Center for the Study
Center
for
the
Study
of Traumatic Stressof Traumatic Stress2020 Annual Report2020 Annual Report

CONTENTS
From the Director ............................................................................... 1
Our Mission........................................................................................ 3
COVID-19 Response Highlights.......................................................... 3
Research............................................................................................. 5
Education and Training ..................................................................... 18
Consultation ..................................................................................... 24
Scientist Profile: Gary H. Wynn, MD................................................. 33
Publications ...................................................................................... 34
Presentations, Blogs, Interviews, Briefings, Awards, andAppointments................................................................................... 37
Directors, Scientists, Science Collaborative Members, and Staff......... 42
Funded Grants.................................................................................. 46
Federal, State, Academic, Non-Profit, and other Organizations ........ 47”In this Annual Report, we present summaries of our recent
contributions. Our goal is to improve trauma-related care by
preparing treatment providers to address the impact of trauma
and its far-reaching effects, thereby building a more traumainformed environment across the continuum of our militaryand civilian healthcare systems.”— Dr. Robert J. Ursano

From the Director
Dear Center Colleagues and Friends,
In 2020, the world experienced
the COVID-19 pandemic, aonce-in-a-generation event thatspared no nation. The UnitedStates alone reported over halfa million deaths during the firstyear of the pandemic. The Centerfor the Study of Traumatic Stress(CSTS) has participated in con­sultation and research to better understand the effects
of COVID-19 on military and civilian populations,
including healthcare providers, and military compo­
nents activated across the United States in support of
the COVID-19 response.
CSTS is an integral part of the Department of
Psychiatry of the Uniformed Services University(USU). As many of you know, CSTS was establishedin 1987 and has been fulfilling our mission to mitigate
the impact of trauma on individuals and communities
from exposure to war, disasters, terrorism, community
violence, and public health threats. The Center isfully engaged in activities that support the Strategic
Framework and mission of USU, as well as theMilitary Health System, and the broader missionof the Department of Defense (DoD). Through our
broad range of activities, we sustain national readiness,enhance national security, and serve an essential
role for the DoD and the nation. The Center’s workand extensive fact sheets related to the COVID-19
pandemic is a recent example of these efforts.
The Center’s mission is accomplished througha multi-faceted approach that includes leadership,
research, training, education, consultation, and global
health engagement. CSTS continues to support an
outstanding multi-disciplinary and collaborative teamof scientists, educators, clinicians, staff, and leaders.
Currently, the Center’s attention is focused on
responding to the COVID-19 pandemic, as well as
our ongoing work on posttraumatic stress disorder(PTSD), traumatic brain injury (TBI), suicide andsuicide-related behavior, and disaster response andpreparedness. CSTS helps inform our nation’s policies
and responses to the impacts of exposure to trauma,
natural and human-made disasters and, especially atthis time, the health emergency response to COVID-19.
The Center’s work begins in our laboratories,
extends to our communities, the nation, and acrossthe globe. Importantly, we bridge science from thegene, to the person, to the community, and from
Service member to unit. We translate knowledge into
action by providing rapid consultation, education, andsupport to personnel responding to the health needsof Service members and their families. In addition, we
provide support to disaster and public health personnel
responding to global crises such as the COVID-19
pandemic. CSTS is uniquely situated to bridge militaryand disaster psychiatry.
Our advanced analytic activities include using
innovative techniques such as ecological momentary
assessment, digital assessments, machine learning,
complex algorithms, and predictive analytics
to enhance personalized medicine. We use data
mining techniques and state-of-the-art statisticalmethods to analyze previously untapped data sources
independently and jointly with other data to gain new
insights, resulting in better and faster decision-making,in order to improve health.
In this Annual Report, we present summaries
of our recent contributions. Our goal is to improve
trauma-related care by preparing treatment providers
to address the impact of trauma and its far-reachingeffects, thereby building a more trauma-informed
environment across the continuum of our military andcivilian healthcare systems.
As we develop this report in early 2021, CSTS
is integrally involved with the DoD’s continuing
COVID-19 pandemic response. CSTS is providing
just-in-time educational resources and surveillance
assessments for DoD and our nation’s healthcare
systems. The Center has developed collaborations with
the New York National Guard as they respond to theContinued on page 22020 ANNUAL REPORT | 1

