Understanding the neurobiological mechanisms that predict posttraumatic stress disorder (PTSD) in recent trauma survivors is important for early interventions. Impaired inhibition of fear or ...behavioral responses is thought to be central to PTSD symptomatology, but its role in predicting PTSD is unknown. Here we examine whether brain function during response inhibition early after a civilian trauma can predict future PTSD symptoms.
Participants (original sample, n = 27; replication sample, n = 31) were recruited in the emergency department within 24 hours of trauma exposure. PTSD symptoms were assessed in the emergency department and 1, 3, and 6 months posttrauma. A Go/NoGo procedure in a 3T magnetic resonance imaging scanner was used to measure neural correlates of response inhibition 1 to 2 months posttrauma. Elastic net regression was used to define the most optimal model to predict PTSD symptoms at 3 and 6 months among demographic, clinical, and imaging measures.
Less hippocampal activation was a significant predictor in the model predicting PTSD symptoms at 3 months (F11,22 = 4.33, p = .01) and 6 months (F9,19 = 4.96, p = .01). Other significant predictors in the model were race and pain level in the emergency department (3 months), and race and baseline depression symptoms (6 months). Using these predictors in a linear regression in the replication sample again resulted in significant models (3 months F3,23 = 3.03, p = .05, 6 months F3,20 = 5.74, p = .007) with hippocampal activation predicting PTSD symptoms at 3 and 6 months.
Decreased inhibition-related hippocampal activation soon after trauma predicted future PTSD symptom severity. This finding may contribute to early identification of at-risk individuals and reveals potential targets for intervention or symptom prevention in the aftermath of trauma.
Abstract Background Studies suggest that exaggerated amygdala reactivity is a vulnerability factor for posttraumatic stress disorder (PTSD); however, our understanding is limited by a paucity of ...prospective, longitudinal studies. Recent studies in healthy samples indicate that, relative to reactivity, habituation is a more reliable biomarker of individual differences in amygdala function. We investigated reactivity of the amygdala and cortical areas to repeated threat presentations in a prospective study of PTSD. Methods Participants were recruited from the emergency department of a large level I trauma center within 24 hours of trauma. PTSD symptoms were assessed at baseline and approximately 1, 3, 6, and 12 months after trauma. Growth curve modeling was used to estimate symptom recovery trajectories. Thirty-one individuals participated in functional magnetic resonance imaging around the 1-month assessment, passively viewing fearful and neutral face stimuli. Reactivity (fearful > neutral) and habituation to fearful faces was examined. Results Amygdala reactivity, but not habituation, 5 to 12 weeks after trauma was positively associated with the PTSD symptom intercept and predicted symptoms at 12 months after trauma. Habituation in the ventral anterior cingulate cortex was positively associated with the slope of PTSD symptoms, such that decreases in ventral anterior cingulate cortex activation over repeated presentations of fearful stimuli predicted increasing symptoms. Conclusions Findings point to neural signatures of risk for maintaining PTSD symptoms after trauma exposure. Specifically, chronic symptoms were predicted by amygdala hyperreactivity, and poor recovery was predicted by a failure to maintain ventral anterior cingulate cortex activation in response to fearful stimuli. The importance of identifying patients at risk after trauma exposure is discussed.
•Anhedonic symptoms of PTSD may play a role in problematic substance use after trauma.•We examined changes in post-trauma anhedonia (PTA) and substance use in recently-traumatized people.•Changes in ...PTA were associated with problematic substance use at 6 months post-trauma.•PTA may be a mechanism through which substance use emerges or worsens in the aftermath of trauma.
Recreational substance use (SU) can emerge or worsen in the aftermath of psychological trauma. Anhedonia is one reason for this problematic SU. Symptoms of posttraumatic stress disorder (PTSD) that represent anhedonia (post-trauma anhedonia; PTA) have been consistently linked to SU disorders. However, no prospective studies have examined whether changes in PTA over time are associated with problematic SU in recently-traumatized people, which was the goal of this study. 165 men and women were recruited as part of a prospective PTSD study in the emergency department of a Level 1 trauma center. Clinical assessments of PTSD and SU were administered at three and six months post-trauma. Compared to participants with minimal SU at six months post-trauma, high substance users at six months post-trauma showed significant increases in PTA during the three to six month time period. This relationship was significant even after accounting for variance associated with other factors, including PTSD symptoms such as re-experiencing and hyperarousal. Participants who demonstrated increases in SU during this time also showed significant increases in PTA, unlike those who demonstrated consistently minimal/no SU during this time. These findings indicate that PTA may be a mechanism through which SU problems emerge in recently-traumatized individuals.
•Trauma narrative organization improves over the course of the year.•Trauma memory organization has implications for psychological health.•Baseline trauma organization predicted changes in ...posttraumatic coping.•Posttraumatic coping mediated ties between organization and psychological health.
