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Yurgil KA, Ricca H, Baker DG. Resilience after combat: A prospective, longitudinal study of Marines and Navy Corpsmen. J Health Psychol 2024:13591053241236539. [PMID: 38494607 DOI: 10.1177/13591053241236539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Resilience is common, yet our understanding of key biopsychosocial and environmental correlates is limited. Additionally, perceived resilience is often conflated with absence of psychiatric symptoms. Here we leverage prospective, longitudinal data from 1835 Marines and Navy Corpsmen to examine predictors of perceived resilience 3 months after a combat deployment, while controlling for pre-deployment and concurrent psychiatric symptoms. Marines and Corpsmen did not differ significantly on psychosocial or clinical factors, and 50.4% reported high perceived resilience after deployment. Across groups, the strongest predictors of post-deployment perceived resilience were pre-deployment perceived resilience, positive emotions, and social support. Concurrent depression was the only clinical symptom negatively associated with perceived resilience. Our findings suggest that perceived resilience is a multi-dimensional construct that involves both psychosocial and personality factors, including but not limited to low psychopathology. Notably, establishing strong social support networks and encouraging positive emotions may help promote resilience following deployment.
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Affiliation(s)
- Kate A Yurgil
- Loyola University New Orleans, USA
- VA San Diego Healthcare System, USA
- Center of Excellence for Stress and Mental Health, USA
| | | | - Dewleen G Baker
- VA San Diego Healthcare System, USA
- Center of Excellence for Stress and Mental Health, USA
- University of California San Diego School of Medicine, USA
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Acheson DT, Baker DG, Nievergelt CM, Yurgil KA, Geyer MA, Risbrough VB. Prospective longitudinal assessment of sensorimotor gating as a risk/resiliency factor for posttraumatic stress disorder. Neuropsychopharmacology 2022; 47:2238-2244. [PMID: 36192631 PMCID: PMC9630259 DOI: 10.1038/s41386-022-01460-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023]
Abstract
Little is understood about cognitive mechanisms that confer risk and resiliency for posttraumatic stress disorder (PTSD). Prepulse Inhibition (PPI) is a measure of pre-attentional response inhibition that is a stable cognitive trait disrupted in many neuropsychiatric disorders characterized by poor behavioral or cognitive inhibition, including PTSD. Differentiating between PTSD-related phenotypes that are pre-existing factors vs. those that emerge specifically after trauma is critical to understanding PTSD etiology and can only be addressed by prospective studies. This study tested the hypothesis that sensorimotor gating performance is associated with risk/resiliency for combat-related PTSD. As part of a prospective, longitudinal study, 1226 active duty Marines and Navy Corpsman completed a PPI test as well as a clinical interview to assess PTSD symptoms both before, and 3 and 6 months after a combat deployment. Participants that developed PTSD 6 months following deployment (N=46) showed lower PPI across pre and post-deployment time points compared to participants who did not develop PTSD (N=1182) . Examination of the distribution of PTSD across PPI performance revealed a lower than expected number of cases in the highest performing quartile compared to the rest of the distribution (p < 0.04). When controlling for other factors that predict PTSD in this population, those in the top 25% of PPI performance showed a >50% reduction in chance to develop PTSD (OR = 0.32). Baseline startle reactivity and startle habituation were not significantly different between PTSD risk and control groups. These findings suggest that robust sensorimotor gating may represent a resiliency factor for development of PTSD following trauma.
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Affiliation(s)
- Dean T Acheson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Dewleen G Baker
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Caroline M Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Kate A Yurgil
- Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychological Sciences, Loyola University New Orleans, New Orleans, LA, USA
| | - Mark A Geyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Mental Illness Research, Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
| | - Victoria B Risbrough
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.
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Hunt C, Stout DM, Tie Z, Acheson D, Colvonen PJ, Nievergelt CM, Yurgil KA, Baker DG, Risbrough VB. Pre-deployment threat learning predicts increased risk for post-deployment insomnia: Evidence from the Marine Resiliency Study. Behav Res Ther 2022; 159:104223. [PMID: 36327523 PMCID: PMC9893737 DOI: 10.1016/j.brat.2022.104223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023]
Abstract
Insomnia is a common and impairing consequence of military deployment, but little is known about pre-deployment risk factors for post-deployment insomnia. Abnormal threat learning tendencies are commonly observed in individuals with insomnia and maladaptive responses to stress have been implicated in the development of insomnia, suggesting that threat learning could be an important risk factor for post-deployment insomnia. Here, we examined pre-deployment threat learning as a predictor of post-deployment insomnia and the potential mechanisms underlying this effect. Male servicemembers (N = 814) completed measures of insomnia, psychiatric symptoms, and a threat learning task before and after military deployment. Threat learning indices that differentiated participants with versus withoutinsomnia at post-deployment were tested as pre-deployment predictors of post-deployment insomnia. Post-deployment insomnia was linked to elevations on several threat learning indices at post-deployment, but only higher threat conditioning, as indexed by higher threat expectancy ratings to the danger cue, emerged as a pre-deployment predictor of post-deployment insomnia. This effect was independent of combat exposure levels and partially mediated by greater post-deployment nightmares. The tendency to acquire stronger expectations of aversive events following encounters with danger cues may increase risk for post-deployment insomnia, in part due to the development of more severe nightmares.
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Affiliation(s)
- Christopher Hunt
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Daniel M Stout
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Ziyun Tie
- University of California San Diego, Department of Psychiatry, United States
| | - Dean Acheson
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Peter J Colvonen
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Caroline M Nievergelt
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Kate A Yurgil
- Department of Psychological Sciences, Loyola University New Orleans, United States
| | - Dewleen G Baker
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States
| | - Victoria B Risbrough
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health, United States; University of California San Diego, Department of Psychiatry, United States.
