Posttraumatic Stress Disorder Group Research Articles

Intereleukine-6 and Interleukine-1β levels in post-traumatic stress disorder, depression and healthy controls: a preliminary report

IntroductionPatients with Post-traumatic stress disorder (PTSD) or mood disorders, as depression, often showed dysregulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, resulting in increased levels of pro-inflammatory cytokines and heightened activity of the immune system that may cause alterations in the structure and function of brain regions through direct neurotoxic effects, oxidative stress, changes in levels of neurotransmitters and decreasing some neurotrophins. Among the most studied pro-inflammatory cytokines in this field there are Intereleukine-6 (IL-6) and Interleukine-1β (IL-1β); however, scant and conflicting data are currently available in the literature about their use as potential biomarkers, and even less on possible comparisons in PTSD and depression.Objectives The aim of the present study was to evaluate circulating levels of IL-6 and IL-1β in patients with PTSD and to compare them with those of subjects with depression and healthy controls.MethodsA sample of 45 subjects, including 15 subjects diagnosed with PTSD (PTSD group), 15 with depression (DEP group), and 15 healthy controls (HC group) were recruited at the Psychiatric Clinic of the Department of Clinical and Experimental Medicine, University of Pisa. HC group included subjects recruited on a voluntary basis. The psychiatric diagnosis was assessed by the Structured Clinical Interview for DSM-5-Clinician Version (SCID-5-CV), the Impact of Event Scale-Revised (IES-R) and the Trauma and Loss Spectrum-Self Report lifetime version (TALS-SR). A peripheral venous blood sample was collected to perform the biochemical assays. The analyses of IL-6 and IL-1β were performed with a dedicated enzyme-linked immunosorbent assay (ELISAs) achieved at the Laboratory of Biochemistry of the Department of Pharmacy, University of Pisa.ResultsNo statistically significant gender or age differences emerged in the three groups. There were no statistically significant differences in IL-1β levels among the three groups. Conversely, the PTSD group showed higher levels of IL-6 compared to the DEP and to the HC ones, with a statistically significant difference in the post-hoc analysis among the PTSD and DEP groups with respect to the HC one (p<0.05).ConclusionsOur results suggest the key role of a chronic low-grade inflammatory state in PTSD and in depression, probably related to a dysregulation in HPA axis and cortisol release, with an increase in proinflammatory cytokines including IL-6 that seemed to be more pronounced in PTSD.Disclosure of InterestNone Declared

Post-traumatic Stress Disorder: The Influence of the Environmental Context and Analysis of Oxidative Stress and Inflammatory and Glycemic Markers in Women Living in Kurdistan Regional Government-Iraq.

Background Internally displaced persons (IDP) camps are still home to a large number of female survivors of the Yazidi genocide carried out in Iraq in 2014 by the Islamic organization known as the Islamic State of Iraq and Syria (ISIS). Many of these women suffer from a persistent form of post-traumatic stress disorder (PTSD), which can last for many years. On the other hand, little is known about the intricate etiology of PTSD. Objectives In this observational cross-sectional study, the biochemical parameters, including inflammatory and oxidative stress (OXS) markers, were evaluated in two groups: the case group (women with newly diagnosed PTSD) and the control group (apparently healthy women). Furthermore, how the environment impacts the biochemical and OXS parameters of people not diagnosed with PTSD but living in IDP camps was also analyzed. Materials and methods The PTSD group (n=55, age=30.0 years) was made up of women survivors of genocide-related events living in IDP camps in the Kurdistan region of Iraq. The studied parameters in the PTSD group have been compared to two healthy control groups: (1) internal control group (n=55, age=28.1 years): healthy women living inside the IDP camps; and (2) external control group (n=55, age=28.3 years): healthy women living outside the IDP camps. The diagnosis of PTSD was conducted using a validated Kurdish version of the PTSD Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PCL-5) scale. Blood samples were collected to determine the level of glycated hemoglobin (HbA1c) and the concentrations of fasting serum glucose (FSG), C-reactive protein (CRP), ceruloplasmin (CP), 8-hydroxydeoxyguanosine (8-OHdG), glutathione (GSH), malondialdehyde (MDA), protein carbonyls (PC), and catalase (CAT) activity. Results Women with PTSD presented increased values of FSG (4.41%, p<0.05), HbA1c (4.74%, p<0.05), and CRP (114.29%, p<0.05), as well as increased levels of 8-OHdG (185.97%, p<0.001), CP (27.08%, p<0.001), MDA (141.97%, p<0.001), and PC (63.01%, p<0.001), besides increased CAT activity (121.5%, p<0.001), when compared with the control groups. A significant reduction of GSH (-20.33%, p<0.05) was observed in PTSD patients as compared to the external control group. In relation to the internal control group, women diagnosed with PTSD presented significantly increased levels of FSG (3.88%, p<0.05), HbA1c (2.83%, p<0.05), CRP (77.97%, p<0.05), and PC (41.3%, p<0.05), as well as increased levels of 8-OHdG (118.84%, p<0.001), CP (22.72%, p<0.001), MDA (90.67%, p<0.001), and CAT activity (55.31%, p<0.001). Healthy individuals residing in IDP camps, compared with external healthy control, presented significantly elevated levels of 8-OHdG (30.68%, p<0.001), MDA (26.91%, p<0.001), PC (15.37%, p<0.001), and CAT activity (42.62%, p<0.001). Conclusion Our findings indicate that PTSD significantly influences glycemic, inflammatory, oxidant, and antioxidant parameters, as evidenced by increased levels of FSG, HbA1C, CRP, PC, MDA, 8-OHdG, and CP, as well as increased CAT activity and a reduced GSH concentration in the PTSD group in comparison to the external control group. Additionally, our results suggest that the environmental context in IDP camps by itself can potentially affect oxidant and antioxidant parameters, as evidenced by the increased concentrations of 8-OHdG, MDA, and PC and increased CAT activity found in individuals not diagnosed with PTSD but living inside the camps.

