Associations of alcohol and cannabis use with change in posttraumatic stress disorder and depression symptoms over time in recently trauma-exposed individuals.

BACKGROUND: Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians. METHODS: In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance. RESULTS: Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12. CONCLUSIONS: Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.

Structural inequities contribute to racial/ethnic differences in neurophysiological tone, but not threat reactivity, after trauma exposure.

Considerable racial/ethnic disparities persist in exposure to life stressors and socioeconomic resources that can directly affect threat neurocircuitry, particularly the amygdala, that partially mediates susceptibility to adverse posttraumatic outcomes. Limited work to date, however, has investigated potential racial/ethnic variability in amygdala reactivity or connectivity that may in turn be related to outcomes such as post-traumatic stress disorder (PTSD). Participants from the AURORA study (n = 283), a multisite longitudinal study of trauma outcomes, completed functional magnetic resonance imaging and psychophysiology within approximately two-weeks of trauma exposure. Seed-based amygdala connectivity and amygdala reactivity during passive viewing of fearful and neutral faces were assessed during fMRI. Physiological activity was assessed during Pavlovian threat conditioning. Participants also reported the severity of posttraumatic symptoms 3 and 6 months after trauma. Black individuals showed lower baseline skin conductance levels and startle compared to White individuals, but no differences were observed in physiological reactions to threat. Further, Hispanic and Black participants showed greater amygdala connectivity to regions including the dorsolateral prefrontal cortex (PFC), dorsal anterior cingulate cortex, insula, and cerebellum compared to White participants. No differences were observed in amygdala reactivity to threat. Amygdala connectivity was associated with 3-month PTSD symptoms, but the associations differed by racial/ethnic group and were partly driven by group differences in structural inequities. The present findings suggest variability in tonic neurophysiological arousal in the early aftermath of trauma between racial/ethnic groups, driven by structural inequality, impacts neural processes that mediate susceptibility to later PTSD symptoms.

Internal capsule microstructure mediates the relationship between childhood maltreatment and PTSD following adulthood trauma exposure.

Childhood trauma is a known risk factor for trauma and stress-related disorders in adulthood. However, limited research has investigated the impact of childhood trauma on brain structure linked to later posttraumatic dysfunction. We investigated the effect of childhood trauma on white matter microstructure after recent trauma and its relationship with future posttraumatic dysfunction among trauma-exposed adult participants (n = 202) recruited from emergency departments as part of the AURORA Study. Participants completed self-report scales assessing prior childhood maltreatment within 2-weeks in addition to assessments of PTSD, depression, anxiety, and dissociation symptoms within 6-months of their traumatic event. Fractional anisotropy (FA) obtained from diffusion tensor imaging (DTI) collected at 2-weeks and 6-months was used to index white matter microstructure. Childhood maltreatment load predicted 6-month PTSD symptoms (b = 1.75, SE = 0.78, 95% CI = [0.20, 3.29]) and inversely varied with FA in the bilateral internal capsule (IC) at 2-weeks (p = 0.0294, FDR corrected) and 6-months (p = 0.0238, FDR corrected). We observed a significant indirect effect of childhood maltreatment load on 6-month PTSD symptoms through 2-week IC microstructure (b = 0.37, Boot SE = 0.18, 95% CI = [0.05, 0.76]) that fully mediated the effect of childhood maltreatment load on PCL-5 scores (b = 1.37, SE = 0.79, 95% CI = [-0.18, 2.93]). IC microstructure did not mediate relationships between childhood maltreatment and depressive, anxiety, or dissociative symptomatology. Our findings suggest a unique role for IC microstructure as a stable neural pathway between childhood trauma and future PTSD symptoms following recent trauma. Notably, our work did not support roles of white matter tracts previously found to vary with PTSD symptoms and childhood trauma exposure, including the cingulum bundle, uncinate fasciculus, and corpus callosum. Given the IC contains sensory fibers linked to perception and motor control, childhood maltreatment might impact the neural circuits that relay and process threat-related inputs and responses to trauma.

The mindful gaze: trait mindful people under an instructed emotion regulation goal selectively attend to positive stimuli.

