Physical Injury,PTSD Symptoms,and Medication Use: Examination in Two Trauma Types

Physical injury is prevalent across many types of trauma experiences and can be associated with posttraumatic stress disorder (PTSD) symptoms and physical health effects, including increased medication use. Recent studies suggest that PTSD symptoms may mediate the effects of traumatic injury on health outcomes, but it is unknown whether this finding holds for survivors of different types of traumas. The current study examined cross‐sectional relationships between injury, PTSD, and pain and psychiatric medication use in 2 trauma‐exposed samples, female survivors of motor vehicle accidents (MVAs; n = 315) and intimate partner violence (IPV; n = 167). Data were obtained from participants at 2 trauma research clinics who underwent a comprehensive assessment of psychopathology following the stressor. Regression with bootstrapping suggested that PTSD symptoms mediate the relationship between injury severity and use of pain medications, R² = .11, F(2, 452) = 28.37, p < .001, and psychiatric medications, R² = .06, F(2, 452) = 13.18, p < .001, as hypothesized. Mediation, however, was not moderated by trauma type (ps > .05). Results confirm an association between posttraumatic psychopathology and medication usage and suggest that MVA and IPV survivors alike may benefit from assessment and treatment of emotional distress after physical injury.     

Self‐Monitoring of Reexperiencing Symptoms: A Randomized Trial

The efficacy of a brief intervention to self‐monitor reexperiencing symptoms was evaluated in 137 U.S. combat veterans with PTSD who were enrolled in 5‐week psychoeducation groups at a large Veterans Affairs Medical Center. Groups were randomized to psychoeducation alone (Education Control, n = 50) or psychoeducation plus intrusion monitoring (Education + Monitoring, n = 87). Education + Monitoring participants were asked to make a daily record of the number and content of nightmares, flashbacks, intrusive trauma‐related thoughts, and physiological and emotional reactions to triggers. Avoidance symptoms were reduced in both conditions (η² = .093), with no additional benefit from intrusion monitoring (η² = .001). Compliance with intrusion monitoring was markedly low, which complicated the interpretation of the study findings. Even though intrusion monitoring has a strong theoretical foundation and may be an efficient and cost‐effective alternative to more structured treatments for PTSD, the effect of intrusion monitoring will not be clearly understood until higher compliance can be achieved. Future work in this area should address barriers to compliance and investigate strategies for enhancing motivation to engage in self‐monitoring.     

Probable Posttraumatic Stress Disorder and Women's Use of Aggression in Intimate Relationships: The Moderating Role of Alcohol Dependence

Posttraumatic stress disorder (PTSD) is highly prevalent among individuals who experience intimate partner violence (IPV) and is associated with aggression in intimate relationships. The present study examined whether alcohol dependence (AD) attenuates the relation between PTSD and IPV‐victimized women's use of physical, psychological, and sexual aggression. Participants were recruited from the community and included 147 women who engaged in substance use and experienced IPV (80.3% Black; M age = 38.24 years, SD = 10.62; M income = $14,323, SD = $12,832). Women with (vs. without) AD reported using significantly more physical and psychological aggression (η_p² = .12 and .03, respectively). The probable PTSD × AD interaction emerged as a significant correlate of physical and sexual aggression (η_p² = .03). Post hoc analyses revealed higher levels of physical aggression among women with probable PTSD and AD and no‐PTSD and AD compared to women with probable PTSD and no‐AD (Cohen's ds = 1.09 and 0.63, respectively) and women without PTSD and no‐AD (Cohen's ds = 0.92 and 0.60, respectively). Further, women with PTSD and AD reported higher levels of sexual aggression than women without PTSD and AD (Cohen's d = 0.80). Findings suggest the utility of identifying and treating PTSD‐AD among IPV‐victimized women.     

