Traumatic triggers come in many forms: the smell of a rose, the taste of a warm pie, the sound of music, the gaze of a loved one, and the touch of soft soil. What appears ordinary to one may repel another, but the tension between these two opposing reactions is what entices me as an artist. Every trigger is tied to a specific memory which causes me, as a survivor, to question my reality and what I believe to be true. Is this love or is this abuse? What happens when I succumb to the memory that haunts me? My work addresses themes of domesticity, trauma, and sentimentality through the creation of sculpture and video works. Asunder is a minefield of such works that are my response to personal trauma while offering a space for outside connection.

Research suggests that trauma plays a part in Post Traumatic Stress Disorder (PTSD) and psychosis, but it is unclear what role psychotic symptoms or hospitalisation have. Some research has been carried out on mediators and predictors of PTSD and integrating the evidence has key implications for individual and service outcomes. The two papers presented in this thesis aim to contribute to research in this area, followed by a critical review of the research, its relevance and future implications.Paper One is a systematic review of the literature investigating the prevalence of psychosis-related and hospital-related PTSD and considered what factors moderate or mediates these symptoms. Studies showed high levels of psychosis-related and hospital-related PTSD and seventeen factors that may influence the development of psychosis-related or hospital-related PTSD were explored. However incidence rates in different populations are lacking and there is a need to better explore mediating and moderating factors.Paper Two aimed to investigate the traumatic nature of psychosis and hospitalisation and their relationships with attachment and recovery styles in people with psychosis in a secure setting. The final section, the Critical Review, aimed to place the research in a wider context, considering the findings from the research, limitations of the study, highlighting important issues for services, and implications for interventions and future studies.

A growing body of research has indicated that the levels of suicidal behaviour are particularly heightened among individuals with Posttraumatic Stress Disorder (PTSD). Two theoretical models of suicide, the Cry of Pain Model of suicide (CoP; Williams, 1997) and the Schematic Appraisals Model of Suicide (SAMS; Johnson, Gooding & Tarrier, 2008) have proposed that perceptions of defeat and entrapment are key components of the psychological mechanisms which drive suicidal behaviour. The SAMS has also emphasized the importance of psychological resilience factors for preventing suicide risk. Resilience to suicide has been recently defined as a set of appraisals which buffer the impact of risk factors on suicidal behaviour. The first aim of this thesis was to investigate the role of perceptions of defeat and entrapment in suicidal behaviour in those with full or subthreshold PTSD. The second aim of this thesis was to obtain empirical evidence for the presence of resilience factors to suicidal behaviour in PTSD. Initially, a comprehensive narrative review and a meta-analysis were conducted to examine the magnitude of the association between various forms of suicidal behaviour and a PTSD diagnosis and the role of comorbid depression in this association. Both, the narrative review and the meta-analysis demonstrated a strong positive association between suicidal behaviour and PTSD, and supported the mediating impact of comorbid depression in this association. A re-analysis of a previous dataset of individuals with PTSD was also pursued to establish the relevance of negative perceptions/appraisals to suicidal behaviour in those with PTSD. Next, three empirical studies were designed to investigate the utility of perceptions of defeat and entrapment in explaining suicidal behaviour in those with full or subthreshold PTSD. The outcomes across the three studies supported the hypothesis that defeat and entrapment represent the proximal psychological drivers of suicidal behaviour in PTSD and fully account for the suicidogenic effects of negative self-appraisals and PTSD symptoms. Two additional empirical studies were conducted to examine resilience factors to suicidal behaviour among individuals with full or subthreshold PTSD. The first of these studies provided evidence that high levels of perceived social support buffered the impact of PTSD symptoms on suicidal behaviour. The last study supported the efficacy of a resilience-boosting technique, the Broad-Minded Affective Coping procedure (BMAC), to enhance the experience of positive emotions and improve mood amongst individuals diagnosed with PTSD. Together, the current results support the SAMS' postulation concerning the role of perceptions of defeat and entrapment in the emergence of suicidal behaviour in PTSD and highlight the importance of boosting resilience as a means of targeting suicidal behaviour in those with PTSD. Clinical implications of these findings are outlined throughout the thesis.