From the Director, continued from page 1

effects of COVID-19. In addition, we have consulted as
subject matter experts to New York City during the fall2020 surge in COVID-19 cases. We have collaborated
with our partner and stakeholder organizations
providing resources and assistance in response to
COVID-19. Closer to home, we have participatedin assessing the impact of the pandemic on USU
personnel and students. This partnership culminatedin the USU resiliency survey providing valuable
information to USU leadership.
Please visit the Center’s website (www.cstsonline.
org) and the Center’s dedicated COVID-19 response
page (https://bit.ly/3gxZ84z) for the latest updates in
our COVID-19 activities. Most of this work started in
2020, and is ongoing.

On behalf of everyone at CSTS, I would like toextend our appreciation to all of our colleagues andfriends who have collaborated with us and assisted
us throughout 2020 to help us support the Military
Health System, the DoD, and the nation, and respondto the COVID-19 pandemic.
Robert J. Ursano, MD
Professor of Psychiatry and Neuroscience
Department of Psychiatry
Director, Center for the Study of Traumatic Stress
Uniformed Services University”The Center for the Study of Traumatic Stress (CSTS)
has participated in consultation and research tobetter understand the effects of COVID-19
on military and civilian populations,
including healthcare providers, andmilitary components activated across theUnited States in support of the COVID-19
response.”— Dr. Robert J. Ursano

2 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Our Mission
As an integral part of USU, CSTS’s activities
support the USU Strategic Framework and the mission of the DoD. CSTS is committed toadvancing trauma-informed care.
We are dedicated to furthering the nation’s understanding of the impactof trauma on individuals, families, andcommunities. The
Center is partof our nation’sfederal medical
school (Amer­
ica’s Medical
School) at USU,
and the Cen­
ter’s mission isaligned with theneeds of the DoD
and the nation, andis well-positioned to
rapidly respond to DoD
mission-relevant activities.
The Center’s work includes
a broad range of trauma exposures: combat, terrorism, natural andhuman-made disasters, public health threats, andhumanitarian operations. CSTS has been involvedin nearly every major disaster our nation has experienced in the past 30 years. The Center helps toensure that behavioral health is addressedin the face of public health threats,disaster planning, and disasterrecovery.
Mitigating the effects
of disaster and trauma
in military and civilian populations ispart of the effort
to foster community and national
resilience. The
Center informs
and educatescommunity, regional, state, national, and global
stakeholders ingovernment, industry, healthcare, publichealth, and academia.
CSTS contributes to advancing trauma-informed careby providing leadership in research,education, training, consultation, global
health, and service.

COVID-19 Response Highlights
The Center was involved with the DoD’s
COVID-19 response from the onset of the pandemic. CSTS Scientists and staff maintained key collaborations with the National Guard Bureau (NGB) andother entities within New York City. In addition, theCenter was critical in developing COVID-19 knowledge products such as fact sheets on critical topics,
including how to talk to children about COVID-19,

how to manage grief during the pandemic, and how
to establish better sleep patterns while working
remotely or in new environments. CSTS was instru­
mental in helping USU leadership assess the impact
of COVID-19 on the USU workforce through consultation on the USU resiliency survey to inform USU
leadership.

2020 ANNUAL REPORT | 3

HIGHLIGHTS OF THE CENTER’S COVID-19 RESPONSE
COVID-19 Activities with the National
Guard Bureau
The Center worked with the National Guard
Bureau (NGB) to help the New York National Guard(NYNG) develop a rapid public health surveillance
assessment to inform leadership and provide actionoriented recommendations
related to stressors, resilience
factors, and behavioral healthresponses. In addition, CSTS
Scientists developed training
materials designed to reduce
distress and increase resilience in NG personnel who
were called upon to handle the remains of the dead.
CSTS continues to collaborate with the NGB and
NYNG with education, consultation, and ongoingsurveillance.

COVID-19 Activities with New York CityIn Spring 2020, the Mayor of New York City
(NYC) and the United States Northern Command(USNORTHCOM) Commander requested sup­port from CSTS to assist NYC during their spring
COVID-19 case surge. CSTS, in collaboration
with other organizations, developed a five-module
resilience training program, which was delivered tomore than 1,000 civilian personnel within the NYC
healthcare system. Center Scientists also provided
consultation support to the Mount Sinai Health
System in addressing initial and ongoing challenges
for healthcare workers during the pandemic.