Evidence for Locus Coeruleus–Norepinephrine System Abnormality in Military Posttraumatic Stress Disorder Revealed by Neuromelanin-Sensitive Magnetic Resonance Imaging

BackgroundThe complex neurobiology of posttraumatic stress disorder (PTSD) calls for the characterization of specific disruptions in brain functions that require targeted treatment. One such alteration could be an overactive locus coeruleus (LC)–norepinephrine system, which may be linked to hyperarousal symptoms, a characteristic and burdensome aspect of the disorder. MethodsStudy participants were Canadian Armed Forces veterans with PTSD related to deployment to combat zones (n = 34) and age- and sex-matched healthy control participants (n = 32). Clinical measures included the Clinician-Administered PTSD Scale for DSM-5, and neuroimaging measures included a neuromelanin-sensitive magnetic resonance imaging scan to measure the LC signal. Robust linear regression analyses related the LC signal to clinical measures. ResultsCompared with control participants, the LC signal was significantly elevated in the PTSD group (t62 = 2.64, p = .010), and this group difference was most pronounced in the caudal LC (t56 = 2.70, Cohen’s d = 0.72). The caudal LC signal was also positively correlated with the severity of Clinician-Administered PTSD Scale for DSM-5 hyperarousal symptoms in the PTSD group (t26 = 2.16, p = .040). ConclusionsThese findings are consistent with a growing body of evidence indicative of elevated LC-norepinephrine system function in PTSD. Furthermore, they indicate the promise of neuromelanin-sensitive magnetic resonance imaging as a noninvasive method to probe the LC-norepinephrine system that has the potential to support subtyping and treatment of PTSD or other neuropsychiatric conditions.

Circulating cell-free mitochondrial DNA levels and glucocorticoid sensitivity in a cohort of male veterans with and without combat-related PTSD

Circulating cell-free mitochondrial DNA (ccf-mtDNA) is a biomarker of cellular injury or cellular stress and is a potential novel biomarker of psychological stress and of various brain, somatic, and psychiatric disorders. No studies have yet analyzed ccf-mtDNA levels in post-traumatic stress disorder (PTSD), despite evidence of mitochondrial dysfunction in this condition. In the current study, we compared plasma ccf-mtDNA levels in combat trauma-exposed male veterans with PTSD (n = 111) with those who did not develop PTSD (n = 121) and also investigated the relationship between ccf mt-DNA levels and glucocorticoid sensitivity. In unadjusted analyses, ccf-mtDNA levels did not differ significantly between the PTSD and non-PTSD groups (t = 1.312, p = 0.191, Cohen’s d = 0.172). In a sensitivity analysis excluding participants with diabetes and those using antidepressant medication and controlling for age, the PTSD group had lower ccf-mtDNA levels than did the non-PTSD group (F(1, 179) = 5.971, p = 0.016, partial η2 = 0.033). Across the entire sample, ccf-mtDNA levels were negatively correlated with post-dexamethasone adrenocorticotropic hormone (ACTH) decline (r = −0.171, p = 0.020) and cortisol decline (r = −0.149, p = 0.034) (viz., greater ACTH and cortisol suppression was associated with lower ccf-mtDNA levels) both with and without controlling for age, antidepressant status and diabetes status. Ccf-mtDNA levels were also significantly positively associated with IC50-DEX (the concentration of dexamethasone at which 50% of lysozyme activity is inhibited), a measure of lymphocyte glucocorticoid sensitivity, after controlling for age, antidepressant status, and diabetes status (β = 0.142, p = 0.038), suggesting that increased lymphocyte glucocorticoid sensitivity is associated with lower ccf-mtDNA levels. Although no overall group differences were found in unadjusted analyses, excluding subjects with diabetes and those taking antidepressants, which may affect ccf-mtDNA levels, as well as controlling for age, revealed decreased ccf-mtDNA levels in PTSD. In both adjusted and unadjusted analyses, low ccf-mtDNA levels were associated with relatively increased glucocorticoid sensitivity, often reported in PTSD, suggesting a link between mitochondrial and glucocorticoid-related abnormalities in PTSD.