The structure of trauma memories impacts mental health, but questions remain about how structure changes with time and may shape coping with trauma. This study considered the structure of trauma narratives collected during an emergency department (ED) visit and at one-year follow-up. We addressed change in narrative structure over time, the extent structure predicted twelve-month psychological symptoms, and possible mechanisms in coping responses.
Sixty-eight community adults (age range 18-67; 41% women) recruited from a trauma center ED provided narratives of the traumatic event that brought them to the ED. Participants provided multiple follow-up reports on psychological symptoms and coping strategies, and another narrative of the traumatic event at twelve months.
Narrative structure improved over time. Baseline narrative structure was negatively associated with twelve-month depressive and posttraumatic symptoms. Two measures of trauma narrative structure—interpretive elaboration and coherence—predicted change in coping strategies. Interpretive elaboration (rich details of the subjective experience) promoted early gains in endorsed engagement and later declines in endorsed disengagement. Coherence (the overall thematic structure of the narrative) buffered participant endorsement of disengagement at earlier follow-ups. Engagement was tied with fewer reported symptoms, whereas disengagement was associated with higher reported symptoms. Coping served as a mediator between baseline narrative structure and later mental health.
The study sample was relatively small and depended on self-reports for symptoms.
Findings suggest there is meaningful variability in trauma memory structure, and early recollections of traumatic experiences may improve targeting of individuals in need of active interventions.
This is the initial report of results from the AURORA multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) ...treatment in the aftermath of a traumatic life experience. We focus on n = 666 participants presenting to EDs following a motor vehicle collision (MVC) and examine associations of participant socio-demographic and participant-reported MVC characteristics with 8-week posttraumatic stress disorder (PTSD) adjusting for pre-MVC PTSD and mediated by peritraumatic symptoms and 2-week acute stress disorder (ASD). Peritraumatic Symptoms, ASD, and PTSD were assessed with self-report scales. Eight-week PTSD prevalence was relatively high (42.0%) and positively associated with participant sex (female), low socioeconomic status (education and income), and several self-report indicators of MVC severity. Most of these associations were entirely mediated by peritraumatic symptoms and, to a lesser degree, ASD, suggesting that the first 2 weeks after trauma may be a uniquely important time period for intervening to prevent and reduce risk of PTSD. This observation, coupled with substantial variation in the relative strength of mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated with more in-depth analyses of the rich and evolving AURORA data.
IMPORTANCE: Adverse posttraumatic neuropsychiatric sequelae after traumatic stress exposure are common and have higher incidence among socioeconomically disadvantaged populations. Pain, depression, ...avoidance of trauma reminders, reexperiencing trauma, anxiety, hyperarousal, sleep disruption, and nightmares have been reported. Wrist-wearable devices with accelerometers capable of assessing 24-hour rest-activity characteristics are prevalent and may have utility in measuring these outcomes. OBJECTIVE: To evaluate whether wrist-wearable devices can provide useful biomarkers for recovery after traumatic stress exposure. DESIGN, SETTING, AND PARTICIPANTS: Data were analyzed from a diverse cohort of individuals seen in the emergency department after experiencing a traumatic stress exposure, as part of the Advancing Understanding of Recovery After Trauma (AURORA) study. Participants recruited from 27 emergency departments wore wrist-wearable devices for 8 weeks, beginning in the emergency department, and completed serial assessments of neuropsychiatric symptoms. A total of 19 019 patients were screened. Of these, 3040 patients met study criteria, provided informed consent, and completed baseline assessments. A total of 2021 provided data from wrist-wearable devices, completed the 8-week assessment, and were included in this analysis. The data were randomly divided into 2 equal parts (n = 1010) for biomarker identification and validation. Data were collected from September 2017 to January 2020, and data were analyzed from May 2020 to November 2022. EXPOSURES: Participants were recruited for the study after experiencing a traumatic stress exposure (most commonly motor vehicle collision). MAIN OUTCOMES AND MEASURES: Rest-activity characteristics were derived and validated from wrist-wearable devices associated with specific self-reported symptom domains at a point in time and changes in symptom severity over time. RESULTS: Of 2021 included patients, 1257 (62.2%) were female, and the mean (SD) age was 35.8 (13.0) years. Eight wrist-wearable device biomarkers for symptoms of adverse posttraumatic neuropsychiatric sequelae exceeded significance thresholds in the derivation cohort. One of these, reduced 24-hour activity variance, was associated with greater pain severity (r = −0.14; 95% CI, −0.20 to −0.07). Changes in 6 rest-activity measures were associated with changes in pain over time, and changes in the number of transitions between sleep and wake over time were associated with changes in pain, sleep, and anxiety. Simple cutoffs for these biomarkers identified individuals with good recovery for pain (positive predictive value PPV, 0.85; 95% CI, 0.82-0.88), sleep (PPV, 0.63; 95% CI, 0.59-0.67, and anxiety (PPV, 0.76; 95% CI, 0.72-0.80) with high predictive value. CONCLUSIONS AND RELEVANCE: These findings suggest that wrist-wearable device biomarkers may have utility as screening tools for pain, sleep, and anxiety symptom outcomes after trauma exposure in high-risk populations.
