangers: An examination of community violence and gender-based harassment.

While ample research examines community violence as a serious public health problem that disproportionately affects minority adolescents, less attention focuses on adolescents' experiences of gender-based harassment in poor, urban neighborhoods. Using data from 416 urban, low-income Latino/a adolescents (53% female; Mage  = 15.5), this study examined (a) the relations between community violence exposure (CVE), gender-based harassment, and posttraumatic stress disorder (PTSD) symptoms and (b) the role of parent-child cohesion as a moderator of the relations between CVE/harassment and PTSD symptoms. Whereas both CVE and gender-based harassment were associated with greater PTSD symptoms, the effect of gender-based harassment on PTSD symptoms was far greater than the effect of community violence. Additionally, the association between gender-based harassment and PTSD symptoms was exacerbated when parent-child cohesion was high, compared to when cohesion was low or average. Finally, Latino/a adolescents exposed to high levels of both CVE and gender-based harassment had worse PTSD symptoms compared to those exposed primarily to gender-based harassment, who in turn had worse PTSD symptoms than those exposed primarily to community violence. Findings highlight the importance of including adolescents' experiences with gender-based harassment when studying community violence.

Risk and protective factors for mental health outcomes among sexual minority and heterosexual college women and men

Objective: Understand the relationship between risk factors (eg, different sexual assault types – coercive, physical, incapacitation by alcohol/drugs) and protective factors (eg, strong maternal ties) with depressive symptoms and post-traumatic stress disorder (PTSD) symptoms among college students. Participants: Six hundred twenty-five undergraduate students. Methods: Students completed paper and pencil surveys in fall 2019 at a large public university. Results: Risk factors of child physical and sexual abuse, all three sexual assault types, and combined sexual assault were associated with greater PTSD symptoms while maternal relationship quality and religious influence served as protective factors. Risk factors of child physical and sexual abuse, coercive sexual assault, and combined sexual assault were associated with depressive symptoms while maternal relationship quality served as a protective factor. Males who identified as sexual minority (SM) had more PTSD symptoms compared to females who identified as SM. Conclusions: Findings have implications for targeted interventions to improve mental health outcomes.

The Influence of Familial and Peer Social Support on Post-Traumatic Stress Disorder Among Black Girls in Juvenile Correctional Facilities

Black girls bear a higher burden of juvenile justice involvement in the United States, relative to other racial/ethnic female groups. Emerging evidence suggests that system involvement is related to trauma histories and post-traumatic stress disorder (PTSD). This study investigated the associations between individual, family, and peer factors, and their relationship to PTSD among Black girls with juvenile justice involvement. Cross-sectional data were collected from 188 Black girls in detention. Measures assessed were history of abuse, negative peer norms, future orientation, caregiver support, self-esteem, age, and PTSD symptoms. Major regression findings indicated that higher rates of caregiver support, higher negative peer norms, lower self-esteem rates, and lower future orientation rates were correlated with greater PTSD symptoms. Treatment programs for this population warrant a multisystemic approach, which includes caregivers and peers, and bolstering important constructs such as self-esteem and hopefulness.

Multiple perpetrator sexual assault: correlates of PTSD and depressive symptoms in a sample of adult women

ABSTRACT While most sexual assaults are committed by a sole perpetrator, multiple-perpetrator assaults (MPSAs) still occur. However, less is known about their post-assault impacts. This study examined demographic, assault, and post-assault characteristics as correlates of post-traumatic stress disorder (PTSD) and depressive symptoms in a community sample of adult sexual assault survivors who experienced MPSA (N = 350) in the Chicago area. This study also included demographic and assault characteristics of perpetrators as reported by survivors. Backward regression analysis showed that stressful life events, more violent assaults, post-assault maladaptive coping and characterological self-blame, and receiving acknowledgement without support (e.g. acknowledging the assault happened, but giving inadequate support) reactions were related to greater PTSD symptoms. Older age and greater perceived control over recovery were associated with fewer PTSD symptoms. Greater violence, maladaptive coping, and characterological self-blame were related to greater depressive symptoms, whereas more education and greater perceived control over recovery correlated with fewer depressive symptoms. This study adds to research on MPSA and findings have implications for clinical treatment, intervention, and prevention with survivors.

Cardiovascular risk as a moderator of associations among anxiety sensitivity, distress tolerance, PTSD and depression symptoms among trauma-exposed firefighters

BackgroundFirefighters experience frequent and severe trauma exposure, which places them at elevated risk for posttraumatic stress disorder (PTSD) and major depression. Cardiovascular issues may exacerbate the effects of mental health risk factors, such as anxiety sensitivity (AS) and distress tolerance (DT), on PTSD and depression. The current study investigated cardiovascular risk as a moderator of associations between risk factors (AS and DT) and psychiatric symptoms (PTSD and depression) among firefighters. MethodsParticipants were 836 trauma-exposed active duty firefighters (93.90% men; with mean age 38 years, [SD = 9]). Participants endorsing at least one of three cardiovascular risk items—experiencing current high blood pressure, history of heart problems, and experiencing chest pains in the past 2 years—were considered high in cardiovascular risk. ResultsA structural equation model indicated that higher AS was associated with greater PTSD (β = 0.38, p < .01) and depression symptoms (β = 0.32, p < .01); lower DT was associated with greater PTSD (β = −0.18, p < .01) and depression symptoms (β = −0.31, p < .01). Multigroup analyses showed that cardiovascular risk moderated the association between 1) AS and PTSD symptoms, but not 2) AS and depression symptoms, 3) DT and PTSD symptoms, or 4) DT and depression symptoms. For those high in cardiovascular risk, higher AS was associated more strongly with greater PTSD symptoms (high cardiovascular risk group: β = 0.46, p < .01]; low cardiovascular risk group: β = 0.33, p < .01). ConclusionsHigh cardiovascular risk may contribute to PTSD symptoms among trauma-exposed firefighters with high AS. These results highlight the importance of considering physical and mental health vulnerabilities in first responder populations.