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Acheson DT, Vinograd M, Nievergelt CM, Yurgil KA, Moore TM, Risbrough VB, Baker DG. Prospective examination of pre-trauma anhedonia as a risk factor for post-traumatic stress symptoms. Eur J Psychotraumatol 2022; 13:2015949. [PMID: 35070161 PMCID: PMC8774051 DOI: 10.1080/20008198.2021.2015949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Anhedonia, the reduction of pleasure and reward-seeking behaviour, is a transdiagnostic symptom with well-described neural circuit mediators. Although typically observed during disease state, extant hypotheses suggest that anhedonia may also be an early risk factor for development of psychopathology. Understanding the contribution of anhedonia to the trauma-response trajectory may bolster inferences about biological mechanisms contributing to pre-trauma risk versus trauma-related symptom expression, knowledge of which could aid in targeted interventions. OBJECTIVE Using a prospective, longitudinal design in a population at risk for trauma disorders, we tested the hypothesis that anhedonia may be a pre-trauma risk factor for post-traumatic stress disorder (PTSD) symptoms. METHODS Adult male participants from the Marine Resilience Study (N = 2,593) were assessed across three time-points (pre-deployment, 3-month and 6-month post-deployment). An anhedonia factor was extracted from self-report instruments pre-trauma and tested for its relationship with development of PTSD re-experiencing symptoms after deployment. RESULTS Higher pre-deployment anhedonia predicted increased PTSD intrusive re-experiencing symptoms at 3- and 6-months post-deployment when controlling for pre-trauma PTSD and depression symptoms. Depression symptoms were not significant predictors of subsequent PTSD intrusive re-experiencing symptoms. Anhedonia at 3 mo also robustly predicted maintenance of PTSD intrusive re-experiencing symptoms at the 6 mo time point. CONCLUSIONS Pre-deployment anhedonia may be a pre-trauma risk factor for PTSD, not simply a state-dependent effect of trauma exposure and PTSD symptom expression. Anhedonia may contribute to persistence and/or chronicity of re-experiencing symptoms after the emergence of PTSD symptoms.
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Affiliation(s)
- Dean T Acheson
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Meghan Vinograd
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Caroline M Nievergelt
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Kate A Yurgil
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA.,Department of Psychological Sciences, Loyola University New Orleans, New Orleans, LA, USA
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria B Risbrough
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Dewleen G Baker
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Huang MX, Huang CW, Harrington DL, Nichols S, Robb-Swan A, Angeles-Quinto A, Le L, Rimmele C, Drake A, Song T, Huang JW, Clifford R, Ji Z, Cheng CK, Lerman I, Yurgil KA, Lee RR, Baker DG. Marked Increases in Resting-State MEG Gamma-Band Activity in Combat-Related Mild Traumatic Brain Injury. Cereb Cortex 2021; 30:283-295. [PMID: 31041986 DOI: 10.1093/cercor/bhz087] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 01/08/2023] Open
Abstract
Combat-related mild traumatic brain injury (mTBI) is a leading cause of sustained impairments in military service members and veterans. Recent animal studies show that GABA-ergic parvalbumin-positive interneurons are susceptible to brain injury, with damage causing abnormal increases in spontaneous gamma-band (30-80 Hz) activity. We investigated spontaneous gamma activity in individuals with mTBI using high-resolution resting-state magnetoencephalography source imaging. Participants included 25 symptomatic individuals with chronic combat-related blast mTBI and 35 healthy controls with similar combat experiences. Compared with controls, gamma activity was markedly elevated in mTBI participants throughout frontal, parietal, temporal, and occipital cortices, whereas gamma activity was reduced in ventromedial prefrontal cortex. Across groups, greater gamma activity correlated with poorer performances on tests of executive functioning and visuospatial processing. Many neurocognitive associations, however, were partly driven by the higher incidence of mTBI participants with both higher gamma activity and poorer cognition, suggesting that expansive upregulation of gamma has negative repercussions for cognition particularly in mTBI. This is the first human study to demonstrate abnormal resting-state gamma activity in mTBI. These novel findings suggest the possibility that abnormal gamma activities may be a proxy for GABA-ergic interneuron dysfunction and a promising neuroimaging marker of insidious mild head injuries.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Charles W Huang
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Deborah L Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Ashley Robb-Swan
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Annemarie Angeles-Quinto
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Lu Le
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, CA, USA
| | - Carl Rimmele
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, CA, USA
| | - Angela Drake
- Cedar Sinai Medical Group Chronic Pain Program, Beverly Hills, CA, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, CA, USA
| | - Jeffrey W Huang
- Department of Computer Science, Columbia University, New York, NY, USA
| | - Royce Clifford
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, CA, USA
| | - Chung-Kuan Cheng
- Department of Computer Science and Engineering, University of California, San Diego, CA, USA
| | - Imanuel Lerman
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Department of Psychological Sciences, Loyola University, New Orleans, LA, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
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Huang MX, Huang CW, Harrington DL, Robb-Swan A, Angeles-Quinto A, Nichols S, Huang JW, Le L, Rimmele C, Matthews S, Drake A, Song T, Ji Z, Cheng CK, Shen Q, Foote E, Lerman I, Yurgil KA, Hansen HB, Naviaux RK, Dynes R, Baker DG, Lee RR. Resting-state magnetoencephalography source magnitude imaging with deep-learning neural network for classification of symptomatic combat-related mild traumatic brain injury. Hum Brain Mapp 2021; 42:1987-2004. [PMID: 33449442 PMCID: PMC8046098 DOI: 10.1002/hbm.25340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 11/16/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022] Open