Trait mindfulness confers emotional benefits and encourages skillful emotion regulation, in part because it helps people more deliberately attend to internal experiences and external surroundings. Such heightened attentional control might help skillfully deploy one's attention towards certain kinds of stimuli, which may in turn help regulate emotions, but this remains unknown. Testing how trait mindful people deploy attention when regulating their emotions could help uncover the specific mechanisms of mindfulness that confer its emotional benefits. The present study aimed to determine whether high trait mindfulness is associated with sustained attention biases to (i.e. longer gaze at) emotional scenes, when all participants are given the emotion regulation goal of staying in a positive mood. To measure this, we used eye tracking to assess selective attention to positive, neutral, and negative photographs. Higher trait mindfulness was associated with both a stronger attention bias for positive (vs. neutral and vs. negative) images, as well as greater success staying in a positive mood during viewing. Surprisingly, this attention bias towards the positive images did not mediate the relationship between mindfulness and maintenance of positive mood. Future work should compare visual attention to other emotion regulation strategies that may maximise positive affect for mindful people.

On the impulsivity path: Examining the unique and conjoint relations between emotion- and non-emotion-related impulsivity, internalizing symptoms, alcohol use, and physical health parameters.

BACKGROUND: Researchers have increasingly differentiated trait-like tendencies toward impulsivity occurring during emotional states (emotion-related impulsivity [ERI]) from impulsivity not tied to emotion (non-ERI). Relative to non-ERI, ERI has shown robust correlations with psychopathology and mild to moderate associations with physical health parameters (e.g., physical activity, poor sleep quality, body mass index [BMI]). Therefore, we first aimed to investigate the unique contributions of ERI and non-ERI to psychopathology symptoms while controlling for neuroticism. Second, we sought to explore the combined associations of physical health parameters with several impulsivity forms. METHODS: German-speaking adults (N = 350, 35.9 ± 14.6 years, 69.1% female, BMI: 24.0 ± 4.8 kg/m2 , mostly students or employees) completed measures of impulsivity, psychopathology symptoms, neuroticism, and physical health. We gathered measures of two ERI forms: Feelings Trigger Action and Pervasive Influence of Feelings. As a control comparison, we gathered a measure of non-ERI, the Lack of Follow-Through scale. We conducted separate path models for Aims 1 and 2. RESULTS: For Aim 1, Pervasive Influence of Feelings showed strong links with internalizing symptoms. Feelings Trigger Action and Lack of Follow-Through showed small links with alcohol use. For Aim 2, poor sleep quality was related to all three impulsivity factors, while physical activity was only related to Pervasive Influence of Feelings and Lack of Follow-Through. BMI showed a curvilinear association with impulsivity. CONCLUSIONS: ERI is more directly relevant than non-ERI for psychopathology symptoms, emphasizing the need to differentiate between the two ERI types. The association of ERI and non-ERI with physical activity and poor sleep quality may serve as potential treatment targets for impulsivity-related problems.

Hippocampal Threat Reactivity Interacts with Physiological Arousal to Predict PTSD Symptoms.

Hippocampal impairments are reliably associated with post-traumatic stress disorder (PTSD); however, little research has characterized how increased threat-sensitivity may interact with arousal responses to alter hippocampal reactivity, and further how these interactions relate to the sequelae of trauma-related symptoms. In a sample of individuals recently exposed to trauma (N=116, 76 Female), we found that PTSD symptoms at 2-weeks were associated with decreased hippocampal responses to threat as assessed with functional magnetic resonance imaging (fMRI). Further, the relationship between hippocampal threat sensitivity and PTSD symptomology only emerged in individuals who showed transient, high threat-related arousal, as assayed by an independently collected measure of Fear Potentiated Startle. Collectively, our finding suggests that development of PTSD is associated with threat-related decreases in hippocampal function, due to increases in fear-potentiated arousal.Significance StatementAlterations in hippocampal function linked to threat-related arousal are reliably associated with post-traumatic stress disorder (PTSD); however, how these alterations relate to the sequelae of trauma-related symptoms is unknown. Prior models based on non-trauma samples suggest that arousal may impact hippocampal neurophysiology leading to maladaptive behavior. Here we show that decreased hippocampal threat sensitivity interacts with fear-potentiated startle to predict PTSD symptoms. Specifically, individuals with high fear-potentiated startle and low, transient hippocampal threat sensitivity showed the greatest PTSD symptomology. These findings bridge literatures of threat-related arousal and hippocampal function to better understand PTSD risk.

Neural responses to reward valence and magnitude from pre- to early adolescence.

