Publications by authors named "Bekh Bradley"

150 Publications

Emotion dysregulation and dissociation contribute to decreased heart rate variability to an acute psychosocial stressor in trauma-exposed Black women.

J Psychiatr Res 2021 Oct 29;142:125-131. Epub 2021 Jul 29.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.

Reduced heart rate variability (HRV) in response to stress is a biomarker of emotion dysregulation (ED) and is related to posttraumatic stress disorder (PTSD), yet less is known about its role with dissociation in trauma-exposed adults. The goals of the current study were to examine unique patterns of associations between ED, dissociation, and PTSD with HRV at 15, 30, and 45 min (T1, T2, T3) following an acute psychosocial stressor task in a sample of 49 trauma-exposed, urban-dwelling Black women. Associations with baseline psychophysiology measures were also examined. ED and dissociation were assessed using self-report; PTSD was determined using a semi-structured interview. Heart rate (HR) and HRV, indexed with low frequency/high frequency (LF/HF) ratio and respiratory sinus arrhythmia (RSA), were measured with electrocardiogram recordings. ED and dissociation were positively correlated with LF/HF ratio at T3 (p < .05). There were no significant differences between individuals with PTSD versus those without PTSD in HR or HRV following acute stressor; PTSD diagnosis was related to higher HR at baseline. Latent growth modeling revealed that ED was associated with higher LF/HF ratio directly following acute stressor, while dissociation was associated with increase in LF/HF ratio over time. These findings demonstrate that ED is related to higher sympathetic reactivity for a prolonged period of time following stress exposure, while dissociation shows a delayed association with LF/HF ratio, suggesting a distinct impaired parasympathetic activation pattern exists for dissociation.
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http://dx.doi.org/10.1016/j.jpsychires.2021.07.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8429185PMC
October 2021

Association of Racial Discrimination With Neural Response to Threat in Black Women in the US Exposed to Trauma.

JAMA Psychiatry 2021 Sep;78(9):1005-1012

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.

Importance: Racial discrimination has a clear impact on health-related outcomes, but little is known about how discriminatory experiences are associated with neural response patterns to emotionally salient cues, which likely mediates these outcomes.

Objective: To examine associations of discriminatory experiences with brainwide response to threat-relevant cues in trauma-exposed US Black women as they engage in an attentionally demanding task.

Design, Setting, And Participants: A cross-sectional study was conducted from May 1, 2014, to July 1, 2019, among 55 trauma-exposed US Black women to examine associations of racial discrimination experiences with patterns of neural response and behavior to trauma-relevant images in an affective attentional control task. Posttraumatic stress disorder (PTSD) symptoms and trauma exposure were entered as covariates to isolate variance associated with experiences of racial discrimination.

Exposures: Varying levels of trauma, PTSD symptoms, and experiences of racial discrimination.

Main Outcomes And Measures: Experiences of Discrimination Questionnaire (EOD) (range, 0-9) for count of the number of situations for which each participant reported having unfair treatment for a racial reason. Experiences of trauma and PTSD symptoms were assessed with the Traumatic Events Inventory (TEI) (number of times the person was exposed to trauma; score range, 0-112) and PTSD Symptom Scale (PSS) (score range, 0-51). Response to trauma-relevant vs neutral distractor cues were assessed via functional magnetic resonance imaging during performance of an affective Stroop (attentional control) task. Statistical analyses were conducted at a whole-brain, voxelwise level with familywise error correction.

Results: In this study of 55 Black women in the US (mean [SD] age, 37.7 [10.7] years; range, 21-61 years), participants reported a mean (SD) TEI frequency of 33.0 (18.8) and showed moderate levels of current PTSD symptoms (mean [SD] PSS score, 15.4 [12.9]). Mean (SD) EOD scores were 2.35 (2.44) and were moderately correlated with current PTSD symptoms (PSS total: r = 0.36; P=.009) but not with age (r = 0.20; P = .15) or TEI frequency (r = -0.02; P = .89). During attention to trauma-relevant vs neutral images, more experiences of racial discrimination were associated with significantly greater response in nodes of emotion regulation and fear inhibition (ventromedial prefrontal cortex) and visual attention (middle occipital cortex) networks, even after accounting for trauma and severity of PTSD symptoms (brainwide familywise error corrected; r = 0.33 for ventromedial prefrontal cortex; P = .02). Racial discrimination was also associated with affective Stroop task performance; errors on trials with threat-relevant stimuli were negatively correlated with experiences of racial discrimination (r = -0.41; P = .003).

Conclusions And Relevance: These findings suggest that experiences of racial discrimination associate with disproportionately greater response in brain regions associated with emotion regulation and fear inhibition and visual attention. Frequent racism experienced by Black individuals may potentiate attentional and regulatory responses to trauma-relevant stressors and lead to heightened modulation of regulatory resources. This may represent an important neurobiological pathway for race-related health disparities.
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http://dx.doi.org/10.1001/jamapsychiatry.2021.1480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319825PMC
September 2021

Examining Individual and Synergistic Contributions of PTSD and Genetics to Blood Pressure: A Trans-Ethnic Meta-Analysis.

Front Neurosci 2021 23;15:678503. Epub 2021 Jun 23.

Department of Psychiatry, Case Western Reserve University, Cleveland, OH, United States.

Growing research suggests that posttraumatic stress disorder (PTSD) may be a risk factor for poor cardiovascular health, and yet our understanding of who might be at greatest risk of adverse cardiovascular outcomes after trauma is limited. In this study, we conducted the first examination of the individual and synergistic contributions of PTSD symptoms and blood pressure genetics to continuous blood pressure levels. We harnessed the power of the Psychiatric Genomics Consortium-PTSD Physical Health Working Group and investigated these associations across 11 studies of 72,224 trauma-exposed individuals of European ( = 70,870) and African ( = 1,354) ancestry. Genetic contributions to blood pressure were modeled via polygenic scores (PGS) for systolic blood pressure (SBP) and diastolic blood pressure (DBP) that were derived from a prior trans-ethnic blood pressure genome-wide association study (GWAS). Results of trans-ethnic meta-analyses revealed significant main effects of the PGS on blood pressure levels [SBP: β = 2.83, standard error (SE) = 0.06, < 1E-20; DBP: β = 1.32, SE = 0.04, < 1E-20]. Significant main effects of PTSD symptoms were also detected for SBP and DBP in trans-ethnic meta-analyses, though there was significant heterogeneity in these results. When including data from the largest contributing study - United Kingdom Biobank - PTSD symptoms were negatively associated with SBP levels (β = -1.46, SE = 0.44, = 9.8E-4) and positively associated with DBP levels (β = 0.70, SE = 0.26, = 8.1E-3). However, when excluding the United Kingdom Biobank cohort in trans-ethnic meta-analyses, there was a nominally significant positive association between PTSD symptoms and SBP levels (β = 2.81, SE = 1.13, = 0.01); no significant association was observed for DBP (β = 0.43, SE = 0.78, = 0.58). Blood pressure PGS did not significantly moderate the associations between PTSD symptoms and blood pressure levels in meta-analyses. Additional research is needed to better understand the extent to which PTSD is associated with high blood pressure and how genetic as well as contextual factors may play a role in influencing cardiovascular risk.
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http://dx.doi.org/10.3389/fnins.2021.678503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8262489PMC
June 2021

