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Pain complaints are highly prevalent among military servicemembers and Veterans of the recent combat operations in Iraq and Afghanistan. The high comorbidity of pain with conditions such as posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) underscores the importance of a greater understanding of factors associated with complex polytraumatic injuries among military personnel. The present study aimed to identify correlates of current pain among 201 U.S. military personnel who reported at least one blast experience during combat deployment (age [mean +/− standard deviation]: 27.20 +/− 7.58 yr). Theoretically derived subsets of variables were analyzed in successive hierarchical regression models to determine correlates of self-reported pain symptoms. Pre models evaluated demographic features, medical and injury characteristics (e.g., TBI classification), psychosocial history (e.g., trauma exposure), and psychiatric variables. A final model was then derived, in which older age, possible or probable mild TBI, depression symptoms, and PTSD re-experiencing symptoms emerged as significant correlates of pain. The findings further the understanding of polytrauma symptoms among military personnel by identifying specific patient characteristics and comorbidity patterns related to pain complaints. Increased awareness of demographic, psychiatric, or medical factors implicated in pain will enhance comprehensive clinical assessment and intervention efforts.

Objective: Posttraumatic stress disorder (PTSD) is one of the only disorders in the Diagnostic and Statistical Manual of Mental Disorders that requires an environmental exposure. The relationship between liability factors for trauma exposure and those for PTSD symptoms following exposure are unclear. Methods: Exposure to a trauma and resulting PTSD symptoms were assessed in a sample of 2,794 members of the Norwegian Institute of Public Health Twin Panel. Results: In the full sample, 737 twins experienced a trauma. A modified causal, contingent, common pathway model was used to examine trauma exposure and liability for PTSD. Genetic and common environmental factors could not be distinguished, so a model that included only familial and individual specific components was fit. The best-fitting model suggested that familial factors played an important role in liability for trauma exposure and for resulting PTSD symptoms, and that there was a modest transmission between trauma exposure and subsequent PTSD symptoms. Conclusions: One third of the variance in liability of PTSD symptoms is due to familial factors, and of this, approximately one fifth overlaps with the familial liability for trauma exposure while the other four fifths of the variance is specific to the risk of PTSD symptoms following exposure. The hypothesis that PTSD is etiologically similar to exposures to a traumatic event is not supported, suggesting that the factors that confer risk for trauma do not overlap completely with those that confer risk for PTSD.

Military personnel returning from conflicts in Iraq and Afghanistan often endorse pain and posttraumatic stress disorder (PTSD) symptoms, either separately or concurrently. Associations between pain and PTSD may be further complicated by blast exposure from explosive munitions. Although many studies have reported on the prevalence and disability associated with polytraumatic injuries following combat, less is known about symptom maintenance over time. Accordingly, this study examined longitudinal interactive models of co-occurring pain and PTSD symptoms in a sample of 209 military personnel (Mage = 27.4 years, SD = 7.6) who experienced combat-related blast exposure. Autoregressive cross-lagged analysis examined longitudinal associations between self-reported pain and PTSD symptoms over a one-year period. The best-fitting model indicated that pain and PTSD were significantly associated with one another across all assessment periods, χ2(3) = 3.66, p = .30; TLI = .98; CFI = 1.00; RMSEA = .03, and PTSD had a particularly strong influence on subsequent pain symptoms. The relationship between pain and PTSD is related to older age, race, and traumatic brain injury characteristics. Results further the understanding of complex injuries among military personnel and highlight the need for comprehensive assessment and rehabilitation efforts addressing the interdependence of pain and co-occurring mental health conditions.

Posttraumatic stress disorder (PTSD) is often considered the primary problematic outcome of child sexual abuse (CSA). However, a number of other, relatively understudied negative sequelae appear to be prevalent as well. Data from 269 adolescents with a CSA history from the National Survey of Adolescents—Replication Study were therefore used to examine the prevalence of risky behaviors (i.e., problematic alcohol and drug use, delinquent behavior) and depression in this sample. The frequencies of these problems in youth with and without a history of PTSD also were examined. Results indicated that risky behaviors and depression were reported as or more frequently than PTSD. Among youth with a history of PTSD, depression and delinquent behavior were more common than among those without a history of PTSD. However, there were no differences between adolescents with and without a history of PTSD in reported problematic substance use. Findings highlight the need for comprehensive trauma-informed interventions for CSAexposed adolescents.

Introduction: A strong association between posttraumatic stress disorder (PTSD) and problematic alcohol use has been demonstrated among Veteran populations exposed to combat trauma. Several traits, such as higher levels of risk-taking propensity (RTP) and impulsivity (e.g., negative urgency [NU]), are associated with both increased PTSD symptomatology and greater alcohol use problems. Methods: The present study examined the effects of NU and RTP on alcohol use (measured by average weekly alcohol consumption and number of binge drinking days in 1 month), as well as their potential moderating effects on the association between PTSD symptom severity and alcohol use in a sample of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) US Veterans. We hypothesized that NU and RTP would both significantly predict alcohol use and moderate the relation between PTSD symptom severity and alcohol use, such that the association between PTSD symptoms and alcohol use would be greater among individuals high compared to low in NU and RTP. Results: As hypothesized, the main effects of RTP and NU were significantly positively associated with average weekly alcohol consumption and the number of binge drinking days in the past month. However, neither NU nor RTP moderated the relation between PTSD and either alcohol variable. Discussion: NU and RTP may represent transdiagnostic risk markers for PTSD and alcohol use problems; however, the current study did not support an exploratory role of NU or RTP in the association between PTSD and alcohol use phenotypes.