Abstract
Combat‐related mild traumatic brain injury (cmTBI) is a leading cause of sustained physical, cognitive, emotional, and behavioral disabilities in Veterans and active‐duty military personnel. Accurate diagnosis of cmTBI is challenging since the symptom spectrum is broad and conventional neuroimaging techniques are insensitive to the underlying neuropathology. The present study developed a novel deep‐learning neural network method, 3D‐MEGNET, and applied it to resting‐state magnetoencephalography (rs‐MEG) source‐magnitude imaging data from 59 symptomatic cmTBI individuals and 42 combat‐deployed healthy controls (HCs). Analytic models of individual frequency bands and all bands together were tested. The All‐frequency model, which combined delta‐theta (1–7 Hz), alpha (8–12 Hz), beta (15–30 Hz), and gamma (30–80 Hz) frequency bands, outperformed models based on individual bands. The optimized 3D‐MEGNET method distinguished cmTBI individuals from HCs with excellent sensitivity (99.9 ± 0.38%) and specificity (98.9 ± 1.54%). Receiver‐operator‐characteristic curve analysis showed that diagnostic accuracy was 0.99. The gamma and delta‐theta band models outperformed alpha and beta band models. Among cmTBI individuals, but not controls, hyper delta‐theta and gamma‐band activity correlated with lower performance on neuropsychological tests, whereas hypo alpha and beta‐band activity also correlated with lower neuropsychological test performance. This study provides an integrated framework for condensing large source‐imaging variable sets into optimal combinations of regions and frequencies with high diagnostic accuracy and cognitive relevance in cmTBI. The all‐frequency model offered more discriminative power than each frequency‐band model alone. This approach offers an effective path for optimal characterization of behaviorally relevant neuroimaging features in neurological and psychiatric disorders.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
| | - Charles W Huang
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Deborah L Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
| | - Ashley Robb-Swan
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
| | - Annemarie Angeles-Quinto
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
| | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego, California, USA
| | - Jeffrey W Huang
- Department of Computer Science, Columbia University, New York, New York, USA
| | - Lu Le
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, California, USA
| | - Carl Rimmele
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, California, USA
| | - Scott Matthews
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, California, USA
| | - Angela Drake
- Cedar Sinai Medical Group Chronic Pain Program, Beverly Hills, California, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, California, USA
| | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, California, USA
| | - Chung-Kuan Cheng
- Department of Computer Science and Engineering, University of California, San Diego, California, USA
| | - Qian Shen
- Department of Radiology, University of California, San Diego, California, USA
| | - Ericka Foote
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Imanuel Lerman
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychological Sciences, Loyola University New Orleans, Louisiana, USA
| | - Hayden B Hansen
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA
| | - Robert K Naviaux
- Department of Medicine, University of California, San Diego, California, USA.,Department of Pediatrics, University of California, San Diego, California, USA.,Department of Pathology, University of California, San Diego, California, USA
| | - Robert Dynes
- Department of Physics, University of California, San Diego, California, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
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Yurgil KA, Barkauskas DA, Baker DG. Deployment and Psychological Correlates of Suicide Ideation: A Prospective, Longitudinal Study of Risk and Resilience Among Combat Veterans. Mil Med 2020; 186:e58-e66. [PMID: 33201239 DOI: 10.1093/milmed/usaa450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/01/2020] [Accepted: 10/13/2020] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Suicide rates among military personnel have risen in part due to war zone deployments. Yet, the degree to which deployment-related stressors, in combination with preexisting and co-occurring psychiatric symptoms and individual resilience factors, contribute to suicide ideation (SI) remains unclear. The current study leverages prospective, longitudinal data to examine both risk and protective factors associated with SI in deployed service members. MATERIALS AND METHODS Participants were 1,805 active duty enlisted Marines and Navy service members assessed before and after a 7-month deployment for SI, preexisting and concurrent symptoms of depression, post-traumatic stress disorder (PTSD), alcohol consumption, as well as prior and deployment-related traumatic brain injury (TBI). Current self-reported psychological resilience and social support were analyzed as potential protective factors. RESULTS Rates of SI were 7.3% and 3.9% before and after deployment, respectively. Of those with post-deployment SI, 68.6% were new-onset cases. Multivariate regression revealed that concurrent mild depression was the strongest risk factor (odds ratio [OR] = 10.03, 95% CI 5.28-19.07). Other significant risk factors included prior SI (OR = 3.36, 95% CI 1.60-7.05), prior subthreshold PTSD (OR = 2.10, 95% CI 1.10-3.99), and deployment TBI (OR = 1.84, 95% CI 1.03-3.28). Controlling for clinical symptoms and TBI, the risk of SI was reduced for those with moderate (OR = 0.50, 95% CI 0.27-0.93) and high psychological resilience scores (OR = 0.25, 95% CI 0.08-0.79) after deployment. CONCLUSIONS Results indicate that even mild symptoms of depression and PTSD may increase the risk of SI. Screening for subthreshold clinical symptoms and TBI while incorporating psychological resilience training would allow for a more multidimensional approach to suicide risk assessment.
