Posttraumatic Stress Disorder Symptom Severity Research Articles

Improved Post-Traumatic Stress Disorder Symptoms and Related Sleep Disturbances after Initiation of Medical Marijuana Use: Evidence from a Prospective Single Arm Pilot Study

Introduction: Post-traumatic stress disorder (PTSD) is a debilitating disorder experienced by a subgroup of individuals following a life-threatening trauma. Several US states have passed laws permitting the medical use of marijuana (MMJ) by individuals with PTSD, despite very little scientific indication on the appropriateness of marijuana as a therapy for PTSD. This prospective pilot study of adults with confirmed PTSD in Florida (FL) investigated whether PTSD symptoms, sleep quality, affect, and general physical and mental health/well-being improved post-initiation of MMJ treatment. Methods: Participants, N = 15, were recruited from two MMJ clinics in Gainesville and Jacksonville, FL. To be eligible, participants had to be 18 years of age or older, not currently on MMJ, and willing to abstain from recreational marijuana, if using any, until the State Medical Cannabis Card was obtained, screen positive for PTSD. Participants were assessed at baseline (pre-MMJ initiation) and 30 and 70 days post-MMJ initiation using the Pittsburgh Sleep Quality Index (PSQI), PTSD Checklist for DSM-5 (PCL-5), Positive and Negative Affect Schedule (PANAS), PROMIS Global Health V1.2, and semi-structured marijuana and other substance use assessment. Results: PTSD symptom severity as measured by total PCL-5 score improved significantly at 30- and 70-day follow-ups. Similarly, statistically significant reductions in nightmares were reported at 30- and 70-day follow-ups. Corresponding improvements in sleep were noticed with participants reporting increased duration of sleep hours, sleep quality, sleep efficiency, and total PSQI score. Likewise, negative affect and global mental health improved significantly at follow-up. According to the post hoc analyses, the most statistically significant changes occurred between baseline and 30-day follow-up. The exception to this pattern was nightmares, which did not show significant improvement until day 70. Conclusion: The findings of this study highlight the potential of MMJ in improving patient outcomes for those with PTSD, particularly concerning sleep disturbances, which often do not respond to currently available treatments.

Cannabis Coping Motives Might Mediate the Association Between PTSD Symptom Severity and Trauma Cue–Elicited Cannabis Craving

Cannabis Coping Motives Might Mediate the Association Between PTSD Symptom Severity and Trauma Cue–Elicited Cannabis Craving

A cross-sectional study of correlations among blood-based biomarkers for intestinal permeability: A pilot study of United States veterans with posttraumatic stress disorder symptoms

While many studies of intestinal permeability (IP) are focused on those with gastrointestinal (GI) disorders, there is a rising trend to analyze IP among individuals with mental health conditions including posttraumatic stress disorder (PTSD) with and without diagnosed GI conditions. This interest stems from the association between gut dysbiosis and chronic inflammation, which are mechanisms linked to stress-related somatic and mental health conditions. Efforts to date have resulted in the exploration of non-invasive and feasible measures to identify an IP biomarker that could also serve as a treatment target. Additionally, those conducting studies regarding IP often recruit individuals without health problems and compare levels of biomarkers of IP to those obtained from participants with conditions of interest. This study aimed to assess correlations between blood-based biomarkers of IP, as well as examine the association between blood-based biomarkers of IP and PTSD symptoms. Blood was sampled from seventeen United States military Veterans with variable severity of PTSD symptoms per the posttraumatic checklist for DSM-5 (PCL-5) (n = 6 with scores over 31 indicating clinically meaningful symptoms of PTSD; overall range 0–49, mean 20.8, standard deviation 15.7) and analyzed blood biomarkers of IP including citrulline, diamine oxidase, glucagon-like peptide-2, intestinal fatty-acid binding protein, lipopolysaccharide binding protein, lipopolysaccharide, and zonulin. Correlations between the IP blood-based biomarkers ranged from ρ of −0.31 to 0.35. None of the measured biomarkers were significantly correlated to PTSD symptom severity scores (ρ of −0.34 to 0.05). Although based on limited sample size, our results call into question the specificity of blood-based biomarkers of IP when: (1) studying persons with and without PTSD symptoms in whom clinical GI disorders are not necessarily the focus of the study; and (2) comparing IP results among individuals with well-defined disease states to those without the disease (e.g., controls). Further studies are needed to explore the role of external factors (e.g., nutrition, obesity, alcohol use) on IP and to determine if the biomarkers studied are appropriate for measuring IP in people with a range of symptoms related to PTSD.