Impulsivity Mediates the Link between Childhood Sexual Abuse and Juvenile Incarceration among Low-Income African American Women.

J Aggress Maltreat Trauma 2021 26;30(3):389-409. Epub 2019 Nov 26.

Emory University School of Medicine and Atlanta VA Medical Center.

A history of childhood trauma has been found to have a robust influence on juvenile delinquency, and evidence suggests that childhood sexual abuse is particularly common among female youth involved in the juvenile justice system. The current study sought to investigate impulsivity as a potential mediator of the relationship between childhood sexual abuse (CSA) and juvenile incarceration amongst a community sample of low-income, urban, African American adult women. Although impulsivity has been studied among justice-involved youth, few studies have examined the influence of impulsivity within the relationship between CSA and juvenile incarceration and no known studies have explored their relationship in community populations of African American women with histories of juvenile incarceration. Results revealed that impulsivity mediated the relationship between CSA and previous juvenile incarceration. As an exploratory analysis, overall emotion dysregulation as well as other facets of emotion dysregulation did not serve as significant mediators in this relationship. These findings suggest that difficulties in impulse control may be one mechanism through which childhood sexual abuse increases risk for juvenile justice system involvement among African American women.
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http://dx.doi.org/10.1080/10926771.2019.1692981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171029PMC
November 2019

The roles of attachment and emotion dysregulation in the association between childhood maltreatment and PTSD in an inner-city sample.

Child Abuse Negl 2021 Aug 3;118:105139. Epub 2021 Jun 3.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA. Electronic address:

Background: Most people will experience a traumatic event in their lifetime, but only a subset (<10%) will develop posttraumatic stress disorder (PTSD).

Objective: To facilitate prevention and intervention of PTSD, it is important to understand how risk and resilience factors interact with one another to explain individual differences in risk for PTSD, especially in underprivileged groups, who often experience greater burden of trauma and PTSD.

Method: The current study utilized multiple and moderated regression to examine the relation between childhood maltreatment and adulthood PTSD risk in the context of various attachment patterns and emotion dysregulation in a sample (n = 856) of mostly low-income, African American participants.

Results: Moderation analysis indicated that the strongest association between self-reported childhood maltreatment and PTSD symptoms was manifest in participants reporting the highest levels of both attachment anxiety and attachment avoidance (b = 0.22, 95% CI [0.15, 0.29], p < .001), whereas, among those low on both these dimensions (i.e., more securely attached participants), there was no significant association between childhood maltreatment and current PTSD (b = 0.07, 95% CI [-0.01, 0.14], p = .07). Separately, multiple regression predicting current PTSD symptoms revealed an effect size for the two attachment dimensions similar to that of emotion dysregulation, while controlling for childhood maltreatment.

Conclusions: These findings suggest more secure attachment may buffer against the deleterious effects of childhood maltreatment, and both attachment difficulties and emotion dysregulation serve as robust correlates of adulthood PTSD.
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http://dx.doi.org/10.1016/j.chiabu.2021.105139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292198PMC
August 2021

Trauma exposure and stress-related disorders in a large, urban, predominantly African-American, female sample.

Arch Womens Ment Health 2021 May 15. Epub 2021 May 15.

Department of Psychiatry and Behavioral Sciences, Yerkes National Primate Research Center, Emory University School of Medicine, 954 Gatewood Rd, Atlanta, GA, 30329, USA.

The current study investigated the relationship between trauma exposure and psychopathology in a sample of predominately African-American women of low socioeconomic status (SES). Women (N = 7430) were recruited from medical clinics at two large public hospitals in Atlanta, GA, from 2005 to 2017. Women were assessed for sociodemographics, life-course trauma burden, posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) utilizing self-report and structured clinical interview assessments. The effects of trauma exposure on current and lifetime PTSD and MDD were examined. Ninety-one percent of women reported trauma exposure, 83% reported a monthly household income of less than $2000, and 41% reported a history of arrest. Regarding psychiatric diagnoses, 30.8% met the criteria for probable MDD, and 32.3% met the criteria for probable PTSD. History of childhood abuse and total lifetime trauma significantly increased PTSD and depressive symptoms with additional incremental trauma exposure. PTSD and depressive symptom scores (95% CI) increased from 5.5 (5.0-6.1) and 8.4 (7.9-9.0) in the no trauma group to 20.8 (20.1-21.5) and 20.4 (19.7-21.2), respectively, in those exposed to four or more types of trauma. These results show high rates of adult and childhood trauma exposure, PTSD, MDD, and an additive effect of lifetime trauma exposure on the development of PTSD and MDD in a sample of low SES African-American women. These findings bring light to the high psychiatric symptom burden in this population and call for increased availability of interventions to address symptoms as well as policies aimed at reducing trauma exposure across the lifespan.
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http://dx.doi.org/10.1007/s00737-021-01141-4DOI Listing
May 2021

Associations Between Emotion Dysregulation Dimensions and Parenting Behaviors in Trauma-Exposed African American Mothers.

Child Maltreat 2021 Jan 19:1077559520988352. Epub 2021 Jan 19.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.

