The Post‐Deployment Mental Health (PDMH) study and repository: A multi‐site study of US Afghanistan and Iraq era veterans

Brancu, Mira; Wagner, H. Ryan; Morey, Rajendra A.; Beckham, Jean C.; Calhoun, Patrick S.; Tupler, Larry A.; Marx, Christine E.; Taber, Katherine H.; Hurley, Robin A.; Rowland, Jared A.; McDonald, Scott D.; Hoerle, Jeffrey M.; Moore, Scott D.; Kudler, Harold; Weiner, Richard D.; Workgroup, VA Mid-Atlantic Mirecc; Fairbank, John A.

doi:10.1002/mpr.1570

Cited by 76 publications

(61 citation statements)

References 89 publications

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“…Twenty-five participants with PTSD and 25 trauma-exposed controls were recruited from a repository of military service members and veterans who served after September 11, 2001 21 . Psychiatric diagnoses were confirmed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) 2 .…”

Section: Methodsmentioning

confidence: 99%

Threat-Induced Anxiety During Goal Pursuit Disrupts Amygdala-Prefrontal Cortex Connectivity in Posttraumatic Stress Disorder

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Gold

Swanson

et al. 2019

Preprint

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To investigate how unpredictable threat during goal pursuit impacts fronto-limbic activity and functional connectivity in posttraumatic stress disorder (PTSD), we compared military veterans with PTSD (n=25) versus trauma-exposed Control (n=25). Participants underwent functional magnetic resonance imaging (fMRI) while engaged in a computerized chase-and-capture game task that involved optimizing monetary rewards obtained from capturing virtual prey while simultaneously avoiding capture by virtual predators. The game was played under two alternating contexts – one involving exposure to unpredictable, task-irrelevant threat by randomly occurring electrical shocks, and a nonthreat control condition. Activation in and functional connectivity between the amygdala and ventromedial prefrontal cortex (vmPFC) was tested across threat and nonthreat task contexts with generalized psychophysiological interaction (gPPI) analyses. PTSD patients reported higher anxiety than controls across contexts. Better task performance represented by successfully avoiding capture by predators under threat than nonthreat contexts was associated with stronger left amygdala-vmPFC functional connectivity in controls and greater vmPFC activation in PTSD patients. PTSD symptom severity was negatively correlated with vmPFC activation in trauma-exposed controls and with right amygdala-vmPFC functional connectivity across all participants in the threat relative to nonthreat contexts. The findings showed that veterans with PTSD have disrupted amygdala-vmPFC functional connectivity and greater localized vmPFC processing under threat-modulation of goal-directed behavior, specifically related to successful task performance while avoiding loss of monetary rewards. In contrast, trauma survivors without PTSD rely on stronger threat-modulated left amygdala-vmPFC functional connectivity during goal-directed behavior, which may represent a resilience-related functional adaptation.

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Section: Methodsmentioning

confidence: 99%

Threat-Induced Anxiety During Goal Pursuit Disrupts Amygdala-Prefrontal Cortex Connectivity in Posttraumatic Stress Disorder

Sun

Gold

Swanson

et al. 2019

Preprint

Self Cite

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“…The sample was selected from US military service members and veterans who participated in the Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) multisite Post-Deployment Mental Health Study (PDMH Study) (Brancu et al, 2017). Inclusion criteria of the broader study entailed serving in the US military and/or reserve forces on or after 11 September 2001.…”

Section: Study Methodsmentioning

confidence: 99%

Exploring resilience models in a sample of combat-exposed military service members and veterans: a comparison and commentary

Sheerin

Stratton

Amstadter

et al. 2018

European Journal of Psychotraumatology

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Background: The term resilience is applied in numerous ways in the mental health field, leading to different perspectives of what constitutes a resilient response and disparate findings regarding its prevalence following trauma. Objective: illustrate the impact of various definitions on our understanding and prevalence of resilience, we compared various resilience definitions (absence of PTSD, absence of current mental health diagnosis, absence of generalized psychological distress, and an alternative trauma load–resilience discrepancy model of the difference between actual and predicted distress given lifetime trauma exposure) within a combat-exposed military personnel and veteran sample. Method: In this combat-trauma exposed sample (N = 849), of which approximately half were treatment seeking, rates of resilience were determined across all models, the kappa statistic was used to determine the concordance and strength of association across models, and t-tests examined the models in relation to a self-reported resilience measure. Results: Prevalence rates were 43.7%, 30.7%, 87.4%, and 50.1% in each of the four models. Concordance analyses identified 25.7% (n = 218) considered resilient by all four models (kappa = .40, p < .001). Correlations between models and self-reported resilience were strong, but did not fully overlap. Conclusions:The discussion highlights theoretical considerations regarding the impact of various definitions and methodologies on resilience classifications, links current findings to a systems-based perspective, and ends with suggestions for future research approaches on resilience.

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“…We enrolled a total of 290 Iraq and Afghanistan era military service veterans, which were recruited from our repository (Brancu et al, 2017). Among these participants, 282 were selected for analysis following quality control (QC) procedures that consisted of 142 individuals with PTSD and 140 trauma exposed controls.…”

Section: Participantsmentioning

confidence: 99%

Smaller hippocampal CA1 subfield volume in posttraumatic stress disorder

et al. 2018

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Background Smaller hippocampal volume in patients with PTSD represents the most consistently reported structural alteration in the brain. Subfields of the hippocampus play distinct roles in encoding and processing of memories, which are disrupted in PTSD. We examined PTSD-associated alterations in 12 hippocampal subfields in relation to global hippocampal shape, and clinical features. Methods Case-control cross-sectional study of US military veterans (n=282) from the Iraq and Afghanistan era were grouped into PTSD (n=142) and trauma-exposed controls (n=140). Participants underwent clinical evaluation for PTSD and associated clinical parameters followed by MRI at 3-Tesla. Segmentation with FreeSurfer v6.0 produced hippocampal subfield volumes for the left and right CA1, CA3, CA4, dentate gyrus, fimbria, fissure, hippocampus-amygdala transition area, molecular layer, parasubiculum, presubiculum, subiculum, and tail, as well as hippocampal meshes. Covariates included age, gender, trauma exposure, alcohol use, depressive symptoms, antidepressant medication use, total hippocampal volume, and MRI scanner model. Results Significantly lower subfield volumes were associated with PTSD in left CA1 (p=.01; d=.21; uncorrected), CA3 (p=.04; d=.08; uncorrected), and right CA3 (p=.02; d=.07; uncorrected) only if ipsilateral whole hippocampal volume was included as a covariate. Conclusions The present finding of smaller hippocampal CA1 in PTSD is consistent with model systems in rodents that exhibit increased anxiety-like behavior from repeated exposure to acute stress. Behavioral correlations with hippocampal subfield volume differences in PTSD will elucidate their relevance to PTSD, particularly behaviors of associative fear learning, extinction training, and formation of false memories.

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The Post‐Deployment Mental Health (PDMH) study and repository: A multi‐site study of US Afghanistan and Iraq era veterans

Cited by 76 publications

References 89 publications

Threat-Induced Anxiety During Goal Pursuit Disrupts Amygdala-Prefrontal Cortex Connectivity in Posttraumatic Stress Disorder

Threat-Induced Anxiety During Goal Pursuit Disrupts Amygdala-Prefrontal Cortex Connectivity in Posttraumatic Stress Disorder

Exploring resilience models in a sample of combat-exposed military service members and veterans: a comparison and commentary

Smaller hippocampal CA1 subfield volume in posttraumatic stress disorder

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