Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics

Yirui Hu,1 Xin Chu,2 Thomas G Urosevich,3 Stuart N Hoffman,4 H Lester Kirchner,1 Richard E Adams,5 Ryan J Dugan,6 Joseph J Boscarino,7 Weixing Shi,2 Carrie A Withey,6 Charles R Figley,8 Joseph A Boscarino6 1Biomedical and Translational Informatics, Geisinger Clinic, Danville, PA, USA; 2Obesity Insti...

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Autores principales:	Hu Y, Chu X, Urosevich TG, Hoffman SN, Kirchner HL, Adams RE, Dugan RJ, Boscarino JJ, Shi W, Withey CA, Figley CR, Boscarino JA
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	posttraumatic stress disorder veterans combat exposure trauma warzone deployment genetic risk resilience. Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/ad64c0ae7f6646b3a9dd089b320131ae
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id	oai:doaj.org-article:ad64c0ae7f6646b3a9dd089b320131ae
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	posttraumatic stress disorder veterans combat exposure trauma warzone deployment genetic risk resilience. Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	posttraumatic stress disorder veterans combat exposure trauma warzone deployment genetic risk resilience. Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Hu Y Chu X Urosevich TG Hoffman SN Kirchner HL Adams RE Dugan RJ Boscarino JJ Shi W Withey CA Figley CR Boscarino JA Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics
description	Yirui Hu,1 Xin Chu,2 Thomas G Urosevich,3 Stuart N Hoffman,4 H Lester Kirchner,1 Richard E Adams,5 Ryan J Dugan,6 Joseph J Boscarino,7 Weixing Shi,2 Carrie A Withey,6 Charles R Figley,8 Joseph A Boscarino6 1Biomedical and Translational Informatics, Geisinger Clinic, Danville, PA, USA; 2Obesity Institute, Geisinger Clinic, Danville, PA, USA; 3Ophthalmology Service, Geisinger Clinic, Mount Pocono, PA, USA; 4Sleep Disorders Center, Geisinger Clinic, Danville, PA, USA; 5Department of Sociology, Kent State University, Kent, OH, USA; 6Department of Population Health Sciences, Geisinger Clinic, Danville, PA, USA; 7Department of Clinical Psychology, William James College, Newton, MA, USA; 8Department of Social Work, Tulane University, New Orleans, LA, USACorrespondence: Joseph A BoscarinoGeisinger Clinic, 100 N. Academy Avenue, 44-00, Danville, PA 17822, USATel +1570-214-9622Email jaboscarino@geisinger.eduBackground: Previously we reported a genetic risk score significantly improved PTSD prediction among a trauma-exposed civilian population. In the current study, we sought to assess this prediction among a trauma-exposed military population.Methods: We examined current PTSD diagnosis and PTSD symptom severity among a random sample of 1042 community-based US military veterans. Main effects and interaction effects were assessed for PTSD genetic risk by trauma exposure using cross-product terms for PTSD x trauma exposures, including combat, lifetime trauma, and adverse childhood exposures. The PTSD risk variants studied were within genetic loci previously associated with PTSD, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variants, which were used to calculate a total PTSD genetic risk score (range=0–8, mean=3.6, SD=1.4).Results: Based on DSM-5 PTSD criteria, 7.1% of veterans (95% CI=5.6–8.8) met criteria for current PTSD. The PTSD genetic risk count was significantly higher among PTSD cases vs non-cases (3.92 vs 3.55, p=0.027). Since the PTSD genetic risk score was not significant in the PTSD diagnosis model, we assessed this association using PTSD symptom severity. Because these symptom data were skewed (mean=9.54, SD=12.71, range=0–76), we used negative binomial regression to assess this outcome. This symptom model included a PTSD genetic risk score, demographic factors, trauma exposures, current insomnia, current depression, concussion history, and attention-deficit disorder, expressed as incident rate ratios (IRR), which is an estimate of one-unit increase in PTSD severity, given other variables are held constant. Variables in the final model included age and sex (both p<0.001), PTSD genetic risk (IRR=1.02, p=0.028), warzone tours (IRR=0.94, p=0.003), childhood abuse (IRR=1.50, p<0.0001), current depression (IRR=1.89, p<0.0001), current insomnia (IRR=2.58, p<0.0001), low social support (IRR=1.19, p<0.0001), attention-deficit disorder (IRR=1.51, p<0.0001), agreeable personality (IRR=0.77, p<0.0001), and concussion (IRR=1.38, p<0.0001). Significant interactions were detected for combat and lifetime trauma exposure by PTSD genetic risk (both p<0.0001), suggesting that the impact of trauma exposures on PTSD severity was lower when the PTSD genetic risk was higher.Conclusion: Both warzone and non-warzone factors predicted current PTSD symptoms among veterans, including a PTSD genetic risk score. Interaction effects were detected for combat exposure and lifetime trauma by genetic risk score for PTSD symptoms, suggesting that PTSD symptom manifestation was more dependent on PTSD risk variants than the level of trauma or combat exposure. This suggests that controlling for other factors, the absence of genetic risk variants may confer PTSD resilience. Further research is planned.Keywords: posttraumatic stress disorder, veterans, combat exposure, trauma, warzone deployment, genetic risk, resilience
format	article
author	Hu Y Chu X Urosevich TG Hoffman SN Kirchner HL Adams RE Dugan RJ Boscarino JJ Shi W Withey CA Figley CR Boscarino JA
