History Of Posttraumatic Stress Disorder Research Articles

Motives for Nonsuicidal Self-Injury in Individuals with Lifetime Depressive Disorders and Posttraumatic Stress Disorder

Although researchers have identified a number of factors that may motivate individuals to engage in nonsuicidal self-injury (NSSI), few studies have examined whether motives for NSSI differ as a function of psychiatric diagnosis. Therefore, the goal of the present study was to examine motives for lifetime NSSI among individuals with a history of psychiatric disorders associated with elevated rates of NSSI: depressive disorders and posttraumatic stress disorder (PTSD). Young adults (N = 139) with a history of NSSI completed several diagnostic interviews and questionnaires, including a measure of lifetime NSSI motives. Results demonstrated that participants with (vs. without) a lifetime depressive disorder reported significantly lower levels of interpersonal influence motives for NSSI, and participants with (vs. without) lifetime PTSD reported significantly higher levels of emotional relief and feeling generation motives. Further, results revealed a significant interaction between lifetime depressive disorders and PTSD for interpersonal communication motives; specifically, whereas participants with lifetime diagnoses of both a depressive disorder and PTSD did not differ significantly in reported interpersonal communication motives from participants with neither diagnosis, those with lifetime PTSD but without a lifetime depressive disorder reported significantly higher levels of interpersonal communication motives than those without either diagnosis. Results suggest that a history of depression and PTSD (alone and in combination) may be associated with different motives for NSSI.

Re-traumatization Cycle: Sexual Abuse, Post-Traumatic Stress Disorder and Sexual Risk Behaviors among Club Drug Users

Background: Club drug users are high risk and vulnerable population for adverse drug-related consequences and sexual risk behaviors. Few investigations have addressed the possible interrelationship between early trauma and PTSD among young club drug using populations. Objective: Exposure to traumatic experiences – especially in childhood, has been linked to risk behaviors exposure and substance use disorder. This study aimed to assess and compare drug use patterns and the presence of childhood sexual abuse (CSA) experiences among ecstasy and LSD users with and without Posttraumatic Stress Disorder (PTSD). Method: This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals. The Global Appraisal of Individual Needs questionnaire was used as the primary assessment instrument. Participants were from 18 to 39 years of age, had used ecstasy and/or LSD in the 90 days prior to the interview, and were not in treatment for alcohol and other drug problems. Results: Out of the 240 participants, 123 (51.2%) presented PTSD symptoms. Those presenting PTSD were younger, less educated, with lower income, and presented higher drug use severity than those without PTSD symptoms. Moreover, a higher prevalence of sexual risk behavior was verified among those with PTSD. There was an association between PTSD symptoms and CSA history, where 64.2% of individuals with PTSD also presented CSA, compared to 47% among those without PTSD (p = .028). Individuals with co-occurring history of CSA and PTSD symptoms reported earlier use of ecstasy, LSD, and cocaine compared to individuals with a history of CSA but without PTSD. Conclusions: In the present study, participants with a history of PTSD demonstrate a history of CSA, as well as pronounced severity in several areas – precocity of use, severity of addiction, and greater exposure to situations of sexual risk. Thus, a cycle of traumatization may be established through early potential trauma, which can remain unprocessed and contribute to earlier and more severe substance use and sexual risk behaviors. Identification of PTSD symptoms and risk for HIV and other STIs among young club drug users is critical to address focused treatment approaches for this vulnerable population.

Validation of an Electronic Medical Record-Based Algorithm for Identifying Posttraumatic Stress Disorder in U.S. Veterans.