Parenting behavior is key to understanding transmission of intergenerational trauma-related risk. Emotion dysregulation (ED) and psychological symptoms are associated with negative parenting behaviors, although their unique roles remain unclear. The current study examined associations of ED dimensions, depression, PTSD, and substance use with parenting behaviors in African American mothers. Participants included 98 mother-child dyads recruited from an urban hospital setting. Trauma exposure, ED, depression, substance use, and parenting behaviors (overreactivity, laxness, demandingness, warmth, corporal punishment) were assessed using self-report measures. PTSD was assessed using a semi-structured interview. Correlational results showed significant positive associations between ED and dysfunctional parenting behavior ( .001), overreactivity ( .001), and laxness ( .01) and negative associations with warmth ( .01). These associations varied across the dimensions of ED examined. Regression analyses were run to examine the unique effects of ED (separate models for overall and specific dimensions) and psychological symptoms; overall ED and its dimensions accounted for significant variance in parental behaviors ( = .10-.24, .01), while additional model steps including psychological symptoms were not significant except for the association between depression and lower warmth. In efforts to reduce the intergenerational effects of trauma, parenting interventions that include a direct focus on certain dimensions of ED may be critical.
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http://dx.doi.org/10.1177/1077559520988352DOI Listing
January 2021

DSM-5 alternative model for personality disorders trait domains and PTSD symptoms in a sample of highly traumatized African American women and a prospective sample of trauma center patients.

Personal Disord 2021 Jan 14. Epub 2021 Jan 14.

Department of Psychiatry and Behavioral Sciences.

Posttraumatic stress disorder (PTSD) has a specified precipitant (i.e., trauma), and thus, is particularly well-suited to examine risk and maintenance factors for the development of the disorder. The alternative model of personality disorder (AMPD) is based, in part, on a dimensional trait model; previous research suggests that personality traits are related to PTSD symptoms. To date, there is little research examining this model with regard to PTSD symptoms, and such research could elucidate new strategies for identification and prevention. The present study investigates associations between AMPD traits and PTSD symptoms in a cross-sectional high-risk sample ( = 490; 100% female; 97.8% African American) and in a prospective, longitudinal sample of Level 1 trauma center patients ( = 185; 46.8% female; 72.5% African American). The Personality Inventory for Brief Form domains were significantly associated with PTSD total symptom severity and symptom clusters across both self-report and clinical interview measures. Personality Inventory for Negative Affectivity and Psychoticism emerged as significant predictors of concurrent PTSD. When prospectively predicting PTSD symptoms in the longitudinal cohort, Negative Affectivity and Psychoticism were significant predictors of PTSD symptom severity. These findings indicate how the AMPD pathological traits are associated with risk for stress-related disorders cross-sectionally and prospectively. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/per0000477DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277882PMC
January 2021

Maternal influences on binge eating behaviors in children.

Psychiatry Res 2021 01 26;295:113600. Epub 2020 Nov 26.

Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States. Electronic address:

Binge eating in childhood has been linked to adverse future health outcomes. Parental factors, such as parents' emotion regulation and executive functioning, are likely to influence children's self-regulatory behaviors, including eating. Executive functioning describes a range of higher-order cognitive functions such as planning, abstraction, inhibitory control and working memory, which involves the ability to learn, update and manipulate new information while managing distractions. No studies have examined associations between maternal emotion regulation and executive functioning and the child's maladaptive eating patterns, which was the goal of the present study. Forty-eight mother and child pairs completed self-report clinical measures of emotion dysregulation and attentional control, and mothers completed a brief neuropsychological battery, which included executive functioning measures. Child's disordered eating was measured with the Child Binge Eating Disorder Scale. Linear regression results indicated that mother's performance on a working memory task and child's emotion dysregulation was significantly associated with child's binge eating symptoms (R  = 0.34). These data, which reveal that maternal executive functioning is associated with self-regulatory behaviors in children, indicate a possible mechanism through which maladaptive eating behaviors may emerge early in development. This relationship merits further exploration in larger-scale prospective intergenerational studies.
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http://dx.doi.org/10.1016/j.psychres.2020.113600DOI Listing
January 2021

Important Correlates of Purpose in Life Identified Through a Machine Learning Approach.

Am J Geriatr Psychiatry 2021 05 28;29(5):488-498. Epub 2020 Sep 28.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA; Division of Mental Health, Atlanta VA Medical Center, Decatur, GA. Electronic address:

Objective: A wealth of evidence has linked purpose in life (PiL) to better mental and physical health and healthy aging. Here, the authors aimed to determine important correlates of PiL using a machine learning approach.

Methods: Participants were recruited from retirement communities by the Rush Memory and Aging Project and assessed for childhood experience, adulthood sociodemographic factors (e.g., education, income, marital status), lifestyle and health behavior (e.g., cognitively stimulating activities, exercise, social activities, social network size), psychological factors (e.g., depression, loneliness, perceived discrimination, perceived social support), personality traits (e.g., PiL, harm avoidance), and medical conditions. Elastic Net was implemented to identify important correlates of PiL.

Results: A total of 1,839 participants were included in our analysis. Among the 23 variables provided to Elastic Net, 10 were identified as important correlates of PiL. In order of decreasing effect size, factors associated with lower PiL were loneliness, harm avoidance, older age, and depressive symptoms, while those associated with greater PiL were perceived social support, more social activities, more years of education, higher income, intact late-life cognitive performance, and more middle-age cognitive activities.

Conclusion: Our findings identify potentially important modifiable factors as targets for intervention strategies to enhance PiL.
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http://dx.doi.org/10.1016/j.jagp.2020.09.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004535PMC
May 2021

Impact of ADCYAP1R1 genotype on longitudinal fear conditioning in children: interaction with trauma and sex.

Neuropsychopharmacology 2020 09 26;45(10):1603-1608. Epub 2020 Jun 26.

McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA.

Dysregulated fear conditioned responses have been associated with PTSD in adults, with increased fear-potentiated startle (FPS) serving as a potential intermediate phenotype for PTSD risk. This phenotype has also been associated with stress-related ADCYAP1R1 gene variants in adult women. However, FPS and genotype have not yet been examined during development. The aim of this study was to examine developmental changes in fear conditioning, and to see whether these changes were impacted by genotype and trauma. Differential fear conditioning using FPS was tested in n = 63 children ages 8-13 at two visits (V1, V2) 1 year apart. Startle response was measured using electromyograph recordings of the eyeblink muscle. The rs2267735 SNP of the ADCYAP1R1 gene was extracted from genome-wide (GWAS) analyses. Trauma exposure was assessed using the Violence Exposure Scale-Revised (VEX-R). We found significant Visit by Genotype interactions, with CC genotype increasing FPS from V1 to V2. At V2 there was a Genotype by Violence interaction, with higher FPS in the CC vs G allele groups among those with higher violence exposure (F = 17.46, p = 0.0002). Females with the CC genotype had higher FPS compared to G allele females (F = 12.09, p = 0.002); there were no effects of genotype in males. This study showed Gene × Environment × Development and Gene × Sex effects of ADCYAP1R1 in a high-risk pediatric population. Those with the CC genotype and high levels of violence exposure, as well as females with the CC genotype, showed the greatest conditioned fear responses in adolescence.
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http://dx.doi.org/10.1038/s41386-020-0748-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7421882PMC
September 2020

Features of Childhood Maltreatment and Resilience Capacity in Adulthood: Results from a Large Community-Based Sample.