Mesangial expansion at 5 years predicts death and death‐censored graft loss after renal transplantation

Death with a functioning graft and death‐censored renal allograft failure remain major problems for which effective preventative protocols are lacking. The retrospective cohort study aimed to determine whether histologic changes on a 5‐year surveillance kidney biopsy predict adverse outcomes after transplantation in recipients who had: both Type 2 diabetes (T2DM) and obesity (BMI ≥ 30 kg/m²) at the time of transplantation (T2DM/Obesity, n = 75); neither (No T2DM/No obesity, n = 78); No T2DM/Obesity (n = 41), and T2DM/No obesity (n = 47). On 5‐year biopsies, moderate‐to‐severe mesangial expansion was more common in the T2DM/Obesity group (Banff mm score ≥2 = 49.3%; Tervaert classification MS ≥ 2b = 26.7%) compared to the other groups (p < .001 for both scores). Risk factors included older age, higher BMI, HbA1C, and triglycerides at 1‐year post‐transplant. Moderate‐to‐severe mesangial expansion correlated with death with function (HR 1.74 (1.01, 2.98), p = .045 Banff and 1.89 (1.01, 3.51) p = .045 Tervaert) and with death‐censored graft loss (HR 3.2 (1.2, 8.8), p = .02 Banff and HR 3.8 (1.3, 11.5), p = .01 Tervaert) over a mean of 11.6 years of recipient follow‐up post‐transplant. These data suggest that mesangial expansion in recipients with T2DM and obesity may reflect systemic vascular injury and might be a novel biomarker to predict adverse outcomes post renal transplant.     

Gender Differences in the Associations of PTSD Symptom Clusters With Relationship Distress in U.S. Vietnam Veterans and Their Partners

Research has consistently linked symptoms of posttraumatic stress disorder (PTSD) with relationship distress in combat veterans and their partners. Studies of specific clusters of PTSD symptoms indicate that symptoms of emotional numbing/withdrawal (now referred to as negative alterations in cognition and mood) are more strongly linked with relationship distress than other symptom clusters. These findings, however, are based predominantly on samples of male veterans. Given the increasing numbers of female veterans, research on potential gender differences in these associations is needed. The present study examined gender differences in the multivariate associations of PTSD symptom clusters with relationship distress in 465 opposite‐sex couples (375 with male veterans and 90 with female veterans) from the National Vietnam Veterans Readjustment Study. Comparisons of nested path models revealed that emotional numbing/withdrawal symptoms were associated with relationship distress in both types of couples. The strength of this association, however, was stronger for female veterans (b = .46) and female partners (b = .28), compared to male veterans (b = .38) and male partners (b = .26). Results suggest that couples‐based interventions (e.g., psychoeducation regarding emotional numbing symptoms as part of PTSD) are particularly important for both female partners of male veterans and female veterans themselves.     

Observed Emotional Expressivity,Posttraumatic Stress Disorder Symptoms,and Intimate Partner Violence Perpetration Among Community Couples

Impaired emotional processes are related to posttraumatic stress disorder (PTSD) and are implicated in intimate partner violence (IPV) perpetration. To address the interpersonal context of PTSD, emotion, and IPV, we examined interactions among one's own and one's partner's emotional expressivity and PTSD symptom severity in association with IPV perpetration. Heterosexual couples (N = 56) in which at least one partner met screening criteria for PTSD engaged in two video‐recorded discussions about negative and positive aspects of their relationships. Videos were coded for observed emotional expressiveness during moments participants reported experiencing significant emotions. Actor‐partner interdependence models revealed few main effects of emotional expressivity, except that women's expressivity of positive emotions was positively associated with men's IPV perpetration, r²_adj = .14. Emotional expressivity played a larger role among couples managing PTSD symptoms; that is, the association between one's own PTSD symptom severity and more IPV perpetration was stronger among men who expressed more negative emotions, r²_adj = .19, and women who expressed fewer negative emotions, r²_adj = .21. Several partner effects suggested the importance of understanding the dyadic nature of these constructs. For example, men's PTSD symptom severity was differentially associated with each partners’ IPV perpetration based on women's expressivity of positive emotion, r²_adj = .22–.27. Understanding of emotional expressivity in the link between PTSD and IPV must include consideration of gender differences in how these constructs operate interpersonally. Strategies to promote moderate and safe communication of positive and negative emotions may prevent IPV escalation, particularly among couples managing PTSD symptoms.     

