Posttraumatic Stress Disorder Inventory Research Articles

Long-term trajectories of depressive symptoms in deployed military personnel: A 10-year prospective study

BackgroundMilitary missions, especially those involving combat exposure, are associated with an increased risk of depression. Understanding the long-term course of depressive symptoms post-deployment is important to improve decision-making regarding deployment and mental health policies in the military. This study investigates trajectories of depressive symptoms in the Dutch army, exploring the influence of factors such as demographics, early-life trauma, posttraumatic stress disorder (PTSD) symptoms, and deployment stressors. MethodsA cohort of 1032 military men and women deployed to Afghanistan (2005–2008) was studied from pre- to 10 years post-deployment. Depressive and PTSD symptoms were assessed using the Symptom CheckList-90 and the Self-Rating Inventory for PTSD. Demographics, early trauma, and deployment experiences were collected at baseline and after deployment, respectively. Latent Class Growth Analysis was used to explore heterogeneity in trajectories of depressive symptoms over time. ResultsFour trajectories were found: resilient (65%), intermediate-stable (20%), symptomatic-chronic (9%), and late-onset-increasing (6%). The resilient group experienced fewer deployment stressors, while the symptomatic-chronic group reported more early life traumas. Trajectories with elevated depressive symptoms consistently demonstrated higher PTSD symptoms. LimitationsPotential nonresponse bias and missing information due to the longitudinal design and extensive follow-up times. ConclusionsThis study identified multiple trajectories of depressive symptoms in military personnel up to 10 years post-deployment, associated with early trauma, deployment stressors, adverse life events and PTSD symptoms. The prevalence of the resilient trajectory suggests a substantial level of resilience among deployed military personnel. These findings provide valuable insights and a foundation for further research.

Mental health status of internally displaced persons in the Garmian region of Kurdistan, Iraq: a cross-sectional survey

ABSTRACT There are an estimated 4 million internally displaced persons (IDPs) in Iraq, mainly settled in the Kurdistan Region of Iraq, and yet few studies have documented the mental health of IDPs in the region. The aims of this study were (1) to assess the prevalence of mental health disorders and trauma experiences amongst IDPs and (2) to explore associations between prior displacement and years living in the camp and mental health disorders. A cross-sectional survey was conducted with adults (N = 100) from March – July 2018. Structured surveys were used to collect sociodemographic information, and adapted measures included the Harvard Trauma Questionnaire (HTQ), Post-traumatic Stress Disorder Inventory (PTSD-8), Hopkins Symptoms Checklist-25 (HSCL-25) and the Post-Migration Living Difficulties Checklist (PMLD). The average number of traumatic events experienced was 4.43 (SD = 2.63). The most commonly reported traumatic events included oppression due to ethnicity, religion or sect (92%) and exposure to combat situations (83%). Nearly half of the participants had experienced ill health without access to medical care, 44% lack of shelter and 43% lack of food or clean water. Thirty-two percent of respondents witnessed someone being murdered. There is a critical need for quality mental health services for IDPs in KR.

High-density EEG sleep correlates of cognitive and affective impairment at 12-month follow-up after COVID-19

ObjectiveTo disentangle the pathophysiology of cognitive/affective impairment in Coronavirus Disease-2019 (COVID-19), we studied long-term cognitive and affective sequelae and sleep high-density electroencephalography (EEG) at 12-month follow-up in people with a previous hospital admission for acute COVID-19. MethodsPeople discharged from an intensive care unit (ICU) and a sub-intensive ward (nonICU) between March and May 2020 were contacted between March and June 2021. Participants underwent cognitive, psychological, and sleep assessment. High-density EEG recording was acquired during a nap. Slow and fast spindles density/amplitude/frequency and source reconstruction in brain gray matter were extracted. The relationship between psychological and cognitive findings was explored with Pearson correlation. ResultsWe enrolled 33 participants ( 17 nonICU) and 12 controls. We observed a lower Physical Quality of Life index, higher post-traumatic stress disorder (PTSD) score, and a worse executive function performance in nonICU participants. Higher PTSD and Beck Depression Inventory scores correlated with lower executive performance. The same group showed a reorganization of spindle cortical generators. ConclusionsOur results show executive and psycho-affective deficits and spindle alterations in COVID-19 survivors – especially in nonICU participants – after 12 months from discharge. SignificanceThese findings may be suggestive of a crucial contribution of stress experienced during hospital admission on long-term cognitive functioning.