Mental health screening in refugees communities: Ukrainian refugees and their post-traumatic stress disorder specificities

Post-Traumatic Stress Disorder (PTSD) symptoms are often consequences of war conflicts that generate trauma in people, resulting from the loss of family, home and belonging. It is associated with the forced migration and lack of structured facilities or health professionals in the hosting country, as a result of varying degrees of clinical assessment and sociocultural intervention. To evaluate the lack of resources for refugees from Ukraine, as well for clinical and research purposes, this study examined the validity and psychometric properties of one Ukrainian adapted version of the PCL-5 (Check-List for PTSD) and the convergent validity for the four factor model of DSM-5 for PTSD. Varying reactions to war events and war zone characterization are among the variables expected to produce PTSD group differences in these refugees. Thus, PTSD was investigated in 77 Ukrainian refugees, who had resided in Portugal for a minimum of four weeks, and who answered the 20-item PCL-5 scored on a Likert scale. The PCL-5 revealed satisfactory convergent validity overall, and in the clusters of the four factor model, based on the DSM-5. Additionally, the role of the participants’ age, sex, education level, time of residence in the host country, and the average income before the russo-ukrainian war was evaluated. 34 of 77 met the criteria for PTSD with a good fit for the four factor model (as the original of DSM-5 for PTSD) after the Confirmatory Factorial Analysis (CFA) was conducted. Mediating factors found for PTSD: female, young adults, high-income in Ukraine, low level of education, married, solo migration. Further investigation into factor modeling and clinical practice are discussed.

Association of 5-HTTLPR With Post-Traumatic Stress Disorder in US Service Members

Objective Post-traumatic stress disorder (PTSD) is a mental disorder that manifests after exposure to a stressful traumatic event, such as combat experience. Accumulated evidence indicates an important genetic influence in the development of PTSD. The serotonin transporter (5-HTT) gene has been identified as a candidate for PTSD and a polymorphism of the serotonin transporter-linked promoter region (5-HTTLPR) is associated with the disorder in the general population. However, whether it is associated with PTSD in active military service members has not been investigated. This study aimed to investigate the relationship between 5-HTTLPR and PTSD in service members. Methods Leucocyte genomic DNA was extracted from service members, including those with PTSD (n = 134) or without PTSD (n = 639). The 5-HTTLPR polymorphism was detected by means of 2 stages of TaqMan fluorescent PCR assay. PTSD symptoms and symptom severity were assessed using the PTSD Checklist (PCL), a 17-item, DSM-based, self-report questionnaire with well-established validity and reliability. PTSD was determined based on endorsement of DSM-IV criteria and a PCL total score ≥ 44. Results Significant differences in biallele distribution were observed between PTSD and controls (χ2 = 7.497, P = .024). The frequency of SS, SL, and LL genotypes in the PTSD group was 0.17, 0.56, and 0.27 respectively, compared to the frequencies of 0.27, 0.43, and 0.29 in non-PTSD controls. Carriers of the L allele had higher scores for reexperiencing and arousal symptoms on the PCL, compared to SS homozygote carriers (P < .05). The triallele genotypes showed no significant differences in distribution between the PTSD and control groups (P > .05) and no relationship with PTSD symptom severity. The interaction of triallelic genotypes of 5-HTTLPR and traumatic life events was associated with re-experiencing, avoidance, and arousal (P < .05 for all). Multiple regression analysis revealed significant correlations between both biallelic and triallelic genotypes of 5-HTTLPR, the interaction of the number of stressful lifetime events, and 5-HTTLPR genotypes with PCL total score (P < .001). Conclusion Our findings suggested that 5-HTT might play a minor role in PTSD, and the interaction between 5-HTTLPR and the environment had effects on PCL score, complementing and emphasizing 5-HTT for PTSD, especially in the military population.