J Trauma Stress 2020 10 14;33(5):665-676. Epub 2020 Jun 14.

Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

Childhood maltreatment is consistently associated with poor outcomes. However, few epidemiological studies have examined the association between childhood maltreatment and adult resilience capacity, defined as one's perceived ability to cope successfully with challenges. This study aimed to determine associations between adult resilience capacity and specific types and features of childhood maltreatment. Participants were African American adults recruited from a public urban hospital in Atlanta, GA (N = 1,962) between 2005 and 2013. Childhood maltreatment, including witnessing domestic violence or physical, emotional, and sexual abuse, was assessed retrospectively using the Traumatic Events Inventory. Perceived resilience capacity was assessed using the Connor-Davidson Resilience Scale. Linear regressions were performed assessing the association between resilience capacity and childhood maltreatment exposure in general, as well as specific dimensions of exposure, including type, co-occurrence, and developmental timing, adjusting for covariates. Participants exposed to any maltreatment reported lower resilience capacity than unexposed peers, B = -0.38, SE = 0.04, p < .001. All maltreatment types were negatively associated with resilience capacity, even after adjusting for other lifetime trauma exposure. Only emotional abuse remained significantly associated with resilience capacity after accounting for current psychological distress, B = -0.11, SE = 0.05, p = .022. Maltreatment co-occurrence followed an inverse dose-response relationship with resilience capacity: For each additional maltreatment type, scores decreased by 0.18 units (SD = 0.02), p < .001. Finally, the developmental timing of maltreatment did not reveal any differential influences on resilience capacity. The results suggest that childhood emotional abuse and co-occurrence of maltreatment types may be particularly deleterious to adult resilience capacity.
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http://dx.doi.org/10.1002/jts.22543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828462PMC
October 2020

Measures of adult psychological resilience following early-life adversity: how congruent are different measures?

Psychol Med 2020 May 14:1-10. Epub 2020 May 14.

Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.

Background: Psychological resilience - positive psychological adaptation in the context of adversity - is defined and measured in multiple ways across disciplines. However, little is known about whether definitions capture the same underlying construct and/or share similar correlates. This study examined the congruence of different resilience measures and associations with sociodemographic factors and body mass index (BMI), a key health indicator.

Methods: In a cross-sectional sample of 1429 African American adults exposed to child maltreatment, we derived four resilience measures: a self-report scale assessing resiliency (perceived trait resilience); a binary variable defining resilience as low depression and posttraumatic stress (absence of distress); a binary variable defining resilience as low distress and high positive affect (absence of distress plus positive functioning); and a continuous variable reflecting individuals' deviation from distress levels predicted by maltreatment severity (relative resilience). Associations between resilience measures, sociodemographic factors, and BMI were assessed using correlations and regressions.

Results: Resilience measures were weakly-to-moderately correlated (0.27-0.69), though similarly patterned across sociodemographic factors. Women showed higher relative resilience, but lower perceived trait resilience than men. Only measures incorporating positive affect or resiliency perceptions were associated with BMI: individuals classified as resilient by absence of distress plus positive functioning had lower BMI than non-resilient (β = -2.10, p = 0.026), as did those with higher perceived trait resilience (β = -0.63, p = 0.046).

Conclusion: Relatively low congruence between resilience measures suggests studies will yield divergent findings about predictors, prevalence, and consequences of resilience. Efforts to clearly define resilience are needed to better understand resilience and inform intervention and prevention efforts.
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http://dx.doi.org/10.1017/S0033291720001191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863576PMC
May 2020

Genomic influences on self-reported childhood maltreatment.

Transl Psychiatry 2020 01 27;10(1):38. Epub 2020 Jan 27.

US Army Medical Research and Materiel Command, Fort Detrick, MD, USA.

Childhood maltreatment is highly prevalent and serves as a risk factor for mental and physical disorders. Self-reported childhood maltreatment appears heritable, but the specific genetic influences on this phenotype are largely unknown. The aims of this study were to (1) identify genetic variation associated with self-reported childhood maltreatment, (2) estimate SNP-based heritability (h), (3) assess predictive value of polygenic risk scores (PRS) for childhood maltreatment, and (4) quantify genetic overlap of childhood maltreatment with mental and physical health-related phenotypes, and condition the top hits from our analyses when such overlap is present. Genome-wide association analysis for childhood maltreatment was undertaken, using a discovery sample from the UK Biobank (UKBB) (n = 124,000) and a replication sample from the Psychiatric Genomics Consortium-posttraumatic stress disorder group (PGC-PTSD) (n = 26,290). h for childhood maltreatment and genetic correlations with mental/physical health traits were calculated using linkage disequilibrium score regression. PRS was calculated using PRSice and mtCOJO was used to perform conditional analysis. Two genome-wide significant loci associated with childhood maltreatment (rs142346759, p = 4.35 × 10, FOXP1; rs10262462, p = 3.24 × 10, FOXP2) were identified in the discovery dataset but were not replicated in PGC-PTSD. h for childhood maltreatment was ~6% and the PRS derived from the UKBB was significantly predictive of childhood maltreatment in PGC-PTSD (r = 0.0025; p = 1.8 × 10). The most significant genetic correlation of childhood maltreatment was with depressive symptoms (r = 0.70, p = 4.65 × 10), although we show evidence that our top hits may be specific to childhood maltreatment. This is the first large-scale genetic study to identify specific variants associated with self-reported childhood maltreatment. Speculatively, FOXP genes might influence externalizing traits and so be relevant to childhood maltreatment. Alternatively, these variants may be associated with a greater likelihood of reporting maltreatment. A clearer understanding of the genetic relationships of childhood maltreatment, including particular abuse subtypes, with a range of phenotypes, may ultimately be useful in in developing targeted treatment and prevention strategies.
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http://dx.doi.org/10.1038/s41398-020-0706-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026037PMC
January 2020

Psychometric Properties of the Personality Inventory for -Brief Form in a Community Sample with High Rates of Trauma Exposure.