COVID-19 Child and Family Knowledge
Products and Consultations
The CSTS Child and Family Program (CFP)
was actively involved in the Center’s response to
the COVID-19 pandemic through programmaticconsultation and the development of child and fam­
ily informational resources. CFP personnel con­sulted with public health organizations regarding

4 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

COVID-19 preparedness, including Sesame Workshop’s Sesame Street in Communities(https://bit.ly/3xcuJPg), Blue Star Families, the MilitaryChild Education Coalition, as well as other education­
al efforts supporting professional communities. The
Center highlighted the effectof the pandemic on children
and families as part of CSTS
fact sheets that were distrib­
uted globally in English andSpanish. In order to address
challenges associated with
COVID-related deaths, Center
Scientists published a blog
post, Death notification, grief,
and posttraumatic stress: Implications for COVID-19
deaths in the International Society for TraumaticStress Studies’ Trauma Blog (https://bit.ly/32x4Jjq).

Uniformed Services University COVID-19
Resilience Operational Assessment
In Spring 2020, CSTS assisted in the developmentof the operational assessment of students and person­
nel working at USU to better understand USU opera­
tions during the pandemic. The assessment examinedfactors pertaining to the experiences of students andpersonnel, including university resources, leadership,
experience working/teleworking, and work/life bal­ance during the COVID-19 pandemic. This assessment
was designed to better understand the impact of the
COVID-19 pandemic on work and morale, support,
and health, as well as identify resources to support themission of USU. In particular, the assessment in­formed work taskings, and organizational support andresources. CSTS developed a follow-up assessment tobe administered in February 2021 in order to further
support the USU mission.
These highlights demonstrate some, but not all, of
the Center’s substantial contributions to mitigate theimpact of COVID-19. In the following pages, we detail
the Center’s research, teaching, and consultation in
response to COVID-19.

Research
CSTS was involved in a broad range of research,
including epidemiological, clinical, and laborato­
ry research. The research was designed to support
the Military Health System (MHS) in its efforts tomaintain a medically-ready military force for bothpeacetime and wartime, and to deliver integrated,affordable, effective, and high quality health services.
CSTS research encompassed investigations ranging
from the causes of suicide in Service members, tothe psychological responses to trauma and disasters,
to clinical investigations of the symptomatology andtreatment of PTSD. The ultimate goals of all CSTS
research activities are to improve military readinessand the quality of military care.

RESEARCH ON SERVICE MEMBERS
Study to Assess Risk and Resilience inServicemembers — Longitudinal Study(STARRS-LS)
Formerly the Army Study to Assess Risk and Resil­
ience in Servicemembers (Army STARRS)

STARRS-LS is the continuation of a research
project that began more than ten years ago toaddress the increasing and persistent problem of sui­cide among Army personnel. The original research
project, Army STARRS, was conducted from 2009
to 2015. The first iteration of STARRS-LS began in2015 and ended in 2020. The current STARRS-LS
continuation project began in 2020 and will run
through 2025. The Army STARRS and STARRS-LS
projects were designed and conducted under thescientific direction and project management over­sight of CSTS through a collaborative effort involv­
ing USU, the University of California, San Diego(UCSD), Harvard Medical School, and the Universi­
ty of Michigan.

Army STARRS, funded by the Army, included
a series of several distinct but integrated studies
designed to comprehensively examine the mental
health and resilience of active duty Soldiers, in­cluding Regular Army, Army National Guard, andactivated Army Reserve. The project involved large
representative samples of Soldiers, making it thelargest research effort of mental health risk andresilience ever conducted among military personnel.
The largest of the studies was an historical cohort
study of all Soldiers (more than 1.6 million) on active
duty from 2004 to 2009. Army STARRS also includ­ed cross-sectional studies, a four-wave longitudinal
study, and two case-control studies that involved col­lecting data directly from a combined total of morethan 100,000 active duty Soldiers throughout the U.S.
and overseas. The studies included administering
questionnaires and neurocognitive tests, collecting
blood samples, and performing state-of-the-art data
analyses and genetic studies.
CSTS is expanding the size, extending thetime-frame, and enhancing the Army STARRS
research through two five-year DoD-funded proj­
ects, STARRS-LS. Under STARRS-LS, the Center is
continuing to use the STARRS platforms, systems,
and data to conduct further analyses and to collectadditional follow-up data for three cohorts of Sol­
diers. The historical cohort established under Army
STARRS has been extended by obtaining an addi­
tional seven years of Army/DoD administrative data(2010-2016). This historical cohort follow-up study
now includes all active-duty Soldiers (approximately
3 million) over the thirteen-year period from 2004 to2016.
In 2020, because wave 3 survey data collection
was to begin during the COVID-19 pandemic, theresearch team added a new COVID-19 section to
the survey that included 22 questions about the
respondents’ experiences during the pandemic andthe impact it may have had on them. This offers aunique opportunity that will allow the research teamto assess and compare the mental health and behav­
2020 ANNUAL REPORT | 5