The effectiveness, efficiency, and acceptability of EMDR vs. EMDR 2.0 vs. the Flash technique in the treatment of patients with PTSD: study protocol for the ENHANCE randomized controlled trial.

Several widely studied therapies have proven to be effective in the treatment of post-traumatic stress disorder (PTSD). However, there is still room for improvement because not all patients benefit from trauma-focused treatments. Improvements in the treatment of PTSD can be achieved by investigating ways to enhance existing therapies, such as eye movement desensitization and reprocessing (EMDR) therapy, as well as exploring novel treatments. The purpose of the current study is to determine the differential effectiveness, efficiency, and acceptability of EMDR therapy, an adaptation of EMDR therapy, referred to as EMDR 2.0, and a novel intervention for PTSD, the so-called Flash technique. The second aim is to identify the moderators of effectiveness for these interventions. This study will be conducted among individuals diagnosed with PTSD using a randomized controlled trial design. A total of 130 patients diagnosed with (complex) PTSD will be randomly allocated to either six sessions of EMDR therapy, EMDR 2.0, or the Flash technique. The primary outcomes used to determine treatment effectiveness include the presence of a PTSD diagnosis and the severity of PTSD symptoms. The secondary outcomes of effectiveness include symptoms of depression, symptoms of dissociation, general psychiatric symptoms, and experiential avoidance. All patients will be assessed at baseline, at 4-week post-treatment, and at 12-week follow-up. Questionnaires indexing symptoms of PTSD, depression, general psychopathology, and experiential avoidance will also be assessed weekly during treatment and bi-weekly after treatment, until the 12-week follow-up. Efficiency will be assessed by investigating the time it takes both to lose the diagnostic status of PTSD, and to achieve reliable change in PTSD symptoms. Treatment acceptability will be assessed after the first treatment session and after treatment termination. This study is the first to investigate EMDR 2.0 therapy and the Flash technique in a sample of participants officially diagnosed with PTSD using a randomized controlled trial design. This study is expected to improve the available treatment options for PTSD and provide therapists with alternative ways to choose a therapy beyond its effectiveness by considering moderators, efficiency, and acceptability. The trial was retrospectively registered in the ISRCTN registry at 10th November 2022 under registration number ISRCTN13100019.

Abstract 12776: Sustained Impact of Peripartum Cardiomyopathy on Mental Health Disorders and Quality of Life

Introduction: Mental health diagnoses such as depression, post-traumatic stress disorder (PTSD), and anxiety are common after acute cardiovascular events. Peripartum cardiomyopathy (PPCM) affects women near the end of pregnancy or in the near post-partum period and occurs during a period of heightened psychosocial stress. There is limited data on the prevalence of mental health diagnoses after the acute PPCM event. Methods: Patients with self-identified PPCM enrolled in the online PPCM Registry (PPCM-R at ppcmr.org) and completed validated surveys for depression (Patient Health Questionnaire - 9, PHQ-9), anxiety (Generalized Anxiety Disorder -7, GAD-7), PTSD ( Posttraumatic Stress Disorder Checklist- Civilian, PCL-C) and quality of life (Rand SF-36). Patients were recruited on PPCM support groups, social media, and physician referral. Results: After 4 months, 103 patients enrolled and 55 (54%) completed the mental health and QOL surveys. Mean age was 32.3 (SD 4.7) and median time since diagnosis was 4.2 years (IQR 1.7, 10.4 years). Mean (SD) PHQ-9 score was 8.1 (7.3) and 27% had a score (≥10) indicating moderate or severe depressive symptoms. Mean (SD) GAD-7 score was 7.3 (6.7) and 36% of participants had scores (≥10) consistent with moderate or severe anxiety symptoms. Mean (SD) PCL-C score was 20.7 (19.3) and 33% screened positive for PTSD. Overall, 30% of participants reported that QOL was ‘fair’ or ‘poor’ with lower domain scores for physical function, emotional function, energy/fatigue and general health compared to the general population. Characteristics of participants stratified by mental health symptom severity and QOL scores are presented in the Table. Conclusions: Half (51%) of participants had at least one mental health screening tool which indicated current moderate or severe symptoms of depression, anxiety or PTSD. These findings confirm a significant burden of mental health symptoms in this PPCM survivor cohort.

Unconditioned response to a naturally aversive stimulus is associated with sensitized defensive responding and self-reported fearful traits in a PTSD sample.