J Pers Assess 2021 Mar-Apr;103(2):204-213. Epub 2020 Jan 29.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine.

In the current study, we used a sample of predominantly African-American women with high rates of trauma exposure (N = 434) to examine psychometric properties of the Personality Inventory for DSM-5-Brief Form (PID-5-BF). We compared model fit between a model with five correlated latent factors and a higher-order model in which the five latent factors were used to estimate a single "general pathology" factor. Additionally, we computed estimates of internal consistency and domain interrelations and examined indices of convergent/discriminant validity of the PID-5-BF domains by examining their relations to relevant criterion variables. The expected five-factor structure demonstrated good fit indices in a confirmatory factor analysis, and the more parsimonious, higher-order model was retained. Within this higher-order model, the first-order factors accounted for more variance in the criterion variables than the general pathology factor in most instances. The PID-5-BF domains were highly interrelated (s = .38 to .66), and convergent/discriminant validity of the domains varied: and generally showed the hypothesized pattern of relations with external criteria, while and displayed less consistent and discriminant relations. Results are discussed in terms of the costs and benefits of using brief pathological trait measures in samples characterized by high levels of psychopathology.
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http://dx.doi.org/10.1080/00223891.2020.1713138DOI Listing
June 2021

Attention bias towards threat in African American children exposed to early life trauma.

Behav Brain Res 2020 04 25;383:112513. Epub 2020 Jan 25.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, United States. Electronic address:

Background: Attentional bias is linked to a range of mood disorders, including posttraumatic stress disorder (PTSD). The present study examined attention bias patterns in African American children exposed to trauma, in order to better understand potential risk factors for PTSD.

Methods: 31 children (ages 8-14) completed an eye-tracking task to assess gaze bias patterns while viewing pairs of emotional and neutral faces. Trauma exposure and PTSD symptoms were assessed in a subsample of children (n = 24).

Results: Repeated measures analysis of variance (ANOVA) results examining attention bias indices and gender showed greater attention bias toward angry faces than happy faces (p < 0.01) and toward emotional faces in males than females (p < 0.05). Correlational analyses showed attention bias toward angry faces was associated with greater levels of child trauma exposure (p < 0.05). Based on linear regression analysis, child trauma exposure accounted for 17 % of variance in attention bias toward angry versus neutral faces independent of gender or posttraumatic stress symptoms (p < 0.05).

Conclusions: Trauma exposure in children is related to altered attention bias, via enhanced attention towards threatening cues. Results contribute to evidence that males and females may exhibit different attentional patterns. This study highlights the importance of additional research on attention bias patterns and prospective mental health outcomes across gender and through development.
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http://dx.doi.org/10.1016/j.bbr.2020.112513DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040527PMC
April 2020

Intergenerational effects of maternal PTSD: Roles of parenting stress and child sex.

Psychol Trauma 2020 Jan 9. Epub 2020 Jan 9.

Department of Psychiatry and Behavioral Sciences.

Objectives: Parental posttraumatic stress disorder (PTSD) increases children's risk for emotional and behavioral problems. We examined parenting stress and parenting behavior quality as mediators of the relation between maternal PTSD and problematic child behaviors in a sample at high risk for trauma exposure. We also examined whether child sex moderated this association.

Method: Participants were 141 African American mother-child dyads (children aged 8-12). Mothers reported PTSD severity, parenting stress, and child behavior (externalizing, internalizing, and emotional self-control). Parenting behavior quality (accounting for factors including parental warmth and engagement) was assessed from an observational parent-child interaction task.

Results: Parenting stress, but not observed parenting behavior quality, mediated the relation between maternal PTSD severity and child behaviors. Child sex moderated this association, such that the effect was stronger for girls.

Conclusions: Maternal PTSD may be associated with negative child behavior outcomes, and this relation appears to be mediated by increased parenting stress. Stress-reducing interventions for parents with PTSD could improve child outcomes, especially for girls. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/tra0000542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343607PMC
January 2020

Intergenerational transmission of risk for PTSD symptoms in African American children: The roles of maternal and child emotion dysregulation.

Psychol Trauma 2020 Jan 2. Epub 2020 Jan 2.

Atlanta Veterans Affairs Medical Center.

Objective: Emotion dysregulation is a transdiagnostic risk factor for many mental health disorders and develops in the context of early trauma exposure. Research suggests intergenerational risk associated with trauma exposure and posttraumatic stress disorder (PTSD), such that maternal trauma experiences and related symptoms can negatively impact child outcomes across development. The goals of the present study were to examine child and mother correlates of child PTSD symptoms and the unique roles of child and maternal emotion dysregulation in understanding child PTSD symptoms.

Method: Subjects included 105 African American mother-child dyads from an urban hospital serving primarily low-income minority individuals.

Results: Correlational results showed that child trauma exposure, child emotion dysregulation, maternal depressive symptoms, maternal emotion dysregulation, and potential for maternal child abuse all were significantly associated with child PTSD symptoms (s < 0.05). Hierarchical linear regression models revealed that child trauma exposure, maternal depression, and maternal abuse potential accounted for 29% of the variance in child PTSD symptoms ( < 0.001). Both child emotion dysregulation (² = 0.14, < .001) and maternal emotion dysregulation (² = 0.04, < .05) were significantly associated with child PTSD symptoms independent of other risk factors and potential for maternal abuse was no longer a significant predictor.

Conclusions: These results suggest that maternal emotion dysregulation may be an important factor in influencing their child's PTSD symptoms above and beyond child-specific variables. Both maternal and child emotion dysregulation could be valuable treatment targets for improving maternal mental health and parenting behaviors and bolstering child health outcomes, thus reducing intergenerational transmission of risk associated with trauma. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/tra0000543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329591PMC
January 2020

The role of negative affect in the association between attention bias to threat and posttraumatic stress: An eye-tracking study.

Psychiatry Res 2020 02 9;284:112674. Epub 2019 Dec 9.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Georgia, United States of America.