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Affiliation(s)
- Kate A Yurgil
- Department of Psychological Sciences, Loyola University New Orleans, New Orleans, LA 70118, USA.,Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA 92161, USA.,Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Donald A Barkauskas
- Department of Preventative Medicine, Keck School of Medicine University of Southern California, Los Angeles, CA 90032, USA
| | - Dewleen G Baker
- Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA 92161, USA.,Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA.,Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA 92093, USA
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Clifford RE, Baker D, Risbrough VB, Huang M, Yurgil KA. Impact of TBI, PTSD, and Hearing Loss on Tinnitus Progression in a US Marine Cohort. Mil Med 2020; 184:839-846. [PMID: 30793178 DOI: 10.1093/milmed/usz016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/18/2018] [Accepted: 01/14/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Mild TBI (TBI) is associated with up to a 75.7% incidence of tinnitus, and 33.0% of tinnitus patients at the US Veterans Administration carry a diagnosis of post-traumatic stress syndrome (PTSD). Yet factors contributing to new onset or exacerbation of tinnitus remain unclear. MATERIALS AND METHODS Here we measure intermittent and constant tinnitus at two time points to ascertain whether pre-existing or co-occurring traumatic brain injury (TBI), hearing loss, or post-traumatic stress disorder (PTSD) predicts new onset, lack of recovery and/or worsening of tinnitus in 2,600 United States Marines who were assessed before and after a combat deployment. RESULTS Ordinal regression revealed that constant tinnitus before deployment was likely to continue after deployment (odds ratio [OR] = 28.62, 95% confidence interval [CI]: 9.84,83.26). Prior intermittent tinnitus increased risk of post-deployment constant tinnitus (OR = 4.95, CI: 2.97,8.27). Likelihood of tinnitus progression increased with partial PTSD (OR = 2.39, CI: 1.50,3.80) and TBI (OR = 1.59, CI: 1.13,2.23), particularly for blast TBI (OR = 2.01, CI: 1.27,3.12) and moderate to severe TBI (OR = 2.57, CI: 1.46,4.51). Tinnitus progression also increased with low frequency hearing loss (OR = 1.94, CI: 1.05,3.59), high frequency loss (OR = 3.01, CI: 1.91,4.76) and loss across both low and high frequency ranges (OR = 5.73, CI: 2.67,12.30). CONCLUSIONS Screening for pre-existing or individual symptoms of PTSD, TBI, and hearing loss may allow for more focused treatment programs of comorbid disorders. Identification of those personnel vulnerable to tinnitus or its progression may direct increased acoustic protection for those at risk.
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Affiliation(s)
- Royce E Clifford
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA.,Harvard University School of Public Health, 677 Huntington Ave, Boston, MA
| | - Dewleen Baker
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA
| | - Victoria B Risbrough
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA
| | - Mingxiong Huang
- Department of Radiology, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA
| | - Kate A Yurgil
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychological Sciences, Loyola University New Orleans, 6363 St. Charles Ave., Box 194, New Orleans, LA
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Huang MX, Nichols S, Robb-Swan A, Angeles-Quinto A, Harrington DL, Drake A, Huang CW, Song T, Diwakar M, Risbrough VB, Matthews S, Clifford R, Cheng CK, Huang JW, Sinha A, Yurgil KA, Ji Z, Lerman I, Lee RR, Baker DG. MEG Working Memory N-Back Task Reveals Functional Deficits in Combat-Related Mild Traumatic Brain Injury. Cereb Cortex 2020; 29:1953-1968. [PMID: 29668852 DOI: 10.1093/cercor/bhy075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 12/24/2022] Open
Abstract
Combat-related mild traumatic brain injury (mTBI) is a leading cause of sustained cognitive impairment in military service members and Veterans. However, the mechanism of persistent cognitive deficits including working memory (WM) dysfunction is not fully understood in mTBI. Few studies of WM deficits in mTBI have taken advantage of the temporal and frequency resolution afforded by electromagnetic measurements. Using magnetoencephalography (MEG) and an N-back WM task, we investigated functional abnormalities in combat-related mTBI. Study participants included 25 symptomatic active-duty service members or Veterans with combat-related mTBI and 20 healthy controls with similar combat experiences. MEG source-magnitude images were obtained for alpha (8-12 Hz), beta (15-30 Hz), gamma (30-90 Hz), and low-frequency (1-7 Hz) bands. Compared with healthy combat controls, mTBI participants showed increased MEG signals across frequency bands in frontal pole (FP), ventromedial prefrontal cortex, orbitofrontal cortex (OFC), and anterior dorsolateral prefrontal cortex (dlPFC), but decreased MEG signals in anterior cingulate cortex. Hyperactivations in FP, OFC, and anterior dlPFC were associated with slower reaction times. MEG activations in lateral FP also negatively correlated with performance on tests of letter sequencing, verbal fluency, and digit symbol coding. The profound hyperactivations from FP suggest that FP is particularly vulnerable to combat-related mTBI.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Ashley Robb-Swan
- Department of Radiology, University of California, San Diego, CA, USA
| | | | - Deborah L Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Angela Drake
- Cedar Sinai Medical Group Chronic Pain Program, Beverly Hills, CA, USA
| | - Charles W Huang
- Department of Bioengineering, University of California, San Diego, CA, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, CA, USA
| | - Mithun Diwakar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Victoria B Risbrough
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Scott Matthews
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, CA, USA
| | - Royce Clifford
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Chung-Kuan Cheng
- Department of Computer Science and Engineering, University of California, San Diego, CA, USA
| | | | - Anusha Sinha
- California Institute of Technology, Pasadena, CA, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Loyola University New Orleans, LA, USA
| | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, CA, USA
| | - Imanuel Lerman
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
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10
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Yurgil KA, Velasquez MA, Winston JL, Reichman NB, Colombo PJ. Music Training, Working Memory, and Neural Oscillations: A Review. Front Psychol 2020; 11:266. [PMID: 32153474 PMCID: PMC7047970 DOI: 10.3389/fpsyg.2020.00266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
This review focuses on reports that link music training to working memory and neural oscillations. Music training is increasingly associated with improvement in working memory, which is strongly related to both localized and distributed patterns of neural oscillations. Importantly, there is a small but growing number of reports of relationships between music training, working memory, and neural oscillations in adults. Taken together, these studies make important contributions to our understanding of the neural mechanisms that support effects of music training on behavioral measures of executive functions. In addition, they reveal gaps in our knowledge that hold promise for further investigation. The current review is divided into the main sections that follow: (1) discussion of behavioral measures of working memory, and effects of music training on working memory in adults; (2) relationships between music training and neural oscillations during temporal stages of working memory; (3) relationships between music training and working memory in children; (4) relationships between music training and working memory in older adults; and (5) effects of entrainment of neural oscillations on cognitive processing. We conclude that the study of neural oscillations is proving useful in elucidating the neural mechanisms of relationships between music training and the temporal stages of working memory. Moreover, a lifespan approach to these studies will likely reveal strategies to improve and maintain executive function during development and aging.
