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Posttraumatic stress disorder (PTSD) is associated with increased rates of smoking although little is known regarding the mechanisms underlying this relationship. The current study examined expectations about smoking outcomes among smokers with and without PTSD. The sample included 96 Veterans (mean age of 34 years) and included 17% women and 50% racial minorities. Smoking expectancies were measured with the Smoking Consequences Questionnaire-Adult (Copeland, Brandon, & Quinn, 1995). Consistent with previous work suggesting that smokers with PTSD smoke in an effort to reduce negative affect, unadjusted analyses indicated that smokers with PTSD (n = 38) had higher expectations that smoking reduces negative affect than smokers without PTSD (d = 0.61). Smokers with PTSD also had increased expectancies associated with boredom reduction (d = 0.48), stimulation (d = 0.61), taste/sensorimotor manipulation aspects of smoking (d = 0.73), and social facilitation (d = 0.61). Results of hierarchical linear regression analyses, indicated that PTSD symptom severity was uniquely associated with these expectancies beyond the effects of gender and nicotine dependence. More positive beliefs about the consequences of smoking may increase risk of continued smoking among those with PTSD who smoke. Further understanding of smoking expectancies in this group may help in developing interventions tailored for this vulnerable population.

OBJECTIVE/BACKGROUND: Despite a well-established role of guilt cognitions in the maintenance and treatment of posttraumatic stress disorder (PTSD), relationships of guilt cognitions to nightmares are not well understood. This study investigated the ways in which guilt cognitions related to traumatic events influenced the relationship between combat exposure and trauma-related sleep disturbance in military Veterans with PTSD. PARTICIPANTS: We recruited a sample of 50 Veterans with PTSD who completed study measures at a screening session. METHODS: Participants completed self-report measures of exposure to potentially traumatic events, trauma-related guilt (hindsight bias, wrongdoing, and lack of justification) and trauma-related sleep disturbance as measured by a self-report scale and clinician ratings of nightmare severity. RESULTS: Bivariate regression analyses established a relationship of combat exposure to wrongdoing (β = .31, p = .031), and a relationship of wrongdoing with self-reported trauma-related sleep disturbance (β = .27, p = .049) and clinician-rated nightmare severity (β = .36, p = .009). Bootstrapping analysis that included years of education as a covariate found a significant overall indirect effect of combat exposure on clinician-rated nightmare severity exerted through wrongdoing (β = .10, 95% CI [.004, .246]). CONCLUSIONS: Results suggest the association of combat exposure with trauma-related sleep disturbance is significantly influenced by perceived wrongdoing related to a traumatic event. Targeting cognitions related to wrongdoing and moral injury during a traumatic event in PTSD treatment may help ameliorate trauma-related sleep disturbance.

Alcohol misuse is associated with negative mental and physical health outcomes, which presents a public health concern in veterans. However, less is known regarding outcomes among veterans with low to moderate alcohol consumption. This study included veterans with military service in Iraq and/or Afghanistan (N = 1,083) who resided in the VA Mid-Atlantic region catchment area (North Carolina, Virginia, and parts of West Virginia). Participants completed a mailed survey that inquired about demographics, past-year alcohol consumption, self-rated physical health, and psychiatric symptoms. Logistic regression was used to evaluate associations between alcohol consumption and posttraumatic stress disorder (PTSD), depression, and self-rated physical health. Both non-drinkers and hazardous drinkers were more likely to endorse clinically significant PTSD and depression symptoms than moderate drinkers. Moderate drinkers were also less likely to report fair/poor health, after adjusting for demographics and psychiatric symptoms. Results overall showed a U-shaped curve, such that moderate alcohol use was associated with lower rates of mental health problems and fair/poor health. While the VA routinely screens for alcohol misuse, current results suggest that non-drinkers are also at risk for poor mental and physical health.