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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / There is accumulating evidence for the role of brain-derived neurotrophic factor (BDNF) in the pathophysiology of depression. However, the role of BDNF in the pathophysiology of post-traumatic stress disorder (PTSD) remains controversial, and no study has assessed BDNF concentrations among pregnant women with PTSD. We examined early-pregnancy BDNF concentrations among women with PTSD with and without depression. A total of 2928 women attending prenatal care clinics in Lima, Peru, were recruited. Antepartum PTSD and depression were evaluated using PTSD Checklist—Civilian Version (PCL-C) and Patient Health Questionnaire-9 (PHQ-9) scales, respectively. BDNF concentrations were measured in a subset of the cohort (N = 944) using a competitive enzyme-linked immunosorbent assay (ELISA). Logistic regression procedures were used to estimate odds ratios (OR) and 95 % confidence intervals (95 % CI). Antepartum PTSD (37.4 %) and depression (27.6 %) were prevalent in this cohort of low-income pregnant Peruvian women. Approximately 19.9 % of participants had comorbid PTSD-depression. Median serum BDNF concentrations were lower among women with comorbid PTSD-depression as compared with women without either condition (median [interquartile range], 20.44 [16.97–24.30] vs. 21.35 [17.33–26.01] ng/ml; P = 0.06). Compared to the referent group (those without PTSD and depression), women with comorbid PTSD-depression were 1.52-fold more likely to have low (<25.38 ng/ml) BDNF concentrations (OR = 1.52; 95 % CI 1.00–2.31). We observed no evidence of reduced BDNF concentrations among women with isolated PTSD. BDNF concentrations in early pregnancy were only minimally and non-significantly reduced among women with antepartum PTSD. Reductions in BDNF concentrations were more pronounced among women with comorbid PTSD-depression. / Revisión por pares

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Purpose We sought to evaluate the extent to which childhood physical and/or sexual abuse history is associated with post-traumatic stress disorder (PTSD) during early pregnancy and to explore the extent to which the childhood abuse-PTSD association is mediated through, or modified by, adult experiences of intimate partner violence (IPV). Methods In-person interviews collected information regarding history of childhood abuse and IPV from 2,928 women aged 18-49 years old prior to 16 weeks of gestation. PTSD was assessed using the PTSD Checklist-Civilian Version. Multivariate logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results Compared to women with no childhood abuse, the odds of PTSD were increased 4.31-fold for those who reported physical abuse only (95% CI, 2.18–8.49), 5.33-fold for sexual abuse only (95% CI, 2.38–11.98), and 8.03-fold for those who reported physical and sexual abuse (95% CI, 4.10–15.74). Mediation analysis showed 13% of the childhood abuse-PTSD association was mediated by IPV. Furthermore, high odds of PTSD were noted among women with histories of childhood abuse and IPV compared with women who were not exposed to either (OR = 20.20; 95% CI, 8.18–49.85). Conclusions Childhood abuse is associated with increased odds of PTSD during early pregnancy. The odds of PTSD were particularly elevated among women with a history of childhood abuse and IPV. Efforts should be made to prevent childhood abuse and mitigate its effects on women's mental health. / Revisión por pares