Quality of Life After Myocardial Infarction as a Function of Temperamental Traits, Stress Coping Styles, and Posttraumatic Stress Disorder Symptoms.

The presented study aims to explore the relationship between quality of life after myocardial infarction and factors such as temperamental traits, stress coping, and posttraumatic stress disorder (PTSD) symptoms. Ninety-six participants, including 51 females and 45 males aged 24–85 years, who have survived ST-elevation myocardial infarction were asked to complete the Formal Characteristics of Behavior—Temperament Inventory, Coping Inventory for Stressful Situations, PTSD Inventory, and Quality of Life SF-36 questionnaire. According to the obtained results, a lower level of briskness and sensory sensitivity, as well as a higher level of perseverance and endurance, correlates with a higher level of emotion-oriented coping, whereas a higher level of perseverance, endurance, and activity correlates with a higher level of avoidant-distracted coping. Moreover, a higher level of briskness and activity is correlated with a higher level of avoidant-social coping. A higher level of emotion-oriented and avoidant-distracted coping is, in turn, associated with a higher intensity of PTSD symptoms, whereas a higher level of avoidant-social coping correlates with lower intensity of PTSD symptoms. Furthermore, a higher level of avoidant-distracted coping is correlated to a better physical quality of life, whereas higher levels of endurance and activity are associated with a better emotional quality of life. Also, the more severe the PTSD symptoms, the lower quality of life in general. Contrastingly, higher sensory sensitivity and briskness correlate with better quality of life. The meaning of other temperamental traits, however, is more ambiguous. Nevertheless, the findings support the model of psychological processes in which the subsequent stages are temperament, coping, PTSD, and quality of life.

116Dementia risk in individuals with lifetime major trauma and post-traumatic stress disorder (PTSD) symptoms

Abstract Background Increasing evidence suggests that stress may be a risk factor for dementia, however further investigation is required particularly in community-dwelling individuals. This study investigated whether lifetime major trauma with and without re-experiencing of PTSD symptoms is associated with dementia risk. Methods Participants were 1,700 community-dwelling men and women enrolled in the ESPRIT study of later-life neuropsychiatric disorders. Lifetime major trauma and PTSD were assessed using Watson’s PTSD Inventory. Cognitive function was measured using tests of global cognition, visual memory, verbal fluency, psychomotor speed and executive function. Fourteen-year incident dementia was diagnosed according to DSM-IV criteria. The association between lifetime trauma and cognition, as well as incident dementia was determined by multivariate logistic regression and Cox-proportional hazards regression, respectively. Results An unexpected, yet consistent finding was the association between lifetime major trauma without re-experiencing symptoms, and better baseline cognition (global OR: 0.67 [95% CI: 0.52-0.87], executive function OR: 0.69 [95% CI: 0.51-0.93]). Furthermore, lifetime trauma without re-experiencing symptoms was associated with a decreased risk of dementia (HR: 0.63, 95% CI: 0.44-0.91), particularly for females (HR: 0.49, 95% CI: 0.29-0.80). Conclusions Lifetime major trauma without re-experiencing symptoms may be protective for later-life cognitive function and could reduce dementia risk, especially in females. The mechanisms and moderating factors underlying these association requires further investigation. Key messages This study presents novel findings, and suggests that in some instances, experiencing traumatic events may be beneficial in later-life health.