Unconditioned responding (UCR) to a naturally aversive stimulus is associated with defensive responding to a conditioned threat cue (CS+) and a conditioned safety cue (CS-) in trauma-exposed individuals during fear acquisition. However, the relationships of UCR with defensive responses during extinction training, posttraumatic stress disorder (PTSD) symptom severity, and fearful traits in trauma-exposed individuals are not known. In a sample of 100 trauma-exposed adults with a continuum of PTSD severity, we recorded startle responses and skin conductance responses (SCR) during fear acquisition and extinction training using a 140 psi, 250-ms air blast to the larynx as the unconditioned stimulus. We explored dimensional associations of two different measures of UCR (unconditioned startle and unconditioned SCR) with conditioned defensive responding to CS+ and CS-, conditioned fear (CS+ minus CS-), PTSD symptom severity, and a measure of fearful traits (composite of fear survey schedule, anxiety sensitivity index, and Connor-Davidson resilience scale). Unconditioned startle was positively associated with startle potentiation to the threat cue and the safety cue across both learning phases (CS+ Acquisition, CS- Acquisition, CS+ Extinction Training, CS- Extinction Training) and with fearful traits. Unconditioned SCR was positively associated with SCR to the CS+ and CS- and SCR difference score during Acquisition. Neither type of UCR was associated with PTSD symptom severity. Our findings suggest that UCR, particularly unconditioned startle to a naturally aversive stimulus, may inform research on biomarkers and treatment targets for symptoms of pervasive and persistent fear in trauma-exposed individuals.

Pain and posttraumatic stress: Associations among women veterans with a history of military sexual trauma.

Chronic pain and posttraumatic stress disorder (PTSD) are two highly prevaxlent and comorbid conditions common within veteran populations. Notably, those with comorbid pain and PTSD tend to have more severe presentations and poorer quality of life than those with either disorder alone. Despite this well-established relationship, limited research has examined the association between pain and PTSD symptom severity among women veterans with a history of military sexual trauma (MST). The current study included 107 women veterans presenting for psychological services to an MST specialty clinic at a large southeastern Veterans Affairs (VA) hospital in the United States. Findings indicated a significant relationship between pain and overall PTSD symptom severity, as well as the intrusions and arousal and reactivity symptom clusters. Contrary to prediction, there was not a significant relationship between pain interference and PTSD symptom or cluster severity. Results highlight the importance of inquiring about pain when working with women veterans with a history of MST. Future research aimed at disentangling the casual relationship between pain and PTSD symptoms is crucial to enhance our understanding of these constructs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

33 Depressive Symptoms Drive the Underutilization of Cognitive Reappraisal in Veterans with PTSD

Objective:Adaptive emotional regulation strategies, such as cognitive reappraisal, are related to better neuropsychological functioning in the general population. Individuals with PTSD demonstrate difficulty with both emotional regulation and cognitive performance that contribute to clinical presentation (e.g., negative mood, irritability). However the extent to which neuropsychological functioning is associated with emotion regulation, alone and in concert with common comorbid symptoms like depression, remains understudied in this population. Better understanding how specific neuropsychological functions relate to cognitive reappraisal could point to novel treatment targets given preliminary evidence that certain cognitive training techniques can improves neuropsychological and affective outcomes. The present study aims to investigate the relationship between clinical symptoms of PTSD and depression, working memory capacity, and cognitive reappraisal in Veterans with PTSD. We hypothesized that clinical symptoms and working memory capacity would interact to predict cognitive reappraisal, such that elevated depression would relate to worse cognitive reappraisal, particularly for individuals with poor working memory capacity.Participants and Methods:Measures of working memory (symmetry span task), mental health symptomatology (Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and Beck Depression Inventory-II (BDI-II), and emotional regulation (Emotion Regulation Questionnaire (ERQ)) were collected in 38 Veterans. A regression analysis was conducted with total CAPS score, total BDI score, total symmetry span score, and the interaction between BDI score and symmetry span score as the independent variables and total ERQ cognitive reappraisal score as the dependent variable.Results:When examining each predictor independently, cognitive reappraisal was not associated with working memory (t=1.42, p=.165), but was significantly associated with PTSD (t=-3.17, p<.003) and depressive (t=-4.15, p<.001) symptom severity. The multiple regression model (F(4, 35)=4.45, p<.005, R2=.26) did not support the hypothesized relationship between working memory and depressive symptoms (t=0.56, p=.579). Depression independently predicted utilization of cognitive reappraisal in veterans with PTSD (t=2.43, p=.020) but PTSD symptom severity and working memory scores did not. However, additional investigation revealed that independently, greater PTSD symptom severity did predict less utilization of cognitive reappraisal (t=-3.17, p<.005).Conclusions:While depressive symptoms did not moderate the relationship between working memory and cognitive reappraisal, depressive symptoms did best predict utilization of cognitive reappraisal in a population with PTSD. Contrary to the hypothesized outcome, neither working memory nor PTSD symptoms were significant predictors of cognitive reappraisal when controlling for depressive symptoms. This suggests that the phenomenon of lower cognitive reappraisal rates in individuals with PTSD may be due to the presence of depressive symptoms rather than traumatic stress symptoms or neuropsychological ability. Due to the sample size and homogeneous diagnosis of the current study it is possible that the predicted relationship between working memory, PTSD severity, and cognitive reappraisal was not observed due to low power or a restricted range. Further investigation specifically in clinical populations on factors that predict utilization of cognitive reappraisal could expand on these findings in populations experiencing other stress-based disorders.