Posttraumatic Stress Disorder in Maltreated Children Grown Up: The Influence of Neighborhood

In this study, we examined the effects of childhood neighborhood characteristics on the development of posttraumatic stress disorder (PTSD) in a sample of abused and neglected individuals and matched controls followed into adulthood (N = 1,132). Using generalized linear models (GLM), the results indicated that growing up in more advantaged neighborhoods (middle‐ and upper‐class) was associated with the development of fewer PTSD symptoms, R² = .09, p < .001. In contrast, growing up in more economically disadvantaged areas was associated with more PTSD symptoms, but only for nonmaltreated controls, R² = .09, p < .001. We did not find that neighborhood characteristics were associated with PTSD in terms of the number of traumatic events reported, R² = .60, p < .001, or being the victim of more than one type of maltreatment, pseudo R² = .11, p < .001. The results generally supported the premise that characteristics of one's residential environment in childhood, especially factors reflecting social and economic advantage and disadvantage, have an influence on mental health functioning later in life. Future research should examine the mechanisms that might explain the impact of childhood neighborhood on PTSD outcomes and the aggravating effects of pretrauma vulnerabilities associated with neighborhood disadvantage.     

Effect of the metabolic syndrome on male reproductive function: a case‐controlled pilot study

The metabolic syndrome (MetS) is a constellation of various risk factors. This study aimed to investigate the effect of MetS on testosterone and progesterone, and semen parameters, in a case‐controlled pilot study. Male patients (n = 54) had body mass index, waist‐to‐hip ratio (WHR) and blood pressure recorded. Blood was analysed for HDL cholesterol, triglycerides and glucose. Saliva was assayed for free testosterone and free progesterone. Ejaculates were analysed for volume, sperm concentration, total sperm count, motility, vitality, mitochondrial membrane potential (MMP), DNA fragmentation and leucocyte concentration. Participants were divided into the control group (n = 28) and the MetS group (n = 26). Differences were found between the groups for body mass index, WHR, blood pressure, high‐density lipoprotein (HDL), triglycerides and glucose. The MetS group showed significant reductions in sperm concentration (P = 0.0026), total sperm count (P = 0.0034), total motility (P = 0.0291), sperm vitality (P = 0.002), MMP (P = 0.0039), free testosterone (P = 0.0093) and free progesterone (P = 0.0130), while values for DNA fragmentation increased (P = 0.0287). Results indicate that patients with MetS have compromised sperm parameters in the absence of leucocytospermia. A reduction in free progesterone suggests that steroidogenesis cascades may be compromised. It is hypothesised that a systemic pro‐inflammatory state with oxidative stress associated with MetS may provide a novel explanation.     

Oxidative stress‐induced alterations in seminal plasma antioxidants: Is there any association with keap1 gene methylation in human spermatozoa?

Kelch‐like ECH‐associated protein 1 (keap1)‐nuclear factor‐erythroid 2‐related factor 2 (Nrf2) pathway is one of the master regulators of cellular defence against oxidative stress. Epigenetic alterations like hypermethylation of keap1 gene impair keap1‐Nrf2 system in several oxidative stress–associated diseases. The objective of this study was to evaluate the epigenetic status of keap1 in sperm DNA of normozoospermic subjects, having different levels of reactive oxygen species (ROS) in seminal plasma. Semen samples were obtained from 151 apparently healthy male partners of couples who attended the Avicenna infertility clinic. Samples were categorised into four groups according to their ROS levels: group A (n = 39, ROS < 20 RLU/s per 10⁶ spermatozoa), group B (n = 38, 20 ≤ ROS < 40 RLU/s per 10⁶ spermatozoa), group C (n = 31, 40 ≤ ROS < 60 RLU/s per 10⁶ spermatozoa) and group D; (n = 43, ROS ≥ 60 RLU/s per 10⁶ spermatozoa). Keap1 methylation status was assessed using methylation‐specific PCR along with seminal total antioxidant capacity. The results showed no significant alterations in keap1 methylation in any groups, whereas the total antioxidant capacity enhanced with increasing levels of ROS exposure. These results indicate that keap1 was not methylated during ROS elevation and oxidative stress, suggesting that the cells have adopted other mechanisms to elevate antioxidant level.     