The perspectives of patients with posttraumatic stress disorder (PTSD) on genetic research have not yet been investigated in the genetics research literature. To provide a basis for research on attitudes toward genetic research in PTSD, we surveyed the U.S. Military Afghanistan/Iraq-era veterans with PTSD and their social support companions to investigate the attitudes and knowledge about genetics and genetic testing. One hundred forty-six veterans (76 with PTSD and 70 without PTSD) participated in this study. Each veteran participant had a corresponding companion (primarily spouses, but also relatives and friends) who they identified as a primary member of their social support network. Participants and companions completed self-report measures on knowledge of genetics and attitudes toward genetic testing for PTSD. Results indicated that, relative to veterans without PTSD, veterans with PTSD had similar levels of genetic knowledge, but less-favorable attitudes toward genetic testing. Differences persisted after controlling for age and genetics knowledge. No differences between companions of those with and without PTSD were observed. Results suggest that the perspective of those with PTSD regarding genetic testing is in need of further investigation, especially if potentially beneficial genetic testing for PTSD is to be utilized in the target population.

To investigate how unpredictable threat during goal pursuit impacts fronto-limbic activity and functional connectivity in posttraumatic stress disorder (PTSD), we compared military veterans with PTSD (n = 25) vs. trauma-exposed control (n = 25). Participants underwent functional magnetic resonance imaging (fMRI) while engaged in a computerized chase-and-capture game task that involved optimizing monetary rewards obtained from capturing virtual prey while simultaneously avoiding capture by virtual predators. The game was played under two alternating contexts-one involving exposure to unpredictable task-irrelevant threat from randomly occurring electrical shocks, and a nonthreat control condition. Activation in and functional connectivity between the amygdala and ventromedial prefrontal cortex (vmPFC) was tested across threat and nonthreat task contexts with generalized psychophysiological interaction (gPPI) analyses. PTSD patients reported higher anxiety than controls across contexts. Better task performance represented by successfully avoiding capture by predators under threat compared with nonthreat contexts was associated with stronger left amygdala-vmPFC functional connectivity in controls and greater vmPFC activation in PTSD patients. PTSD symptom severity was negatively correlated with vmPFC activation in trauma-exposed controls and with right amygdala-vmPFC functional connectivity across all participants in the threat relative to nonthreat contexts. The findings showed that veterans with PTSD have disrupted amygdala-vmPFC functional connectivity and greater localized vmPFC processing under threat modulation of goal-directed behavior, specifically related to successfully avoiding loss of monetary rewards. In contrast, trauma survivors without PTSD relied on stronger threat-modulated left amygdala-vmPFC functional connectivity during goal-directed behavior, which may represent a resilience-related functional adaptation. ; Department of Veterans Affairs' (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) of the VA Office of Mental Health Services; Office of Research and Development (ORD) [5I01CX000748-01, 5I01CX000120-02]; National Institute for Neurological Disorders and StrokeUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Neurological Disorders & Stroke (NINDS) [R01NS086885-01A1]; VA Career Development Awards, from the Clinical Science Research and Development (CSRD) Service [IK2CX000525, IK2CX000718]; VA Career Development Award from the Rehabilitation Research and Development (RRD) [5IK2RX001298]; VA Research Career Scientist Award [11S-RCS-009]; Intramural Research Program at the National Institute of Mental HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Mental Health (NIMH); Office of the Director, National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [S10 OD 021480]; Mid-Atlantic Healthcare Network ; This project was supported in part by the Department of Veterans Affairs' (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) of the VA Office of Mental Health Services, the Mid-Atlantic Healthcare Network, and the Office of Research and Development (ORD; 5I01CX000748-01, 5I01CX000120-02). Additional financial support was provided by the National Institute for Neurological Disorders and Stroke (R01NS086885-01A1; R.A.M.). Work Group Members: Drs Kimbrel and Dedert were supported by VA Career Development Awards #IK2CX000525 and IK2CX000718, respectively, from the Clinical Science Research and Development (CSR&D) Service. Dr Van Voorhees was supported by a VA Career Development Award (#5IK2RX001298) from the Rehabilitation Research and Development (RR&D). Dr Beckham was supported by a VA Research Career Scientist Award (#11S-RCS-009). A.L.G. was supported by the Intramural Research Program at the National Institute of Mental Health. Research reported in this publication was supported by the Office of the Director, National Institutes of Health under Award Number S10 OD 021480.

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.