Longitudinal associations of PTSD and social support by support functions among returning veterans.

Research has shown a consistent, negative correlation between social support and PTSD severity among a variety of populations, including military servicemembers and veterans. However, longitudinal data has been mixed on the direction of this effect. One possible explanation for these contradictory findings is that the direction of the effect varies depending on the function of social support. The current study examined naturalistic longitudinal associations between functions of social support and PTSD symptoms among returning veterans. 238 military veterans who had deployed to Afghanistan or Iraq were recruited. Veterans were assessed at baseline, 6, 12, and 24-months postdeployment. Assessments included a self-report measure of perceived social support by support function and the Clinician Administered PTSD Scale to measure PTSD symptoms. Multilevel modeling was used to test longitudinal associations between PTSD symptoms and social support. Secondary analyses tested associations by PTSD symptom cluster. Between-person PTSD symptom severity was associated with lower average social support of all functions of support and predicted decreases in tangible support over time. Between-person belonging support predicted decreases in PTSD symptom severity over time. No within-person effects were significant. Supplemental analyses suggested the DSM-IV-TR avoidance/numbing cluster of PTSD was most consistently associated with lower social support. The direction of associations between PTSD symptoms and support varied by function of support, suggesting nuanced associations between PTSD and perceived social support. Clinicians should assess and target social functioning during PTSD treatment. Further research is needed to replicate findings in other populations and for other trauma types. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

48 Elevated Postconcussive Symptoms are Associated with Increased Anterior Cerebral Blood Flow and Not Cortical Thickness in Veterans with a History of Remote mTBI

Objective:Veterans with a history of mild traumatic brain injury (mTBI) often endorse enduring postconcussive symptoms (PCS) including cognitive and neuropsychiatric complaints. However, although several studies have shown associations between these complaints and brain structure and cerebrovascular function, few studies have examined relationships between structural and functional brain alterations and PCS in the context of remote mTBI. We therefore examined whether PCS were associated with cortical thickness and cerebral blood flow (CBF) in a well-characterized sample of Veterans with a history of mTBI.Participants and Methods:116 Veterans underwent structural neuroimaging and a clinical interview to obtain detailed TBI history and injury-related information. Participants also completed the following self-report measures: the Neurobehavioral Symptom Inventory (NSI) for ratings of cognitive, emotional, somatic-sensory, and vestibular symptoms, and the Posttraumatic Stress Disorder (PTSD) Checklist for PTSD symptom severity. Regional brain thickness was indexed using FreeSurfer-derived cortical parcellations of frontal and temporal regions of interest (ROIs) including the superior frontal gyrus (SFG), middle frontal gyrus (MFG), inferior frontal gyrus (IFG), orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), medial temporal lobe (MTL), and lateral temporal lobe (LTL). A subset of Veterans (n=50) also underwent multi-phase pseudo-continuous arterial spin labeling (MPPCASL) to obtain resting CBF. T1-weighted structural and MPPCASL scans were co-registered and CBF estimates were extracted from the 7 bilateral parcellations of ROIs. To assess the relationship between NSI total and subscale scores and ROI thickness and CBF, multiple regression analyses were conducted adjusting for age, sex, and PTSD symptom severity. False Discovery Rate was used to correct for multiple comparisons.Results:NSI total and subscale scores were not associated with cortical thickness of any ROI. However, higher NSI scores were associated with increased ROI CBF of the SFG (q=.014) and MFG CBF (q=.014). With respect to symptom subscales, higher affective subscale scores were associated with increased SFG (q=.001), MFG (q=.001), IFG (q=.039), ACC (q=.026), and LTL CBF (q=.026); higher cognitive subscale scores were associated with increased SFG (q=.014) and MFG CBF (q=.032); and higher vestibular subscale scores were associated with increased ACC CBF (q=.021). NSI somatic-sensory subscale scores were not associated with ROI CBF.Conclusions:Results demonstrate that in TBI-susceptible anterior ROIs, alterations in CBF but not cortical thickness are associated with postconcussive symptomatology in Veterans with a history of mTBI. Specifically, postconcussive total symptoms as well as affective, cognitive, and vestibular subscale symptoms were strongly linked primarily to CBF of frontal regions. Remarkably, these results indicate that enduring symptoms in generally younger samples of Veterans with head injury histories may be closely tied to cerebrovascular function rather than brain structure changes. These findings may provide a neurological basis for negative clinical outcomes (e.g., enduring PCS and poor quality of life) that is frequently reported by many individuals following mTBI. Future work is needed to examine unique effects of blast exposure as well as associations with repeated injury on brain-behavior relationships.