Nocturnal Olfactory Stimulation for Improvement of Sleep Quality in Patients With Posttraumatic Stress Disorder: A Randomized Exploratory Intervention Trial

Posttraumatic stress disorder (PTSD) is characterized by sleep impairment and nightmares. As pleasant odors presented during sleep affect the emotional tone of dreams without inducing arousal, we investigated whether sleep patterns in PTSD can be improved via nocturnal olfactory stimulation. Participants were 40 inpatients with PTSD (n = 35 women; age range: 20–59 years) who completed a randomized, patient‐blind, placebo‐controlled trial. Baseline measurement for 5 consecutive nights was followed by a 5‐night experimental intervention or placebo trial. During the intervention, patients received nocturnal stimulation with a pleasant odor (odor condition) or clean air (placebo condition) via an olfactometer that delivered inspiration‐triggered stimuli in a nasal tube or via an odorized nasal clip. After each night, the patients completed standardized questionnaires that assessed sleep parameters and dream content. Each night, sleep efficiency, sleep onset latency, and wakefulness after sleep onset were monitored with a motion biosensor. Baseline assessment revealed that PTSD severity was associated with poorer sleep outcomes. An interaction effect showed that nocturnal odorization affected dream intensity. Post hoc tests revealed an improvement in the group that used the nasal clip as compared to baseline, d = 0.68. No negative effects were observed after odorization with the nasal clip. Considering the limited sample size, the study indicates that nocturnal olfactory stimulation may serve as a low‐cost concomitant intervention to improve sleep quality in PTSD.     

Pupillary Response to Affective Voices: Physiological Responsivity and Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is related to dysfunctional emotional processing, thus motivating the search for physiological indices that can elucidate this process. Toward this aim, we compared pupillary response patterns in response to angry and fearful auditory stimuli among 99 adults, some with PTSD (n = 14), some trauma‐exposed without PTSD (TE; n = 53), and some with no history of trauma exposure (CON; n = 32). We hypothesized that individuals with PTSD would show more pupillary response to angry and fearful auditory stimuli compared to those in the TE and CON groups. Among participants who had experienced a traumatic event, we explored the association between PTSD symptoms and pupillary response; contrary to our prediction, individuals with PTSD displayed the least pupillary response to fearful auditory stimuli compared those in the TE, B = ?0.022, p = .077, and CON, B = ?0.042, p = .002, groups, but they did not differ on angry auditory stimuli, B = 0.019, p = .118 and B = 0.006, p = .634, respectively. It is important to note that within‐group analyses revealed that participants with PTSD differed significantly in their response to angry versus fearful stimuli, B = ?0.032, p = .015. We also found a positive association between PTSD symptoms and pupillary response to angry stimuli. Our findings suggest that differential pupil response to anger and fear stimuli may be a promising way to understand emotional processing in PTSD.     