Secondary posttraumatic stress symptom trajectories and perceived health among spouses of war veterans: a 12-year longitudinal study

Objective: War-related trauma may indirectly affect veterans’ spouses both in terms of secondary posttraumatic stress symptoms (PTSS) and negative perceived health. The present study aimed to examine trajectories of secondary PTSS over a twelve-year period and its association with various measures of subjectively perceived health, among spouses of war veterans. Methods: Spouses of war veterans (n = 155) were assessed prospectively 30 (T1, 2003), 37 (T2, 2010), and 42 (T3, 2015) years after the 1973 Yom Kippur War. Participants completed self-report questionnaires of PTSS (PTSD inventory) in all three measurement waves, while perceived health measures (Short-Form Health Survey-SF-36) were assessed only at T3. Results: Most spouses were classified to the ‘resilient’ trajectory with low and stable secondary PTSS over time, followed by recovered, chronic, and delayed onset PTSS trajectories. Importantly, spouses in the ‘chronic’ and ‘delayed’ secondary PTSS trajectories reported a higher severity of general negative subjective health perceptions and health-related social malfunctioning. Conclusion: Veterans’ spouses who were grouped in the ‘chronic’ and ‘delayed’ PTSS trajectories are to be considered as at-risk populations for both PTSS and negative perceived health perceptions. Mental health professionals as well as family physicians should be aware of the ongoing nature of secondary PTSS which might negatively affect veterans’ spouses medical conditions and ability to cope with the aging process.

The Role of Negative Affect in Differentiating Posttraumatic Stress Disorder, Depression, and Their Comorbidity Among United States Veterans.

Following trauma exposure, two frequently co-occurring forms of psychopathology include posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Although these diagnoses have been identified as distinct constructs, the proper classification of these disorders remains a challenge due to overlapping symptoms. Instead, systematically establishing higher- and lower-order personality traits associated with each diagnosis may avoid this confound and improve differential diagnosis. In the present study, we examined how higher-order negative affect and its lower-order facets (i.e., anxiousness, emotional lability, and separation insecurity) may be associated with a diagnosis of PTSD only, MDD only, both diagnoses, or neither diagnosis. Participants were 1,175 veterans enrolled in the Veterans After DischargeLongitudinalRegistry. Higher- and lower-order negative affect were assessed using the Personality Inventory for DSM-5 (PID-5), and PTSD and MDD diagnoses were based on the Structured Clinical Interview for DSM-5 (SCID-5). Multinomial logistic regressions were used to model the association between higher- and lower-order negative affect and diagnostic status, after controlling for potential covariates. Diagnostic utility analyses were conducted to examine the degree to which higher- and lower-order negative affect classified participants across groups. Higher-order negative affect and lower-order anxiousness differentiated diagnostic groups, ORs = 1.76-4.66, and had strong specificity and negative predictive value for individuals with PTSD and MDD and those with MDD only. These findings help explain the role of higher-order negative affect and lower-order anxiousness in differentiating PTSD from MDD and comorbid PTSD and MDD and may have implications for assessment, differential diagnosis, and treatment planning.

The long-term consequences of trauma and posttraumatic stress disorder symptoms on later life cognitive function and dementia risk

Stress may be a risk factor for dementia, however it is unknown whether post-traumatic stress disorder (PTSD) symptoms are associated with incident dementia in community-dwelling older individuals. The aim was to determine whether lifetime major trauma with and without re-experiencing of PTSD symptoms is associated with later-life cognition and dementia risk. Participants were 1,700 community-dwelling older adults (65+) in the longitudinal ESPRIT study followed over 14 years. Lifetime major traumatic exposure and PTSD were assessed using Watson's PTSD Inventory. Cognitive tests assessed global cognition, visual memory, verbal fluency, psychomotor speed and executive function. Incident dementia was diagnosed according to DSM-IV criteria. Lifetime major trauma (versus no trauma) was associated with significantly increased executive function and increased global function in men, however women with lifetime trauma and re-experiencing symptoms had a significantly increased risk of low global cognition. Over 14 years, lifetime trauma without re-experiencing symptoms was associated with a significantly decreased risk of incident dementia, particularly for women. Lifetime major trauma without re-experiencing symptoms (but not with) may be protective for later life cognitive function. However, the mechanisms and moderating factors underlying these association requires further investigation.