Examining the unique and interactive associations of gender and race on PTSD symptom severity among military sexual trauma survivors.

Despite a robust association between military sexual trauma (MST) and posttraumatic stress disorder (PTSD), few studies have examined factors that are associated with increased symptom severity. To this end, the current study was designed to examine the unique and interactive effects of gender and race on PTSD symptoms using a sample of MST survivors. The sample included 126 veterans (71% Women, 29% Men; 70% Black/African American and 30% White/Caucasian) presenting for psychological services to a MST specialty clinic at a large Southeastern Veterans Affairs (VA) hospital. As part of their intake evaluation, veterans completed a diagnostic interview and battery of self-report questionnaires. Results revealed a main effect of gender and race such that veteran men and Black/African American veterans were found to have increased PTSD symptom severity. However, there was not a significant gender by race interaction. Findings are discussed with regard to previous research and treatment implications. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Posttraumatic stress disorder and depression residual symptoms among veterans and service members who completed a 3-week cognitive processing therapy-based intensive treatment program.

While previous studies have documented that evidence-based treatments for posttraumatic stress disorder (PTSD) are efficacious, treatment completers often continue to experience residual symptoms. However, no studies to date have assessed residual symptoms following intensive treatment programs (ITPs) for PTSD, which combine evidence-based PTSD treatment along with adjunctive interventions. The present study examined residual symptoms of PTSD and depression in 482 veterans and service members who completed a 3-week Cognitive Processing Therapy-based ITP. Residual symptoms were examined at posttreatment and 3 months following ITP completion. Frequency analyses and logistic regressions were conducted to discern the presence of residual symptoms among (a) the total sample and (b) participants who did and did not experience clinically meaningful change in PTSD symptom severity over the course of treatment. Study results indicated that the majority of participants (80%-87%) reported some PTSD and depression residual symptoms at ITP completion, which commonly continued to be endorsed at 3 months following ITP completion. At both treatment completion and 3 months following treatment, participants who experienced clinically meaningful changes during the ITP exhibited statistically lower odds of PTSD and depression residual symptoms as compared to participants who did not experience clinically meaningful changes. However, regardless of whether clinically meaningful changes in PTSD symptoms were experienced, participants most commonly endorsed residual symptoms in the hyperarousal cluster of PTSD and general depression symptoms at high rates. Findings suggest the need to further examine functional impairment and coping skill use associated with these long-standing residual symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Genetic Liability to Posttraumatic Stress Disorder Symptoms and Its Association With Cardiometabolic and Respiratory Outcomes