BACKGROUND: Neural activation during reward processing is thought to underlie critical behavioral changes that take place during the transition to adolescence (e.g., learning, risk-taking). Though literature on the neural basis of reward processing in adolescence is booming, important gaps remain. First, more information is needed regarding changes in functional neuroanatomy in early adolescence. Another gap is understanding whether sensitivity to different aspects of the incentive (e.g., magnitude and valence) changes during the transition into adolescence. We used fMRI from a large sample of preadolescent children to characterize neural responses to incentive valence vs. magnitude during anticipation and feedback, and their change over a period of two years. METHODS: Data were taken from the Adolescent Cognitive and Brain DevelopmentSM (ABCD®) study release 3.0. Children completed the Monetary Incentive Delay task at baseline (ages 9-10) and year 2 follow-up (ages 11-12). Based on data from two sites (N = 491), we identified activation-based Regions of Interest (ROIs; e.g., striatum, prefrontal regions, etc.) that were sensitive to trial type (win $5, win $0.20, neutral, lose $0.20, lose $5) during anticipation and feedback phases. Then, in an independent subsample (N = 1470), we examined whether these ROIs were sensitive to valence and magnitude and whether that sensitivity changed over two years. RESULTS: Our results show that most ROIs involved in reward processing (including the striatum, prefrontal cortex, and insula) are specialized, i.e., mainly sensitive to either incentive valence or magnitude, and this sensitivity was consistent over a 2-year period. The effect sizes of time and its interactions were significantly smaller (0.002≤η2≤0.02) than the effect size of trial type (0.06≤η2≤0.30). Interestingly, specialization was moderated by reward processing phase but was stable across development. Biological sex and pubertal status differences were few and inconsistent. Developmental changes were mostly evident during success feedback, where neural reactivity increased over time. CONCLUSIONS: Our results suggest sub-specialization to valence vs. magnitude within many ROIs of the reward circuitry. Additionally, in line with theoretical models of adolescent development, our results suggest that the ability to benefit from success increases from pre- to early adolescence. These findings can inform educators and clinicians and facilitate empirical research of typical and atypical motivational behaviors during a critical time of development.

Individual and environmental correlates of childhood maltreatment and exposure to community violence: Utilizing a latent profile and a multilevel meta-analytic approach.

BACKGROUND: Childhood maltreatment (CM) and exposure to community violence (ETV) are correlated with physical/mental health and psychosocial problems. Typically, CM and ETV are examined separately, by subtypes within category, or collapsed across both into one category of adversity. Consequently, research is limited in identifying subgroups of individuals with different amounts of exposure to both CM and ETV. Accordingly, we lack sufficient understanding of the extent to which problems associated with CM and ETV vary based on the amount (i.e. dose) of exposure to both of these experiences. METHODS: We used 20 samples (28,300 individuals) to estimate person-centered profiles of CM and ETV occurrence and co-occurrence within each sample. An individual data multilevel meta-analytic framework was used to determine the average effect size across samples for different profiles and conditional probability correlations within sociodemographic, neighborhood, health, mental health, and psychosocial domains. RESULTS: The profile characterized by high levels of CM and high levels of ETV correlated with stressful life events, depression and anxiety symptoms, and general indicators of externalizing behaviors. CM predominant profiles were associated with mental health diagnoses and treatment. ETV predominant profiles associated with risk-taking/violent behavior and neighborhood-level disadvantage. However, nuance based on the dose of CM or ETV was evident. CONCLUSIONS: It is important to identify subgroups based on the amount of exposure to CM and ETV. These subgroups have differential relationships with correlates across domains. Greater delineation and description of the lived experience will allow for more precision in addressing the burden of childhood adversity.

The effect of attention bias modification on depressive symptoms in a comorbid sample: a randomized controlled trial.

BACKGROUND: Studies investigating the long-term effect of attention bias modification (ABM) in clinical samples are lacking. This study investigates the 6-months follow-up effect of ABM on depressive symptoms in participant with major depressive disorder with and without comorbid disorders. METHODS: We conducted a double-blind randomized sham-controlled trial in 101 participants between 19 November 2019, and 17 August 2021. Follow-up ended 3 April 2022. Participants were allocated to ABM or sham condition twice daily for 14 consecutive days. Primary outcomes were the total score on the Beck Depression Inventory-II (BDI-II) at 6 months, mean Brief State Rumination Inventory (BSRI) score post-treatment and reduction in BSRI post-treatment. Secondary outcome was change in attentional bias (AB). The trial was preregistered in ClinicalTrials.gov (#NCT04137367). RESULTS: A total of 118 patients aged 18-65 years were assessed for eligibility, and 101 were randomized and subjected to intention-to-treat analyses. At 6 months, ABM had no effect on depression and anxiety compared to a sham condition. While rumination decreased during the intervention, there was no effect of condition on rumination and AB. Predictor analysis did not reveal differences between participants with ongoing major depressive episode or comorbid anxiety. CONCLUSION: Compared to sham training, there was no effect of ABM on depressive symptoms at 6-months follow-up. Since the intervention failed at modifying AB, it is unclear whether changes in AB are related to long-term outcomes.