Prefrontal Metabolite Alterations in Individuals with Posttraumatic Stress Disorder: A 7T Magnetic Resonance Spectroscopy Study

Background Evidence from animal and human studies suggests glutamatergic dysfunction in posttraumatic stress disorder (PTSD). The purpose of this study was to investigate glutamate abnormalities in the dorsolateral prefrontal cortex (DLFPC) of individuals with PTSD using 7T MRS, which has better spectral resolution and signal-to-noise ratio than lower field strengths, thus allowing for better spectral quality and higher sensitivity. We hypothesized that individuals with PTSD would have lower glutamate levels compared to trauma-exposed individuals without PTSD and individuals without trauma exposure. Additionally, we explored potential alterations in other neurometabolites and the relationship between glutamate and psychiatric symptoms. Methods Individuals with PTSD (n = 27), trauma-exposed individuals without PTSD (n = 27), and individuals without trauma exposure (n = 26) underwent 7T MRS to measure glutamate and other neurometabolites in the left DLPFC. The severities of PTSD, depression, anxiety, and dissociation symptoms were assessed. Results We found that glutamate was lower in the PTSD and trauma-exposed groups compared to the group without trauma exposure. Furthermore, N-acetylaspartate (NAA) was lower and lactate was higher in the PTSD group compared to the group without trauma exposure. Glutamate was negatively correlated with depression symptom severity in the PTSD group. Glutamate was not correlated with PTSD symptom severity. Conclusion In this first 7T MRS study of PTSD, we observed altered concentrations of glutamate, NAA, and lactate. Our findings provide evidence for multiple possible pathological processes in individuals with PTSD. High-field MRS offers insight into the neurometabolic alterations associated with PTSD and is a powerful tool to probe trauma- and stress-related neurotransmission and metabolism in vivo.

Daily life participation in PTSD: pilot study on patterns and correlators.

Participation in daily life activities with both the personal and community meaning is an important component of health and well-being. Even though there are mounting reports on the challenges in various aspects of daily-life functioning among individuals with post-traumatic stress disorder (PTSD), to date little research has been conducted on their comprehensive patterns of participation. The study aimed to describe objective and subjective participation dimensions in PTSD compared to healthy controls and investigate the association between personal and environmental factors and participation. Sixty-one individuals were enrolled in two groups: PTSD (N=31; age: M=34.3; women:77.4%) and healthy controls matched by age and gender. The PTSD group completed standard assessments for symptom severity, general cognition, executive function (EF), sensory processing, self-efficacy, functional capacity, and environmental properties. Both groups completed a participation questionnaire. Individuals with PTSD participated with low intensity and diversity, more occupations were abandoned (-4.73<t<5.73, p<0.05), and less meaning was found in the included occupations. Participation objective dimensions were associated with self-reported EF (-0.47<r<-0.42, p<0.05), sensory modulation profile (2.51<t<2.81, p<0.05), and environmental properties (-0.44<r<0.5, p<0.05), but not with PTSD symptom severity, and objective measures of cognition and functional capacity. No correlators were identified for subjective participation dimensions. The study demonstrates profound restrictions in participation in PTSD raising serious concerns. There are unique patterns of association between objective participation dimensions, subjective cognitive indices, sensory modulation, and environmental factors, suggesting a need for PTSD feature-specific intervention approaches to advance the participation of those with PTSD as a means of promoting health and well-being.

Structural covariance, topological organization, and volumetric features of amygdala subnuclei in posttraumatic stress disorder

The amygdala is divided into functional subnuclei which have been challenging to investigate due to functional magnetic resonance imaging (MRI) limitations in mapping small neural structures. Hence their role in the neurobiology of posttraumatic stress disorder (PTSD) remains poorly understood. Examination of covariance of structural MRI measures could be an alternate approach to circumvent this issue. T1-weighted anatomical scans from a 3 T scanner from non-trauma-exposed controls (NEC; n = 71, 75 % female) and PTSD participants (n = 67, 69 % female) were parcellated into 105 brain regions. Pearson’s r partial correlations were computed for three and nine bilateral amygdala subnuclei and every other brain region, corrected for age, sex, and total brain volume. Pairwise correlation comparisons were performed to examine subnuclei covariance profiles between-groups. Graph theory was employed to investigate subnuclei network topology. Volumetric measures were compared to investigate structural changes.We found differences between amygdala subnuclei in covariance with the hippocampus for both groups, and additionally with temporal brain regions for the PTSD group. Network topology demonstrated the importance of the right basal nucleus in facilitating network communication only in PTSD. There were no between-group differences for any of the three structural metrics. These findings are in line with previous work that has failed to find structural differences for amygdala subnuclei between PTSD and controls. However, differences between amygdala subnuclei covariance profiles observed in our study highlight the need to investigate amygdala subnuclei functional connectivity in PTSD using higher field strength fMRI for better spatial resolution.