Structural brain changes with lifetime trauma and re-experiencing symptoms is 5-HTTLPR genotype-dependent

ABSTRACT Background: Findings on structural brain alterations following trauma are inconsistent due probably to heterogeneity in imaging studies and population, clinical presentations, genetic vulnerability, and selection of controls. This study examines whether trauma and re-experiencing symptoms are associated with specific alterations in grey matter volumes and if this varies according to 5-HTTLPR genotype. Methods: Structural MRI was used to acquire anatomical scans from 377 community-dwelling older adults. Quantitative regional estimates of 22 subregional volumes were derived using FreeSurfer software. Lifetime trauma was assessed using the validated Watson’s PTSD inventory, which evaluates the most severe trauma experienced according to DSM criteria. Analyses adjusted for age, sex, total brain volume, head injury, and comorbidities. Results: Of the 212 participants reporting lifetime trauma, 35.4% reported re-experiencing symptoms and for 1.9%, this was severe enough to meet criteria for full threshold PTSD. In participants with the SS 5-HTTLPR genotype only, re-experiencing symptoms were associated with smaller volumes in middle and superior temporal, frontal (lateral orbital, rostral and caudal middle) and parietal (precuneus, inferior and superior) regions. The trauma-exposed participants without re-experiencing symptoms were not significantly different from the non-trauma-exposed participants except for smaller precuneus and superior parietal region in traumatized participants and a larger amygdala in traumatized women specifically. Conclusions: In the non-clinical sample, lifetime trauma and re-experiencing symptoms were associated with smaller volume in prefrontal, temporal and parietal cortex subregions, and this varied according to serotonergic genetic vulnerability, 5-HTTLPR SS individuals being most susceptible.

The prediction of alexithymia as a state or trait characteristic in patients with substance use disorders and PTSD

Alexithymia is common in patients with a substance use disorder (SUD) and is possibly a negative prognostic factor in their treatment. The aim of this study was twofold. First, we explored whether SUD patients with posttraumatic stress disorder (PTSD) are more alexithymic than SUD patients without PTSD. Next, we explored whether trait and state-related parts of alexithymia could be differentiated in these patients. This phenomenon was studied in 197 SUD patients with the Toronto Alexithymia Scale-20 (TAS-20); Clinician Administered PTSD Scale; Self-Report Inventory for PTSD; Traumatic Experiences Checklist; European Addiction Severity Index; and the Depression, Anxiety and Stress Scale in a cross-sectional design. SUD patients with current PTSD showed more alexithymic characteristics than patients without PTSD or with previous lifetime/not current PTSD. The severity of PTSD complaints; alcohol addiction; and the combination of depression, anxiety and stress symptoms, all of which are more related to alexithymia as a state, explained 38.1% of the TAS-20. In conclusion, we advise that SUD patients be assessed for alexithymia and that its degree is taken into account. We also tentatively assume that a considerable part of alexithymia is more state- than trait-related in these patients.

Prevalence, comorbidity and predictors of post-traumatic stress disorder, depression, and anxiety in adolescents following an earthquake

This study sought to assess prevalence rate, comorbidity and predictors of Post-Traumatic Stress Disorder (PTSD), depression and anxiety among adolescents affected by the 2016 Aceh Earthquake. A cross-sectional study was conducted six months after the earthquake. The multi-stage random sampling method was applied to a selection of respondents from district schools. A total of 321 students participated in the study. In addition to generating demographic data, a brief PTSD inventory, the Patient Health Questionnaire (PHQ), the Generalized Anxiety Disorder (GAD-7) questionnaire and the Disaster Impact Questionnaire (DIQ) were administered. Approximately 58.3%, 16.8% and 32.1% of adolescents reported the clinical symptoms of PTSD, depression and anxiety, respectively. The associations and comorbidity between PTSD, depression, and anxiety were statistically significant (p = 0.001). Gender, depression, having directly seen someone injured or trapped, the injury or hospitalization of a member of the nuclear family and being afraid to stay inside a building since the earthquake were demonstrated to be the significant predictors for PTSD. The injury and hospitalization of a member of the nuclear family and feeling stressed after the earthquake were significant predictors for depression. Having been injured, having one's house destroyed; being afraid to stay inside a building and gender were significant predictors for generalized anxiety disorder. The prevalence of PTSD in the current study population is relatively high and the fact that a significant number of adolescents were afraid to stay inside a building following the earthquake calls for further investigation and treatments.

