Over the past 15 years, mental health professionals have seen an increasing number of Vietnam combat veterans suffering from stress disorders resulting from the trauma of combat and continued exposure to life threatening situations. Prior to 1980, professional repudiation of and hostility toward Vietnam veterans and toward a clinical reality of Post Traumatic Stress Disorder was common while nondiagnosis and nontreatment was prevalent

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A dissertation submitted in partial fulfilment of requirements for the degree of Master of Arts At the University of Witwatersrand Johannesburg 2016 / This study explored the subjective experiences of a population who appear to be at relatively high risk of potential violence and harm, specifically female university students who are compelled to commute by taxi on a daily basis. The study aimed to explore and document the psychological experiences of these female university students including their anxieties, levels of traumatic stress related responses, cognitions and fantasies, and conscious and unconscious adaptations to their circumstances. It was hoped that information gleaned would contribute to, and possibly expand the understanding of what the lived experience of Continuous Traumatic Stress (CTS) might entail. In order to investigate the research questions, ten students who were identified as being compelled to use minibus taxis as their primary mode of transport to and from university participated in semi-structured interviews on the topic of their experiences in this space and how they adapt to and survive in their circumstances. The study was located in the qualitative research tradition and the interview transcripts were analysed using critical thematic analysis. The main themes were identified and presented under four sections; exposure to traumatic events, the effects and impacts of these events, managing and coping, and gender related experiences in the taxi commuting space. Exposure to traumatic events included taxi driver aggression, motor vehicle accidents, crime and violence, xenophobic attacks and gender related trauma. The most prominent effects or impacts that were identified were firstly, anxiety, fear and preoccupation with danger and secondly, numbing, resignation and hopelessness. The tactics which were employed by participants in managing and coping with their circumstances included, prayer and observation and management of their commuting environment. It was through observation and self-management that participants practiced strategies that allowed them some measure of control in terms of how they conducted themselves in the taxi commuting space. Under the final section, participants revealed their gender related experiences reporting a sense of being exploited, being subject to sexual harassment, and the constant fear of rape or sexual violation. The links between these participants’ experience and the concept of CTS are presented and it is argued that many aspects of their experience appear consistent with CTS. / GR2017

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Experiencing early life adversity (ELA) increases the risk of anxiety disorders, such as generalized anxiety disorder and post-traumatic stress disorder, with disproportionally higher risk in women compared to men. Neurodevelopmental and behavioral outcomes following ELA are multifaceted and are influenced heavily by the type of adversity experienced and sex of the individual. A major contributor to emotional dysfunction and anxiety disorders resulting from ELA are changes in fear and threat circuitry. Children who experienced ELA have been reported to show an accelerated development of the amygdala, a region involved in processing threat, and greater cerebrospinal levels of corticotrophin releasing hormone (Crh), an orchestrator of neuroendocrine and behavioral responses to stress. Work in rodents have linked Crh signaling within the lateral central amygdala (CeAL) with processing and responding to threat, core features disrupted in anxiety-related disorders. Further, sex biases in risk and symptom presentation have been proposed to be related to sexual dimorphic signaling of Crh across the brain that differentially influence a variety of Crh-dependent behaviors. However, it remains unclear what properties of ELA portend differential neurobiological risk, what is the basis of sex-differences for negative outcomes, and how specific mechanistic changes give rise to certain endophenotypes. In this work, I use genetic, cellular, and behavioral approaches to explore the impact of ELA and sex on perinatal development in mice and the functional consequences of altered Crh neuron activity in the CeAL on threat responding in adulthood. In Chapter 1, I review how factors such as sex and type of ELA influence amygdala development and Crh. In Chapter 2, I assess the impact of two forms of ELA, maternal separation (MS) and limited bedding and nesting (LBN) on perinatal development and anxiety-like behavior. Both forms of ELA shifted the timing of somatic maturation and basal CORT levels and led to increased anxiety-like behaviors, but the degree of the impact depended on the sex and type of adversity experienced. In Chapter 3, I demonstrate that a distinguishing feature between types of ELA was the predictability of maternal care. The type of ELA also contributed to sex-differences in Crh related gene expression in the perinatal amygdala. Increased expression was primarily observed in males following MS and in females following LBN. In Chapter 4, I investigate the functional consequences of ELA in the form of LBN on the activity of CeALCrh+ neurons in vivo and their causal role in threat reactivity indexed by the startle response. LBN rearing led to sustained activity of CeALCrh+ in female mice but diminished in male mice. Persistent activity of this population was necessary for and predicted the magnitude of startle responding. In Chapter 5, I discuss important considerations when integrating new advancements in the study of ELA and the use of sex as a biological variable. Collectively, this work deepens our understanding of the neurobiological mechanisms impacted by sex and ELA and holds promise for future strategies that may consider the sex and specific experiences of the individual to target specific endophenotypes and address the underlying root causes of anxiety disorders.