Modified Acceptance and Commitment Psychotherapy in Complex Treatment of Comorbidity of Post-traumatic Stress Disorder and Mild Traumatic Brain Injury

The objective: approbation of the effectiveness of modified Acceptance and Commitment Therapy in a complex treatment of patients with comorbidity of posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). Materials and methods. 329 veterans from three clinical groups: individuals with PTSD (n=109), with mild TBI (n=112) and with comorbid PTSD + TBI (n=108), underwent a course of combined therapy lasting 8 weeks: in addition to standard therapy, they received psychotherapeutic intervention (psychoeducation with elements of motivational interviewing and acceptance and commitment therapy for PTSD) and transcranial direct current stimulation (tDCS). The evaluation of the effectiveness of the treatment, in addition to a comprehensive psychodiagnostic examination before and after the therapy, included the Quality of Life Assessment Scale (O. Chaban). Results. Based on the obtained data, we can assume that representatives of the PTSD group, who initially evaluated the quality of social aspects of their lives more negatively, after the therapy looked more positively at the emotionally colored spheres of life (sex and mood). At the same time, after the therapy, the feeling of satisfaction with life was more positively assessed by those patients who were more satisfied with their life conditions before the therapy, and a higher assessment of the quality of life after the therapy was observed in those patients who, even before the therapy, had a higher level of satisfaction with your sex life. Summarizing the obtained data, it can be asserted that as a result of the therapy, the best results in the direction of increasing self-esteem of the quality of life were achieved precisely in relation to patients with PTSD/TBI. Conclusions. Complex treatment of patients with comorbid PTSD and TBI using modified acceptance and Acceptance and Commitment Therapy in combination of standard treatment and tDCS is a promising individual treatment methodology in this patient population.

Diversity in emotion regulation strategy use: Resilience against posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is associated with impaired emotion regulation (ER). ER diversity, the variety, prevalence, and relative abundance of ER strategy use, may provide resilience against PTSD. This study examined the prospective relation between ER diversity and PTSD, while accounting for negative and positive life events, in interpersonal violence (IPV) survivors. IPV-exposed women with PTSD onset (PTSD; n = 22), without PTSD onset (IPV; n = 37), and non-traumatized control participants (NTC; n = 41) rated their ER strategy use and experience of negative and positive life events. The ER diversity index differentiated the participant groups. Importantly, group differences in ER diversity depended on the experience of life events. When experiencing fewer positive life events and more negative life events, the IPV and NTC groups, but not the PTSD group, demonstrated higher ER diversity. Thus, greater ER diversity during periods with more negative life events and fewer positive life events may play a protective role against PTSD onset for IPV survivors.

An empirical investigation of definitions of subthreshold posttraumatic stress disorder.

Subthreshold posttraumatic stress disorder (PTSD) has long been recognized as an important construct that identifies a subgroup of individuals who report significant PTSD symptoms and associated disability but do not endorse enough symptoms to meet the criteria for a full PTSD diagnosis. Different investigators have defined subthreshold PTSD in various ways, making it difficult to interpret findings across studies. To address this problem, we systematically compared individuals who met criteria for nine different subthreshold PTSD definitions with individuals diagnosed with either full PTSD or no PTSD (i.e., failed to meet the criteria for a subthreshold definition) with respect to prevalence and associated clinical outcomes of interest. Participants were 1,082 veterans enrolled in the Veterans After DischargeLongitudinalRegistry. PTSD and subthreshold PTSD diagnostic status were determined using the Structured Clinical Interview for DSM-5 (SCID-5) and validated self-report instruments were used to assess clinical outcomes. Across outcomes, subthreshold definitions generally identified a group of participants that was distinguishable from participants in both the PTSD and no PTSD groups, rs = .02-.47. We discuss the benefits and drawbacks of various subthreshold definitions and highlight the need for additional work evaluating these definitions across additional outcomes and samples. In the interim, we propose a working case definition of subthreshold PTSD as meeting any three of the four DSM-5 symptom criteria (i.e., Criteria B, C, D, and E) along with Criterion A and Criteria F-H. The results suggest subthreshold PTSD is a clinically meaningful construct.