Quality of Life and PTSD Symptoms, and Temperament and Coping With Stress.

Due to advances in medicine, a malignant neoplasm is a chronic disease that can be treated for a lot of patients for many years. It may lead to profound changes in everyday life and may induce fear of life. The ability to adjust to a new situation may depend on temperamental traits and stress coping strategies. The research presented in this paper explores the relationships between quality of life, PTSD symptoms, temperamental traits, and stress coping in a sample of patients diagnosed with cancer. One hundred and twenty nine participants aged 24–81 years, 69 females diagnosed with breast cancer and 60 males diagnosed with lung cancer completed Formal Characteristics of Behavior – Temperament Inventory, Coping Inventory for Stressful Situations, PTSD Inventory, and Quality of life SF-36 questionnaire. Higher level of emotional reactivity and higher level of perseveration was associated with lower emotional quality of life. Higher level of emotion oriented-coping and higher level of avoidant-distracted coping was associated with higher level of PTSD symptoms. Emotion-oriented coping and avoidant-distracted coping are ineffective in dealing with stress in the case of patients diagnosed with cancer, because they are associated with a higher level of PTSD symptoms. The significance of temperamental traits for quality of life in the situation of the patients is marginal. Control of specific factors concerned with current health and treatment status is needed the future research.

Quality of life in cancer as a function of temperament, coping and posttraumatic stress disorder

The research presented in this paper explores the relationship between three blocks of explaining variables, ie. temperamental traits, stress coping PTSD and the explained variable which is quality of life in a sample of patients diagnosed with cancer. One hundred and twenty nine participants aged 24–81 years, 69 females diagnosed with breast cancer and 60 males diagnosed with lung cancer completed Formal Characteristics of Behaviour – Temperament Inventory (FCB-TI), Coping Inventory for Stressful Situations (CISS), PTSD Inventory (PTSD-C) and Quality of life SF-36 questionnaire. Higher level of emotional reactivity was associated with lower emotional quality of life. Higher level of emotion oriented-coping and higher level of avoidant-distracted coping was associated with higher level of intrusion/arousal and avoidance/numbing, ie. dimensions of PTSD symptoms. There were no statistically significant associations between temperamental traits and stress coping strategies nor between PTSD symptoms level and quality of life. Emotion-oriented coping and avoidant-distracted coping are ineffective in dealing with stress in the situation of patients diagnosed with cancer, because it leads to higher level of PTSD symptoms. The significance of temperamental traits for quality of life in the situation of the patients is marginal. Control of specific factors concerned with current health and treatment status is needed the future research.

5 Hz Repetitive transcranial magnetic stimulation for posttraumatic stress disorder comorbid with major depressive disorder

BackgroundStandard clinical protocols for repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) apply 10 Hz pulses over left prefrontal cortex, yet little is known about the effects of rTMS in more diagnostically complex depressed patients. Objective/hypothesisPosttraumatic stress disorder (PTSD) is commonly comorbid with MDD, and while rTMS has been shown to alleviate PTSD symptoms in preliminary studies, ideal parameters remain unclear. We conducted a prospective, open-label study of 5 Hz rTMS for patients with comorbid PTSD + MDD and hypothesized stimulation would reduce symptoms of both disorders. MethodsOutpatients (N = 40) with PTSD + MDD and at least moderate global severity were enrolled. 5 Hz rTMS included up to 40 daily sessions followed by a 5-session taper. Symptoms were measured using the PTSD Checklist (PCL-5) and Inventory of Depressive Symptomatology, Self-Report (IDS-SR). Baseline-to-endpoint changes were analyzed. ResultsThe intent-to-treat population included 35 participants. Stimulation significantly reduced PTSD symptoms (PCL-5 baseline mean ± SD score 52.2 ± 13.1 versus endpoint 34.0 ± 21.6; p < .001); 23 patients (48.6%) met a pre-defined categorical PTSD response criteria. MDD symptoms also improved significantly (IDS-SR, baseline 47.8 ± 11.9 to endpoint 30.9 ± 18.9; p < .001); 15 patients (42.9%) demonstrated categorical response and 12 (34.3%) remitted. PTSD and MDD symptom change was highly correlated (r = 0.91, p < .001). LimitationsUnblinded single-arm study, with modest sample size. ConclusionSignificant and clinically meaningful reductions in both MDD and PTSD symptoms were observed following stimulation. The preliminary efficacy of 5 Hz rTMS for both symptom domains in patients with comorbid disorders supports future controlled studies.

