Ongoing traumatic stress during a global pandemic.

OBJECTIVE: The COVID-19 pandemic has been conceptualized as a potentially traumatic event, although heterogeneity in experience (e.g., isolation) and in type and severity of traumatic stress response (e.g., hygiene hypervigilance) query the applicability of the posttraumatic stress disorder (PTSD) diagnostic construct. Parallels may be drawn to chronic illness and continuous traumatic situations (CTS) literature, which suggests unique symptom presentations that may occur during cumulative, ongoing traumas. METHOD: Eighty-four adults completed the PTSD Checklist with appended questions evaluating pandemic index events, temporality of intrusive symptoms, self-appraised abnormality, and context dependence of symptoms. Using exploratory latent profile analysis, we modeled the latent structure of traumatic stress response to COVID-19 in order to evaluate possible nuanced patterns of symptoms differentiating PTSD from a transient ongoing trauma response. RESULTS: Two profiles broadly delineated by severity across all variables emerged, suggesting the framework of PTSD is apt when applied to COVID-19. However, secondary analyses revealed subtle signals supporting chronic illness and CTS frameworks. Specifically, some participants who met criteria for PTSD did not endorse index events meeting Criterion A, most endorsed intrusive symptoms related to a present or future threat (versus a past trauma), and 30% reported their symptoms to be context dependent. CONCLUSION: Results highlight a need for improved assessment and opportunities for treatment modification. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mental health and resilience during the coronavirus pandemic: A machine learning approach.

OBJECTIVE: This study explored risk and resilience factors of mental health functioning during the coronavirus disease (COVID-19) pandemic. METHODS: A sample of 467 adults (M age = 33.14, 63.6% female) reported on mental health (depression, anxiety, posttraumatic stress disorder [PTSD], and somatic symptoms), demands and impacts of COVID-19, resources (e.g., social support, health care access), demographics, and psychosocial resilience factors. RESULTS: Depression, anxiety, and PTSD rates were 44%, 36%, and 23%, respectively. Supervised machine learning models identified psychosocial factors as the primary significant predictors across outcomes. Greater trauma coping self-efficacy and forward-focused coping, but not trauma-focused coping, were associated with better mental health. When accounting for psychosocial resilience factors, few external resources and demographic variables emerged as significant predictors. CONCLUSION: With ongoing stressors and traumas, employing coping strategies that emphasize distraction over trauma processing may be warranted. Clinical and community outreach efforts should target trauma coping self-efficacy to bolster resilience during a pandemic.

The power of appraisals in predicting PTSD symptom improvement following cognitive rehabilitation: A randomized clinical trial.

BACKGROUND: Patients with PTSD often voice concern over their perceived change in cognitive functioning. However, these negative appraisals do not always align with objective neuropsychological performance, yet are strongly predictive of PTSD symptom severity and self-reported functional impairment. METHODS: The present study involves a secondary analysis examining the role of appraisals of a subsample of 81 adults with full or subthreshold PTSD on treatment outcomes in a randomized controlled trial investigating the effectiveness of a cognitive rehabilitation treatment, Strategic Memory and Reasoning Training (n = 38), compared to a psychoeducation control arm, the Brain Health Workshop (n = 43). Neither condition addressed PTSD symptoms, focusing instead on cognitive skills training and psychoeducation about the brain. RESULTS: Intent-to-treat models showed statistically significant improvements for both groups on composite scores of executive functioning and memory. Additionally, both groups experienced clinically significant reductions in PTSD symptoms (assessed via the Clinician-Administered PTSD Interview) and the SMART group showed fewer negative appraisals about cognitive functioning following training. Change in appraisals of cognitive functioning was associated with change in PTSD as well as change in quality of life, with no differential associations based on group status. In contrast, neurocognitive test score changes were not associated with change in symptoms or functional outcomes. LIMITATIONS: We did not collect data on other appraisals (e.g., self-efficacy), which could have further elucidated pathways of change. CONCLUSIONS: Our findings suggest that interventions that do not directly target PTSD symptoms can lead to PTSD symptom change via change in appraisals of functioning.

Social engagement, self-efficacy, and posttraumatic stress symptoms across 6 months of psychotherapy.