ioral health effects among a representative sampleof Soldiers, both pre-pandemic and eventually
post-pandemic.
The research team conducted briefings of the re­search progress and findings throughout 2020. These
included briefings to the STARRS Government
Steering Committee, and briefings at the Pentagon
to senior DoD and Army leadership, including theAssistant Secretary of Defense for Health Affairs, theDeputy Under Secretary of the Army, and the Army
Surgeon General.
Due to the abundance of actionable findings
produced by the STARRS research, the Army es­
tablished a workgroup called the STARRS Research
Advisory Team (SRAT). The SRAT is comprised ofArmy and DoD personnel tasked to review STARRS
findings and recommend actions that the Army
and/or DoD can take, based on those findings. The
STARRS PIs continued to meet with the SRAT on aquarterly basis throughout 2020 to present STARRS
findings and discuss how to best translate the re­search findings into Army and DoD actions.

Psychological Stress and Resilience in
Mortuary Affairs (MA) Soldiers: Longitudinal
Study
U.S. Army mortuary affairs (MA) Soldiers recov­
er, identify, and evacuate the remains of the deceased
from the theater of war and other mission sites. They
are a unique population of Soldiers who are exposed
to death and deployment-related stress, and work in
combat and other extreme environments. The CSTS
longitudinal research of MA Soldiers represents the

6 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

longest ongoing study to examine the individual,
unit, and family stressors, risk factors, and resilienceof MA Soldiers. The study includes quantitative datacollected through questionnaires, qualitative datacollected through semi-structured interviews, andsaliva samples, which will be analyzed for potential
DNA- and RNA-related biomarkers of stress andresilience. Questionnaires were group-administered
to MA detachments approximately one week before
and after deployment to the Middle East. Empiricaland descriptive data were collected on factors suchas PTSD, depression, distress (e.g., anger, hostility,
somatization), substance use, and instrumental andemotional support.
In 2020, Reserve MA Soldiers from the 1019th
Quartermaster Company (QM CO) (Staten Island,
New York) and the 673rd QM CO (Dover, Delaware)participated in the study by completing deploy­ment-related questionnaires. In March, CSTS study
personnel met with MA Soldiers in-person at Fort
Hood, Texas to administer questionnaires and col­lect saliva samples. Afterward, questionnaire admin­
istration was adapted to an online format due to the
COVID-19 pandemic. In total, 150 questionnaires
and 62 saliva samples were collected in 2020. Over­
all, the study questionnaire has been administered
more than 70 times and more than 3,450 question­
naires have been collected since the study began in
2005.
In July 2020, interviews were conducted withactive-duty MA Soldiers from the 54th and 111th
QM COs (Fort Lee, Virginia) who participated in
Defense Support of Civil Authorities missions to
NYC and Washington, DC, respectively. The goal ofthe missions was to support the Federal Emergency
Management Agency (FEMA) and the local offic­
es of the Chief Medical Examiner during surges in
the COVID-19 pandemic. MA Soldiers processed
remains of the deceased and assisted in the designand setup of disaster portable mortuary units. The
remains were civilians of all ages and demographic
backgrounds and the Soldiers saw all causes andmanners of death (e.g., vehicular accidents, homi­cide, suicide, and COVID-19).
Findings from the MA study target resilience,
preparation, training, and education of Soldiers forthe stressors of deployment and work with the de­ceased. Data analyses in 2020 included an examina­tion of traumatic exposures, deployments, psycho­
logical distress, and rates of PTSD and depression.
Fact sheets describing stress management strategies
for mortuary operations were created based on MA
Soldier interviews.
Related to the work with MA Soldiers, in 2020
CSTS personnel began participating in weekly MA
synchronization meetings with the U.S. Northern
Command (USNORTHCOM), U.S. Army North(USARNORTH), 377th Theater Sustainment Com­
mand, 4th Expeditionary Sustainment Command,
Joint Mortuary Affairs Center, and others in supportof Defense Support of Civil Authorities missions
involving mass death.