Biased processing of threatening stimuli, including attention toward and away from threat, has been implicated in the development and maintenance of PTSD symptoms. Research examining theoretically-derived mechanisms through which dysregulated processing of threat may be associated with PTSD is scarce. Negative affect, a transdiagnostic risk factor for many types of psychopathology, is one potential mechanism that has yet to be examined. Thus, the present study (n = 92) tested the indirect effect of attention bias on PTSD via negative affect using rigorous eye-tracking methodology in a sample of urban-dwelling, trauma-exposed African-American women. We found support for the hypothesis that attention bias toward threat was indirectly associated with PTSD symptoms through increased negative affect. These results suggest that negative affect may be an important etiological process through which attention bias patterns could impact PTSD symptom severity. Implications for psychological and pharmacological therapeutic interventions targeting threat-related attention biases and negative affect are discussed.
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http://dx.doi.org/10.1016/j.psychres.2019.112674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012707PMC
February 2020

The PedBE clock accurately estimates DNA methylation age in pediatric buccal cells.

Proc Natl Acad Sci U S A 2020 09 14;117(38):23329-23335. Epub 2019 Oct 14.

Department of Psychiatry, Harvard Medical School-McLean Hospital, Belmont, MA 02478.

The development of biological markers of aging has primarily focused on adult samples. Epigenetic clocks are a promising tool for measuring biological age that show impressive accuracy across most tissues and age ranges. In adults, deviations from the DNA methylation (DNAm) age prediction are correlated with several age-related phenotypes, such as mortality and frailty. In children, however, fewer such associations have been made, possibly because DNAm changes are more dynamic in pediatric populations as compared to adults. To address this gap, we aimed to develop a highly accurate, noninvasive, biological measure of age specific to pediatric samples using buccal epithelial cell DNAm. We gathered 1,721 genome-wide DNAm profiles from 11 different cohorts of typically developing individuals aged 0 to 20 y old. Elastic net penalized regression was used to select 94 CpG sites from a training dataset ( = 1,032), with performance assessed in a separate test dataset ( = 689). DNAm at these 94 CpG sites was highly predictive of age in the test cohort (median absolute error = 0.35 y). The Pediatric-Buccal-Epigenetic (PedBE) clock was characterized in additional cohorts, showcasing the accuracy in longitudinal data, the performance in nonbuccal tissues and adult age ranges, and the association with obstetric outcomes. The PedBE tool for measuring biological age in children might help in understanding the environmental and contextual factors that shape the DNA methylome during child development, and how it, in turn, might relate to child health and disease.
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http://dx.doi.org/10.1073/pnas.1820843116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519312PMC
September 2020

International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci.

Nat Commun 2019 10 8;10(1):4558. Epub 2019 Oct 8.

Durham VA Medical Center, Research, Durham, NC, USA.

The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5-20%, varying by sex. Three genome-wide significant loci are identified, 2 in European and 1 in African-ancestry analyses. Analyses stratified by sex implicate 3 additional loci in men. Along with other novel genes and non-coding RNAs, a Parkinson's disease gene involved in dopamine regulation, PARK2, is associated with PTSD. Finally, we demonstrate that polygenic risk for PTSD is significantly predictive of re-experiencing symptoms in the Million Veteran Program dataset, although specific loci did not replicate. These results demonstrate the role of genetic variation in the biology of risk for PTSD and highlight the necessity of conducting sex-stratified analyses and expanding GWAS beyond European ancestry populations.
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http://dx.doi.org/10.1038/s41467-019-12576-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6783435PMC
October 2019

Trauma, psychiatric disorders, and treatment history among pregnant African American women.

Psychol Trauma 2020 Feb 29;12(2):138-146. Epub 2019 Aug 29.

Department of Psychiatry and Behavioral Sciences.

Objective: Pregnant African American women living in low-income urban communities have high rates of trauma exposure and elevated risk for the development of trauma-related disorders, including posttraumatic stress disorder (PTSD) and depression. Yet, engagement in behavioral health services is lower for African American women than Caucasian women. Limited attention has been given to identifying trauma exposure and PTSD, especially within at-risk communities. The present study examined rates of trauma exposure, PTSD, depression, and behavioral health treatment engagement in an obstetrics/gynecology (OB/GYN) clinic within an urban hospital.

Method: The study included 633 pregnant African American women screened within the OB/GYN clinic waiting room; 55 of the women also participated in a subsequent detailed clinical assessment based on eligibility for a separate study of intergenerational risk for trauma and PTSD in African American mother-child dyads.

Results: Overall, 98% reported trauma exposure, approximately one third met criteria for probable current PTSD, and one third endorsed moderate-or-severe depression based on self-report measures. Similar levels were found based on clinical assessments in the subsample. While 18% endorsed depression treatment, only 6% received treatment for PTSD. In a subsample of women with whom chart reviews were conducted ( = 358), 15% endorsed a past psychiatric diagnosis but none shared their PTSD diagnosis with their OB/GYN provider.

Conclusion: Results of the current study highlight elevated levels of trauma exposure, PTSD, and depression in low-income, African American pregnant women served by this urban clinic, and demonstrate the need for better identification of trauma-related disorders and appropriate linkage to culturally responsive care especially for PTSD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/tra0000507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986992PMC
February 2020

Glucocorticoid-induced leucine zipper "quantifies" stressors and increases male susceptibility to PTSD.

Transl Psychiatry 2019 07 25;9(1):178. Epub 2019 Jul 25.

Department of Neurobiology, Weizmann Institute of Science, 76100, Rehovot, Israel.

Post-traumatic stress disorder (PTSD) selectively develops in some individuals exposed to a traumatic event. Genetic and epigenetic changes in glucocorticoid pathway sensitivity may be essential for understanding individual susceptibility to PTSD. This study focuses on PTSD markers in the glucocorticoid pathway, spotlighting glucocorticoid-induced leucine zipper (GILZ), a transcription factor encoded by the gene Tsc22d3 on the X chromosome. We propose that GILZ uniquely "quantifies" exposure to stressors experienced from late gestation to adulthood and that low levels of GILZ predispose individuals to PTSD in males only. GILZ mRNA and methylation were measured in 396 male and female human blood samples from the Grady Trauma Project cohort (exposed to multiple traumatic events). In mice, changes in glucocorticoid pathway genes were assessed following exposure to stressors at distinct time points: (i) CRF-induced prenatal stress (PNS) with, or without, additional exposure to (ii) PTSD induction protocol in adulthood, which induces PTSD-like behaviors in a subset of mice. In humans, the number of traumatic events correlated negatively with GILZ mRNA levels and positively with % methylation of GILZ in males only. In male mice, we observed a threefold increase in the number of offspring exhibiting PTSD-like behaviors in those exposed to both PNS and PTSD induction. This susceptibility was associated with reduced GILZ mRNA levels and epigenetic changes, not found in females. Furthermore, virus-mediated shRNA knockdown of amygdalar GILZ increased susceptibility to PTSD. Mouse and human data confirm that dramatic alterations in GILZ occur in those exposed to a stressor in early life, adulthood or both. Therefore, GILZ levels may help identify at-risk populations for PTSD prior to additional traumatic exposures.
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http://dx.doi.org/10.1038/s41398-019-0509-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658561PMC
July 2019

The differential effects of PTSD, MDD, and dissociation on CRP in trauma-exposed women.