We developed an algorithm for identifying U.S. veterans with a history of posttraumatic stress disorder (PTSD), using the Department of Veterans Affairs (VA) electronic medical record (EMR) system. This work was motivated by the need to create a valid EMR-based phenotype to identify thousands of cases and controls for a genome-wide association study of PTSD in veterans. We used manual chart review (n = 500) as the gold standard. For both the algorithm and chart review, three classifications were possible: likely PTSD, possible PTSD, and likely not PTSD. We used Lasso regression with cross-validation to select statistically significant predictors of PTSD from the EMR and then generate a predicted probability score of being a PTSD case for every participant in the study population (range: 0-1.00). Comparing the performance of our probabilistic approach (Lasso algorithm) to a rule-based approach (International Classification of Diseases [ICD] algorithm), the Lasso algorithm showed modestly higher overall percent agreement with chart review than the ICD algorithm (80% vs. 75%), higher sensitivity (0.95 vs. 0.84), and higher accuracy (AUC = 0.95 vs. 0.90). We applied a 0.7 probability cut-point to the Lasso results to determine final PTSD case-control status for the VA population. The final algorithm had a 0.99 sensitivity, 0.99 specificity, 0.95 positive predictive value, and 1.00 negative predictive value for PTSD classification (grouping possible PTSD and likely not PTSD) as determined by chart review. This algorithm may be useful for other research and quality improvement endeavors within the VA.

Posttraumatic Stress Disorder and Neurocognitive Impairment in a U.S. Military Cohort of Persons Living with HIV

Objective: Neurocognitive impairment (NCI) is a well-known complication of human immunodeficiency virus (HIV) infection and may be influenced by a number of psychological factors. We examined the relationship between NCI and mental health disorders, including posttraumatic stress disorder (PTSD), in a cohort of 189 active-duty and retired U.S. military men living with HIV. Methods: Participants completed selected modules of the Composite International Diagnostic Interview (CIDI) to ascertain the presence of PTSD, major depressive disorder, and other mental health diagnoses. We also obtained demographic data, including history of head trauma, via personal interview. NCI was assessed with a comprehensive battery of standardized neuropsychological tests. Results: The median age of study subjects was 36 years (interquartile range [IQR] 28 to 43) and median total years of education was 14 (IQR 12 to 16). NCI was diagnosed in 19% of subjects. Individuals with and without a history of PTSD were similar with respect to most HIV-related characteristics; however, the former were significantly more likely to have a prior acquired immunodeficiency syndrome (AIDS) diagnosis. In multivariate analysis, lifetime history of PTSD was independently associated with NCI (odds ration [OR] = 6.12; 95% confidence interval [CI] = 1.85, 20.27), while a history of head of trauma was negatively associated (OR = 0.37 95% CI = 0.15,0.92). Conclusions: Our findings demonstrate that PTSD is an important predictor of NCI in this U.S. military cohort. HIV-infected individuals with cognitive difficulties should be screened for mental health disorders, including PTSD, and prospective studies of the longitudinal relationship between PTSD and NCI, as well as the impact of PTSD treatment on future NCI, are warranted.

Inner City Blues: Children Raised in Inner-Cities Face Comparable PTSD Causing Conditions and Consequences as Military Veterans and Deserve Our Attention

Check your surroundings, trust no one, move quickly, and leave no man behind. These instructions may sound like the words by which military personnel live. But they are also utilized by youth in many inner cities of the United States. Many children in places like Chicago, Baltimore and other cities experience the same posttraumatic-stress disorder symptoms as military veterans. This is the result of growing up in crime ridden cities which sometimes have higher rates of violence than those locations military personnel are deployed to. Despite this, little is said about the effects the crime rates have on children living in American cities. It is not the goal of this Article to diminish the experiences of military personnel, but rather to compare the similarities and differences between the two. Military veterans and children are expected to grow and function as ordinary citizens. A noticeable difference, however, is that while veterans may return to the comfort of their own home, for inner city youth, the war never ends. This Article addresses more of the similarities and differences that these two groups share. The objective is to highlight the need for positive coping strategies, preventative programs, and guidance to those children growing up in these environments. The author accomplishes this by explaining the history of posttraumatic stress disorder in relation to children and veterans, using United States crime statistics, and presenting remedies for the issue, some of which have been proven by the YMCA in Chicago via the Urban Warriors Program, and others which have been recognized by Rodney Walker, an author and former child of an inner city. Only by recognizing and taking action may we end the elements that contribute to a cycle of violence and overshadowed youth.