There is heightened risk for physical and mental health concerns among U.S. veterans. For instance, 26% of veterans experience insomnia (i.e., chronic difficulty initiating or maintaining sleep), compared to 15% of the general population. This may be due, in part, to the presence of post-traumatic stress disorder (PTSD) symptoms, as veterans are twice as likely to be diagnosed with PTSD. Rumination or flashbacks focused on traumatic events (e.g., witnessing death) may contribute to problems with the onset and quality of sleep. However, not all veterans experience insomnia or PTSD symptoms, perhaps due to a positive future orientation (FO). Adaptive, goal-directed thinking may lessen risk for rumination about past actions or experiences (e.g., combat exposure), with consequent beneficial effects on sleep quality. Yet, to the extent that other negative emotions remain in the presence of FO, potential benefits may be thwarted. Specifically, feelings of shame (i.e., judging self as intolerable or defective) or anger may arise from discrepancies between military actions taken or witnessed and one’s moral beliefs. In turn, this may limit future-oriented coping abilities, with negative implications for PTSD symptoms and insomnia. At the bivariate level, we hypothesized that PTSD symptoms, insomnia, shame, and anger would be positively related, and that these variables would be negatively related to FO. At the multivariate level, we hypothesized that PTSD symptoms would mediate the relation between FO and insomnia, such that greater FO would be associated with fewer PTSD symptoms and, in turn, to fewer insomnia symptoms. Further, we hypothesized that shame and anger would moderate these linkages, reducing beneficial effects and exacerbating risk. Our sample of U.S. veterans (n=551) was recruited online from national organizations and social media groups and was primarily white (n=469; 85.1%) and male (n=382; 69.3%). Participants completed self-report measures, including the Zimbardo Time Perspective Inventory - Brief (future subscale), PTSD Checklist - Military Version, Insomnia Severity Index, and Differential Emotions Scale (shame and anger subscales). Bivariate correlations and moderated-mediation analyses, per Hayes (2013), were conducted, covarying age, sex, and ethnicity. In bivariate analyses, all variables were significantly related in hypothesized directions (p<.01). In mediation analyses, the total effect of FO on insomnia was significant (t=-5.336, p<.001), and the direct effect was nonsignificant when PTSD was added (t=-1.840, p=.07), indicating mediation. In moderated-mediation analyses, the PTSD-insomnia linkage was strengthened by shame (b2=-.011, t=-2.451, p=.015, CI=[-.019, -.002])and anger (b2=-.012,t=-3.1, p=.002, CI=[-.020, -.005]), in separate models. In our veteran sample, to the extent one is future-oriented, PTSD symptoms may be ameliorated, with consequent beneficial impact on sleep quantity and quality. Yet, shame and anger may exacerbate the linkage between PTSD symptoms and insomnia, suggesting that therapeutic interventions to reduce shame (e.g., Acceptance and Commitment Therapy) and anger (e.g., cognitive reframing) may promote better sleep. Clinical strategies to promote positive future-oriented thinking (e.g., Cognitive Processing Therapy) may also help to alleviate PTSD symptoms and associated insomnia within the veteran population.

Background: Posttraumatic stress disorder (PTSD) is heritable and a potential consequence of exposure to traumatic stress. Evidence suggests that a quantitative approach to PTSD phenotype measurement and incorporation of lifetime trauma exposure (LTE) information could enhance the discovery power of PTSD genome-wide association studies (GWASs). Methods: A GWAS on PTSD symptoms was performed in 51 cohorts followed by a fixed-effects meta-analysis (N = 182,199 European ancestry participants). A GWAS of LTE burden was performed in the UK Biobank cohort (N = 132,988). Genetic correlations were evaluated with linkage disequilibrium score regression. Multivariate analysis was performed using Multi-Trait Analysis of GWAS. Functional mapping and annotation of leading loci was performed with FUMA. Replication was evaluated using the Million Veteran Program GWAS of PTSD total symptoms. Results: GWASs of PTSD symptoms and LTE burden identified 5 and 6 independent genome-wide significant loci, respectively. There was a 72% genetic correlation between PTSD and LTE. PTSD and LTE showed largely similar patterns of genetic correlation with other traits, albeit with some distinctions. Adjusting PTSD for LTE reduced PTSD heritability by 31%. Multivariate analysis of PTSD and LTE increased the effective sample size of the PTSD GWAS by 20% and identified 4 additional loci. Four of these 9 PTSD loci were independently replicated in the Million Veteran Program. Conclusions: Through using a quantitative trait measure of PTSD, we identified novel risk loci not previously identified using prior case-control analyses. PTSD and LTE have a high genetic overlap that can be leveraged to increase discovery power through multivariate methods. © 2021 Society of Biological Psychiatry / National Institutes of Health / Revisión por pares