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Affiliation(s)
- Kate A. Yurgil
- Department of Psychological Sciences, Loyola University, New Orleans, LA, United States
| | | | - Jenna L. Winston
- Department of Psychology, Tulane University, New Orleans, LA, United States
| | - Noah B. Reichman
- Brain Institute, Tulane University, New Orleans, LA, United States
| | - Paul J. Colombo
- Department of Psychology, Tulane University, New Orleans, LA, United States
- Brain Institute, Tulane University, New Orleans, LA, United States
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11
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Nievergelt CM, Maihofer AX, Mustapic M, Yurgil KA, Schork NJ, Miller MW, Logue MW, Geyer MA, Risbrough VB, O'Connor DT, Baker DG. Genomic predictors of combat stress vulnerability and resilience in U.S. Marines: A genome-wide association study across multiple ancestries implicates PRTFDC1 as a potential PTSD gene. Psychoneuroendocrinology 2015; 51:459-71. [PMID: 25456346 DOI: 10.1016/j.psyneuen.2014.10.017] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 10/10/2014] [Accepted: 10/16/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Research on the etiology of post-traumatic stress disorder (PTSD) has rapidly matured, moving from candidate gene studies to interrogation of the entire human genome in genome-wide association studies (GWAS). Here we present the results of a GWAS performed on samples from combat-exposed U.S. Marines and Sailors from the Marine Resiliency Study (MRS) scheduled for deployment to Iraq and/or Afghanistan. The MRS is a large, prospective study with longitudinal follow-up designed to identify risk and resiliency factors for combat-induced stress-related symptoms. Previously implicated PTSD risk loci from the literature and polygenic risk scores across psychiatric disorders were also evaluated in the MRS cohort. METHODS Participants (N=3494) were assessed using the Clinician-Administered PTSD Scale and diagnosed using the DSM-IV diagnostic criterion. Subjects with partial and/or full PTSD diagnosis were called cases, all other subjects were designated controls, and study-wide maximum CAPS scores were used for longitudinal assessments. Genomic DNA was genotyped on the Illumina HumanOmniExpressExome array. Individual genetic ancestry was determined by supervised cluster analysis for subjects of European, African, Hispanic/Native American, and other descent. To test for association of SNPs with PTSD, logistic regressions were performed within each ancestry group and results were combined in meta-analyses. Measures of childhood and adult trauma were included to test for gene-by-environment (GxE) interactions. Polygenic risk scores from the Psychiatric Genomic Consortium were used for major depressive disorder (MDD), bipolar disorder (BPD), and schizophrenia (SCZ). RESULTS The array produced >800K directly genotyped and >21M imputed markers in 3494 unrelated, trauma-exposed males, of which 940 were diagnosed with partial or full PTSD. The GWAS meta-analysis identified the phosphoribosyl transferase domain containing 1 gene (PRTFDC1) as a genome-wide significant PTSD locus (rs6482463; OR=1.47, SE=0.06, p=2.04×10(-9)), with a similar effect across ancestry groups. Association of PRTFDC1 with PTSD in an independent military cohort showed some evidence for replication. Loci with suggestive evidence of association (n=25 genes, p<5×10(-6)) further implicated genes related to immune response and the ubiquitin system, but these findings remain to be replicated in larger GWASs. A replication analysis of 25 putative PTSD genes from the literature found nominally significant SNPs for the majority of these genes, but associations did not remain significant after correction for multiple comparison. A cross-disorder analysis of polygenic risk scores from GWASs of BPD, MDD, and SCZ found that PTSD diagnosis was associated with risk sores of BPD, but not with MDD or SCZ. CONCLUSIONS This first multi-ethnic/racial GWAS of PTSD highlights the potential to increase power through meta-analyses across ancestry groups. We found evidence for PRTFDC1 as a potential novel PTSD gene, a finding that awaits further replication. Our findings indicate that the genetic architecture of PTSD may be determined by many SNPs with small effects, and overlap with other neuropsychiatric disorders, consistent with current findings from large GWAS of other psychiatric disorders.