The Implication of Combat Stress and PTSD Trajectories in Metabolic Syndrome and Elevated C-Reactive Protein Levels: A Longitudinal Study.

This study sheds light on the importance of long-term follow-up of trauma survivors, posttraumatic stress disorder (PTSD) trajectories, and early detection of health risk factors in trauma survivors. The present study prospectively assessed the following over 23 years: (1) the association of psychological and physiologic stress during captivity with elevated C-reactive protein (CRP) levels and metabolic syndrome (MetS), which includes hypertension; elevated levels of insulin, triglycerides, and fasting glucose; decreased levels of high-density lipoprotein cholesterol; and obesity and (2) the implication of PTSD trajectories in elevated CRP levels and MetS. Measurements were taken in 1991, 2003, 2008, and 2015. Participants were 116 Israeli combat veterans of the 1973 Yom Kippur War (of these, 101 were former prisoners of war [ex-POWs] and 15 were comparable controls). The medical assessments relevant for this study were body mass index, fasting blood glucose levels, and diabetes, blood pressure or a diagnosis of hypertension, high-density lipoprotein cholesterol and triglyceride levels, and medication intake. In addition, the PTSD Inventory was used to assess PTSD symptoms and trajectories over time according to DSM-IV-TR PTSD criteria. Captivity-in particular, the captivity stressors of weight loss, physical suffering, psychological suffering, and humiliation-was implicated in both elevated CRP levels and MetS, significantly so with elevated CRP levels (P = .01, R² = 0.33). Captivity-induced PTSD, in particular chronic and delayed PTSD trajectories, was associated with elevated CRP levels and MetS, significantly so for MetS (P = .05). Monitoring inflammation using markers like CRP level in trauma survivors can be beneficial, particularly if PTSD is chronic or delayed. Clinicians treating trauma survivors should raise awareness of the importance of such measures in light of long-term health vulnerabilities.

Longitudinal changes in glucocorticoid receptor exon 1F methylation and psychopathology after military deployment

Several cross-sectional studies have demonstrated the relevance of DNA methylation of the glucocorticoid receptor exon 1F region (GR-1F) for trauma-related psychopathology. We conducted a longitudinal study to examine GR-1F methylation changes over time in relation to trauma exposure and the development of post-deployment psychopathology. GR-1F methylation (52 loci) was quantified using pyrosequencing in whole blood of 92 military men 1 month before and 6 months after a 4-month deployment period to Afghanistan. GR-1F methylation overall (mean methylation and the number of methylated loci) and functional methylation (methylation at loci associated with GR exon 1F expression) measures were examined. We first investigated the effect of exposure to potentially traumatic events during deployment on these measures. Subsequently, changes in GR-1F methylation were related to changes in mental health problems (total Symptom Checklist-90 score) and posttraumatic stress disorder (PTSD) symptoms (Self-Report Inventory for PTSD). Trauma exposure during deployment was associated with an increase in all methylation measures, but development of mental health problems 6 months after deployment was only significantly associated with an increased functional methylation. Emergence of post-deployment PTSD symptoms was not related to increased functional methylation over time. Pre-deployment methylation levels did not predict post-deployment psychopathology. To our knowledge, this is the first study to prospectively demonstrate trauma-related increases in GR-1F methylation, and it shows that only increases at specific functionally relevant sites predispose for post-deployment psychopathology.