Individual differences in cognitive processes and coping behaviors play a role in the development and maintenance of posttraumatic stress disorder (PTSD). Given the large numbers of combat-exposed service members returning from the Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) conflicts, exploring individual differences in cognitive-affective processes is important for informing our understanding of PTSD etiology and early intervention in military samples. The present study examined the unique main and interactive effects of negative posttrauma cognitions (i.e., negative beliefs about self [NS], the world [NW], and self-blame [SB]) and coping strategies (i.e., positive behavioral, positive cognitive, avoidant coping, and social and emotional coping) on PTSD diagnosis within 155 (M(age) = 30.7, SD = 4.48) OEF/OIF/OND combat trauma-exposed veterans recruited from an ongoing study examining the effects of combat trauma and stress reactivity. In the final, stepwise logistic regression analysis, avoidant coping, but no other coping strategy, was significantly positively related to PTSD diagnosis in the initial step. Higher levels of NS, but not NW, were significantly associated with having a PTSD diagnosis, while SB was associated with decreased likelihood of PTSD, above and beyond coping strategies. A significant interaction effect was found between NS and positive cognitive coping, such that greater positive cognitive coping weakened the relationship between NS and PTSD. Examining and addressing coping behaviors and negative thoughts of self jointly may benefit assessment and intervention approaches in a combat-trauma population.

The current study tested whether COVID-19 disruptions and perceived discrimination were related to mental health (i.e., posttraumatic stress disorder [PTSD] symptoms and emotional, psychological, and social well-being), and whether exercise moderated relations. Additionally, we tested whether findings varied by ethnicity/race. Participants were 368 African American and Asian American emerging adults ( Mage = 19.92, SD = .34). Findings did not vary by ethnicity/race. COVID-19 disruptions predicted poorer emotional, psychological, and social well-being, and more PTSD symptoms. Discrimination predicted more PTSD symptoms. Exercise was associated with better emotional, psychological, and social well-being, and moderated the relation between COVID-19 disruptions and emotional well-being. At low levels of exercise, COVID-19 disruptions predicted poorer emotional well-being, but this relation was not significant at high levels of exercise. Findings highlight that discrimination and disruptions during the pandemic negatively affect African American and Asian American emerging adults' mental health, but that exercise plays an important protective role.

Background: Community-based estimates of psychopathology prevalence in developing countries such as Vietnam, are needed to reduce presumed significant burden of poor mental health. Aims: This study derived population-based prevalence estimates of mental distress, as measured by the SRQ-20, in a community sample of 4,981 adults living in Vietnam. This study also examined correlates of mental distress based on SRQ-20 caseness indications. Risk and protective factors were identified in terms of their unique contribution to caseness. Results: Using a cut-off of 7/8, 19.2% of the sample was considered to be a probable case ( n = 954), with females endorsing more items than males. Marital status and employment status were not associated with mental health distress. Higher wealth, endorsing religious affi liation, and self-reports of good health were associated with lower SRQ-20 scores. Age and being female were associated with higher SRQ-20 scores. Conclusions: A single item was as adequate a measure of wealth as multi-item rating scales. Our estimate of mental distress using the SRQ-20 is much greater than that of other studies, and in contrast to western prevalence studies, age was not a protective factor in this study. The SRQ-20 is a brief, cost-effective and reasonably valid measure of both community and individual mental distress.

Epigenetic differences may help to distinguish between PTSD cases and trauma-exposed controls. Here, we describe the results of the largest DNA methylation meta-analysis of PTSD to date. Ten cohorts, military and civilian, contribute blood-derived DNA methylation data from 1,896 PTSD cases and trauma-exposed controls. Four CpG sites within the aryl-hydrocarbon receptor repressor (AHRR) associate with PTSD after adjustment for multiple comparisons, with lower DNA methylation in PTSD cases relative to controls. Although AHRR methylation is known to associate with smoking, the AHRR association with PTSD is most pronounced in non-smokers, suggesting the result was independent of smoking status. Evaluation of metabolomics data reveals that AHRR methylation associated with kynurenine levels, which are lower among subjects with PTSD. This study supports epigenetic differences in those with PTSD and suggests a role for decreased kynurenine as a contributor to immune dysregulation in PTSD.

Epigenetic differences may help to distinguish between PTSD cases and trauma-exposed controls. Here, we describe the results of the largest DNA methylation meta-analysis of PTSD to date. Ten cohorts, military and civilian, contribute blood-derived DNA methylation data from 1,896 PTSD cases and trauma-exposed controls. Four CpG sites within the aryl-hydrocarbon receptor repressor (AHRR) associate with PTSD after adjustment for multiple comparisons, with lower DNA methylation in PTSD cases relative to controls. Although AHRR methylation is known to associate with smoking, the AHRR association with PTSD is most pronounced in non-smokers, suggesting the result was independent of smoking status. Evaluation of metabolomics data reveals that AHRR methylation associated with kynurenine levels, which are lower among subjects with PTSD. This study supports epigenetic differences in those with PTSD and suggests a role for decreased kynurenine as a contributor to immune dysregulation in PTSD. PTSD has been associated with DNA methylation of specific loci in the genome, but studies have been limited by small sample sizes. Here, the authors perform a meta-analysis of DNA methylation data from 10 different cohorts and identify CpGs in AHRR that are associated with PTSD.