427 Prevalence and Risk Factors for Posttraumatic Stress Disorder after Burn Injury

After burn injury, patients can struggle psychologically in addition to issues with physical function and cosmesis. Posttraumatic stress disorder (PTSD) is a known sequela of burn injury, with a suggested frequency of 18-33%. However objective measures of injury have not been reliably linked to the development of symptoms, making routine identification a challenge. The objective of this study to identify patient characteristics associated with a positive PTSD screening exam in the outpatient setting. The Primary Care Posttraumatic Stress Disorder screening questionnaire (PC-PTSD-4) was administered to patients at their initial outpatient clinic visit at a large regional Burn Center over a four month period of May-October 2018. Patients excluded included those with dermatologic disorders, known history of PTSD and repeat questionnaires. Patient demographics, injury mechanism, total body surface area (TBSA) involvement and questionnaire results were recorded. Patients were considered screen positive if they responded affirmatively to at least three of the four questions. Chi-square and student’s t-tests were used to compare patients with positive and negative screens. Further evaluation assessed the sub-population that answered affirmatively to all four screening questions. 188 surveys were answered in total, with 182 remaining for analysis after exclusions. Patients had a mean age of 41.8±15.5 years, mean TBSA of 4.5±7.5%, with equal gender distribution. 6.6% of questionnaires were completed in Spanish. The most common injury etiologies included scald (24.2%), flame (24.2%) and grease burns (20.3%). Positive screens were noted in 48 patients (26.4%), with 30 of these patients responding affirmatively to all four questions, and 83 with negative responses to all questions. The only significant predictor for a positive screen was increased total TBSA% (4.0±5.6 vs 6.0±11.2, p = 0.004). A similar finding was noted when examining patients with four affirmative responses (p < 0.001). Although all patients are susceptible to PTSD after burn injury, positive screening correlates with larger initial injury. Future directions of this project will evaluate additional factors including concurrent traumatic injuries, prior psychiatric history and the presence of assault. Early identification of at-risk individuals enables expedited efforts to provide education and support.

Abstract P280: The Association of Sleep Apnea with Psychiatric History: A Veteran Twin Study

Introduction: Sleep apnea is exceedingly common in elderly men and is associated with higher risk of cardiovascular disease. Post-traumatic stress disorder (PTSD) and depression have been shown to be associated with sleep apnea, however results have not been consistent, and it is unclear whether this association is confounded by cardiovascular and behavioral risk factors. In this study, our objective was to explore the risk factors for sleep apnea with a focus on psychiatric history, and we hypothesized that the association of sleep apnea with psychiatric history can be largely influenced by cardiovascular and behavioral factors. Methods: This was a cross-sectional analysis of 100 members of the Vietnam Era Twin (VET) Registry (50 twin pairs, mean age=68; range: 61-71 years). All twins underwent a one night in-lab polysomnography (PSG) to assess the apnea/hypopnea index (AHI). Clinical diagnoses of lifetime history of major depression and PTSD were obtained with the Structured Clinical Interview for DSM V (SCID); we also measured current depressive symptoms with the Beck Depression Inventory-II (BDI-II). To assess associations of study variables with AHI, within-pair differences in multivariable mixed-effects regression models were examined and β coefficients were calculated. In addition to lifetime history of depression and PTSD, we included in the model the following variables previously reported in the literature to be associated with AHI: body mass index (BMI), current smoking, history of alcohol abuse, and physical activity assessed with the Baecke score. Other variables included years of education, sedative/hypnotic use, and antidepressant use. Results: The mean AHI among these men was 15.5 [SD=16.1]. A total of 18 and 28 twins had diagnoses of lifetime history of depression and PTSD, respectively. In bivariate analysis without adjustment for covariates, psychiatric history (depression or PTSD) was not significantly associated with higher AHI. In mixed-effects multivariable regression analysis, only higher BMI (β=2.3, 95% CI=1.5, 3.1) and less education (β=-1.3, 95% CI=-2.4, -0.1) were independently associated with higher AHI. Psychiatric history of depression (β=3.9, 95% CI=-3.5, 11.3) or PTSD (β=6.0, 95% CI=-0.9, 12.9) were not significantly associated with AHI. Additional analyses examining number of depressive symptoms (BDI-II) showed similar results. Conclusion: As expected, higher BMI was associated with higher AHI, but several other variables thought to be associated with higher AHI were not confirmed, such as smoking status, alcohol abuse, sedative/hypnotic use, and lack of physical activity. In contrast to the prevailing literature, neither lifetime history of depression nor PTSD were associated with sleep apnea. However, the role for poor sleep quality other than sleep-disordered breathing still remains to be investigated.