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Affiliation(s)
- Caroline M Nievergelt
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA; VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, La Jolla, CA 92161, USA.
| | - Adam X Maihofer
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA
| | - Maja Mustapic
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA; Department of Medicine, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA
| | - Kate A Yurgil
- VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, La Jolla, CA 92161, USA
| | - Nicholas J Schork
- Department of Molecular and Experimental Medicine, J. Craig Venter Institute, La Jolla, CA 92037, USA
| | - Mark W Miller
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Mark W Logue
- Biomedical Genetics, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Mark A Geyer
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA
| | - Victoria B Risbrough
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA; VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, La Jolla, CA 92161, USA
| | - Daniel T O'Connor
- Department of Medicine, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA
| | - Dewleen G Baker
- VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, La Jolla, CA 92161, USA; Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, CA 92093, USA
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12
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Huang MX, Yurgil KA, Robb A, Angeles A, Diwakar M, Risbrough VB, Nichols SL, McLay R, Theilmann RJ, Song T, Huang CW, Lee RR, Baker DG. Voxel-wise resting-state MEG source magnitude imaging study reveals neurocircuitry abnormality in active-duty service members and veterans with PTSD. Neuroimage Clin 2014; 5:408-19. [PMID: 25180160 PMCID: PMC4145534 DOI: 10.1016/j.nicl.2014.08.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/25/2014] [Accepted: 08/02/2014] [Indexed: 11/25/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a leading cause of sustained impairment, distress, and poor quality of life in military personnel, veterans, and civilians. Indirect functional neuroimaging studies using PET or fMRI with fear-related stimuli support a PTSD neurocircuitry model that includes amygdala, hippocampus, and ventromedial prefrontal cortex (vmPFC). However, it is not clear if this model can fully account for PTSD abnormalities detected directly by electromagnetic-based source imaging techniques in resting-state. The present study examined resting-state magnetoencephalography (MEG) signals in 25 active-duty service members and veterans with PTSD and 30 healthy volunteers. In contrast to the healthy volunteers, individuals with PTSD showed: 1) hyperactivity from amygdala, hippocampus, posterolateral orbitofrontal cortex (OFC), dorsomedial prefrontal cortex (dmPFC), and insular cortex in high-frequency (i.e., beta, gamma, and high-gamma) bands; 2) hypoactivity from vmPFC, Frontal Pole (FP), and dorsolateral prefrontal cortex (dlPFC) in high-frequency bands; 3) extensive hypoactivity from dlPFC, FP, anterior temporal lobes, precuneous cortex, and sensorimotor cortex in alpha and low-frequency bands; and 4) in individuals with PTSD, MEG activity in the left amygdala and posterolateral OFC correlated positively with PTSD symptom scores, whereas MEG activity in vmPFC and precuneous correlated negatively with symptom score. The present study showed that MEG source imaging technique revealed new abnormalities in the resting-state electromagnetic signals from the PTSD neurocircuitry. Particularly, posterolateral OFC and precuneous may play important roles in the PTSD neurocircuitry model. Resting-state MEG detects abnormal electromagnetic activity in PTSD neurocircuitry PTSD showed hyperactivity in amygdala, hippocampus, and orbitofrontal cortex PTSD showed hypoactivity in vmPFC, frontal pole, and dlPFC PTSD symptom score correlated with MEG activity
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Ashley Robb
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Annemarie Angeles
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Mithun Diwakar
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Victoria B Risbrough
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA ; Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sharon L Nichols
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Robert McLay
- Naval Medical Center San Diego, San Diego, CA, USA
| | - Rebecca J Theilmann
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Tao Song
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Charles W Huang
- Department of Bioengineering, University of California San Diego, San Diego, CA, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA ; Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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13
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Huang MX, Nichols S, Baker DG, Robb A, Angeles A, Yurgil KA, Drake A, Levy M, Song T, McLay R, Theilmann RJ, Diwakar M, Risbrough VB, Ji Z, Huang CW, Chang DG, Harrington DL, Muzzatti L, Canive JM, Christopher Edgar J, Chen YH, Lee RR. Single-subject-based whole-brain MEG slow-wave imaging approach for detecting abnormality in patients with mild traumatic brain injury. Neuroimage Clin 2014; 5:109-19. [PMID: 25009772 PMCID: PMC4087185 DOI: 10.1016/j.nicl.2014.06.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 01/13/2023]
Abstract
Traumatic brain injury (TBI) is a leading cause of sustained impairment in military and civilian populations. However, mild TBI (mTBI) can be difficult to detect using conventional MRI or CT. Injured brain tissues in mTBI patients generate abnormal slow-waves (1–4 Hz) that can be measured and localized by resting-state magnetoencephalography (MEG). In this study, we develop a voxel-based whole-brain MEG slow-wave imaging approach for detecting abnormality in patients with mTBI on a single-subject basis. A normative database of resting-state MEG source magnitude images (1–4 Hz) from 79 healthy control subjects was established for all brain voxels. The high-resolution MEG source magnitude images were obtained by our recent Fast-VESTAL method. In 84 mTBI patients with persistent post-concussive symptoms (36 from blasts, and 48 from non-blast causes), our method detected abnormalities at the positive detection rates of 84.5%, 86.1%, and 83.3% for the combined (blast-induced plus with non-blast causes), blast, and non-blast mTBI groups, respectively. We found that prefrontal, posterior parietal, inferior temporal, hippocampus, and cerebella areas were particularly vulnerable to head trauma. The result also showed that MEG slow-wave generation in prefrontal areas positively correlated with personality change, trouble concentrating, affective lability, and depression symptoms. Discussion is provided regarding the neuronal mechanisms of MEG slow-wave generation due to deafferentation caused by axonal injury and/or blockages/limitations of cholinergic transmission in TBI. This study provides an effective way for using MEG slow-wave source imaging to localize affected areas and supports MEG as a tool for assisting the diagnosis of mTBI. A voxel-based whole-brain MEG slow-wave source imaging method for mild TBI. The new approach showed 84.5% positive detection rate in 84 mild TBI patients. The new approach detected loci of injury in mild TBI patients on a single-subject basis. MEG slow-wave source imaging revealed brain areas vulnerable to mild TBI. MEG slow-wave generations correlated with mild TBI symptoms.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Psychiatry, University of California, San Diego, CA, USA ; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Ashley Robb