OBJECTIVE: The current study was conducted in a naturalistic treatment setting to examine whether and how perceptions about social engagement, trauma coping self-efficacy, and posttraumatic stress symptoms (PTS) influence one another across 6 months of psychotherapy for trauma survivors. METHOD: The sample included 183 clients who reported exposure to traumatic events and significant PTS (PCL-5 ≥ 33). Participants (Mage = 37.8, 53.6% female) completed surveys at intake, 3 months, and 6 months into treatment. A cross-lagged panel analysis was used to test the relationships among perceived social engagement, coping self-efficacy, and PTS across three assessment points. RESULTS: PTS at 3-months was a mediator in the relationship between intake perceived social engagement and 6-month coping self-efficacy and between intake perceived social engagement and 6-month perceived social engagement. CONCLUSIONS: PTS several months into treatment may serve as a mechanism between intake perceived social engagement and functional outcomes such as coping self-efficacy.

Cognitive Training for Mild Traumatic Brain Injury and Posttraumatic Stress Disorder.

Although there is evidence of mild cognitive impairments for many individuals with mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD), little research evaluating the effectiveness of cognitive training interventions has been conducted. This randomized controlled trial examined the effectiveness of a 9-h group cognitive training targeting higher-order functions, Strategic Memory Advanced Reasoning Training (SMART), compared to a 9-h psychoeducational control group in improving neurocognitive functioning in adults with mTBI and PTSD. A sample of 124 adults with histories of mild TBI (n = 117) and/or current diagnoses of PTSD (n = 84) were randomized into SMART (n = 66) or Brain Health Workshop (BHW; n = 58) and assessed at three time points: baseline, following training, and 6 months later. Participants completed a battery of neurocognitive tests, including a test of gist reasoning (a function directly targeted by SMART) as well as tests of verbal, visual, and working memory and executive functioning, functions commonly found to be mildly impaired in mTBI and PTSD. The two groups were compared on trajectories of change over time using linear mixed-effects models with restricted maximum likelihood (LMM). Contrary to our hypothesis that SMART would result in superior improvements compared to BHW, both groups displayed statistically and clinically significant improvements on measures of memory, executive functioning, and gist reasoning. Over 60% of the sample showed clinically significant improvements, indicating that gains can be found through psychoeducation alone. A longer SMART protocol may be warranted for clinical samples in order to observe gains over the comparison group.

Predictors of Posttraumatic Stress Disorder, Anxiety, and Depression Symptoms in Survivors of Torture Living in the United States.

A constellation of psychosocial factors contributes to the complex trauma symptoms that survivors of torture may experience. We examined the roles of pretrauma, peritrauma, and postmigration factors as predictors of posttraumatic stress disorder, depression, and anxiety in a sample of 101 culturally heterogeneous torture survivors residing in the United States. Predictors included demographic variables (sex, education, marital status), peritrauma torture type variables generated by principal components analysis (PCA), and postmigration variables (employment status, legal immigration status, and family separation). Of the torture factors identified through PCA (torture inflicted on the self and torture inflicted on family members), torture inflicted on the self significantly predicted anxiety. Undocumented legal status and female sex were related to poorer psychological outcomes. Results highlight the importance of considering postmigration factors, specifically legal status, rather than elements of the torture experience itself, in the delivery of trauma-informed psychological interventions and policy development for survivors of torture.

Acute cognitive effects of the hypocretin receptor antagonist almorexant relative to zolpidem and placebo: a randomized clinical trial.

STUDY OBJECTIVES: Hypnotic medications can adversely affect behavior during unanticipated awakenings during the night. Animals treated with the hypocretin (Hcrt) receptor antagonist almorexant (ALM) have less acute cognitive impairment compared to the GABAA receptor modulator zolpidem (ZOL). This study aimed to determine whether ALM produces less acute cognitive impairment than ZOL in human subjects. METHODS: Healthy, young adult, unmedicated male and female subjects participated in a controlled trial of a single dose of ALM 100 mg (N = 48), ALM 200 mg (N = 53), ZOL 10 mg (N = 49), and placebo (PBO, N = 52). RESULTS: ZOL and both doses of ALM produced similar levels of subjective sleepiness and impaired the ability of subjects to remain awake in a dark, low-stimulus setting relative to PBO. For most cognitive measures, performance under ZOL was significantly worse than ALM or PBO. For tasks involving verbal memory or visual-motor coordination, ZOL impaired performance, whereas the two doses of ALM were no different than PBO. For tasks involving higher-order executive function, ZOL produced impairment in processing speed and inhibitory control, whereas the two doses of ALM were no different than PBO. Performance decrements for ALM were less than ZOL but greater than PBO for some reaction time measures. CONCLUSIONS: The data provide support for the hypothesis that Hcrt receptor antagonists produce less functional impairment than a benzodiazepine receptor agonist (BzRA). These observations are particularly relevant to patients treated with sedative-hypnotics who are at elevated risk for falls and other untoward events during the intended hours for sleep.