Compr Psychiatry 2019 08 3;93:33-40. Epub 2019 Jul 3.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, United States of America.

Objective: C-reactive protein (CRP), a marker of systemic inflammation, has been associated with psychiatric disorders including major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Some research suggests that exposure to trauma can trigger increased activity in the inflammatory system. Dissociation is associated with chronic trauma exposure and may be an important factor in understanding the risk for psychiatric outcomes associated with inflammation. The main objective of the current study was to understand how CRP was related to trauma, dissociation, PTSD and MDD in a sample of 55 traumatized African American women with type 2 diabetes mellitus recruited from an urban hospital.

Method: High sensitivity CRP (hsCRP) was assayed through blood samples; psychiatric disorders were assessed with structured clinical interviews, dissociation was assessed with the Multiscale Dissociation Inventory, and exposure to trauma in childhood and adulthood was assessed with the Childhood Trauma Questionnaire and the Traumatic Events Inventory, respectively.

Results: Correlational results showed a significant association between higher concentrations of hsCRP and child abuse (p < 0.05), overall dissociation severity (p < 0.001), and PTSD symptoms (p < 0.01). ANOVA results showed significantly higher levels of hsCRP in those with current MDD, current PTSD, and remitted PTSD. A hierarchical linear regression model demonstrated a significant association between dissociation symptoms and greater hsCRP levels independent of childhood abuse, PTSD, and MDD (R∆ = 0.11, p = 0.001) and independent of emotion dysregulation (p < 0.05).

Conclusion: These findings suggest that dissociation symptoms among those with a history of trauma may be particularly associated with higher levels of inflammation.
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http://dx.doi.org/10.1016/j.comppsych.2019.06.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689425PMC
August 2019

Epigenetic upregulation of FKBP5 by aging and stress contributes to NF-κB-driven inflammation and cardiovascular risk.

Proc Natl Acad Sci U S A 2019 06 21;116(23):11370-11379. Epub 2019 May 21.

Institute of Epidemiology, Helmholtz Zentrum München - German Research Centre for Environmental Health, D-85764 Neuherberg, Germany.

Aging and psychosocial stress are associated with increased inflammation and disease risk, but the underlying molecular mechanisms are unclear. Because both aging and stress are also associated with lasting epigenetic changes, a plausible hypothesis is that stress along the lifespan could confer disease risk through epigenetic effects on molecules involved in inflammatory processes. Here, by combining large-scale analyses in human cohorts with experiments in cells, we report that FKBP5, a protein implicated in stress physiology, contributes to these relations. Across independent human cohorts (total > 3,000), aging synergized with stress-related phenotypes, measured with childhood trauma and major depression questionnaires, to epigenetically up-regulate expression. These age/stress-related epigenetic effects were recapitulated in a cellular model of replicative senescence, whereby we exposed replicating human fibroblasts to stress (glucocorticoid) hormones. Unbiased genome-wide analyses in human blood linked higher mRNA with a proinflammatory profile and altered NF-κB-related gene networks. Accordingly, experiments in immune cells showed that higher promotes inflammation by strengthening the interactions of NF-κB regulatory kinases, whereas opposing FKBP5 either by genetic deletion (CRISPR/Cas9-mediated) or selective pharmacological inhibition prevented the effects on NF-κB. Further, the age/stress-related epigenetic signature enhanced response to NF-κB through a positive feedback loop and was present in individuals with a history of acute myocardial infarction, a disease state linked to peripheral inflammation. These findings suggest that aging/stress-driven FKBP5-NF-κB signaling mediates inflammation, potentially contributing to cardiovascular risk, and may thus point to novel biomarker and treatment possibilities.
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http://dx.doi.org/10.1073/pnas.1816847116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561294PMC
June 2019

Powerful and Efficient Strategies for Genetic Association Testing of Symptom and Questionnaire Data in Psychiatric Genetic Studies.

Sci Rep 2019 05 17;9(1):7523. Epub 2019 May 17.

Center for Computational and Quantitative Genetics, Emory University, Atlanta, GA, USA.

Genetic studies of psychiatric disorders often deal with phenotypes that are not directly measurable. Instead, researchers rely on multivariate symptom data from questionnaires and surveys like the PTSD Symptom Scale (PSS) and Beck Depression Inventory (BDI) to indirectly assess a latent phenotype of interest. Researchers subsequently collapse such multivariate questionnaire data into a univariate outcome to represent a surrogate for the latent phenotype. However, when a causal variant is only associated with a subset of collapsed symptoms, the effect will be challenging to detect using the univariate outcome. We describe a more powerful strategy for genetic association testing in this situation that jointly analyzes the original multivariate symptom data collectively using a statistical framework that compares similarity in multivariate symptom-scale data from questionnaires to similarity in common genetic variants across a gene. We use simulated data to demonstrate this strategy provides substantially increased power over standard approaches that collapse questionnaire data into a single surrogate outcome. We also illustrate our approach using GWAS data from the Grady Trauma Project and identify genes associated with BDI not identified using standard univariate techniques. The approach is computationally efficient, scales to genome-wide studies, and is applicable to correlated symptom data of arbitrary dimension.
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http://dx.doi.org/10.1038/s41598-019-44046-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525248PMC
May 2019

PTSD and self-rated health in urban traumatized African American adults: The mediating role of emotion regulation.

Psychol Trauma 2020 Jan 16;12(1):84-91. Epub 2019 May 16.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine.