Development of a model to predict antidepressant treatment response for depression among Veterans.

BACKGROUND: Only a limited number of patients with major depressive disorder (MDD) respond to a first course of antidepressant medication (ADM). We investigated the feasibility of creating a baseline model to determine which of these would be among patients beginning ADM treatment in the US Veterans Health Administration (VHA). METHODS: A 2018-2020 national sample of n = 660 VHA patients receiving ADM treatment for MDD completed an extensive baseline self-report assessment near the beginning of treatment and a 3-month self-report follow-up assessment. Using baseline self-report data along with administrative and geospatial data, an ensemble machine learning method was used to develop a model for 3-month treatment response defined by the Quick Inventory of Depression Symptomatology Self-Report and a modified Sheehan Disability Scale. The model was developed in a 70% training sample and tested in the remaining 30% test sample. RESULTS: In total, 35.7% of patients responded to treatment. The prediction model had an area under the ROC curve (s.e.) of 0.66 (0.04) in the test sample. A strong gradient in probability (s.e.) of treatment response was found across three subsamples of the test sample using training sample thresholds for high [45.6% (5.5)], intermediate [34.5% (7.6)], and low [11.1% (4.9)] probabilities of response. Baseline symptom severity, comorbidity, treatment characteristics (expectations, history, and aspects of current treatment), and protective/resilience factors were the most important predictors. CONCLUSIONS: Although these results are promising, parallel models to predict response to alternative treatments based on data collected before initiating treatment would be needed for such models to help guide treatment selection.

Derivation and Validation of a Brief Emergency Department-Based Prediction Tool for Posttraumatic Stress After Motor Vehicle Collision.

STUDY OBJECTIVE: To derive and initially validate a brief bedside clinical decision support tool that identifies emergency department (ED) patients at high risk of substantial, persistent posttraumatic stress symptoms after a motor vehicle collision. METHODS: Derivation (n=1,282, 19 ED sites) and validation (n=282, 11 separate ED sites) data were obtained from adults prospectively enrolled in the Advancing Understanding of RecOvery afteR traumA study who were discharged from the ED after motor vehicle collision-related trauma. The primary outcome was substantial posttraumatic stress symptoms at 3 months (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders-5 ≥38). Logistic regression derivation models were evaluated for discriminative ability using the area under the curve and the accuracy of predicted risk probabilities (Brier score). Candidate posttraumatic stress predictors assessed in these models (n=265) spanned a range of sociodemographic, baseline health, peritraumatic, and mechanistic domains. The final model selection was based on performance and ease of administration. RESULTS: Significant 3-month posttraumatic stress symptoms were common in the derivation (27%) and validation (26%) cohort. The area under the curve and Brier score of the final 8-question tool were 0.82 and 0.14 in the derivation cohort and 0.76 and 0.17 in the validation cohort. CONCLUSION: This simple 8-question tool demonstrates promise to risk-stratify individuals with substantial posttraumatic stress symptoms who are discharged to home after a motor vehicle collision. Both external validation of this instrument, and work to further develop more accurate tools, are needed. Such tools might benefit public health by enabling the conduct of preventive intervention trials and assisting the growing number of EDs that provide services to trauma survivors aimed at promoting psychological recovery.

Attentional biases in facial emotion processing in individuals at clinical high risk for psychosis.

Individuals at clinical high risk (CHR) for psychosis exhibit altered facial emotion processing (FEP) and poor social functioning. It is unclear whether FEP deficits result from attentional biases, and further, how these abnormalities are linked to symptomatology (e.g., negative symptoms) and highly comorbid disorders that are also tied to abnormal FEP (e.g., depression). In the present study, we employed an eye-tracking paradigm to assess attentional biases and clinical interviews to examine differences between CHR (N = 34) individuals and healthy controls (HC; N = 46), as well as how such biases relate to symptoms and functioning in CHR individuals. Although no CHR-HC differences emerged in attentional biases, within the CHR group, symptoms and functioning were related to biases. Depressive symptoms were related to some free-view attention switching biases (e.g., to and from fearful faces, r = .50). Negative symptoms were related to more slowly disengaging from happy faces (r = .44), spending less time looking at neutral faces (r = - .42), and more time looking at no face (Avolition, r = .44). In addition, global social functioning was related to processes that overlapped with both depression and negative symptoms, including time looking at no face (r = - .68) and free-view attention switching with fearful faces (r = - .40). These findings are consistent with previous research, indicating that negative symptoms play a prominent role in the CHR syndrome, with distinct mechanisms relative to depression. Furthermore, the results suggest that attentional bias indices from eye-tracking paradigms may be predictive of social functioning.