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Annemarie Angeles
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Michael Levy
- Rady Children's Hospital San Diego, University of California, San Diego, CA, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, CA, USA
| | - Robert McLay
- Naval Medical Center San Diego, San Diego, CA, USA
| | | | - Mithun Diwakar
- Department of Radiology, University of California, San Diego, CA, USA
| | - Victoria B Risbrough
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Psychiatry, University of California, San Diego, CA, USA ; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, CA, USA
| | | | - Douglas G Chang
- Department of Orthopaedics, University of California, San Diego, CA, USA
| | - Deborah L Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Radiology, University of California, San Diego, CA, USA
| | - Laura Muzzatti
- Department of Radiology, University of California, San Diego, CA, USA
| | - Jose M Canive
- Psychiatry Research, New Mexico VA Healthcare System, Albuquerque, NM, USA ; Departments of Psychiatry and Neurosciences, University of New Mexico, Albuquerque, NM, USA
| | - J Christopher Edgar
- The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Yu-Han Chen
- Departments of Psychiatry and Neurosciences, University of New Mexico, Albuquerque, NM, USA ; The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Radiology, University of California, San Diego, CA, USA
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14
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Yurgil KA, Barkauskas DA, Vasterling JJ, Nievergelt CM, Larson GE, Schork NJ, Litz BT, Nash WP, Baker DG. Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty Marines. JAMA Psychiatry 2014; 71:149-57. [PMID: 24337530 DOI: 10.1001/jamapsychiatry.2013.3080] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Whether traumatic brain injury (TBI) is a risk factor for posttraumatic stress disorder (PTSD) has been difficult to determine because of the prevalence of comorbid conditions, overlapping symptoms, and cross-sectional samples. OBJECTIVE To examine the extent to which self-reported predeployment and deployment-related TBI confers increased risk of PTSD when accounting for combat intensity and predeployment mental health symptoms. DESIGN, SETTING, AND PARTICIPANTS As part of the prospective, longitudinal Marine Resiliency Study (June 2008 to May 2012), structured clinical interviews and self-report assessments were administered approximately 1 month before a 7-month deployment to Iraq or Afghanistan and again 3 to 6 months after deployment. The study was conducted at training areas on a Marine Corps base in southern California or at Veterans Affairs San Diego Medical Center. Participants for the final analytic sample were 1648 active-duty Marine and Navy servicemen who completed predeployment and postdeployment assessments. Reasons for exclusions were nondeployment (n = 34), missing data (n = 181), and rank of noncommissioned and commissioned officers (n = 66). MAIN OUTCOMES AND MEASURES The primary outcome was the total score on the Clinician-Administered PTSD Scale (CAPS) 3 months after deployment. RESULTS At the predeployment assessment, 56.8% of the participants reported prior TBI; at postdeployment assessment, 19.8% reported sustaining TBI between predeployment and postdeployment assessments (ie, deployment-related TBI). Approximately 87.2% of deployment-related TBIs were mild; 250 of 287 participants (87.1%) who reported posttraumatic amnesia reported less than 24 hours of posttraumatic amnesia (37 reported ≥ 24 hours), and 111 of 117 of those who lost consciousness (94.9%) reported less than 30 minutes of unconsciousness. Predeployment CAPS score and combat intensity score raised predicted 3-month postdeployment CAPS scores by factors of 1.02 (P < .001; 95% CI, 1.02-1.02) and 1.02 (P < .001; 95% CI, 1.01-1.02) per unit increase, respectively. Deployment-related mild TBI raised predicted CAPS scores by a factor of 1.23 (P < .001; 95% CI, 1.11-1.36), and moderate/severe TBI raised predicted scores by a factor of 1.71 (P < .001; 95% CI, 1.37-2.12). Probability of PTSD was highest for participants with severe predeployment symptoms, high combat intensity, and deployment-related TBI. Traumatic brain injury doubled or nearly doubled the PTSD rates for participants with less severe predeployment PTSD symptoms. CONCLUSIONS AND RELEVANCE Even when accounting for predeployment symptoms, prior TBI, and combat intensity, TBI during the most recent deployment is the strongest predictor of postdeployment PTSD symptoms.
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Affiliation(s)
- Kate A Yurgil
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California2Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, California
| | - Donald A Barkauskas
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Jennifer J Vasterling
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts 5Division of Behavioral Sciences, Veterans Affairs National Center for Posttraumatic Stress Syndrome, Boston, Massachusetts 6Department of Psychology, Veterans Affairs B
| | - Caroline M Nievergelt
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California2Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, California7Department of Psychiatry, School of Medicine, University of California
| | - Gerald E Larson
- Department of Behavioral Science and Epidemiology, Naval Health Research Center, San Diego, California
| | - Nicholas J Schork
- Department of Molecular and Experimental Medicine, Scripps Translational Research Institute, San Diego, California
| | - Brett T Litz
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts 5Division of Behavioral Sciences, Veterans Affairs National Center for Posttraumatic Stress Syndrome, Boston, Massachusetts 6Department of Psychology, Veterans Affairs B
| | - William P Nash
- Boston Veterans Affairs Research Institute, Boston, Massachusetts
| | - Dewleen G Baker
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California2Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, California7Department of Psychiatry, School of Medicine, University of California
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15
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Yurgil KA, Golob EJ. Cortical potentials in an auditory oddball task reflect individual differences in working memory capacity. Psychophysiology 2013; 50:1263-74. [PMID: 24016201 PMCID: PMC4082305 DOI: 10.1111/psyp.12140] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 07/18/2013] [Indexed: 11/30/2022]
Abstract
This study determined whether auditory cortical responses associated with mechanisms of attention vary with individual differences in working memory capacity (WMC) and perceptual load. The operation span test defined subjects with low versus high WMC, who then discriminated target/nontarget tones while EEG was recorded. Infrequent white noise distracters were presented at midline or ±90° locations, and perceptual load was manipulated by varying nontarget frequency. Amplitude of the N100 to distracters was negatively correlated with WMC. Relative to targets, only high WMC subjects showed attenuated N100 amplitudes to nontargets. In the higher WMC group, increased perceptual load was associated with decreased P3a amplitudes to distracters and longer-lasting negative slow wave to nontargets. Results show that auditory cortical processing is associated with multiple facets of attention related to WMC and possibly higher-level cognition.