and intervention materials were requested by the
U.S. National Guard Bureau in order to educate andsupport National Guard personnel who, althoughlargely not trained for mortuary affairs duties, were
frequently called on to handle remains of the deadfrom the COVID-19 pandemic. The online TEAM
intervention content can be delivered through groupsessions at specified intervals (e.g., once a week) or
posted on a dedicated website for 24/7 access. The
2020 online adaptation of TEAM broadened applica­tion of the intervention for use in other military andcivilian populations, including medical personnel,
police, firefighters, disaster workers, mortuary per­sonnel, or others who work with the dead.

Troop Education for Army Morale

Ecological Momentary Assessment of
Posttraumatic Stress Symptoms in U.S.
Military Service Members (Daily Diary Study)

Troop Education for Army Morale (TEAM), a
novel stress management and resilience building
early intervention program, was designed to improve
post-deployment readjustment in U.S. Army mortu­
ary affairs (MA) Soldiers — a group at high risk forpsychological distress. The intervention was basedon the five evidence-informed principles of Psycho­
logical First Aid (PFA): safety, calming, connected­
ness, self-efficacy, and hope/optimism. TEAM wasdelivered through four group workshops, informa­tional handouts, a dedicated website, and phone andemail support services. A total of 125 MA Soldiersparticipated in the study. Baseline questionnaires
indicated that MA Soldiers had a high number oftraumatic exposures and rates of PTSD and depres­sion, similar to combat troops. While the inter­
vention did not specifically reduce rates of PTSD,
the TEAM intervention was well-accepted and the
majority of Soldiers (89%) reported that TEAM was
helpful for them. Calming (relaxation training) andproblem solving were two of the skills reported to be
most helpful.
In 2020, the TEAM intervention materials wereadapted for an online format using remote videoconferencing and sharing materials electronicallywhen individuals were not able to meet in-person
due to restrictions related to the COVID-19 pan­demic. Importantly, the TEAM program information

The Daily Diary Study used a novel ecologicalmomentary assessment methodology to assess inreal time the posttraumatic stress symptoms of U.S.
Service members. The Daily Diary Study represents
the cutting edge in psychological assessment meth­odology, measures, equipment, technology, andresearch designed to better understand and im­prove the well-being of Service members. The study
examined the relationship between variability inposttraumatic stress symptoms and psychiatric dis­orders, sleep, health risk behaviors (e.g., alcohol andtobacco use), pain, and other areas of health andfunctioning. Participants completed assessmentsof posttraumatic stress symptoms four times dailyfor 15 consecutive days on electronic tablets, using
a sophisticated software application developed foruse in this study. Psychiatric disorders (e.g., PTSD,
depression) were assessed at baseline and in oneand three-month follow-up assessments. Partici­
pants had the option to donate saliva and/or blood
samples for genetic analysis to identify potential
genetic biomarkers and gene-environment inter­actions that may distinguish and/or mediate stressresponses and resilience to stress-related disorders.
Participants also had the option to wear a wrist acti­
graph to objectively measure sleep and complement
self-reports of sleep during the 15-day daily diaryassessment period.
2020 ANNUAL REPORT | 7

In early 2020, nine Service members enrolled in
the study, provided genetic biomarker samples, andwore wrist actigraphs. Recruitment was paused in
March to protect the safety of participants and study
staff due to the COVID-19 pandemic. In total, 183
subjects were recruited since the study began. Data
analyses in 2020 included an examination of nightto-night and weekday versus weekend variation insleep disturbances (i.e., short sleep duration, poor
sleep quality, trouble falling asleep, and difficul­
ty staying asleep) in individuals with and without
PTSD. A manuscript examining the relationshipbetween sleep disturbances and variation in posttraumatic stress symptoms was published in thepeer-reviewed journal BMC Psychiatry, and a poster
on statistical approaches to analyzing ecological mo­mentary assessment data was presented at a nation­
al scientific conference. In addition, a manuscript
presenting the most recent findings was submitted
for publication.