Posttraumatic stress disorder (PTSD) has been reported to be a risk factor for several physical and somatic symptoms. However, the genetics of PTSD and its potential association with medical outcomes remain unclear. To examine disease categories and laboratory tests from electronic health records (EHRs) that are associated with PTSD polygenic scores. This genetic association study was conducted from July 15, 2021, to January 24, 2023, using EHR data from participants across 4 biobanks. The polygenic scores of PTSD symptom severity (PGS-PTSD) were tested with all available phecodes in Vanderbilt University Medical Center's biobank (BioVU), Mass General Brigham (MGB), Michigan Genomics Initiative (MGI), and UK Biobank (UKBB). The significant medical outcomes were tested for overrepresented disease categories and subsequently tested for genetic correlation and 2-sample mendelian randomization (MR) to determine genetically informed associations. Multivariable MR was conducted to assess whether PTSD associations with health outcomes were independent of the genetic effect of body mass index and tobacco smoking. Polygenic score of PTSD symptom severity. A total of 1680 phecodes (ie, International Classification of Diseases, Ninth Revision- and Tenth Revision-based phenotypic definitions of health outcomes) across 4 biobanks and 490 laboratory tests across 2 biobanks (BioVU and MGB). In this study including a total of 496 317 individuals (mean [SD] age, 56.8 [8.0] years; 263 048 female [53%]) across the 4 EHR sites, meta-analyzing associations of PGS-PTSD with 1680 phecodes from 496 317 individuals showed significant associations to be overrepresented from mental health disorders (fold enrichment = 3.15; P = 5.81 × 10-6), circulatory system (fold enrichment = 3.32; P = 6.39 × 10-12), digestive (fold enrichment = 2.42; P = 2.16 × 10-7), and respiratory outcomes (fold enrichment = 2.51; P = 8.28 × 10-5). The laboratory measures scan with PGS-PTSD in BioVU and MGB biobanks revealed top associations in metabolic and immune domains. MR identified genetic liability to PTSD symptom severity as an associated risk factor for 12 health outcomes, including alcoholism (β = 0.023; P = 1.49 × 10-4), tachycardia (β = 0.045; P = 8.30 × 10-5), cardiac dysrhythmias (β = 0.016, P = 3.09 × 10-5), and acute pancreatitis (β = 0.049, P = 4.48 × 10-4). Several of these associations were robust to genetic effects of body mass index and smoking. We observed a bidirectional association between PTSD symptoms and nonspecific chest pain and C-reactive protein. Results of this study suggest the broad health repercussions associated with the genetic liability to PTSD across 4 biobanks. The circulatory and respiratory systems association was observed to be overrepresented in all 4 biobanks.

Distress tolerance mitigates effects of posttraumatic stress, traumatic brain injury, and blast exposure on psychiatric and health outcomes.

Exposure to blasts is common among service members and history of these exposures has been associated with chronic psychiatric and health outcomes. Evidence suggests that distress tolerance (DT) may moderate this relationship and be a valuable treatment target in this population. The purpose of this manuscript was to evaluate DT as a modifying factor in the association between posttraumatic stress disorder (PTSD), mild traumatic brain injury (TBI), blast exposure, and functional indicators. Participants were 275 (86.55% male) combat veterans who served in Iraq or Afghanistan after September 11, 2001. Clinical interviews for PTSD diagnosis, TBI history, and blast exposure were administered, and participants completed self-report questionnaires (DT, PTSD symptom severity, depressive symptom severity, neurobehavioral symptom severity, sleep quality, pain interference, and quality of life). DT was significantly associated with all functional indicators beyond PTSD diagnosis, mild TBI, and blast severity. There were significant interaction effects between DT and PTSD diagnosis for posttraumatic stress symptom severity, sleep quality, and quality of life. Specifically, there were significant differences in these reported functional indicators between individuals with and without a PTSD diagnosis as DT increases, such that reported symptoms were lower (quality of life better) for individuals without PTSD as DT improved. Our results demonstrate that DT might be a key factor in postdeployment function for military service members. Treatments targeting DT may be particularly effective in individuals who attribute psychiatric symptoms to history of blast exposure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Event-level positive and negative reinforcement risk factors for alcohol use: Moderation by individual-level alcohol consequences and post-traumatic stress disorder symptom severity.

The multistage model of drug addiction posits that risk processes contributing to alcohol use change as individuals develop alcohol use disorders. However, few studies have tested this theory outside of the lab or at the event level. We assessed whether event-level associations between positive reinforcement (e.g., positive affect, sociability expectancies) and negative reinforcement risk factors (e.g., negative affect, tension reduction expectancies) and same-/next-day alcohol consumption varied as a function of an individual's level of alcohol consequences. Given elevated alcohol use consequences among individuals with post-traumatic stress disorder (PTSD) and disruptions in reward processing that affect this population, we also tested whether these processes differed based on the presence and severity of PTSD. We used data from a 30-day ecological momentary assessment study with 174 undergraduate women who regularly engaged in heavy episodic drinking. A majority (78%) of the sample had experienced sexual assault and 44% had current PTSD. Analyses used Bayesian multilevel structural equation modeling with diffuse (non-informative) priors. We used markov chain monte carlo (MCMC) algorithms to generate a series of 10,000 random draws from the multivariate posterior distribution of our sample for each model. Results partially supported the multistage model. Event-level negative reinforcement risk factors only predicted more alcohol consumption among individuals who experienced more alcohol consequences. Findings for positive reinforcement risk factors were partially consistent with hypotheses. Overall, findings appear to operate similarly across PTSD symptom severity. Results suggest that interventions for heavy episodic drinking could benefit from attending to an individual's level of alcohol consequences. For example, preventive interventions for individuals who tend to experience few consequences may benefit more from addressing positive reinforcement risk factors, while treatment interventions for those who experience more consequences may benefit from attending to both positive and negative reinforcement.