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Affiliation(s)
- Kate A. Yurgil
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161
- VA San Diego Healthcare System, San Diego, CA 92161
- Department of Psychology, Tulane University, New Orleans, LA 70118
| | - Edward J. Golob
- Department of Psychology, Tulane University, New Orleans, LA 70118
- Program in Neuroscience, Tulane University, New Orleans, LA 70118
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16
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Agorastos A, Nash WP, Nunnink S, Yurgil KA, Goldsmith A, Litz BT, Johnson H, Lohr JB, Baker DG. The Peritraumatic Behavior Questionnaire: development and initial validation of a new measure for combat-related peritraumatic reactions. BMC Psychiatry 2013; 13:9. [PMID: 23289606 PMCID: PMC3598773 DOI: 10.1186/1471-244x-13-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/02/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is one of the most commonly observed stress-related conditions following combat exposure and its effective prevention is a high health-care priority. Reports of peritraumatic reactions have been shown to be highly associated with PTSD among combat exposed service members. However, existing instruments measuring peritraumatic symptoms were not specifically developed to assess combat-related peritraumatic stress and each demonstrates a different peritraumatic focus. We therefore developed the Peritraumatic Behavior Questionnaire (PBQ), a new military-specific rating scale focused upon the wide range of symptoms suggestive of combat-related peritraumatic distress in actively deployed Service Members. This study describes the development of the PBQ and reports on the psychometric properties of its self-rated version (PBQ-SR). METHODS 688 Marine infantry service members were retrospectively assessed by the PBQ-SR within the scope of the Marine Resiliency Study after their deployment to war zone. Participants have been additionally assessed by a variety of questionnaires, as well as clinical interviews both pre and post-deployment. RESULTS The PBQ-SR demonstrated satisfactory internal consistency, convergent and discriminant validity, as well as high correlation with trait dissociation prior to deployment. Component analysis suggested a latent bi-dimensional structure separating a peritraumatic emotional distress and physical awareness factor. The PBQ-SR total score showed high correlation to general anxiety, depression, poorer general health and posttraumatic symptoms after deployment and remained a significant predictor of PTSD severity, after controlling for those measures. The suggested screening cut-off score of 12 points demonstrated satisfactory predictive power. CONCLUSIONS This study confirms the ability of the PBQ-SR to unify the underlying peritraumatic symptom dimensions and reliably assess combat-related peritraumatic reaction as a general construct. The PBQ-SR demonstrated promise as a potential standard screening measure in military clinical practice, while It's predictive power should be established in prospective studies.
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Affiliation(s)
- Agorastos Agorastos
- Veterans Affairs Center of Excellence for Stress and Mental Health, VA San Diego, CA, USA
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - William P Nash
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sarah Nunnink
- Veterans Affairs Center of Excellence for Stress and Mental Health, VA San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Abigail Goldsmith
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Brett T Litz
- Department of Psychiatry and Department of Psychology, Boston University School of Medicine, Boston, MA, USA
- National Center for Post Traumatic Stress Disorder, VA Boston Healthcare System, Boston, MA, USA
| | | | - James B Lohr
- Veterans Affairs Center of Excellence for Stress and Mental Health, VA San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Dewleen G Baker
- Veterans Affairs Center of Excellence for Stress and Mental Health, VA San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0603V), 92093-0603V, La Jolla, CA, USA
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Yurgil KA, Golob EJ. Neural activity before and after conscious perception in dichotic listening. Neuropsychologia 2010; 48:2952-8. [PMID: 20542046 DOI: 10.1016/j.neuropsychologia.2010.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 05/28/2010] [Accepted: 06/03/2010] [Indexed: 10/19/2022]
Abstract
The neural basis of conscious perception can be studied using stimuli that elicit different percepts on different occasions (multistable perception). Multistable perception allows direct comparisons between brain activity and conscious perception that control for sensory input, and also serves as a model for attentional competition, with the winning perceptual outcome varying across trials. Dichotic listening tasks present multistable stimuli consisting of two different consonant-vowels (CVs, one/ear). For each trial one ear usually conveys the dominant percept. We used EEG to measure neural activity before and after dichotic stimulus presentation to compare activity among left vs. right ear percepts and a control task. Consonant-vowels were perceived more often to the right vs. left ear. Pre-stimulus EEG power in the beta band (16-20 Hz) increased for left compared to right ear percepts and control trials. Event-related potentials after stimulus onset showed smaller P50 amplitudes ( approximately 50 ms latency) for left ear compared to right ear and control trials. Results indicate that neural activity for right ear percepts is comparable to control conditions, while activity for the atypical left ear percept differs before and after stimulus onset. Pre-stimulus EEG changes for left ear percepts may indicate a mechanism of spontaneous fluctuations in cortical networks that bias attentional competition during subsequent sensory processing. The P50 amplitude differences among perceived ears suggests that rapid sensory and/or arousal-related activities contribute to the content of conscious perception, possibly by biasing attentional competition away from the dominant right ear channel.
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Affiliation(s)
- Kate A Yurgil
- Department of Psychology, Tulane University, New Orleans, LA 70118, United States
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