Sickness absence after work injuries and post-traumatic stress among white-collar workers

Abstract Background There is very little knowledge about sickness absence (SA) and disability pension (DP) after work injuries and post-traumatic stress disorder (PTSD) among white collar workers. The aim was to examine diagnosis-specific SA and DP after healthcare due to a workplace injury and PTSD, respectively, among white-collar workers in the wholesale and retail industry in Sweden. Methods A prospective population-based cohort study of all 192,077 such white-collar workers (44% women) in Sweden in 2012, using linked microdata from three nationwide registers covering 2012-2016. We identified individuals who had specialised out- or inpatient healthcare due to a work injury (n = 1114) or to PTSD (n = 216) in the years 2012-2016. Their average number of net days of diagnosis-specific SA and DP was calculated for the 365 days before and 365 days after the healthcare visit. Results 64% of women and 45% of the men had at least one new SA spell during the 365 days after healthcare due to a work injury. On average, women had 14 SA/DP days the year before the injury and 31 days after; corresponding days for men were 9 and 21 days. SA days with fractures and with other injuries increased most, while SA days with mental diagnoses increased slightly. In the PTSD group, 80% of women and 65% of men had a new SA spell. Women's SA/DP days increased from 121 to 157 and men's from 112 to 174. SA with stress-related disorders and other mental diagnoses increased most, while DP with stress-related diagnoses and SA with musculoskeletal diagnoses increased slightly. Conclusions About half of those who had healthcare due to work injuries, and the majority of those who had PTSD, had new SA following the healthcare. SA due to diagnoses related to injury and mental diagnoses, respectively, increased most, however, SA/DP days due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP with different diagnoses after work injuries and PTSD. Key messages • About half of those who had specialised healthcare due to work injuries, and the majority of those who had PTSD, had new SA in the following 365 days. • Individuals with healthcare for PTSD had more SA/DP days both before and after their healthcare visit than those with work injuries, but individuals with work injuries had a larger increase.

Psychometric properties of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) in male military personnel with and without PTSD

BackgroundThe 10-item Connor-Davidson Resilience Scale (CD-RISC-10) is a scale widely used to assess resilience among various clinical and nonclinical populations. Measurement invariance of a scale is essential for group comparison. However, to our knowledge, the psychometric properties, including the measurement invariance, validity and reliability, of the CD-RISC-10 in male military personnel with posttraumatic stress disorder (PTSD) are unknown. The current study aimed to determine the measurement invariance of the CD-RISC-10 and its validity and reliability in male military personnel with and without PTSD. MethodsA total of 8089 male military personnel were enrolled in the study, 370 of whom were screened as having PTSD based on the screening criteria of a Posttraumatic Stress Disorder Checklist-Civilian score ≥38 and 7719 of whom did not have PTSD. Confirmatory factor analysis (CFA) was conducted to evaluate whether the scale had a single factor and to determine the measurement invariance in PTSD and non-PTSD samples. ResultsThe results showed that the CD-RISC-10 had satisfactory and reliable internal consistency and criterion-related validity among the PTSD (α = 0.91; r = -0.54, -0.44, -0.55, P<0.01) and non-PTSD (α = 0.94, r = -0.61, -0.49, -0.56, P<0.01) groups. The unidimensional structure of the CD-RISC-10 was verified by CFA in the PTSD and non-PTSD groups. Moreover, the scalar invariance of the CD-RISC-10 was established across PTSD and non-PTSD groups(△CFI = -0.002, △TLI = 0.001, △RMSEA =-0.001). ConclusionsThe findings indicate that the CD-RISC-10 is an effective instrument for assessing psychological resilience across PTSD and non-PTSD male military personnel.