Social interpretation inflexibility moderates emotional reactions to social situations in children and adolescents.

Interpretation biases and inflexibility (i.e., difficulties revising interpretations) have been linked to increased internalizing symptoms. Although adolescence is a developmental period characterized by novel social situations and increased vulnerability to internalizing disorders, no studies have examined interpretation inflexibility in adolescents. Additionally, no studies (on adolescents or adults) have examined interpretation flexibility as a protective factor against adverse outcomes of interpersonal events. Using a novel task and a 28-day diary we examined relations among interpretation bias and inflexibility, internalizing symptoms, and negative interpersonal events in a sample of children and adolescents (N = 159, ages 9-18). At baseline, negative interpretation bias was positively correlated with social anxiety symptoms, and positive interpretation bias negatively correlated with social anxiety and depressive symptoms. Inflexible positive interpretations were correlated with higher social anxiety and depressive symptoms, while inflexible negative interpretations were correlated with higher social anxiety. Finally, interpretation inflexibility moderated daily associations between negative interpersonal events and depressive symptoms in daily life, such that higher inflexibility was associated with stronger associations between interpersonal events and subsequent depressive symptoms, potentially increasing depressive symptom instability. These results suggest that interpretation biases and inflexibility may act as both risk and protective factors for adolescent anxiety and depression.

Social impression formation and depression: examining cognitive flexibility and bias.

Depression is associated with a bias toward negative interpretations of social situations and resistance to integrating evidence consistent with positive interpretations. These features could contribute to social isolation by generating negative expected value for future social interactions. The present study examined potential associations between depressive symptoms and positive (i.e. trust and liking) and negative (i.e. distrust and disliking) social impression formation of individuals who previously appeared in positive or negative contexts. Participants (N = 213) completed the Interpretation Inflexibility Task and were subsequently asked to provide social impression ratings of characters from each scenario type of the task (i.e. positive and negative) as well as characters not previously encountered. In examining social impression formation, higher severity of depressive symptoms was associated with higher negative social impression ratings regardless of scenario outcome, as well as lower positive social impression ratings, but only for characters who previously appeared in positive contexts. Those higher in depression also rated novel characters as significantly more unlikeable and untrustworthy and to an equivalent degree as the characters previously encountered. These findings suggest a role of negative interpretation bias and inflexibility in contributing to negative evaluations of potential social interaction partners in depression.

Emotion regulation and disordered eating behaviour in youths: Two daily-diary studies.

OBJECTIVE: Disordered eating cognitions and behaviours in childhood and adolescence have been identified as precursors for the development of eating disorders. Another important contributor to eating disorder risk is maladaptive emotion regulation. However, while the regulation of negative affect has been the focus of much research, the literature on the role of positive emotion regulation in eating pathology is extremely limited. The present study extends previous research by examining the regulation of both positive and negative affect in disordered eating using two waves of a daily diary design. METHOD: Every evening for 21 days, 139 youths (8-15 years) reported their use of rumination, dampening, and disordered eating cognitions and behaviours. 1 year later, during the onset of the COVID-19 pandemic, 115 of these youths were followed-up. RESULTS: As predicted, higher levels of rumination and dampening were found to be associated with a higher frequency of weight concerns and restrictive eating on person-level (both Waves) and day-level (Wave 2). Further, a higher frequency of rumination at Wave 1 predicted increases in the frequency of restrictive eating 1 year later. CONCLUSIONS: Our findings underline the importance of examining regulation of both positive and negative emotion in order to understand eating disorder risk.

Socio-demographic and trauma-related predictors of depression within eight weeks of motor vehicle collision in the AURORA study.

BACKGROUND: This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience. METHODS: We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression. RESULTS: Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma. CONCLUSIONS: These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.

Socio-demographic and trauma-related predictors of PTSD within 8 weeks of a motor vehicle collision in the AURORA study.