The effect of an adverse psychological environment on salivary cortisol levels in the elderly differs by 5-HTTLPR genotype

BackgroundAn adverse psychological environment (e.g. stressful events or depression) has been shown to influence basal cortisol levels and cortisol response to stress. This differs depending on the adverse stimuli, but also varies across individuals and may be influenced by genetic predisposition. An insertion/deletion polymorphism in the serotonin transporter gene (5-HTTLPR) is a strong candidate in this regard. ObjectiveTo investigate how stressful life events and depression are associated with diurnal cortisol levels in community-dwelling elderly and determine whether this varies according to genetic variability in the 5-HTTLPR. MethodsThis population-based study included 334 subjects aged 65 and older (mean (SD) = 76.5 (6.3)). Diurnal cortisol was measured on two separate days, under quiet (basal) and stressful conditions. The number of recent major stressful events experienced during the past year was assessed from a 12-item validated questionnaire as an index of cumulative recent stressful events. Lifetime trauma was evaluated using the validated Watson's PTSD inventory, which evaluates the most severe traumatic or frightening experience according to DSM criteria. Depression was defined as having a Mini-International Neuropsychiatric Interview (MINI) diagnosis of current major depressive disorder or high levels of depressive symptoms (Center for Epidemiologic Studies-Depression Scale ≥16). 5-HTTLPR genotyping was performed on blood samples. ResultsExposure to stressful life events was associated with lower basal evening cortisol levels overall, and in the participants with the 5-HTTLPR L allele but not the SS genotype. The greatest effects (over 50% decrease, p < 0.001) were observed for the LL participants having experienced multiple recent stressful events or severe lifetime traumas. Participants with the L allele also had higher evening cortisol stress response. Conversely, depression tended to be associated with a 42% higher basal morning cortisol in the SS participants specifically, but did not modify the association between stressful events and cortisol levels. ConclusionAn adverse psychological environment is associated with basal cortisol levels and cortisol stress response, but this differs according to 5-HTTLPR genotype.

Self-Disclosing Trauma and Post-Traumatic Stress Symptoms in Couples: A Longitudinal Study

Objective: Most research concerning the implications of self-disclosure on trauma’s aftermath has focused on the salubrious effects disclosure may foster for the primary victim. However, the manner in which recipients of disclosure are symptomatically affected by it remains unexamined. Of particular interest are spouses who are often the primary support providers and are therefore susceptible to secondary traumatization. Assessing posttraumatic stress symptoms (PTSS) and self-disclosure among traumatized veterans and their wives, the current longitudinal study begins to fill this gap in the literature. Method: A total of 220 couples consisting of Israeli veterans, of whom 128 were former prisoners of war (ex-POWs) and 92 were combatants, and their wives were examined. PTSS and self-disclosure of both partners were assessed 30 and 35 years after the war using the Posttraumatic Stress Disorder Inventory (PTSD-I; Solomon et al., 1993) and the Self-Disclosure Index (SDI; Miller, Berg, & Archer, 1983), respectively. Analyses included Pearson intercorrelations analyses and four stepwise hierarchical multiple regression analyses. Results: Findings indicated that increments in veterans’ disclosure are not only consistently associated with the reduction of their wives’ PTSS but may also explain and predict some of the change in the wives’ PTSS over time. However, such a longitudinal effect was not evident concerning the veterans’ PTSS. Conclusion: Traumatized ex-POWs’ and combatants’ self-disclosure within the marital relationship may contribute to the amelioration of their wives’ secondary traumatization, and thus may be a goal worth pursuing in therapy. However, more research is needed to further understand this relation.