Objective: Although previous research has demonstrated a link between posttraumatic stress disorder (PTSD) and self-rated health, the role of regulatory processes within this relationship has yet to be fully understood for African American urban populations. The goal of the present study was to determine whether emotion dysregulation mediated the relationship between PTSD diagnosis and self-rated health problems.

Method: Data were collected from 446 adult participants (92% female, 97% African American) between the ages of 18 and 65 years who were recruited as part of the Grady Trauma Project, a National Institutes of Health-funded study of risk and resilience factors related to PTSD. Participants were recruited from a public hospital, and interviews included demographic characteristics, self-rating of health, assessment of emotion dysregulation using the Difficulties in Emotion Regulation Scale, and PTSD diagnosis using the Modified PTSD Symptom Scale.

Results: Results revealed that emotion dysregulation significantly mediated the relationship between PTSD and self-rated health. Exploratory analyses revealed that specific dimensions of emotion regulation were significant mediators in this relationship. Age, sex, education, marital status, income, and total number of lifetime traumas experienced were controlled for in all analyses.

Conclusions: Our findings suggest that emotion dysregulation may play a significant role in the PTSD-health relationship for African Americans. Future research investigating culturally relevant emotion regulation strategies are warranted given likely consequences for both physical and mental health outcomes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/tra0000472DOI Listing
January 2020

Attentional control abnormalities in posttraumatic stress disorder: Functional, behavioral, and structural correlates.

J Affect Disord 2019 06 30;253:343-351. Epub 2019 Apr 30.

Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States; Atlanta VA Medical Center, United States.

Background: Attentional disruptions are common in PTSD, but findings across neuropsychological and neuroimaging studies have been variable. Few PTSD studies have investigated abnormalities in attention networks using a multi-modal imaging approach and attentional tasks that include emotionally-salient images. This study combined a behavioral task that included these images (emotional Stroop) with functional and structural neuroimaging (fMRI and diffusion tensor imaging; DTI) methods to comprehensively investigate attentional control abnormalities in a highly-traumatized civilian sample.

Methods: 48 traumatized women with and without PTSD received clinical assessments, fMRI and DTI. During fMRI, the Affective Stroop (AS), an attentional control task that includes emotionally-salient distractor images (trauma-relevant, positive, neutral) and variable task demands, was administered.

Results: In response to more difficult AS trials, participants with PTSD demonstrated lower activation in the dorsal and rostral anterior cingulate cortex and greater activation in the insula. This group also showed comparatively poorer performance on positive AS distractor trials, even after adjusting for trauma exposure. Performance on these trials inversely correlated with structural integrity of the cingulum bundle and uncinate fasciculus.

Conclusions: Even after adjusting for trauma exposure, participants with PTSD showed worse performance on an attentional control task in the context of emotional stimuli. They also showed relatively lower cognitive control network activation and greater salience network activation. Fronto-parietal and fronto-limbic white matter connectivity corresponded with AS performance. Our findings indicate that attentional control impairments in PTSD are most evident in the context of emotional cues, and are related to decrements in function and structure of cognitive control and salience networks.
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http://dx.doi.org/10.1016/j.jad.2019.04.098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857173PMC
June 2019

Attention bias toward threatening faces in women with PTSD: eye tracking correlates by symptom cluster.

Eur J Psychotraumatol 2019 13;10(1):1568133. Epub 2019 Feb 13.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.

Maladaptive patterns of attention to emotional stimuli are a common feature of posttraumatic stress disorder (PTSD), with growing evidence supporting sustained attention to threatening stimuli across trauma samples. However, it remains unclear how different PTSD symptom clusters are associated with attentional bias patterns, particularly in urban civilian settings with high rates of trauma exposure and PTSD. The present study examined associations among these variables in 70 traumatized primarily African American women. PTSD was measured using the Clinician Administered PTSD Scale, and eye tracking was used to measure patterns of attention as participants engaged in an attention bias (dot probe) task to emotional faces; average initial fixation (1 s) and dwell duration (overall time spent looking at emotional face versus neutral face across the 5 s task) were used to assess attention bias patterns toward emotional faces. Women with PTSD showed significantly longer dwell duration toward angry faces than women without PTSD (5.16, .05). Bivariate correlation analyses with the PTSD symptom clusters showed a significant association between average initial fixation toward angry faces and higher levels of avoidance symptoms (0.29, .05) as well as sustained attention to angry faces and higher levels of re-experiencing symptoms (0.24, .05). Using separate linear regression models based on initial significant correlations, we found that PTSD avoidance symptoms were significantly related to average initial fixation toward angry faces ( = 0.09, .05) and PTSD re-experiencing symptoms were significantly related to dwell duration toward angry faces ( = 0.06, .05). These findings contribute to evidence that PTSD is related to both initial vigilance and sustained attention to threat and that certain symptom clusters may either drive or be more impacted by attentional biases, highlighting the benefits of addressing attentional biases within treatment.
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http://dx.doi.org/10.1080/20008198.2019.1568133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374933PMC
February 2019

Cognitive and neural facets of dissociation in a traumatized population.

Emotion 2019 Aug 20;19(5):863-875. Epub 2018 Aug 20.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine.

Dissociative phenomena are frequently experienced by psychologically traumatized people. However, little is known about the cognitive profiles of highly dissociative traumatized individuals, and corresponding patterns of neural connectivity when attentional networks are engaged in the context of emotion. One hundred seventeen traumatized women completed the multiscale dissociation inventory (MDI) and neuropsychological testing; MDI scores were used to classify high- and low-dissociative participants. Forty-six participants also underwent fMRI during performance of an attentional control task that incorporates emotionally distracting images (Affective Number Stroop; ANS). Compared to low-dissociative participants, high-dissociative participants demonstrated better performance on an executive functioning task (F1,111 = 4.64, p = .03), worse performance on a task of visual memory (F1,111 = 9.52, p = .003), and similar performance on all other neuropsychological measures. In addition, dissociative symptoms were negatively correlated with functional connectivity between the amygdala and right anterior insula in response to trauma-related ANS trials. These findings indicate that highly dissociative traumatized people experience difficulties with attentional control in the context of emotionally evocative stimuli, but in a neutral context, their overall cognitive profiles are similar to low-dissociative people. Highly dissociative participants also demonstrated weaker connectivity between the amygdala and insula in response to trauma-relevant images. Evocative, trauma-relevant stimuli appear to disrupt neutral networks involved with attention to salient cues and interoception in highly dissociative traumatized individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/emo0000466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382601PMC
August 2019
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