Effect of traumatic experiences and future threats on executive functioning and verbal fluency amongst Farsi-Dari speaking immigrants, refugees, and asylum seekers

BackgroundImpairments in executive functioning associated with posttraumatic stress disorder (PTSD) may impact the capacity of refugees and asylum seekers. AimsTo examine the association between executive functioning and PTSD with and without prominent future-focused threat (FFT) intrusions at rest and after threat priming. Method66 Farsi and Dari-speaking asylum-seekers, refugees, and immigrants were recruited into 3 groups: High PTSD & FFT Symptoms; High PTS Symptoms; Low PTSD & FFT symptoms. The Category Fluency Test (animals; food; flora) in Farsi was administered at baseline and after two counter-balanced future- and past-focused threat narrative tasks. Results: Higher PTSD and FFT symptom scores was associated with reduced verbal fluency [correct words (PTS p < 0.001; FFT p < 0.007), clustered words (PTS, p < 0.004; FFT p < 0.009) and clusters (PTS p < 0.017; FFT p < 0.009)]. The PTSD group retrieved fewer correct words (17.6, p < 0.009) using fewer clusters (p < 0.008) than the low-symptom group at baseline. It was only after exposure to the narrative task that the FFT group displayed comparable impairment. ConclusionsA subset of displaced persons with future threat symptoms exhibit cognitive impairment when asked to recount narrative details. Future threat may limit capacity to engage in cognitively demanding activities, such as participating in Refugee Status Determination.

Imagining emotional future events in PTSD: clinical and neurocognitive correlates.

Emotional future thinking serves important functions related to goal pursuit and emotion regulation but has been scantly studied in posttraumatic stress disorder (PTSD). The current study sought to characterize emotional future thinking in PTSD and to identify clinical and neurocognitive profiles associated with potential alterations in the level of detail in narratives of imagined future events. Fifty-eight, trauma-exposed, war-zone veterans, who were classified into current PTSD, past PTSD, and no-PTSD groups, were asked to vividly imagine future events in response to positive and negative cue words occurring in the near and distant future. These narratives were scored for internal (i.e., pertaining to the main event) and external (i.e., tangential to the main event) details. Participants also performed neurocognitive tasks of generative ability, working memory, and relational verbal memory. Linear mixed modeling revealed that the current and past PTSD groups generated fewer internal details than the no-PTSD group across positive and negative cue words and across temporal proximity. Partial leastsquares analysis revealed that symptom severity for all PTSD clusters was inversely associated with production of internal details, albeit with the association relatively weaker for intrusion symptoms. Among the neurocognitive tasks, only relational verbal memory was associated with production of internal details. These findings suggest, as predicted, that functional avoidance may underlie reduced detail generation but also point to potential additional mechanisms to be further investigated. That future event simulation remains overgeneral even when PTSD symptoms abate highlights the importance of addressing alterations in future thinking in this population.

Association of PTSD history with confusion or memory loss among World Trade Center Health Registry enrollees

BackgroundBurgeoning research suggests that people exposed to the 9/11/2001 terrorist attacks in New York City (NYC) may be at greater risk for cognitive impairment due to a variety of potential exposures. We investigated whether posttraumatic stress disorder (PTSD) history was associated with self-reported confusion or memory loss (CML) among World Trade Center Health Registry enrollees. MethodsThe study sample included enrollees who completed all five wave surveys (W1 in 2003–04 through W5 in 2020–21), were between the ages of 35 and 64 during W3-W5, and had no history of stroke or dementia (N = 11,432). We categorized PTSD history during W1-W3 as chronic-high, increased, decreased, or resilient-low with trajectory analysis. Generalized estimating equations modeling was used for the repeated measures analysis of the outcome, CML. ResultsCompared to those in the resilient-low PTSD group, those in the decreased and increased PTSD groups were at over 52% greater risk of reporting CML; those in the chronic-high PTSD group had between a 1.62 and 1.92 times greater risk of CML than the resilient-low PTSD group, with non-rescue/recovery workers having greater risk on average. PTSD history was also associated with elevated risk of more severe CML-related outcomes in W5 – specifically, experiencing worsening symptoms and functioning in daily life. LimitationsCML symptoms are self-reported, and generalizability of results may be limited. ConclusionsThese findings suggest that survivors with PTSD should be monitored for cognitive issues, including CML. Effective treatment of PTSD may have benefits beyond mitigation of PTSD symptoms.

