Predicting post-injury depression and PTSD risk
June 5, 2019
Science Daily/University of Pennsylvania School of Nursing
Although injury is unexpected and acute, it can result in long-term health problems and disability. Up to half of all patients experience postinjury depression and posttraumatic stress disorder (PTSD) in the months after injury, increasing suboptimal recovery, disability, and costs for care. For patients like urban black men, some of whom have experienced prior trauma, childhood adversity and neighborhood disadvantage, acute postinjury stress responses are exacerbated.
Addressing the psychological effects of injury can improve health and reduce the negative outcomes of injury. Yet, in a national survey, only seven percent of trauma centers incorporate routine screening for PTSD symptoms.
An original investigation from the University of Pennsylvania School of Nursing (Penn Nursing) explores the risk and protective factors that contribute to postinjury mental health symptoms in urban black men. It finds that those men with violent injuries as compared to non-violent injuries have more severe postinjury mental health symptoms. But importantly it shows the need to take into consideration prior life experiences, such as adverse childhood experiences, neighborhood disadvantage, pre-injury health and psychological resources in addition to acute stress responses to an injury event, in order to identify injured patients at highest risk for poor postinjury mental health outcomes.
"The intersection of prior trauma and adversity, prior exposure to challenging neighborhood disadvantage, and poorer preinjury health and functioning should not be overlooked in the midst of acute injury care when assessing for the risk of postinjury mental health symptoms," said lead-investigator Therese S. Richmond, PhD, CRNP, FAAN, the Andrea B. Laporte Professor of Nursing, and Associate Dean for Research & Innovation.
Results of the study are set for publication in an upcoming issue of JAMA Surgery in an article titled "Contributors to Postinjury Mental Health in Urban Black Men With Serious Injuries."
The three-and-a-half-year study focused on outcomes in more than 600 urban black men who were hospitalized for serious injury. The researchers followed study participants for three months after hospital discharge to access for depression and PTSD symptoms. Almost one half of study participants met the diagnostic criteria for depression and/or PTSD at follow-up.
"This study takes a life-trajectory approach, helps inform potential points of intervention to improve outcomes, and adds to understanding both risk and protective factors across the life trajectory in an understudied group at high risk for injury," said Richmond. "We must integrate psychological care into the very essence of trauma care if we are to improve outcomes from serious injuries. Because symptoms develop after hospital discharge, further developing and using screening instruments designed to predict the future development of postinjury mental health problems is warranted to focus services on those patients at highest risk."
https://www.sciencedaily.com/releases/2019/06/190605133516.htm
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PTSD may be physical and not only psychological
Brain's emotional control center shown to be physically larger
July 11, 2017
Science Daily/American Academy of Neurology
The part of the brain that helps control emotion may be larger in people who develop post-traumatic stress disorder (PTSD) after brain injury compared to those with a brain injury without PTSD, according to a new study.
"Many consider PTSD to be a psychological disorder, but our study found a key physical difference in the brains of military-trained individuals with brain injury and PTSD, specifically the size of the right amygdala," said Joel Pieper, MD, MS, of University of California, San Diego. "These findings have the potential to change the way we approach PTSD diagnosis and treatment."
In the brain there is a right and left amygdala. Together, they help control emotion, memories, and behavior. Research suggests the right amygdala controls fear and aversion to unpleasant stimuli.
For this study, researchers studied 89 current or former members of the military with mild traumatic brain injury. Using standard symptom scale ratings, 29 people were identified with significant PTSD. The rest had mild traumatic brain injury without PTSD.
The researchers used brain scans to measure the volume of various brain regions. The subjects with mild traumatic brain injury and PTSD had 6 percent overall larger amygdala volumes, particularly on the right side, compared to those with mild traumatic brain injury only.
No significant differences in age, education or gender between the PTSD and control groups were found.
"People who suffered a concussion and had PTSD demonstrated a larger amygdala size, so we wonder if amygdala size could be used to screen who is most at risk to develop PTSD symptoms after a mild traumatic brain injury," said Pieper. "On the other hand, if there are environmental or psychological cues that lead to brain changes and enlargement of the amygdala, then maybe such influences can be monitored and treated."
"Further studies are needed to better define the relationship between amygdala size and PTSD in mild traumatic brain injury," said Pieper. "Also, while these findings are significant, it remains to be seen whether similar results may be found in those with sports-related concussions."
He pointed out that these participants' brain injuries were caused mostly by blast injuries as opposed to sports-related concussions. The study also shows only an association and does not prove PTSD causes structural changes in the amygdala.
https://www.sciencedaily.com/releases/2017/07/170711171704.htm