56 TBI Severity Moderates the Association between Subjective and Objective Attention in Older Veterans

Objective:Prior work on associations between self-reported cognition and objective cognitive performance in Veterans has yielded mixed findings, with some evidence indicating that mild traumatic brain injury (TBI) may not impact the associations between subjective and objective cognition. However, few studies have examined these relationships in both mild and moderate-to-severe TBI, in older Veterans, and within specific cognitive domains. Therefore, we assessed the moderating effect of TBI severity on subjective and objective cognition across multiple cognitive domains.Participants and Methods:This study included 246 predominately male Vietnam-Era Veterans (age M=69.61, SD=4.18, Range = 60.87 – 85.16) who completed neuropsychological testing and symptom questionnaires as part of the Department of Defense-Alzheimer’s Disease Neuroimaging Initiative (DoD-ADNI). Participants were classified as having history of no TBI (n=81), mild TBI (n=80), or moderate-tosevere TBI (n=85). Neuropsychological composite scores in the domains of memory, attention/executive functioning, and language were included as the outcome variables. The Everyday Cognition (ECog) measure was used to capture subjective cognition and, specifically, the ECog domain scores of memory, divided attention, and language were chosen as independent variables to mirror the objective cognitive domains. General linear models, adjusting for age, education, apolipoprotein E ε4 carrier status, pulse pressure, depressive symptom severity, and PTSD symptom severity, tested whether TBI severity moderated the associations of domain-specific subjective and objective cognition.Results:Across the sample, subjective memory was associated with objective memory (β=-.205, 95% CI [-.332, -.078], p=.002) and subjective language was associated with objective language (β=-.267, 95% CI [-.399, -.134], p<.001). However, the main effect of subjective divided attention was not associated with objective attention/executive functioning (p=.124). The main effect of TBI severity was not associated with any of the objective cognitive domain scores after adjusting for the other variables in the model. The TBI severity x subjective cognition interaction was significant for attention/executive functioning [F(2,234)=5.18, p=.006]. Specifically, relative to Veterans without a TBI, participants with mild TBI (β=-.311, 95% CI [-.620, -.002], p=.048) and moderate-to-severe TBI (β=-.499, 95% CI [-.806, -.193], p=.002) showed stronger negative associations between subjective divided attention and objective attention/executive functioning. TBI severity did not moderate the associations between subjective and objective cognition for memory or language domains. The pattern of results did not change when the total number of TBIs was included in the models.Conclusions:In this DoD-ADNI sample, stronger associations between subjective and objective attention were evident among individuals with mild and moderate-to-severe TBI compared to Veterans without a TBI history. Attention/executive functioning measures (Trails A and B) may be particularly sensitive to detecting subtle cognitive difficulties related to TBI and/or comorbid psychiatric symptoms, which may contribute to these attention-specific findings. The strongest associations were among those with moderate-to-severe TBI, potentially because the extent to which their attention difficulties are affecting their daily lives are more apparent despite no significant differences in objective attention performance by TBI group. This study highlights the importance of assessing both subjective and objective cognition in older Veterans and the particular relevance of the attention domain within the context of TBI.

Intelligence quotient, combat experiences, psychosocial functioning, and depressive symptoms’ roles in PTSD symptom severity and treatment completion

Intelligence quotient, combat experiences, psychosocial functioning, and depressive symptoms’ roles in PTSD symptom severity and treatment completion

PTSD, depression, and suicidality among survivors of childhood sexual trauma (CST), military sexual trauma (MST), and sexual revictimization (CST + MST).

Research to date has not examined how childhood sexual trauma (CST) followed by sexual trauma during military service (MST) relates to posttraumatic stress disorder (PTSD), depression, and suicidality among women and men. Given the strong association between MST in particular, and these serious posttraumatic outcomes, the current study sought to address this gap. The current study compared the mental health concerns of 268 treatment-seeking veterans who were survivors of CST, MST, or both (CST + MST). We hypothesized that MST would be associated with greater severity of symptoms compared with CST and that those who experienced sexual revictimization (CST + MST) would report more severe symptoms than veterans who experienced CST or MST alone. Veteran men presented with significantly higher suicidality but not higher PTSD or depression scores than women. Controlling for gender, MST survivors had significantly higher PTSD and depression symptom severity scores, but not suicidality, than CST survivors. PTSD, depression, and suicidality scores were significantly higher for the CST + MST group than for CST only survivors, but did not significantly differ from survivors of MST alone. Findings support the more severe clinical impact of CST + MST-specific sexual revictimization compared with CST-only among military men and women, but also suggest that MST alone can have negative consequences similar to revictimization. While results point to the need to consider context and trauma history in future trauma research and clinical applications, they should be interpreted in light of our sample demographics, which were representative of the southwest U.S. veteran population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Clinical outcomes of veterans affairs residential PTSD treatment for PTSD and depressive symptoms: 1-year follow-up outcomes and gender differences.