Early Aftermath of February 6 Earthquakes in Turkey: PTSD, PTG, and Resilience

On February 6, 2023, earthquakes with magnitudes of 7.7 and 7.6 on the Richter scale struck Turkey, impacting eleven cities within Turkey and adjacent parts of Syria. This study investigates the immediate aftermath (50 days after the disaster) effects of these earthquakes on survivors. The primary focus is on posttraumatic stress disorder (PTSD) and post-traumatic growth (PTG), coupled with an exploration of the explanatory roles played by resilience, intolerance to uncertainty, and anxiety. For data collection, the study employs instruments such as the PTSD Checklist for DSM-5, Beck Anxiety Inventory, Brief Resilience Scale, PTG Inventory, and Intolerance to Uncertainty Scale. For the analysis, PTSD groups were formed (categorized using cutoff scores based on PTSD severity [69% high PTSD, 31% low PTSD]) and subjected to t-tests. In addition, multiple regression analysis is utilized to assess whether anxiety, resilience, and intolerance to uncertainty account for variations in PTSD and PTG. The findings revealed that the high PTSD group exhibited higher levels of anxiety, PTG, and intolerance to uncertainty, while displaying lower age and resilience in comparison to the low PTSD group. Moreover, the study found that intolerance to uncertainty (specifically in the inhibitory anxiety subscale), anxiety, and age significantly contributed to explaining PTSD. For PTG, the predictors were intolerance to uncertainty (inhibitory anxiety subscale), resilience, and age. This study underscores the significance of anxiety, resilience, and intolerance to uncertainty in comprehending PTG and PTSD. While PTSD was perceived as a negative aftermath of trauma, PTG was seen as a positive facet.

Levels of Arachidonic Acid-Derived Oxylipins and Anandamide Are Elevated Among Military APOE ɛ4 Carriers With a History of Mild Traumatic Brain Injury and Post-Traumatic Stress Disorder Symptoms.

Currently approved blood biomarkers detect intracranial lesions in adult patients with mild to moderate traumatic brain injury (TBI) acutely post-injury. However, blood biomarkers are still needed to help with a differential diagnosis of mild TBI (mTBI) and post-traumatic stress disorder (PTSD) at chronic post-injury time points. Owing to the association between phospholipid (PL) dysfunction and chronic consequences of TBI, we hypothesized that examining bioactive PL metabolites (oxylipins and ethanolamides) would help identify long-term lipid changes associated with mTBI and PTSD. Lipid extracts of plasma from active-duty soldiers deployed to the Iraq/Afghanistan wars (control = 52, mTBI = 21, PTSD = 34, and TBI + PTSD = 13) were subjected to liquid chromatography/mass spectrometry analysis to examine oxylipins and ethanolamides. Linear regression analyses followed by post hoc comparisons were performed to assess the association of these lipids with diagnostic classifications. Significant differences were found in oxylipins derived from arachidonic acid (AA) between controls and mTBI, PTSD, and mTBI + PTSD groups. Levels of AA-derived oxylipins through the cytochrome P450 pathways and anandamide were significantly elevated among mTBI + PTSD patients who were carriers of the apolipoprotein E E4 allele. These studies demonstrate that AA-derived oxylipins and anandamide may be unique blood biomarkers of PTSD and mTBI + PTSD. Further, these AA metabolites may be indicative of an underlying inflammatory process that warrants further investigation. Future validation studies in larger cohorts are required to determine a potential application of this approach in providing a differential diagnosis of mTBI and PTSD in a clinical setting.

Anhedonia and Delay Discounting: Differing Patterns of Brain-Behavior Relationships in Healthy Control Participants Versus Individuals With Posttraumatic Stress Disorder

BackgroundAnhedonia may contribute to individual differences in delay discounting (DD). In prior work, we found that higher anhedonia was associated with shallower DD in healthy control (HC) participants but steeper DD in individuals with posttraumatic stress disorder (PTSD). In this study, we aimed to directly compare the relationship between anhedonia and DD across groups and to identify functional brain correlates of this interaction. MethodsParticipants (HC group: n = 23, DSM-5 PTSD group: n = 23) completed a questionnaire assessing anhedonia (Snaith-Hamilton Pleasure Scale [SHAPS]), task-based functional magnetic resonance imaging of decision making including DD, and resting-state functional magnetic resonance imaging. Task-based activity and resting-state functional connectivity were evaluated in reward-related regions that have also been implicated in PTSD (nucleus accumbens [NAcc], right anterior insula). ResultsHigher SHAPS scores were associated with steeper DD in PTSD, but there was no relationship between DD and SHAPS in the HC group. There was a significant group-by-SHAPS interaction for NAcc activity, t31 = 2.92, p = .007: Greater NAcc activity when immediate rewards were chosen was associated with higher SHAPS in the PTSD group but lower SHAPS in the HC group. In resting-state functional connectivity, there was a group-by-SHAPS interaction between the NAcc seed and right parietal and frontal pole clusters. ConclusionsThese results extend prior findings that anhedonia is associated with steeper DD in PTSD and demonstrate that this behavioral finding occurs in the context of NAcc hyperactivity to immediate rewards and hyperconnectivity in anhedonic individuals with PTSD.