Jennifer J. Runnals

Childhood trauma exposure in Iraq and Afghanistan war era veterans: Implications for posttraumatic stress disorder symptoms and adult functional social support

OBJECTIVE This study examined the relationship among childhood trauma, posttraumatic stress disorder (PTSD) symptoms, and adult social support in a large sample of veterans who served in the military after 09/11/2001, with a specific focus on the potential role of the PTSD avoidance and numbing cluster as intervening in the association between childhood abuse and adult functional social support. METHOD Participants were 1,301 veterans and active duty soldiers who have served in the military since 09/11/2001; a subsample of these participants (n=482) completed an inventory of current functional social support. Analyses included linear regression and nonparametric bootstrapping procedures. RESULTS After controlling for combat exposure, exposure to childhood trauma was associated with PTSD symptoms in adulthood. Further, PTSD symptoms, and particularly PTSD avoidance/numbing cluster symptoms, intervened in the relationship between childhood trauma and adult functional social support. CONCLUSIONS Findings support the association of childhood trauma (both abuse related and other, non-abuse related trauma) with PTSD symptoms in military personnel and veterans, even after accounting for combat exposure. Additionally, the avoidance and numbing symptom cluster of childhood trauma-based PTSD may be particularly salient in compromising ones subsequent ability to garner functional social support in adulthood.

Self-Reported Pain Complaints among Afghanistan/Iraq Era Men and Women Veterans with Comorbid Posttraumatic Stress Disorder and Major Depressive Disorder

OBJECTIVE Research has shown significant rates of comorbidity among posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and pain in prior era veterans but less is known about these disorders in Iraq and Afghanistan war era veterans. This study seeks to extend previous work by evaluating the association among PTSD, MDD, and pain (back, muscle, and headache pain) in this cohort. METHOD A sample of 1,614 veterans, recruited from 2005 to 2010, completed a structured clinical interview and questionnaires assessing trauma experiences, PTSD symptoms, depressive symptoms, and pain endorsement. RESULTS Veterans with PTSD endorsed pain-related complaints at greater rates than veterans without PTSD. The highest rate of pain complaints was observed in veterans with comorbid PTSD/MDD. Women were more likely to endorse back pain and headaches but no gender by diagnosis interactions were significant. CONCLUSIONS Findings highlight the complex comorbid relationship between PTSD, MDD, and pain among Iraq and Afghanistan veterans. This observed association suggests that integrated, multidisciplinary treatments may be beneficial, particularly when multiple psychological and physical health comorbidities are present with pain. Further support may be indicated for ongoing education of mental health and primary care providers about these co-occurring disorders.

Alcohol use and trauma exposure among male and female veterans before, during, and after military service

BACKGROUND The present study examined lifespan and combat-related trauma exposure as predictors of alcohol use among male and female veterans. Posttraumatic stress and depressive symptoms were examined as mediators of the effects of trauma exposure on alcohol use. METHODS Data were examined from 1825 (1450 male, 375 female) veterans and active duty service members who took part in a multi-site research study conducted through the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC). RESULTS For both men and women, depressive symptoms significantly mediated the effects of non-combat trauma exposure experienced before, during and after the military, as well as combat-exposure, on alcohol use. With posttraumatic stress symptoms, the models for men and women differed. For men, the effects of non-combat trauma exposure during and after military service, and combat exposure, on alcohol use were mediated by PTSD symptoms; however, for women, PTSD symptoms did not mediate these relationships. CONCLUSION Findings are discussed in the context of potential gender differences in response to trauma such as use of alcohol to cope with traumatic events.

No association between RORA polymorphisms and PTSD in two independent samples

Logue et al.1 reported genome-wide significant association between a polymorphism (rs8042149) in the RORA gene, encoding the retinoic acid orphan receptor A, and posttraumatic stress disorder (PTSD) in a cohort of trauma-exposed white non-Hispanic US veterans and their partners. The genome-wide association study yielded evidence of association for three additional SNPs at the 10-6 threshold in the same cohort (rs8041061, rs8024133, rs11071561). Amstadter et al.2 reported a significant association between rs8042149 and PTSD symptoms in the 2004 Florida Hurricane Study. The RORA gene encodes a nuclear hormone receptor that regulates the transcription activity of nearby genes. It is widely expressed in the brain, where it protects cortical neurons against oxidative stress-induced apoptosis by increasing the expression of antioxidant proteins.1 Logue et al.1 proposed that genetic variations in RORA may alter its expression, reducing the capacity of neurons to respond to biochemical stressors induced by traumatic stress.

Drug use and childhood-, military- and post-military trauma exposure among women and men veterans.

BACKGROUND The current study was undertaken to examine whether posttraumatic stress symptoms (PTSS) and depressive symptoms mediated the association between trauma exposure (combat-related trauma and non-combat traumas occurring before, during, and after military service), and drug abuse symptoms use among male and female veterans. METHODS Participants were 2304 (1851 male, 453 female) veterans who took part in a multi-site research study conducted through the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC). Path analytic models were used to determine the association between problematic past-year drug use and combat-related and non-combat trauma experienced before, during, or after the military and whether current post-traumatic stress symptoms or depressive symptoms mediated these associations. RESULTS For both male and female veterans, depressive symptoms significantly mediated the effects of pre- and post-military trauma on drug abuse symptoms. CONCLUSION Mental health providers who work with trauma-exposed Iraq and Afghanistan era veterans should assess for drug use, depressive symptoms, and life-span trauma (i.e., not only combat-related traumas) as part of a thorough trauma-based assessment for both men and women.