Equine‐Assisted Therapy for Anxiety and Posttraumatic Stress Symptoms

We tested the efficacy of the Equine Partnering Naturally^© approach to equine‐assisted therapy for treating anxiety and posttraumatic stress disorder (PTSD) symptoms. Participants were 16 volunteers who had experienced a Criterion A traumatic event, such as a rape or serious accident, and had current PTSD symptoms above 31 on the PTSD Checklist (PCL‐S; Weathers, Litz, Herman, Huska, & Keane, 1993). Participants engaged in tasks with horses for 6 weekly 2‐hour sessions. Immediately following the final session, participants reported significantly reduced posttraumatic stress symptoms, d = 1.21, less severe emotional responses to trauma, d = 0.60, less generalized anxiety, d = 1.01, and fewer symptoms of depression, d = 0.54. As well, participants significantly increased mindfulness strategies, d = 1.28, and decreased alcohol use, d = 0.58. There was no significant effect of the treatment on physical health, proactive coping, self‐efficacy, social support, or life satisfaction. Thus, we found evidence that the Equine Partnering Naturally^© approach to equine‐assisted therapy may be an effective treatment for anxiety and posttraumatic stress symptoms. Future research should include larger groups, random assignment, and longer term follow‐up.     

Relationships of Posttraumatic Stress Symptoms and Sleep Measures to Cognitive Performance in Young‐Adult African Americans

Disturbed sleep is a prominent feature of posttraumatic stress disorder (PTSD). PTSD and disrupted sleep have been independently linked to cognitive deficits; however, synergistic effects of PTSD and poor sleep on cognition have not been investigated. The purpose of this study was to examine the effects of PTSD symptoms and objectively measured disruptions to sleep on cognitive function. Forty‐four young‐adult African American urban residents comprised the study sample. The Clinician‐Administered PTSD Scale (CAPS; Blake et al., 1995) was utilized to determine the severity of PTSD symptoms. Participants underwent 2 consecutive nights of polysomnography. The Automated Neuropsychological Assessment Metrics (Reeves, Winter, Bleiberg, & Kang, 2007 ) was utilized to assess sustained attention and the Rey Auditory Verbal Learning Test (Schmidt, 1996 ) was used to evaluate verbal memory. PTSD symptom severity, r(42) = .40, p = .007, was significantly associated with omission errors on the sustained attention task, and sleep duration, r(42) = .41, p = .006, and rapid eye movement sleep, r(42) = .43, p = .003, were positively correlated with verbal memory. There was an interaction of PTSD symptom severity and sleep duration on omission errors such that more than 7 hours 12 minutes of sleep mitigated attentional lapses that were associated with PTSD.     

Underweight and obesity increase the risk of mortality after lung transplantation: a systematic review and meta‐analysis

Many studies have found an association between abnormal body mass index (BMI) and poor outcomes among lung transplant recipients. We performed a systematic review and meta‐analysis to identify outcomes associated with an abnormal pretransplant BMI after lung transplantation (LTx). The MEDLINE and EMBASE databases were searched from inception to May 2015 with focus on original observational studies with post‐transplant survival data in candidates with abnormal BMI (underweight, overweight, or obese). We performed meta‐analyses examining survival and primary graft dysfunction after LTx. We identified 866 citations; 13 observational cohort studies involving 40 742 participants met our inclusion criteria for systematic review. Seven of the 13 were included in the meta‐analysis. There was a significant risk of mortality after LTx in candidates with underweight and obesity (underweight versus normal, relative risk [RR] 1.36, 95% confidence interval [CI] 1.11–1.66, I² = 0%; obesity vs. normal, RR 1.90, 95% CI 1.45–2.56, I² = 0%; overweight vs. normal, RR 1.36, 95% CI 1.11–1.66, I² = 0). There was also a significant risk of primary graft dysfunction in obese (RR 1.92, 95% CI 1.39–2.65, I² = 0%) and overweight (RR 1.72, 95% CI, 1.32–2.24, I² = 0%) candidates. Lung transplant candidates who are underweight or obese have a higher risk of post‐transplant mortality than recipients with a normal BMI.     