Is Amazon's Mechanical Turk (MTurk) a comparable recruitment source for trauma studies?

OBJECTIVE: Trauma researchers have recently begun using Amazon's Mechanical Turk (MTurk) as a data collection platform that is both time- and cost-efficient. Research is needed to determine the utility, generalizability, and validity of MTurk as a recruitment source for trauma-exposed samples. METHOD: Data were collected from 266 trauma-exposed MTurk participants on several clinical and psychological constructs relevant to trauma research. The mean scores, prevalence rates, and correlation strengths of the MTurk sample were compared to those reported in previously published studies of undergraduate, community, and treatment-seeking samples. RESULTS: Findings indicated that prevalence rates of posttraumatic stress disorder (PTSD) and depression were not significantly different from comparison samples, but prevalence rates of generalized anxiety were significantly higher than that of a community sample. The MTurk sample showed significantly lower mean scores of PTSD, depression, and generalized anxiety symptoms than all comparison samples. Correlations were examined to determine whether established relationships between common trauma-related constructs were correlated for MTurk participants as they were in other samples. Correlations between PTSD symptom severity, posttraumatic cognitions (PTCs), and trauma coping self-efficacy (CSE-T) in the MTurk sample were not significantly different from the correlations observed in all comparison samples. Finally, MTurk participants who met criteria for probable PTSD scored significantly higher on measures of depression, generalized anxiety, and PTCs, and lower on CSE-T, than those without probable PTSD. CONCLUSIONS: Future trauma researchers utilizing MTurk should consider potential similarities and differences between MTurk samples and community, clinical, and undergraduate samples when interpreting the generalizability of findings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Somatic burden and perceived cognitive problems in trauma-exposed adults with posttraumatic stress symptoms or pain.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is associated with somatic and cognitive changes, which may be magnified when accompanied by persistent pain. The mechanisms of somatic sensation processing may extend to cognitive symptoms, revealing a potential generalization of impairment across cognitive and somatic domains in PTSD. We hypothesized that somatic burden would mediate relationships between PTSD, pain, and perceived cognitive impairment. METHODS: Two samples-360 trauma-exposed college students and 268 mechanical Turk users-completed self-report measures. RESULTS: Both samples revealed similar findings. There was a significant indirect effect of PTSD and pain on perceived cognitive problems through somatic burden. There remained a direct effect of PTSD symptoms. These findings indicate that in trauma-exposed samples with pain, somatic burden rather than pain severity accounts for perceived cognitive problems. CONCLUSION: High somatic burden may reflect an underlying appraisal about somatic cues, which extend in part to interpretation of cognitive cues.

Predeployment neurocognitive functioning predicts postdeployment posttraumatic stress in Army personnel.