author_facet	Hu Y Chu X Urosevich TG Hoffman SN Kirchner HL Adams RE Dugan RJ Boscarino JJ Shi W Withey CA Figley CR Boscarino JA
author_sort	Hu Y
title	Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics
title_short	Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics
title_full	Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics
title_fullStr	Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics
title_full_unstemmed	Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics
title_sort	predictors of current dsm-5 ptsd diagnosis and symptom severity among deployed veterans: significance of predisposition, stress exposure, and genetics
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/ad64c0ae7f6646b3a9dd089b320131ae
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spelling	oai:doaj.org-article:ad64c0ae7f6646b3a9dd089b320131ae2021-12-02T09:39:56ZPredictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics1178-2021https://doaj.org/article/ad64c0ae7f6646b3a9dd089b320131ae2020-01-01T00:00:00Zhttps://www.dovepress.com/predictors-of-current-dsm-5-ptsd-diagnosis-and-symptom-severity-among--peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Yirui Hu,1 Xin Chu,2 Thomas G Urosevich,3 Stuart N Hoffman,4 H Lester Kirchner,1 Richard E Adams,5 Ryan J Dugan,6 Joseph J Boscarino,7 Weixing Shi,2 Carrie A Withey,6 Charles R Figley,8 Joseph A Boscarino6 1Biomedical and Translational Informatics, Geisinger Clinic, Danville, PA, USA; 2Obesity Institute, Geisinger Clinic, Danville, PA, USA; 3Ophthalmology Service, Geisinger Clinic, Mount Pocono, PA, USA; 4Sleep Disorders Center, Geisinger Clinic, Danville, PA, USA; 5Department of Sociology, Kent State University, Kent, OH, USA; 6Department of Population Health Sciences, Geisinger Clinic, Danville, PA, USA; 7Department of Clinical Psychology, William James College, Newton, MA, USA; 8Department of Social Work, Tulane University, New Orleans, LA, USACorrespondence: Joseph A BoscarinoGeisinger Clinic, 100 N. Academy Avenue, 44-00, Danville, PA 17822, USATel +1570-214-9622Email jaboscarino@geisinger.eduBackground: Previously we reported a genetic risk score significantly improved PTSD prediction among a trauma-exposed civilian population. In the current study, we sought to assess this prediction among a trauma-exposed military population.Methods: We examined current PTSD diagnosis and PTSD symptom severity among a random sample of 1042 community-based US military veterans. Main effects and interaction effects were assessed for PTSD genetic risk by trauma exposure using cross-product terms for PTSD x trauma exposures, including combat, lifetime trauma, and adverse childhood exposures. The PTSD risk variants studied were within genetic loci previously associated with PTSD, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variants, which were used to calculate a total PTSD genetic risk score (range=0–8, mean=3.6, SD=1.4).Results: Based on DSM-5 PTSD criteria, 7.1% of veterans (95% CI=5.6–8.8) met criteria for current PTSD. The PTSD genetic risk count was significantly higher among PTSD cases vs non-cases (3.92 vs 3.55, p=0.027). Since the PTSD genetic risk score was not significant in the PTSD diagnosis model, we assessed this association using PTSD symptom severity. Because these symptom data were skewed (mean=9.54, SD=12.71, range=0–76), we used negative binomial regression to assess this outcome. This symptom model included a PTSD genetic risk score, demographic factors, trauma exposures, current insomnia, current depression, concussion history, and attention-deficit disorder, expressed as incident rate ratios (IRR), which is an estimate of one-unit increase in PTSD severity, given other variables are held constant. Variables in the final model included age and sex (both p<0.001), PTSD genetic risk (IRR=1.02, p=0.028), warzone tours (IRR=0.94, p=0.003), childhood abuse (IRR=1.50, p<0.0001), current depression (IRR=1.89, p<0.0001), current insomnia (IRR=2.58, p<0.0001), low social support (IRR=1.19, p<0.0001), attention-deficit disorder (IRR=1.51, p<0.0001), agreeable personality (IRR=0.77, p<0.0001), and concussion (IRR=1.38, p<0.0001). Significant interactions were detected for combat and lifetime trauma exposure by PTSD genetic risk (both p<0.0001), suggesting that the impact of trauma exposures on PTSD severity was lower when the PTSD genetic risk was higher.Conclusion: Both warzone and non-warzone factors predicted current PTSD symptoms among veterans, including a PTSD genetic risk score. Interaction effects were detected for combat exposure and lifetime trauma by genetic risk score for PTSD symptoms, suggesting that PTSD symptom manifestation was more dependent on PTSD risk variants than the level of trauma or combat exposure. This suggests that controlling for other factors, the absence of genetic risk variants may confer PTSD resilience. Further research is planned.Keywords: posttraumatic stress disorder, veterans, combat exposure, trauma, warzone deployment, genetic risk, resilienceHu YChu XUrosevich TGHoffman SNKirchner HLAdams REDugan RJBoscarino JJShi WWithey CAFigley CRBoscarino JADove Medical Pressarticleposttraumatic stress disorderveteranscombat exposuretraumawarzone deploymentgenetic riskresilience.Neurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 16, Pp 43-54 (2020)

Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics

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