Cigarette Smoking and Musculoskeletal Pain Severity Among Male and Female Afghanistan/Iraq Era Veterans

Objective Cigarette smoking and musculoskeletal pain are prevalent among Department of Veterans Affairs (VA) health care system users. These conditions frequently co-occur; however, there is limited empirical information specific to Afghanistan/Iraq era veterans. The present study sought to examine gender differences in the association between cigarette smoking and moderate to severe musculoskeletal pain in US veterans with Afghanistan/Iraq era service. Methods A random sample of 5,000 veterans with service after November 11, 2001, participated in a survey assessing health care needs and barriers to care. One thousand ninety veterans completed the survey assessing post-traumatic stress disorder (PTSD) symptoms, depressive symptoms, and current pain severity. Multivariate logistic regression was used to examine the association between gender, cigarette smoking status, and current moderate to severe musculoskeletal pain. Results Findings indicated a significant gender by smoking interaction on moderate/severe musculoskeletal pain, adjusting for age, self-reported race/ethnicity and weight status, combat exposure, probable PTSD, depressive symptoms, service-connected injury during deployment, and VA health care service utilization. Deconstruction of the interaction indicated that female veteran smokers, relative to female nonsmokers, had increased odds of endorsing moderate to severe musculoskeletal pain (odds ratio [OR] = 2.73, 95% confidence interval [CI] = 1.16-6.41), whereas this difference was nonsignificant for male veterans (OR = 1.03, 95% CI = 0.69-1.56). Conclusions Survey data from Operation Enduring Freedom/Operation Iraqi Freedom veterans suggest an association between current smoking, gender, and moderate to severe musculoskeletal pain. The stronger relationship between smoking and pain in women supports the need for interventional and longitudinal research that can inform gender-based risk factors for pain in veteran cigarette smokers.

Brain Structural Covariance Network Topology in Remitted Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a prevalent, chronic disorder with high psychiatric morbidity; however, a substantial portion of affected individuals experience remission after onset. Alterations in brain network topology derived from cortical thickness correlations are associated with PTSD, but the effects of remitted symptoms on network topology remain essentially unexplored. In this cross-sectional study, US military veterans (N = 317) were partitioned into three diagnostic groups, current PTSD (CURR-PTSD, N = 101), remitted PTSD with lifetime but no current PTSD (REMIT-PTSD, N = 35), and trauma-exposed controls (CONTROL, n = 181). Cortical thickness was assessed for 148 cortical regions (nodes) and suprathreshold interregional partial correlations across subjects constituted connections (edges) in each group. Four centrality measures were compared with characterize between-group differences. The REMIT-PTSD and CONTROL groups showed greater centrality in left frontal pole than the CURR-PTSD group. The REMIT-PTSD group showed greater centrality in right subcallosal gyrus than the other two groups. Both REMIT-PTSD and CURR-PTSD groups showed greater centrality in right superior frontal sulcus than CONTROL group. The centrality in right subcallosal gyrus, left frontal pole, and right superior frontal sulcus may play a role in remission, current symptoms, and PTSD history, respectively. The network centrality changes in critical brain regions and structural networks are associated with remitted PTSD, which typically coincides with enhanced functional behaviors, better emotion regulation, and improved cognitive processing. These brain regions and associated networks may be candidates for developing novel therapies for PTSD. Longitudinal work is needed to characterize vulnerability to chronic PTSD, and resilience to unremitting PTSD.

Behavioral and Health Outcomes Associated With Deployment and Nondeployment Acquisition of Traumatic Brain Injury in Iraq and Afghanistan Veterans

OBJECTIVE To characterize behavioral and health outcomes in veterans with traumatic brain injury (TBI) acquired in nondeployment and deployment settings. DESIGN Cross-sectional assessment evaluating TBI acquired during and outside of deployment, mental and behavioral health symptoms, and diagnoses. SETTING Veterans Affairs Medical Centers. PARTICIPANTS Iraq and Afghanistan veterans who were deployed to a warzone (N=1399). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Comprehensive lifetime TBI interview, Structured Clinical Interview for DSM-IV Disorders, Combat Exposure Scale, and behavioral and health measures. RESULTS There was a main effect of deployment TBI on depressive symptoms, posttraumatic stress symptoms, poor sleep quality, substance use, and pain. Veterans with deployment TBI were also more likely to have a diagnosis of bipolar, major depressive, alcohol use, and posttraumatic stress disorders than those who did not have a deployment TBI. CONCLUSIONS TBIs acquired during deployment are associated with different behavioral and health outcomes than TBI acquired in nondeployment environments. The presence of TBI during deployment is associated with poorer behavioral outcomes, as well as a greater lifetime prevalence of behavioral and health problems in contrast to veterans without deployment TBI. These results indicate that problems may persist chronically after a deployment TBI and should be considered when providing care for veterans. Veterans with deployment TBI may require treatment alterations to improve engagement and outcomes.