Post-traumatic stress disorder
PTSD
Research on how re-experiencing, avoidance, and heightened arousal persist after trauma and how everyday functioning changes.
Research question
Could repeated imaging and symptom assessments before and after trauma establish when differences in hippocampal volume first appear?
Findings
Symptoms and functioning after trauma
NICE guidance considers re-experiencing, avoidance, heightened arousal, and changes in mood and thinking alongside everyday functional impairment when assessing PTSD.
Hippocampal volume across 16 cohorts
ENIGMA-PGC analyzed MRI and clinical data from 1,868 people, including 794 with PTSD. People with current PTSD had smaller hippocampal volumes on average than trauma-exposed controls (standardized difference d = −0.17).
Genomic loci in the PGC PTSD study
The PGC PTSD genome-wide study identified 81 associated loci in its European-ancestry analysis and 85 in its multi-ancestry analysis. Across both analyses, 95 distinct loci passed the genome-wide significance threshold.
Two psychotherapies compared in veterans
In a randomized study of 916 US veterans, PTSD symptoms improved in both the prolonged exposure and cognitive processing therapy groups. The mean difference between groups was statistically significant and fell below the prespecified threshold for clinical importance.
Predicting three-month outcomes after a motor vehicle collision
An AURORA analysis included 1,003 emergency department patients who completed a three-month assessment after a motor vehicle collision. A model trained in other regions had an AUC of 0.815 for identifying the combined outcome of PTSD or a major depressive episode at three months in a Southern US test sample.
Early intervention after trauma in people with marked symptoms
A Jerusalem randomized trial compared early interventions in recent trauma survivors who met PTSD symptom criteria. At five months, 21.6% of the early prolonged exposure group (63 assigned) and 57.1% of the comparable waitlist group met PTSD criteria in clinician interviews (odds ratio 0.21, 95% CI 0.09–0.46). The waitlist group was later offered treatment, changing the interpretation of longer-term comparisons.
PTSD symptoms and type 2 diabetes incidence
A 22-year analysis of 49,739 women in the US Nurses’ Health Study II found a hazard ratio for incident type 2 diabetes of 1.8 (95% CI 1.5–2.1) among women reporting six or seven PTSD screening symptoms, compared with women reporting no trauma exposure. The observational association comes from a cohort of women who reported trauma and symptoms retrospectively.
Limitations
The analysis estimated an average difference in hippocampal volume between groups. Distinguishing a pre-existing difference from one that emerged after trauma requires repeated measurements.
Original sources
Post-traumatic stress disorder (NG116)
National Institute for Health and Care Excellence
Smaller Hippocampal Volume in Posttraumatic Stress Disorder: A Multisite ENIGMA-PGC Study: Subcortical Volumetry Results From Posttraumatic Stress Disorder Consortia
Mark W. Logue et al.
Genome-wide association analyses identify 95 risk loci and provide insights into the neurobiology of post-traumatic stress disorder
Caroline M. Nievergelt et al.
Comparison of Prolonged Exposure vs Cognitive Processing Therapy for Treatment of Posttraumatic Stress Disorder Among US Veterans: A Randomized Clinical Trial
Paula P. Schnurr et al.
Development and Validation of a Model to Predict Posttraumatic Stress Disorder and Major Depression After a Motor Vehicle Collision
Hannah N. Ziobrowski et al.
Prevention of posttraumatic stress disorder by early treatment: results from the Jerusalem Trauma Outreach And Prevention study
Arieh Y. Shalev et al.
Posttraumatic stress disorder and incidence of type 2 diabetes mellitus in a sample of women: a 22-year longitudinal study
Andrea L. Roberts et al.