Evaluation of a Trauma‐Focused Group Intervention for Unaccompanied Young Refugees: A Pilot Study

Recent research has shown that unaccompanied young refugees (UYR) encounter a wide range of traumatic events during preflight, flight, and resettlement. Although many UYR are resourceful, many develop posttraumatic stress symptoms (PTSS). However, only a small number of vulnerable UYR have access to trauma‐focused interventions. Trauma‐focused group interventions, adapted to the needs of UYR, may be one way of improving their mental health. A total of 29 male UYR between 14 and 18 years of age, mainly from Afghanistan, participated in the evaluation study of a trauma‐focused group intervention entitled Mein Weg (My Way ). The intervention included six sessions of psychoeducation, relaxation, trauma narrative, and cognitive restructuring. Pre–post comparisons of PTSS assessed by the Child and Adolescent Trauma Screen (CATS) were used. At study entry, participants endorsed, on average, eight traumatic events. After the group intervention, the participants reported significantly fewer overall PTSS preintervention mean = 27.6, SD  = 7.9; postintervention mean = 20.7, SD  = 6.3; t (28) = 4.2, p  = .001, Cohen's d  = 0.97. Improvement was especially pronounced in the domains of reexperiencing and avoidance, as well as negative alterations in cognitions and mood. There were 14 participants preintervention and 7 postintervention who fulfilled the PTSD criteria. This pilot study presented initial evidence of the efficacy of the trauma‐focused group intervention with regard to PTSS reduction.     

Contribution of Criterion A2 to PTSD Screening in the Presence of Traumatic Events

Criterion A2 according to the Diagnostic and Statistical Manual of Mental Disorders (4^th ed.; DSM‐IV; American Psychiatric Association [APA], 1994) for posttraumatic stress disorder (PTSD) aims to assess the individual's subjective appraisal of an event, but it has been claimed that it might not be sufficiently specific for diagnostic purposes. We analyse the contribution of Criterion A2 and DSM‐IV criteria to detect PTSD for the most distressing life events experienced by our subjects. Young adults (N = 1,033) reported their most distressing life events, together with PTSD criteria (Criteria A2, B, C, D, E, and F). PTSD prevalence and criterion specificity and agreement with probable diagnoses were estimated. Our results indicate 80.30% of the individuals experienced traumatic events and met one or more PTSD criteria; 13.22% cases received a positive diagnosis of PTSD. Criterion A2 showed poor agreement with the final probable PTSD diagnosis (correlation with PTSD .13, specificity = .10); excluding it from PTSD diagnosis did not the change the estimated disorder prevalence significantly. Based on these findings it appears that Criterion A2 is scarcely specific and provides little information to confirm a probable PTSD case.     

Semen quality and infertility status can be identified through measures of oxidation–reduction potential

Standard analyses for evaluating semen quality require technical expertise and are interpretive in nature. Oxidative stress (OS) alters many of the semen parameters; thus, a measure of OS could be an indicator of semen quality. Static oxidation‐reduction potential (sORP) is a universal measure of OS traditionally used in environmental applications but is increasingly used in biomedical studies. sORP was measured to determine how well it associates with semen quality and if it differentiates semen from infertile patients and fertile donors. All study participants (Infertile, n = 365 and Fertile, n = 50) underwent standard semen analyses, and sORP was measured in unprocessed semen. In infertile patients, sORP increased with decreased total sperm number, motility and morphology. sORP values were higher in samples with abnormal quality (low number, motility and/or normal morphology) compared with those of normal quality. Infertile patients had higher sOPR values compared to fertile donors. A sORP cut‐off value of 1.38 mV/10⁶ sperm/ml can differentiate normal from abnormal semen samples, while a cut‐off value of 1.41 mV/10⁶ sperm/ml, can differentiate between infertile and fertile semen samples. In conclusion, sORP provides a quick and unbiased indicator of semen quality that can be a beneficial addition to semen analysis to determine semen quality and fertility status.     