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School-age children are at high risk of experiencing traumatic and stressful events that can negatively impact their academic, emotional, and behavior performance (Brock et al., 2016). Any stressful situation (i.e., natural disaster) or adverse childhood experience (ACE) can potentially become a traumatic event for a child or adolescent. The current literature indicates that 60% of children experience at least one ACE, putting them at high risk for a variety of health and social problems (Manyema et al., 2018). Natural disasters adversely impact children's life as they have the potential to destroy physical structures and injure the child or family members. According to Inoue and colleagues (2018) natural disasters can additionally be considered as an ACE. The purpose of this study was to explore the relationship between PTSD symptoms of students who have experienced a natural disaster (e.g., hurricane exposure) and students’ internalizing and externalizing behaviors. Participants included 75 students from elementary, middle, and high school in a school district in the Southeastern United States. Linear regression showed that PTSD symptoms are significantly correlated with internalizing and externalizing behaviors. However, moderation and interaction effects showed that he type of hurricane exposure did not significantly moderate the relationship between PTSD symptoms and students' internalizing and externalizing behaviors. Implications from these results suggest that trauma-informed strategies are needed for students that are exposed to a traumatic event.

<p>Magnetic resonance spectroscopy (MRS) is a non-invasive diagnostic technique that provides unique information about the biochemical composition of the human body. By excluding the overwhelming signals from water and fat, clinically relevant biomarkers such as lactate, N-acetyl aspartate, choline, creatine, glutamate/glutamine (Glx), gamma-aminobutyric acid (GABA), glutathione, and myoinositol can be reliably quantified. MRS has diverse applications in investigating the metabolic window of a wide range of biochemical processes. </p> <p>Here, we have utilized MRS to better understand chemical changes associated with neurological disorders and treatment response. We have investigated neurometabolic imbalances in brain regions related to post-traumatic stress disorder (PTSD). MRS was applied to better understand the neurobiological processes of hyperbaric oxygen therapy in military veterans with clinically diagnosed traumatic brain injury and/or PTSD.</p>

Traumatic events are a common part of the human experience. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are common sequelae of trauma that are both associated with poor physical health and mortality. The objective of this dissertation is to identify common and unique risk factors for each disorder in order to identify at-risk groups for PTSD and/or depression following trauma. his dissertation is organized into five parts: 1) an introduction, 2) a simulation study exploring the use of test equating methods to standardize the Hospital Anxiety and Depression Scale (HADS) to the Beck Depression Inventory II (BDI) in order to create common depression scale across studies in a pooled analysis, 3) an individual participant data meta-analysis on risk factors for PTSD and depression following incident trauma, 4) a Mendelian Randomization analysis of childhood abuse victimization and neuroticism on PTSD and depression, 5) a discussion of the findings and avenues for future research. The simulation study found that an Equated BDI diagnosis had higher specificity (range: 0.86 to 0.91) compared to using the HADS diagnosis (range: 0.80 to 0.82) when the correlation between the BDI and HADS was greater than 0.7, but had lower sensitivity (Equated BDI range: 0.67 to 0.72; HADS range: 0.84 to 0.92). The Equated BDI diagnosis was found to improve statistical power when the prevalence of depression was 20% or higher with greater improvements when the proportion of studies assessing the depression with the HADS was less than 50%. In the individual participant data meta-analysis, common risk factors for acute and persistent MDD and PTSD were found including increased risk for female sex and reduced risk for those who experienced an accident versus an assault or other traumatic event as the index trauma. Acute MDD symptom severity was associated with persistent PTSD and remained significant after inclusion of acute PTSD symptom severity. In an analysis of PTSD symptom clusters, only reexperiencing symptoms were associated with persistent PTSD along with MDD symptom severity. In models of persistent MDD, acute PTSD symptom severity was associated with persistence, but neither overall symptom severity nor cluster symptom severities were associated with persistence after inclusion of acute MDD symptom severity. In the Mendelian Randomization analysis, childhood abuse victimization was found to be associated with PTSD symptom severity but was not associated with an increased odds of a MDD diagnosis, while neuroticism was associated with an increased odds of a diagnosis of MDD, but was not associated with an increase in PTSD symptom severity. Findings from the meta-analysis that leveraged the use of item-response theory imply that while PTSD and MDD share many risk factors for onset of symptoms following the experience of a traumatic event, persistence of symptoms depends most strongly on initial symptoms. However, PTSD and MDD were also found to have different relationships with childhood abuse victimization and neuroticism, indicating that some risk factors are unique to each disorder. Future studies can build upon these results, especially when pooling data from different studies, to further explicate the associations between PTSD, MDD, and their causes.

The purpose of the present study was to assess if combining the two frameworks would account for more variance in PTSS than could be accounted for using the frameworks separately. An online community sample from Amazon.com's Mechanical Turk (N = 437), who reported experiencing a prior traumatic event, completed measures that reflected the constructs of narrative centrality, negative affectivity, and death concerns, along with a measure of PTSS. PTSS was regressed on the latent variables of death concerns, narrative centrality, and negative affectivity, along with the latent variable interactions between narrative centrality*death concerns and narrative centrality*negative affectivity. Death concerns was not be predictive of PTSS, whereas narrative centrality and negative affectivity were found to uniquely and interactively account for 77% of the variance in PTSS. Death concerns was found to be a separate construct from negative affectivity. The implications of these findings for the two frameworks are discussed along with future directions. By considering aspects of narrative centrality and negative affectivity, substantial portions of PTSS can be accounted for.