An Assessment of Long-Term Physical and Emotional Quality of Life of Persons Injured on 9/11/2001.

Fifteen years after the disaster, the World Trade Center Health Registry (Registry) conducted The Health and Quality of Life Survey (HQoL) assessing physical and mental health status among those who reported sustaining an injury on 11 September 2001 compared with non-injured persons. Summary scores derived from the Short Form-12 served as study outcomes. United States (US) population estimates on the Physical Component Score (PCS-12) and Mental Component Score (MCS-12) were compared with scores from the HQoL and were stratified by Post-traumatic Stress Disorder (PTSD) and injury status. Linear regression models were used to estimate the association between both injury severity and PTSD and PCS-12 and MCS-12 scores. Level of injury severity and PTSD history significantly predicted poorer physical health (mean PCS-12). There was no significant difference between injury severity level and mental health (mean MCS-12). Controlling for other factors, having PTSD symptoms after 9/11 predicted a nearly 10-point difference in mean MCS-12 compared with never having PTSD. Injury severity and PTSD showed additive effects on physical and mental health status. Injury on 9/11 and a PTSD history were each associated with long-term decrements in physical health status. Injury did not predict long-term decrements in one’s mental health status. Although it is unknown whether physical wounds of the injury healed, our results suggest that traumatic injuries appear to have a lasting negative effect on perceived physical functioning.

Effect of Chronic Low Back Pain and Post-Traumatic Stress Disorder on the Risk for Separation from the US Army.

Co-morbid post-traumatic stress disorder (PTSD) and low back pain (LBP) are common reasons for increased disability in the Veteran communities. Medical discharge from the military represents a considerable financial cost to society. Little is currently known about the impact of LBP and PTSD as longitudinal risk factors for medical discharge from Active Duty military service. A retrospective analysis of US Army Active Duty Soldiers from 2002 to 2012 was performed to determine the risk for medical discharge. Four levels of exposure for were identified as independent variables: no chronic LBP or PTSD, chronic LBP only, PTSD only, and co-morbid PTSD present with chronic LBP. Statistical analysis utilized modified Poisson regression controlling for sex, age, rank, time in service, deployment, mental health, sleep disorders, alcohol use, tobacco use, obesity, and military occupation. This study was approved by a Department of Defense Institutional Review Board. After controlling for potential confounding variables, the RR for chronic LBP and PTSD independently was 3.65 (95% CI: 3.59-3.72) and 3.64 (95% CI: 3.53-3.75), respectively, and 5.17 (95% CI: 5.01-5.33) when both were present. This is the first study to identify a history of both chronic LBP and PTSD as substantial risk factors for medical discharge from the US Army. PTSD and chronic LBP may mutually reinforce one another and deplete active coping strategies, making Soldiers less likely to be able to continue military service. Future research should target therapies for co-morbid PTSD and chronic LBP as these conditions contribute a substantial increase in risk of medical discharge from the US Army.

History of posttraumatic stress disorder and outcomes after kidney transplantation.

A history of posttraumatic stress disorder (PTSD), if uncontrolled, represents a contraindication for kidney transplantation. However, no previous large study has assessed the association between pretransplant history of PTSD and posttransplantation outcomes. We examined 4479 US veterans who had undergone transplantation. The diagnosis of history of PTSD was based on a validated algorithm. Measured covariates were used to create a matched cohort (n=560). Associations between pretransplant PTSD and death with functioning graft, all-cause death, and graft loss were examined in survival models. Posttransplant medication nonadherence was assessed using proportion of days covered (PDC). From among 4479 veterans, 282 (6.3%) had a history of PTSD. The mean age±standard deviation (SD) of the cohort at baseline was 61±11years, 91% were male, and 66% and 28% of patients were white and African American, respectively. Compared to patients without a history of PTSD, patients with a history of PTSD had a similar risk of death with a functioning graft (subhazard ratio [SHR] 0.97, 95% confidence interval [CI] 0.61-1.54), all-cause death (1.05, 0.69-1.58), and graft loss (1.09, 0.53-2.26). Moreover, there was no difference in immunosuppressive drug PDC in patients with and without a history of PTSD (PDC: 98±4% vs 99±3%, P=.733 for tacrolimus; PDC: 99±4% vs 98±7%, P=.369 for mycophenolic acid). A history of PTSD in US veterans with end-stage renal disease should not on its own preclude a veteran from being considered for transplantation.