The Impact of Childhood Abuse Among Women With Assault‐Related PTSD Receiving Short‐Term Cognitive–Behavioral Therapy

This study examined the effect of child sexual or physical abuse on brief cognitive–behavioral therapy treatments with adults with posttraumatic stress disorder (PTSD). We analyzed secondary data from two randomized controlled trials (Resick, Nishith, Weaver, Astin, & Feuer, 2002; Resick et al., 2008) that included women with PTSD who did or did not have child sexual abuse (CSA) or child physical abuse (CPA) histories to determine whether childhood abuse impacted dropout rate or reduction in PTSD symptoms. In Study 1, presence, duration, or severity of CSA was not associated with dropout; however, frequency of CSA significantly predicted dropout (OR = 1.23). A significant CPA Severity × Treatment Group interaction emerged such that CPA severity was associated with greater dropout for prolonged exposure (PE; OR = 1.45), but not cognitive processing therapy (CPT; OR = 0.90). Study 2 found no differences in dropout. Study 1, comparing CPT and PE among women who experienced at least 1 rape found no differences in outcome based on childhood abuse history (r_p²s = .000–.009). Study 2, a dismantling study of CPT with women seeking treatment for adult or child sexual or physical abuse found that for those with no childhood abuse, CPT‐C, the cognitive‐only version of CPT, had an advantage, whereas both forms of CPT worked best for those with higher frequency of childhood abuse; the effect size was small.     

Attachment,Personality Characteristics,and Posttraumatic Stress Disorder in U.S. Veterans of Iraq and Afghanistan

U.S. veterans of Iraq and/or Afghanistan (N = 116) completed an Internet survey with questions related to attachment style in intimate relationships, personality factors, and posttraumatic stress disorder (PTSD). Participants completed the PTSD Checklist‐Military, Experiences in Close Relationships Scale‐Short Form, and the International Personality Item Pool Big Five Short Form Questionnaire. Most participants were male and Caucasian. Hierarchical linear regression analysis results indicated that emotional stability (β = ?.46, p < .001) and attachment avoidance (β = .20, p < .05) were associated with PTSD symptom severity (adjusted R² = .63). An interaction between conscientiousness and attachment anxiety was found (β = ?.26, p < .001; ΔR² = .06), with secure attachment moderating the relationship between conscientiousness and PTSD symptom severity. Results of this study indicate that emotional stability, conscientiousness, and secure relationship attachment styles (low attachment anxiety and avoidance) are important for postcombat mental health.     

Associations Among Hair Cortisol Concentrations,Posttraumatic Stress Disorder Status,and Amygdala Reactivity to Negative Affective Stimuli in Female Police Officers

Posttraumatic stress disorder (PTSD) is associated with altered hypothalamic‐pituitary‐adrenal (HPA) axis function. Measurement of hair cortisol concentrations (HCC) allows retrospective assessment of HPA axis regulation over prolonged periods of time. Currently, research investigating HCC in PTSD remains sparse. Previous cross‐sectional studies have included only civilian populations, although it is known that trauma type moderates associations between PTSD status and HPA axis function. We investigated differences in HCC between trauma‐exposed female police officers with current PTSD (n = 13) and without current and lifetime PTSD (n = 15). To investigate whether HCC was associated with neural correlates of PTSD, we additionally performed exploratory correlational analyses between HCC and amygdala reactivity to negative affective stimuli. We observed significantly lower HCC in participants with PTSD than in participants without PTSD, d = 0.89. Additionally, within participants with PTSD, we observed positive correlations between HCC and right amygdala reactivity to negative affective (vs. happy/neutral) faces, r = .806 (n = 11) and left amygdala reactivity to negative affective (vs. neutral) pictures, r = .663 (n = 10). Additionally, left amygdala reactivity to negative faces was positively correlated with HCC in trauma‐exposed controls, r = .582 (n = 13). This indicates that lower HCC is associated with diminished amygdala differentiation between negative affective and neutral stimuli. Thus, we observed lower HCC in trauma‐exposed noncivilian women with PTSD compared to those without PTSD, which likely reflects prolonged HPA axis dysregulation. Additionally, HCC was associated with hallmark neurobiological correlates of PTSD, providing additional insights into pathophysiological processes in PTSD.