OBJECTIVE: The Fort Campbell Cohort study was designed to assess predeployment biological and behavioral markers and build predictive models to identify risk and resilience for posttraumatic stress disorder (PTSD) following deployment. This article addresses neurocognitive functioning variables as potential prospective predictors. METHOD: In a sample of 403 soldiers, we examined whether PTSD symptom severity (using the PTSD Checklist) as well as posttraumatic stress trajectories could be prospectively predicted by measures of executive functioning (using two web-based tasks from WebNeuro) assessed predeployment. RESULTS: Controlling for age, gender, education, prior number of deployments, childhood trauma exposure, and PTSD symptom severity at Phase 1, linear regression models revealed that predeployment sustained attention and inhibitory control performance were significantly associated with postdeployment PTSD symptom severity. We also identified two posttraumatic stress trajectories utilizing latent growth mixture models. The "resilient" group consisted of 90.9% of the soldiers who exhibited stable low levels of PTSD symptoms from pre- to postdeployment. The "increasing" group consisted of 9.1% of the soldiers, who exhibited an increase in PTSD symptoms following deployment, crossing a threshold for diagnosis based on PTSD Checklist scores. Logistic regression models predicting trajectory revealed a similar pattern of findings as the linear regression models, in which predeployment sustained attention (95% CI of odds ratio: 1.0109, 1.0558) and inhibitory control (95% CI: 1.0011, 1.0074) performance were significantly associated with postdeployment PTSD trajectory. CONCLUSIONS: These findings have clinical implications for understanding the pathogenesis of PTSD and building preventative programs for military personnel. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Impulsivity, Painful and Provocative Events, and Suicide Intent: Testing the Interpersonal Theory of Suicide.

OBJECTIVE: The Interpersonal Theory of Suicide (IPTS; Joiner, 2005. Why People Die by Suicide. Cambridge, MA: Harvard University Press) hypothesizes that repeated exposure to painful and provocative events (PPE) increases capability for suicide (CS), therefore facilitating the development of suicidal intent, and that impulsive individuals are more likely to experience these painful and provocative events, creating an indirect relationship between impulsivity and CS. Research to date largely supports this hypothesis but has not translated this theory to actual suicidal intent. METHOD: The present study used data from the MacArthur Violence Risk Assessment Study to examine the relationship between PPE and intent, and the indirect relationship between impulsivity and intent among a sample of 245 recent suicide attempters, using the clinician-rated Suicide Intent Scale as an objective measure of intent. RESULTS: Results supported the hypothesized direct relationship between PPE and intent, and the indirect relationship between impulsivity and intent through PPE. There was no direct relationship between impulsivity and intent, suggesting that the relationship between impulsivity and intent occurs entirely through exposure to PPE. CONCLUSIONS: These findings suggest that assessing exposure to painful and provocative events is critical in evaluating risk of suicide, and that impulsivity itself does not confer an increased risk of lethal or nearly lethal attempts.

The Association Between PTSD and Functional Outcome Is Mediated by Perception of Cognitive Problems Rather Than Objective Neuropsychological Test Performance.

Posttraumatic stress disorder (PTSD) has been consistently linked to poorer functional outcomes, including quality of life, health problems, and social and occupational functioning. Less is known about the potential mechanisms by which PTSD leads to poorer functional outcomes. We hypothesized that neurocognitive functioning and perception of cognitive problems would both mediate the relationship between PTSD diagnosis and functioning. In a sample of 140 veterans of the recent wars and conflicts in Iraq and Afghanistan, we assessed PTSD symptoms, history of traumatic brain injury (TBI), depression, self-report measures of quality of life, social and occupational functioning, and reintegration to civilian life, as well as perception of cognitive problems. Veterans also completed a comprehensive neuropsychological battery of tests. Structural equation modeling revealed that perception of cognitive problems, but not objective neuropsychological performance, mediated the relationship between PTSD diagnosis and functional outcomes after controlling for TBI, depression, education, and a premorbid IQ estimate, b = -6.29, 95% bias-corrected bootstrapped confidence interval [-11.03, -2.88], showing a large effect size. These results highlight the importance of addressing appraisals of posttrauma cognitive functioning in treatment as a means of improving functional outcomes.

Trauma Type and Posttraumatic Stress Disorder as Predictors of Parenting Stress in Trauma-Exposed Mothers.

Trauma exposure is associated with various parenting difficulties, but few studies have examined relationships between trauma, posttraumatic stress disorder (PTSD), and parenting stress. Parenting stress is an important facet of parenting and mediates the relationship between parental trauma exposure and negative child outcomes (Owen, Thompson, & Kaslow, 2006). We examined trauma type (child maltreatment, intimate partner violence, community violence, and non-interpersonal traumas) and PTSD symptoms as predictors of parenting stress in a sample of 52 trauma-exposed mothers. Community violence exposure and PTSD symptom severity accounted for significant variance in parenting stress. Further analyses revealed that emotional numbing was the only PTSD symptom cluster accounting for variance in parenting stress scores. Results highlight the importance of addressing community violence exposure and emotion regulation difficulties with trauma-exposed mothers.