Posttraumatic stress disorder and traumatic brain Injury: Sex differences in veterans

Around half of Iraq and Afghanistan war veterans with traumatic brain injury (TBI) have co-occurring posttraumatic stress disorder (PTSD). Research on the differences between male and female veterans with co-occurring PTSD/TBI is sparse. This study evaluated behavioral health differences between sexes with these conditions. Veterans (N = 1577) completed a structured psychiatric interview, TBI interview, and self-report interviews assessing sleep quality, alcohol use, substance use, pain, depression symptoms, PTSD symptoms, and combat exposure. Groups depended on the presence/absence of a lifetime PTSD diagnosis and history of TBI. Among veterans with PTSD and TBI, males and females were equally likely to meet criteria for current PTSD, and in the PTSD only group, male veterans were more likely to have current PTSD. Male veterans with PTSD were also more likely to meet criteria for lifetime alcohol and substance use disorders (AUD and SUD), and mild TBI. Although TBI severity did not differ between sexes in the TBI only group, female veterans were more likely to have a moderate/severe TBI among veterans with co-occurring PTSD. Female veterans without PTSD and TBI were more likely to have major depressive disorder (MDD). Significant sex differences were found for AUD, MDD, current PTSD, and TBI severity.

Cognitive Behavioral Therapy (CBT) in Psychogenic Non-Epileptic Seizures (PNES): A Case Report and Literature Review

Psychogenic non-epileptic seizures (PNES) are classified as a somatoform conversion disorder. We present a case of a 24-year-old male with a past psychiatric history of posttraumatic stress disorder (PTSD) and anxiety disorder, admitted to our inpatient psychiatric unit. The patient experienced multiple episodes of seizures during hospitalization. Work up was unremarkable, and PNES were suspected and later confirmed with video-electroencephalography (video-EEG). He underwent supervised withdrawal of antiepileptic medications with the initiation of cognitive behavioral therapy (CBT), which reduced the frequency of seizures. Diagnosis of PNES can present as a challenge and failure to diagnose its psychological nature can lead to a delay in the psychological intervention. CBT leads to a decrease in seizure frequency, and improvement in psychiatric symptoms, psychosocial functioning, and quality of life. It is important to consider PNES in the differential diagnosis of seizures presented by psychiatric patients, as CBT is necessary for better patient outcomes.

Tauopathy in veterans with long-term posttraumatic stress disorder and traumatic brain injury

PurposeTraumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) have emerged as independent risk factors for an earlier onset of Alzheimer’s disease (AD), although the pathophysiology underlying this risk is unclear. Postmortem studies have revealed extensive cerebral accumulation of tau following multiple and single TBI incidents. We hypothesized that a history of TBI and/or PTSD may induce an AD-like pattern of tau accumulation in the brain of nondemented war veterans.MethodsVietnam War veterans (mean age 71.4 years) with a history of war-related TBI and/or PTSD underwent [18F]AV145 PET as part of the US Department of Defense Alzheimer’s Disease Neuroimaging Initiative. Subjects were classified into the following four groups: healthy controls (n = 21), TBI (n = 10), PTSD (n = 32), and TBI+PTSD (n = 17). [18F]AV1451 reference tissue-normalized standardized uptake value (SUVr) maps, scaled to the cerebellar grey matter, were tested for differences in tau accumulation between groups using voxel-wise and region of interest approaches, and the SUVr results were correlated with neuropsychological test scores.ResultsCompared to healthy controls, all groups showed widespread tau accumulation in neocortical regions overlapping with typical and atypical patterns of AD-like tau distribution. The TBI group showed higher tau accumulation than the other clinical groups. The extent of tauopathy was positively correlated with the neuropsychological deficit scores in the TBI+PTSD and PTSD groups.ConclusionA history of TBI and/or PTSD may manifest in neurocognitive deficits in association with increased tau deposition in the brain of nondemented war veterans decades after their trauma. Further investigation is required to establish the burden of increased risk of dementia imparted by earlier TBI and/or PTSD.