T62 - Longitudinal Changes In Glucocorticoid Receptor 1f Methylation And Psychopathology After Military Deployment

Background The glucocorticoid receptor (GR) 1F region is involved in transcription and expression of the GR protein and influences hypothalamic-pituitary-adrenal (HPA)-axis activity. Several studies have investigated GR-1F DNA methylation in the context of traumatic stress and psychiatric disorders, such as major depressive disorder and posttraumatic stress disorder (PTSD). However, longitudinal studies examining GR-1F DNA methylation before and after exposure to traumatic stress are lacking. We therefore aimed to investigate prospective DNA methylation changes in the GR-1F region after military deployment and its relation to the emergence of psychopathology. Methods Whole blood DNA methylation in the entire GR-1F region (52 CpGs) before and six months after deployment was quantified using pyrosequencing (N=92). Methylation levels were linked to post-deployment mental health problems (Revised Symptom Checklist, SCL-90), PTSD symptoms (Self-Rating Inventory for PTSD) and trauma exposure during deployment. Moreover, methylation was related to GR-1F expression, GR binding and genetic variation in the GR. Mean methylation, the number of methylated sites (methylation burden), mean methylation at transcription factor binding sites and at CpGs significantly associated with GR-1F expression (functional methylation) were examined. Results Trauma exposure during deployment and the emergence of mental health problems were significantly related to an increased methylation burden (t=2.23, p=2.8x10-2, =0.45 and t=2.24, p=2.7x10-2 and =0.085, respectively), which was associated with both decreased GR-1F expression (t=-2.92, p=4.7x10-3, =-1.93) and GR binding (t=-2.13, p=3.9x10-2, =-2.9x10-3). Moreover, development of psychopathology symptoms was significantly associated with increased methylation at functionally relevant CpGs (mental health problems: t=3.73, p=3.5x10-4, =1.2x10-2; PTSD symptoms: t=2.10, p=3.8x10-2, =0.59). Change in mean methylation was associated with a change in mental health problems (t=1.99, p=5.0x10-2, =4.1x10-3) and in GR-1F expression (t=-2.35, p=2.2x10-2, =-0.074). Discussion This longitudinal study in a military cohort shows that GR-1F DNA methylation levels are related to trauma exposure during deployment and the development of post-deployment psychopathology symptoms, particularly at functionally relevant sites. Together, our results provide further insight in transcriptional regulation of the glucocorticoid receptor gene, by demonstrating that GR-1F DNA methylation levels can vary over time and are related to stress vulnerability and the emergence of post-deployment psychopathology symptoms.

Development of psychopathology in deployed armed forces in relation to plasma GABA levels

The GABA system is pivotal for an adequate response to a stressful environment but has remained largely unexplored in this context. The present study investigated the relationship of prospectively measured plasma GABA levels with psychopathology symptoms in military deployed to Afghanistan at risk for developing psychopathology following trauma exposure during deployment, including posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Plasma GABA levels were measured in military personnel (N=731) one month prior to deployment (T0), and one (T1) and six months (T2) after deployment using ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC–MS/MS). Mental health problems and depressive symptoms were measured with the Dutch revised Symptom Checklist (SCL-90) and PTSD symptoms with the Dutch Self-Rating Inventory for PTSD (SRIP). Six months after deployment increases in GABA concentrations were present in individuals who had developed mental health problems (T2: β=0.06, p=1.6×10−2, T1: β=4.7×10−2, p=0.13), depressive symptoms (T2: β=0.29, p=7.9×10−3, T1: β=0.23, p=0.072) and PTSD symptoms at T2 (T2: β=0.12, p=4.3×10−2, T1: β=0.11, p=0.13). Plasma GABA levels prior to and one month after deployment poorly predicted a high level of psychopathology symptoms either one or six months after deployment. The number of previous deployments, trauma experienced during deployment, childhood trauma, age and sex were not significantly associated with plasma GABA levels over time. Exclusion of subjects who either started or stopped smoking, alcohol or medication use between the three time points rendered the association of increasing GABA levels with the emergence of psychopathology symptoms more pronounced (mental health problems at T2: β=0.09, p=4.2×10−3; depressive symptoms at T2: β=0.35, p=3.5×10−3, PTSD symptoms at T2: β=0.17, p=1.7×10−2). To our knowledge, this is the first study to provide prospective evidence that the development of psychopathology after military deployment is associated with increasing plasma GABA levels. Our finding that plasma GABA rises after the emergence of psychopathology symptoms suggests that GABA increase may constitute a compensatory mechanism and warrants further exploration of the GABA system as a potential target for treatment.