Many low-income neighborhoods do not include a full-service grocery store. In these communities, discount variety stores (DVS) can be convenient points of food access. However, no identified DVS are ...authorized to accept Special Supplemental Nutrition Program for Women, Infants, and Children Program (WIC) benefits.
One national DVS retailer implemented WIC in 10 stores located in low-income communities in North Carolina over a 10-month pilot period to assess WIC feasibility.
To better understand the facilitators and barriers to WIC implementation from the perspective of DVS staff, we analyzed 36 in-depth interviews with employees of this DVS chain at corporate, manager, and store clerk levels.
Most participants provided positive feedback about implementing and offering WIC. Many store employees had personal experience participating in WIC, which increased their understanding of the WIC shopping experience. Store staff’s prior WIC participation and customers’ proximity to DVS locations were facilitators to implementation. Primary barriers included limited choice of store products for customers, complicated or unclear labeling of WIC products, and difficulty training employees to process WIC vouchers.
These findings suggest that whereas most employees viewed WIC positively, barriers related to product selection and training must be addressed. Notably, North Carolina’s recent change to an electronic system to process WIC transactions requires minimal manual employee training and should address several barriers to implementation. However, the computer system upgrades necessary to accept electronic WIC transactions may be a barrier for DVS to continued WIC acceptance. Future research is needed to evaluate implementation of electronic WIC transactions in DVS.
Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand ...this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians.
In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance.
Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12.
Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.
Safety policy for e-scooters in the United States tends to vary by municipality, and the effects of safety interventions have not been well studied. We reviewed medical records at a large, urban ...tertiary care and trauma center in Atlanta, Georgia with the goal of identifying trends in e-scooter injury and the effects of Atlanta's nighttime ban on e-scooter rentals on injuries treated in the emergency department (ED). Records from all ED visits occurring between June 2018 through August 2020 were reviewed. To account for ambiguity in medical records, confidence levels of either "certain" or "possible" were assigned using a set of predefined criteria to categorize patient injuries as being associated with an e-scooter. A total of 380 patients categorized as having certain e-scooter related injuries were identified. The average age of these patients was 31 years old, 65% were male, 41% had head injuries, 20% of injuries were associated with the built environment, and approximately 20% were admitted to the hospital. Approximately 19% of patients with injuries associated with e-scooters noted to be clinically intoxicated or have a serum ethanol level exceeding 80 mg/dL. The implementation of a nighttime rental ban on e-scooter rentals reduced the proportion of patients with e-scooter injuries with times of arrival during the hours of the ban from 32% to 22%, however this effect was not significant (
= 0.16). More research is needed to understand how e-scooter use patterns are affected by the nighttime rental ban.
Childhood trauma is a known risk factor for trauma and stress-related disorders in adulthood. However, limited research has investigated the impact of childhood trauma on brain structure linked to ...later posttraumatic dysfunction. We investigated the effect of childhood trauma on white matter microstructure after recent trauma and its relationship with future posttraumatic dysfunction among trauma-exposed adult participants (n = 202) recruited from emergency departments as part of the AURORA Study. Participants completed self-report scales assessing prior childhood maltreatment within 2-weeks in addition to assessments of PTSD, depression, anxiety, and dissociation symptoms within 6-months of their traumatic event. Fractional anisotropy (FA) obtained from diffusion tensor imaging (DTI) collected at 2-weeks and 6-months was used to index white matter microstructure. Childhood maltreatment load predicted 6-month PTSD symptoms (b = 1.75, SE = 0.78, 95% CI = 0.20, 3.29) and inversely varied with FA in the bilateral internal capsule (IC) at 2-weeks (p = 0.0294, FDR corrected) and 6-months (p = 0.0238, FDR corrected). We observed a significant indirect effect of childhood maltreatment load on 6-month PTSD symptoms through 2-week IC microstructure (b = 0.37, Boot SE = 0.18, 95% CI = 0.05, 0.76) that fully mediated the effect of childhood maltreatment load on PCL-5 scores (b = 1.37, SE = 0.79, 95% CI = -0.18, 2.93). IC microstructure did not mediate relationships between childhood maltreatment and depressive, anxiety, or dissociative symptomatology. Our findings suggest a unique role for IC microstructure as a stable neural pathway between childhood trauma and future PTSD symptoms following recent trauma. Notably, our work did not support roles of white matter tracts previously found to vary with PTSD symptoms and childhood trauma exposure, including the cingulum bundle, uncinate fasciculus, and corpus callosum. Given the IC contains sensory fibers linked to perception and motor control, childhood maltreatment might impact the neural circuits that relay and process threat-related inputs and responses to trauma.
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