The interaction of emotion and memory is necessary for establishing a cognitive map including current context and past experiences, which is used by prefrontal cortex to regulate the internal state and guide goal directed actions and decision making. The amygdala, hippocampus and anterior cingulate cortex (ACC) play critical roles in these processes, but the organization of pathways between them is largely unknown in primates. This issue was addressed using neural tracers in rhesus monkeys to label the bidirectional pathways between amygdala and hippocampus and the unidirectional pathway from hippocampus to ACC. The amygdala sent a robust projection to hippocampus that formed large and closely spaced dual synapses on spines from the same dendritic segment, suggesting a strong influence. Further, amygdalar axon boutons innervated some disinhibitory calretinin neurons in CA1, suggesting enhanced excitatory influence. In contrast, in CA3 the amygdala pathway innervated calretinin and some of the powerful parvalbumin inhibitory neurons, which may help enhance memory of affective events. The reverse pathway from hippocampus densely and mainly targeted the ventro-medial part of the amygdala, including the basolateral (BL) and paralaminar basolateral (PLBL) nuclei. Hippocampal terminations formed synapses mostly on spines vii of presumed excitatory neurons. Some hippocampal terminations innervated inhibitory neurons in BL and PLBL and showed a rank of preference, by targeting mostly calretinin, and then calbindin and least parvalbumin inhibitory neurons. This pattern of innervation may allow contextual information represented by hippocampus to influence affective processes in the amygdala. The hippocampus sent strong projections to ACC (A32, A24a and A25) and targeted particularly A25, suggesting a role in affective and autonomic regulation. About 90% of hippocampal terminations in A25 innervated excitatory neurons, suggesting strong excitatory effects. The hippocampal pathway had a close relationship with postsynaptic D1 receptors in A25, especially in the deep layers. Dopamine has a strong influence in goal-directed actions, rewards, and attention in prefrontal cortex in primates, and may facilitate contextual information from the hippocampus to A25 to influence emotional regulation. The pathways studied were distinct, and suggest specific roles in emotional memory by the amygdala in hippocampus, in flexible learning and forgetting fear based on context transmitted from hippocampus to the amygdala, and in the synthesis of current context and past experience carried out by the hippocampal pathway to ACC to influence adaptive goal directed behavior. / 2021-09-27T00:00:00Z

Stigmatization has shown to negatively impact service members with Posttraumatic Stress Disorder (PTSD). Published research has shown stigma to significantly affect service members through increased suicide, homicide, unemployment, homelessness, and criminal justice system interaction rates. Additionally, stigma also affects overall readiness and cohesion of the military organization. However, little research has focused on the perceptions of Reserve Officer Training Corps (ROTC) cadets about service members with a combat-related stress disorder in which they will eventually be charged with leading. The purpose of this quantitative study was to measure a cohort of ROTC cadets and determine their perceptions about service members serving with PTSD. Socialization theory was used as the lens to measure ROTC cadet's acceptance into the military culture. The study population consisted of 14 cadets within 5 ROTC battalions in Louisiana. Fisher's exact test revealed no significant relationships among ROTC cadet's overall perceptions. However, valuable insight was discovered regarding religion and branch of service the cadets intended to commission with as potential significant variables regarding their perceptions about PTSD. Further research, including a larger population size, is still needed to determine how these perceptions impact currently serving service members. Implications for positive social change include improved knowledge about PTSD and the stigma associated with negative perceptions, which will improve education through socialization into the military culture and reduce suicide, homicide, criminal justice system interaction, homelessness, and unemployment rates in addition to improving the overall readiness and cohesion of the Armed Forces.