PTSD symptoms and perception of cognitive problems: The roles of posttraumatic cognitions and trauma coping self-efficacy.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is associated with mild neurocognitive deficits, yet clients often complain of cognitive problems that exceed what their objective performance demonstrates. In addition, PTSD is associated with negative appraisals about the self, traumatic event, and one's ability to cope. This study examined posttraumatic cognitions as a moderator, and trauma coping self-efficacy as a mediator, of the relationship between PTSD symptoms and self-report of cognitive problems. METHOD: A sample of 268 trauma-exposed adults completed the PTSD Checklist for DSM-5, the Posttraumatic Cognitions Inventory, the Trauma Coping Self-Efficacy Scale, the Cognitive Self-Report Questionnaire, and the Quality of Life Scale. RESULTS: Negative self-appraisals was a significant moderator in the relationship between PTSD symptoms and perception of cognitive problems (ß = -.252, p = .001). In participants with high levels of negative posttraumatic cognitions, perception of cognitive problems was high regardless of PTSD symptom level. In a mediator analysis, there was a significant indirect effect of trauma coping self-efficacy (b = .125, 95% CI [.088, .172]). Finally, there was evidence of moderated mediation, such that trauma coping self-efficacy was a mediator only when posttraumatic cognitions were low or average. CONCLUSIONS: Results indicate that posttraumatic appraisals and coping self-efficacy play significant roles in perception of cognitive problems following trauma. Clinically, in patients for which there is a perception of cognitive impairment that is not borne out in neuropsychological testing, cognitive-behavioral therapy focused on altering negative self-perceptions and appraisals may be beneficial. (PsycINFO Database Record

Maternal PTSD and Children's Adjustment: Parenting Stress and Emotional Availability as Proposed Mediators.

OBJECTIVES: Maternal posttraumatic stress disorder (PTSD) is a risk factor for negative child adjustment, but it is unclear whether this association is direct (e.g., a mother's PTSD symptoms are observed, learned, and internalized by children which results in behavioral and emotional problems) or indirect, through parent-child relationship difficulties or parenting stress. We hypothesized that parenting stress and maternal emotional availability would exhibit indirect effects on relationships between maternal PTSD and children's functioning. METHOD: Participants were 52 trauma-exposed mothers and their children (aged 7-12 years). Mothers completed measures of PTSD and parenting stress and reported on their children's functioning. Emotional availability was assessed through observer-rated mother-child interactions. RESULTS: Emotional availability was not related to PTSD or child outcomes. Parenting stress had a substantial indirect effect on the relationships between maternal PTSD and child emotion regulation, internalizing, and externalizing behaviors. CONCLUSIONS: Results highlight the need to target parenting stress in interventions with trauma-exposed families.

Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans.

The Department of Veterans Affairs traumatic brain injury (TBI) screening program is intended to detect and expedite treatment for TBI and postconcussive symptoms. Between April 14, 2007, and May 31, 2012, of 66,089 Iraq and Afghanistan Veterans who screened positive on first-level TBI screening and later completed comprehensive TBI evaluation that includes the Neurobehavioral Symptoms Inventory, 72% reported moderate to very severe cognitive impairment (problems with attention, concentration, memory, etc.) that interfered with daily activities. This included 42% who were found not to have sustained combat-related mild TBI (mTBI). In contrast, 70.0% received a posttraumatic stress disorder (PTSD) diagnosis and 45.8% received a depression diagnosis. Compared with Veterans without mTBI, PTSD, or depression diagnoses, the lowest risk for self-reported cognitive impairment was in Veterans with confirmed mTBI only; a greater risk was found in those with PTSD diagnoses, with the greatest risk in Veterans with PTSD, depression, and confirmed mTBI, suggesting only a weakly additive effect of mTBI. These findings suggest that Veterans with multiple mental health comorbidities, not just those with TBI, report moderate to very severe cognitive impairment. Mental health treatment for conditions such as PTSD and depression (with or without TBI) may result in improvements in cognitive functioning and/or include assessment and support for Veterans experiencing cognitive problems.

Predicting Suicide Intent: The Roles of Experiencing or Committing Violent Acts.