An investigation of the effect of trauma script exposure on risk-taking among patients with substance use disorders and posttraumatic stress disorder

Studies show that patients with substance use disorders (SUD) and posttraumatic stress disorder (PTSD) are at high risk for engaging in risky behaviors. However, these studies do not speak to the context in which these behaviors are more likely to occur. This study examined whether SUD patients with current PTSD, compared to those without a history of PTSD, are more likely to exhibit risk-taking on a laboratory-based risk-taking task, the Iowa Gambling Task (IGT), following exposure to a personalized trauma script versus a neutral script. The sample consisted of 122 trauma-exposed SUD patients with and without PTSD. Participants were administered a series of diagnostic interviews and personalized trauma scripts were created. On separate days, participants were exposed to a neutral or trauma script, followed by the IGT. Contrary to expectations, PTSD-SUD patients exhibited significantly greater risk-taking after the neutral (vs. trauma) script than those without PTSD. Moreover, whereas SUD patients without PTSD evidenced stability in IGT performance across scripts, those with PTSD exhibited significantly lower risk-taking on the IGT following the trauma (vs. neutral) script. Results provide support for the context dependent nature of risk-taking in PTSD-SUD patients and suggest they may become more risk averse in the context of trauma-related distress.

The Association of Lifetime Suicide Attempts With Anxiety Disorders in Patients With Bipolar Disorder.

The association of lifetime suicidal behaviors with anxiety disorders (ADs) in patients with bipolar disorder (BD) has been controversial. In this study, we hypothesized that certain types of ADs were related to the occurrence of past suicide attempts (SAs) independent of the severity of the BD, including the presence of past affective episodes. Lifetime diagnoses of BD and ADs were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders (SCID-I). Of the total sample of 200 patients with BD, 32.0% had at least 1 past SA. The mean number of previous hospitalizations, a history of social AD, and a history of posttraumatic stress disorder were strongly associated with past SAs in patients with bipolar I disorder. The presence of lifetime social AD was associated with lifetime SAs independent of previous depressive episodes. Therefore, we suggest that social AD itself is associated with a greater risk for SAs in patients with BD independent of the presence of depression.