A-107 Historyt of Remote Mild TBI Predicts Poor Health-Related Quality of Life Outcomes in Military Veterans

Abstract Objective We examined health-related quality of life (QOL) in military Veterans with and without a history of mild traumatic brain injury (mTBI). Additionally, we investigated how mTBI injury characteristics modify health-related QOL. Method Veterans with a history of remote mTBI (n = 81) and military controls (MCs) without a history of mTBI (n = 62) completed self-report questionnaires measuring combat exposure, posttraumatic stress disorder (PTSD) and neurobehavioral symptoms, and health-related QOL. Primary outcomes included the eight subscales of the 36-Item Short-Form Survey (SF-36). Results ANCOVAs adjusting for combat exposure and PTSD symptoms found that the mTBI group demonstrated significantly more health-related QOL symptoms when compared to MCs across the following SF-36 subscales: General Health, Vitality, Bodily Pain, Physical Role Functioning, and Social Functioning (p = .001–.045, ηp2 = 0.03–0.07). Within the mTBI sample, repetitive mTBI, combat exposure, and PTSD and neurobehavioral symptoms collectively significantly predicted all five QOL subscales (all p’s &amp;lt; .001), accounting for roughly 33–53% of the total variance. Greater neurobehavioral symptoms were associated with lower Physical Role Functioning, Vitality, and Social Functioning scores; repetitive TBI was associated with higher Bodily Pain scores; greater PTSD symptoms were associated with lower Social Functioning scores; and greater combat exposure was associated with lower General Health scores. Conclusions Results suggest that, over and above PTSD and combat exposure, mTBI status independently contributes to health-related QOL. Moreover, specific dimensions of health-related QOL are influenced by different factors, with affective and vestibular-related neurobehavioral symptoms showing the strongest negative associations with health-related QOL. Findings highlight the need for comprehensive assessment and multimodal treatment within this vulnerable population.

Testosterone and Resting State Connectivity of the Parahippocampal Gyrus in Men With History of Deployment-Related Mild Traumatic Brain Injury.

The purpose of this study was to explore the effect of low testosterone level on whole-brain resting state (RS) connectivity in male veterans with symptoms such as sleep disturbance, fatiguability, pain, anxiety, irritability, or aggressiveness persisting after mild traumatic brain injury (mTBI). Follow-up analyses were performed to determine if sleep scores affected the results. In our cross-sectional design study, RS magnetic resonance imaging scans on 28 veterans were performed, and testosterone, sleep quality, mood, and post-traumatic stress symptoms were measured. For each participant, we computed the average correlation of each voxel's time-series with the rest of the voxels in the brain, then used AFNI's 3dttest++ on the group data to determine whether the effects of testosterone level on whole-brain connectivity were significant. We then performed follow-up region of interest-based RS analyses of testosterone, with and without sleep quality as a covariate. The study protocol was approved by the National Institute of Health's Combined Neuroscience Institutional Review Board. Sixteen participants reported repeated blast exposure in theater, leading to symptoms; the rest reported exposure to a single blast or a nonblast TBI. Thirty-three percent had testosterone levels <300ng/dL. Testosterone level was lower in participants who screened positive for post-traumatic stress disorder compared to those who screened negative, but it did not reach statistical significance. Whole-brain connectivity and testosterone level were positively correlated in the left parahippocampal gyrus (LPhG), especially in its connectivity with frontal areas, the lingual gyrus, cingulate, insula, caudate, and right parahippocampal gyrus. Further analysis revealed that the effect of testosterone on LPhG connectivity is only partially mediated by sleep quality. Sleep quality by itself had an effect on connectivity of the thalamus, cerebellum, precuneus, and posterior cingulate. Lower testosterone levels were correlated with lower connectivity of the LPhG. Weaknesses of this study include a retrospective design based on self-report of mTBI and the lack of a control group without TBI. Without a control group or pre-injury testosterone measures, we were not able to attribute the rate of low testosterone in our participants to TBI per se. Also testosterone levels were checked only once. The high rate of low testosterone level that we found suggests there may be an association between low testosterone level and greater post-traumatic stress disorder symptoms following deployment, but the causality of the relationships between TBI and deployment stress, testosterone level, behavioral symptomatology, and LPhG connectivity remains to be determined. Our study on men with persistent symptoms postdeployment and post-mTBI may help us understand the role of low testosterone and sleep quality in persistent symptoms and may be important in developing therapeutic interventions. Our results highlight the role of the LPhG, as we found that whole-brain connectivity in that region was positively associated with testosterone level, with only a limited portion of that effect attributable to sleep quality.