This is the initial report of results from the AURORA multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience. We focus on n = 666 participants presenting to EDs following a motor vehicle collision (MVC) and examine associations of participant socio-demographic and participant-reported MVC characteristics with 8-week posttraumatic stress disorder (PTSD) adjusting for pre-MVC PTSD and mediated by peritraumatic symptoms and 2-week acute stress disorder (ASD). Peritraumatic Symptoms, ASD, and PTSD were assessed with self-report scales. Eight-week PTSD prevalence was relatively high (42.0%) and positively associated with participant sex (female), low socioeconomic status (education and income), and several self-report indicators of MVC severity. Most of these associations were entirely mediated by peritraumatic symptoms and, to a lesser degree, ASD, suggesting that the first 2 weeks after trauma may be a uniquely important time period for intervening to prevent and reduce risk of PTSD. This observation, coupled with substantial variation in the relative strength of mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated with more in-depth analyses of the rich and evolving AURORA data.

Prior histories of posttraumatic stress disorder and major depression and their onset and course in the three months after a motor vehicle collision in the AURORA study.

BACKGROUND: A better understanding of the extent to which prior occurrences of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) predict psychopathological reactions to subsequent traumas might be useful in targeting posttraumatic preventive interventions. METHODS: Data come from 1306 patients presenting to 29 U.S. emergency departments (EDs) after a motor vehicle collision (MVC) in the advancing understanding of recovery after trauma study. Patients completed self-reports in the ED and 2-weeks, 8-weeks, and 3-months post-MVC. Associations of pre-MVC probable PTSD and probable MDE histories with subsequent 3-months post-MVC probable PTSD and probable MDE were examined along with mediation through intervening peritraumatic, 2-, and 8-week disorders. RESULTS: 27.6% of patients had 3-month post-MVC probable PTSD and/or MDE. Pre-MVC lifetime histories of these disorders were not only significant (relative risk = 2.6-7.4) but were dominant (63.1% population attributable risk proportion [PARP]) predictors of this 3-month outcome, with 46.6% prevalence of the outcome among patients with pre-MVC disorder histories versus 9.9% among those without such histories. The associations of pre-MVC lifetime disorders with the 3-month outcome were mediated largely by 2- and 8-week probable PTSD and MDE (PARP decreasing to 22.8% with controls for these intervening disorders). Decomposition showed that pre-MVC lifetime histories predicted both onset and persistence of these intervening disorders as well as the higher conditional prevalence of the 3-month outcome in the presence of these intervening disorders. CONCLUSIONS: Assessments of pre-MVC PTSD and MDE histories and follow-ups at 2 and 8 weeks could help target early interventions for psychopathological reactions to MVCs.

Learned helplessness: expanding on a goal-directed perspective.

This commentary reviews a novel model of learned helplessness proposed by Boddez et al. in this issue of Cognition and Emotion. Combining operant and goal-directed perspectives, Boddez et al. suggest that helplessness stems from a lack of reinforcement when striving toward a goal, with the degree of generalisation dependent on subjective perceptions of goal similarity. We begin by reviewing the theoretical model, describe possible expansions from a cognitive perspective, and discuss several considerations. We finish with a brief discussion of possible directions for future work.

The AURORA Study: a longitudinal, multimodal library of brain biology and function after traumatic stress exposure.

Adverse posttraumatic neuropsychiatric sequelae (APNS) are common among civilian trauma survivors and military veterans. These APNS, as traditionally classified, include posttraumatic stress, postconcussion syndrome, depression, and regional or widespread pain. Traditional classifications have come to hamper scientific progress because they artificially fragment APNS into siloed, syndromic diagnoses unmoored to discrete components of brain functioning and studied in isolation. These limitations in classification and ontology slow the discovery of pathophysiologic mechanisms, biobehavioral markers, risk prediction tools, and preventive/treatment interventions. Progress in overcoming these limitations has been challenging because such progress would require studies that both evaluate a broad spectrum of posttraumatic sequelae (to overcome fragmentation) and also perform in-depth biobehavioral evaluation (to index sequelae to domains of brain function). This article summarizes the methods of the Advancing Understanding of RecOvery afteR traumA (AURORA) Study. AURORA conducts a large-scale (n = 5000 target sample) in-depth assessment of APNS development using a state-of-the-art battery of self-report, neurocognitive, physiologic, digital phenotyping, psychophysical, neuroimaging, and genomic assessments, beginning in the early aftermath of trauma and continuing for 1 year. The goals of AURORA are to achieve improved phenotypes, prediction tools, and understanding of molecular mechanisms to inform the future development and testing of preventive and treatment interventions.