PTSD: A Short History by Allan V. Horwitz

Reviewed by: PTSD: A Short History by Allan V. Horwitz Edgar Jones Allan V. Horwitz. PTSD: A Short History. Johns Hopkins Biographies of Disease. Baltimore: Johns Hopkins University Press, 2018. xviii + 238 pp. Ill. $28.95 (978–1–4214–2639–6). Post-traumatic stress disorder (PTSD) was formally recognized by the American Psychiatric Association in 1980 with the publication of DSM-III. It followed a sustained campaign by critics of the Vietnam War who sought to highlight the injurious psychological effects of the conflict, but the diagnosis was included only when the committee on reactive disorders concluded that PTSD had a general applicability and could be observed after any form of traumatic event. In this study, Allan Horwitz, author of Anxiety, a Short History, has applied his sociological insight to PTSD. He adopts a thematic approach with chapters devoted to the history of post-traumatic illness, the conceptual antecedents of PTSD, psychological casualties created by war and the campaign to persuade psychiatrists that this was a legitimate diagnosis. Horwitz also explores how the recovered memory movement offered an implicit challenge to PTSD by suggesting that some severe traumatic experiences are repressed to an extent that they leave no conscious trace. [End Page 144] Vivid and intrusive memories, by contrast, are key symptoms of PTSD beyond the ability of sufferers to suppress. The author vividly documents the rise in the incidence of PTSD and analyzes the culture of vulnerability and compensation with which it is associated. As Horwitz acknowledges, PTSD is but one position in the enduring debate about where to locate causality for post-traumatic illness between the poles of environmental stressor and individual vulnerability. In the late nineteenth and early twentieth centuries, people themselves, their personality and inherited characteristics, were held primarily responsible for their breakdown. To explain why only a subgroup succumbed to the psychological effects of battle, combat stress was relegated to a secondary role or that of a trigger. With evidence from casualty statistics collected after World War II and during the Vietnam conflict, psychiatrists increasingly attributed causality to the traumatic event. This reversal eroded much of the stigma associated with post-traumatic illness, though it failed to address the shame and guilt commonly experienced by those with a diagnosis of PTSD. Shell shock is explored as part of the intellectual and clinical heritage of PTSD, though the role of Frederick Mott is overlooked. As a neuropathologist with an international reputation, he was appointed by the War Office to lead research into its causality and treatment. Based at the Maudsley Hospital with a regular influx of patients, Mott was arguably the first clinician in the UK to identify the fundamentals of the PTSD model. He observed that most cases arose from a pre-existing vulnerability and some the result of concussion or toxic exposure. However, Mott identified a third group who were healthy individuals subjected to “terrifying or horrifying conditions,” soldiers whose record demonstrated that they are “neither of a timid disposition” or possessed of “any neuropathic tendency” and for whom the event was the primary cause.1 Although Horwitz describes the momentum behind research into the limbic system designed to identify the neuro-biology of PTSD, more detail could have been given on the hypotheses and findings in the search for an organic explanation. This research, if successful, could result in the disorder being reframed as a neurological illness with specific therapeutic targets. In sum, Horwitz draws together an impressive array of work to produce a balanced and concise analysis of PTSD that will serve as an insightful guide to the nature and evolution of the disorder. Whilst the fourth iteration of PTSD, published in DSM-5 (2013), incorporated much additional research, a new critique of the disorder has gathered momentum. The growing interest in moral injury is, in part, driven by the idea that PTSD fails to capture the full range of emotions and cognitions that follow exposure to traumatic events. A high percentage of those with mild traumatic brain injury also report the symptoms of PTSD, prompting the hypothesis that microscopic brain lesions may account for both disorders. Horwitz’s measured history of PTSD may have come at a time when the disorder...

Protective correlates of suicidality among veterans with histories of posttraumatic stress disorder and major depressive disorder: Results from the National Health and Resilience in Veterans Study.

Although several studies have identified risk factors for suicidal behaviors in general samples of Veterans, fewer studies have examined protective factors, particularly in high-risk samples. To address this gap, we examined protective correlates of suicidal ideation (SI) and suicide attempts (SA) in a sample of Veterans with histories of posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD). Data were analyzed from a nationally representative sample of 3157 U.S. Veterans who completed the first wave of a web-based survey as part of the National Health and Resilience in Veterans Study (NHRVS). Of this sample, 577 Veterans met criteria for history of PTSD, MDD or both. Multivariable logistic regression analyses were used to examine relationships between protective factors (curiosity, resilience, purpose in life, dispositional gratitude, optimism, and community integration) and suicidal behaviors (SI and SA). The prevalence of any SI during the previous two weeks was 29.4% and the prevalence of lifetime SA was 28.0%. After adjusting for relevant sociodemographic and military characteristics, greater purpose in life, curiosity, and optimism were negatively associated with SI. None of the protective correlates were associated with SA. Given the cross-sectional nature of this study, conclusions about causality cannot be made. The assessment of suicidality also was limited to three self-report items. Results provide a characterization of protective factors for suicidality, and may help inform prevention and treatment approaches designed to mitigate suicide risk among high-risk military Veterans.

Posttraumatic stress disorder and incidence of thyroid dysfunction in women.