According to the interpersonal theory of suicide (Joiner, 2005), repeated exposure to painful or provocative experiences is associated with lethal or nearly lethal suicide attempts. However, suicide research often focuses on suicide ideation or attempts, rather than intent. Using data from the Collaborative Psychiatric Epidemiological Surveys, we examined traumatic experiences, with a focus on repeated exposure to traumas, in individuals who described their suicide attempts as a strong intent to die versus a cry for help. Only repeated acts of committing violence were associated with high suicide intent, suggesting that individuals who engage in violence are at heightened risk for suicide.

Towards Constructing a New Taxonomy for Psychiatry Using Self-reported Symptoms.

The Diagnostic and Statistical Manual (DSM) has served as the gold standard for psychiatric diagnosis for the past several decades in the USA, and DSM diagnoses mirror mental health and substance abuse diagnoses in ICD-9 and ICD-10. However, DSM diagnoses have severe limitations when used as phenotypes for studies of the pathophysiology underlying mental disorders, as well as for clinical treatment and research. In this paper, we use a novel approach of deconstructing DSM diagnostic criteria, and using expert knowledge to inform feature selection for unsupervised machine learning. We are able to identify clusters of symptoms that stratify subjects with the same DSM disorders into cohorts with increased clinical and biological homogeneity. These findings suggest that itemized self-report symptom data should inform a new taxonomy for psychiatry, and will enhance the bi-directional translation of knowledge from the bench to the clinic through a common terminology.

Altered inflammatory activity associated with reduced hippocampal volume and more severe posttraumatic stress symptoms in Gulf War veterans.

BACKGROUND: Inflammation may reduce hippocampal volume by blocking neurogenesis and promoting neurodegeneration. Posttraumatic stress disorder (PTSD) has been linked with both elevated inflammation and reduced hippocampal volume. However, few studies have examined associations between inflammatory markers and hippocampal volume, and none have examined these associations in the context of PTSD. METHODS: We measured levels of the inflammatory markers interleukin-6 (IL-6) and soluble receptor II for tumor necrosis factor (sTNF-RII) as well as hippocampal volume in 246 Gulf War veterans with and without current and past PTSD as assessed with the Clinician Administered PTSD Scale (CAPS). Enzyme-linked immunosorbent assays were used to measure inflammatory markers, and 1.5Tesla magnetic resonance imaging (MRI) and Freesurfer version 4.5 were used to quantify hippocampal volume. Hierarchical linear regression and analysis of covariance models were used to examine if hippocampal volume and PTSD status would be associated with elevated levels of IL-6 and sTNF-RII. RESULTS: Increased sTNF-RII, but not IL-6, was significantly associated with reduced hippocampal volume (ß=-0.14, p=0.01). The relationship between sTNF-RII and hippocampal volume was independent of potential confounds and covariates, including PTSD status. Although we observed no PTSD diagnosis-related differences in either IL-6 or sTNF-RII, higher PTSD severity was associated with significantly increased sTNF-RII (ß=0.24, p=0.04) and reduced IL-6 levels (ß=-0.24, p=0.04). CONCLUSIONS: Our results indicate that specific inflammatory proteins may be associated with brain structure and function as indexed by hippocampal volume and PTSD symptoms.

Hippocampal volume is inversely related to PTSD duration.

Numerous imaging studies have reported smaller hippocampal volumes in patients with PTSD. To investigate whether decreased hippocampal volume is associated with PTSD chronicity, independent of age, we used hierarchical linear regression to examine the relationship between PTSD duration (estimated from the amount of time that had elapsed since the traumatic event; mean=17 years; range=6-36 years) and hippocampal volume, adjusting for age and other factors. Freesurfer version 4.5 was used to quantify the volumes of the hippocampus and the caudate nucleus, which served as a "control" region, from the 1.5T Magnetic Resonance Images (MRI) of 55 combat veterans (mean age 45±9 years) with chronic and current PTSD. PTSD duration was significantly associated with right hippocampal volume (ß=-0.34, t=-2.40, P=0.02) after accounting for intracranial volume, age, gender (entered in the first step) and comorbidities (e.g., early life trauma, current major depression, history of substance abuse/dependence, psychotropic medication use, entered in the second step). This finding provides support for the potential neurotoxic effects of PTSD on hippocampal volume.