The long-term effectiveness of Department of Veterans Affairs (VA) residential treatment for posttraumatic stress disorder (PTSD), and how it may vary for men and women veterans, is unknown. This is the first national investigation of symptom change from admission, discharge, 4 months, and 1-year postdischarge from VA PTSD residential rehabilitation treatment programs (RRTPs). Participants included all veterans discharged from 40 VA PTSD RRTPs October 1, 2017-September 30, 2020 (n = 2,937; 14.3% women). Linear mixed models examined PTSD and depressive symptoms across time points; it was hypothesized that women veterans would experience greater symptom reduction during and after treatment. Overall, veterans reported large-sized reductions of PTSD symptoms at all time points (Cohen's d: discharge = 1.23, 4-month follow-up d = 0.97, 1-year follow-up d = 1.51). Treatment effects for depressive symptoms were large-sized at all time points (Cohen's d; discharge = 1.03, 4-month follow-up d = 0.94, 1-year follow-up d = 1.05). Women veterans showed greater improvement in PTSD and depressive symptom severity (p < .001) than men at discharge, but not at 4-month or 1-year follow-ups. Veterans reported significant reductions in PTSD and depressive symptoms, and treatment gains were maintained one year postdischarge. Women experienced greater benefit during, but not after, treatment. Results not only provide support for the effectiveness of VA residential treatment for PTSD but also highlight the continued need for strategies to maximize and maintain treatment gains. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

3 Type 2 Diabetes Moderates the Association between Amyloid PET and Attention/Executive Functioning in Older Veterans

Objective:Type 2 diabetes (T2D) is a risk factor for cognitive impairment/dementia and has been shown to modify the impact of Alzheimer’s disease (AD) biomarkers on cognition and everyday functioning. Studies examining amyloid-ß (Aß), one of the hallmark AD pathologies, have shown mixed results regarding associations of Aß biomarkers with cross-sectional cognition as well as T2D, though Aß is generally associated with future cognitive declines. The purpose of the present study is to examine whether T2D impacts the associations between amyloid positron emission tomography (PET) and cognition in older Veterans.Participants and Methods:The current study included 202 mostly male Vietnam-Era Veterans from the Department of Defense-Alzheimer’s Disease Neuroimaging Initiative (DOD ADNI) study (age M=69.38 years, SD=4.37; 40% with self-reported T2D) who completed neuropsychological testing and florbetapir PET imaging. The Aß PET standardized uptake variable ratio (SUVR) was measured using a previously-validated summary SUVR calculated by dividing the mean uptake across 4 AD-vulnerable cortical regions by whole cerebellar uptake. General linear models examined whether T2D moderated the relationship of Aß PET with memory, attention/executive functioning, and language composite scores. Models adjusted for age, education, apolipoprotein E e4 carrier status, vascular risk burden, depressive symptoms, post-traumatic stress disorder (PTSD) symptom severity, and history of traumatic brain injury (TBI).Results:There was no main effect of diabetes on memory, attention/executive functioning, or language performance, and higher Aß PET SUVR was only associated with worse attention/executive functioning performance (ß=-.146, 95% CI [-.261, -.031], p=.013). The Aß PET x T2D interaction was significant for attention/executive functioning such that higher Aß PET SUVR was associated with lower attention/executive functioning scores, but only in those with T2D (ß=-.116, [-.225, -.006], p=.038). This interaction was not significant for language or memory.Conclusions:The results show that Aß may negatively impact attention/executive functioning, but this effect was only found in Veterans with T2D. Prior work has suggested that T2D may be more associated with tau biomarkers than markers of Aß, so it is possible that the current results are due to a compounding effect of Aß pathology plus microvascular and/or tau pathology. Notably, the sample was relatively young, a relatively large proportion had elevated PTSD symptoms and/or a TBI history (which have both been shown to relate to attention/executive function), and the measures that made up the attention/executive composite (Trail Making Test A and B) have been shown to be particularly sensitive - all of which may have contributed to the domain-specific effects. Future research is needed to investigate the role that tau and vascular pathology may play in cognition among individuals with T2D. Longitudinal studies are also needed to better understand the timing and progression of these relationships.