Abnormal thyroid function is prevalent among women and has been linked to increased risk of chronic disease. Posttraumatic stress disorder (PTSD) has been linked to thyroid dysfunction in some studies; however, the results have been inconsistent. Thus, we evaluated trauma exposure and PTSD symptoms in relation to incident thyroid dysfunction in a large longitudinal cohort of civilian women. We used data from 45 992 women from the ongoing Nurses' Health Study II, a longitudinal US cohort study that began in 1989. In 2008, history of trauma and PTSD were assessed with the Short Screening Scale for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, PTSD, and incident thyroid dysfunction was determined by participants' self-report in biennial questionnaires of physician-diagnosed hypothyroidism and Graves' hyperthyroidism. The study period was from 1989 to 2013. Proportional hazard models were used to estimate multivariable-adjusted hazard ratios and 95% confidence intervals (CIs) for incident hypothyroidism and Graves' hyperthyroidism. In multivariable-adjusted models, we found significant associations for PTSD only with hypothyroidism [p-trend <0.001; trauma with no PTSD symptoms, 1.08 (95% CI 1.02-1.15); 1-3 PTSD symptoms, 1.12 (95% CI 1.04-1.21); 4-5 PTSD symptoms, 1.23 (95% CI 1.13-1.34); and 6-7 PTSD symptoms, 1.26 (95% CI 1.14-1.40)]. PTSD was not associated with risk of Graves' hyperthyroidism (p-trend = 0.34). Associations were similar in sensitivity analyses restricted to outcomes with onset after 2008, when PTSD was assessed. PTSD was associated with higher risk of hypothyroidism in a dose-dependent fashion. Highlighted awareness for thyroid dysfunction may be especially important in women with PTSD.

Attention Deficit Hyperactivity Disorder and Risk of Posttraumatic Stress and Related Disorders: A Prospective Longitudinal Evaluation in U.S. Army Soldiers.

Cross-sectional associations between attention deficit hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD) have been observed, but longitudinal studies assessing this association are lacking. This prospective study evaluated the association between predeployment ADHD and postdeployment PTSD among U.S. Army soldiers. Soldiers who deployed to Afghanistan were surveyed before deployment (T0) and approximately 1 month (T1), 3 months (T2), and 9 months (T3) after their return. Logistic regression was performed to estimate the association between predeployment ADHD and postdeployment (T2 or T3) PTSD among 4,612 soldiers with data at all waves and no record of stimulant medication treatment during the study. To evaluate specificity of the ADHD-PTSD association, we examined associations among predeployment ADHD, postdeployment major depressive episode (MDE), generalized anxiety disorder (GAD), and suicidal ideation. Weighted prevalence of ADHD predeployment was 6.1% (SE = 0.4%). Adjusting for other risk factors, predeployment ADHD was associated with risk of postdeployment PTSD, adjusted odds ratio (AOR) = 2.13, 95% CI [1.51, 3.00], p < .001, including incidence among soldiers with no predeployment history of PTSD, AOR = 2.50, 95% CI [1.69, 3.69], p < .001. ADHD was associated with postdeployment MDE, AOR = 2.80, 95% CI [2.01, 3.91], p < .001, and GAD, AOR = 3.04, 95% CI [2.10, 4.42], p < .001, but not suicidal ideation. Recognition of associations between predeployment ADHD and postdeployment PTSD, MDE, and GAD may inform targeted prevention efforts. Future research should examine whether treatment of ADHD is protective against PTSD and related disorders in trauma-exposed individuals.

Rehospitalization to a child and adolescent psychiatry unit: Role of trauma and bullying.

Psychiatric rehospitalizations results in a significant burden to patients, families, and health care systems. Understanding psychiatric rehospitalizations offers an opportunity to identify weaknesses in current systems of care. The objective of this study was to test the hypothesis that a history of trauma or ongoing bullying increases the risk of psychiatric rehospitalization. Retrospective cohort study of 366 individual patients (71% female) admitted to a pediatric psychiatry unit between 1/1/2015 and 12/31/2015. The primary outcome measure was rehospitalization to the same psychiatric hospital unit within one year of first discharge. Trauma was defined as having a history of Post-Traumatic Stress Disorder, Reactive Attachment Disorder, or a filed Suspected Abuse and Neglect of a Child report by the end of first hospitalization. Ongoing bullying was identified by medical record review. History of trauma (Odds Ratio (OR) = 3.2, 95% Confidence Interval (CI) = 1.8-5.6, p < 0.0001) and ongoing bullying (OR = 2.2, CI = 1.2-3.9, p = 0.009) were significantly associated with increased rates of rehospitalizations. We controlled for the following covariates: Patient Health Questionnaire-9 Modified (PHQ-9M) score, gender, age, relative age, initial length of stay, disrupted family system, and sexual orientation/identity. History of trauma or ongoing bullying are important risk factors for pediatric psychiatric rehospitalization.