Firearm Behavioral Practices in U.S. Army
Service Members and Veterans
In 2020, CSTS Scientists, along with collabora­
tors at Harvard University, were awarded a two-year
R01 grant from the Centers for Disease Control andPrevention (CDC) to study firearm behavioral prac­
tices in U.S. Army Service members and veteransand their impact on suicidal behaviors. This study
will examine the longitudinal relationships between
firearm storage and carrying practices, personality
traits, and local gun laws, and the risk for suicide
attempts and death by suicide. The study will use
STARRS-LS data to perform secondary analyses.
An in-depth analysis of the interactions between
personality characteristics, reasons for gun owner­
ship, use and storage practices, geographical loca­
tion, and current firearms laws will identify potential
medical, psychosocial, public policy, and commandinterventions to mitigate the relationship between
firearm ownership and suicide. The broader impactof this study will enhance our understanding of thefactors that put people at risk or protect them from
firearm-related violence. This study will examine fac­
tors related to suicide in a controlled setting among
a population of men and women in the age range in
8 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

which suicide is most prevalent in the general popu­
lation. This study will provide opportunities for new
insights that can assist the military in suicide pre­vention, and which can carry forward more generally
to civilian society.

PTSD and Sleep Study
Sleep disturbances and PTSD are prevalentand often co-occur among Service members with
combat experience. Whether sleep disruptions
occur singly or with PTSD, they are associated withlong-term negative consequences, including depres­sion, hospitalizations, disability, and — as this CSTS
research study has demonstrated — increased risk
for cardiovascular disease. No treatment for sleep
disturbances is universally effective, and co-occur­
ring PTSD further complicates treatment decisions.
The Center is leading an effort to identify factorsthat predict variation in sleep disorder treatment
response, thereby helping clinicians select effective
treatments for individuals. This effort, in collabora­tion with Harvard Medical School, utilizes data fromthe Army STARRS, as well as data from the Sleep
Disorders Center at the Walter Reed National Mil­
itary Medical Center (WRNMMC). This approachcircumvents issues that have plagued prior studies
by providing a large sample of Service members withsleep disturbances and an abundance of predictors
for use in Heterogeneity of Treatment Effects anal­
yses to identify predictors of treatment response.
During COVID-19, the study team reordered
priorities to focus on aspects of research that could
be done remotely. Resumption of research activi­
ties at WRNMMC is expected as vaccination rates
increase. This research will form the basis for clinicaltools to improve treatment selection for individuals
with PTSD-related and other sleep disturbanc­es, a goal that is more urgent given evidence thatsleep disorders are among the long-term sequelae
of COVID-19, and an effect of the social isolation,
disruptions in daily routines, and other stressors thathave occurred in response to the pandemic.

Reserve Components of the U.S. Armed Forces
The Citizen Soldiers of the Reserve Compo­
nents (RC) of the U.S. Armed Forces play an im­portant role in national defense, and a critical roleassisting communities nationwide in response to
the COVID-19 pandemic. Compared to the Active
Component (AC), RC personnel experience uniquestressors, both when the nation is at war and when
the RC is called upon to activate for emergency
service, such as disasters, and situations such as
COVID-19, or providing support to civil authorities
during times of unrest. CSTS is strongly commit­
ted to supporting the RC through the full range of
their activities and providing understanding of theunique stressors and how they affect health andperformance of the RC. This commitment extends toaddressing the needs of not only RC members, butalso their families. CSTS fulfills this commitment
to the RC through research to better understandtheir special needs, combined with consultation to
RC units and leaders. The Center’s goal is to provide
information products that will enable RC decision
makers to use the best available knowledge in sup­porting RC members.
Reserve Component Longitudinal Studies
CSTS continued the Mental Health and Service
Utilization among Reserve and National Guard
Forces study in collaboration with Dr. Sandro Galea
at Boston University. Using a representative national
cohort of 2,003 National Guard and Reserve Ser­vice members, this study specifically addresses the
epidemiology and trajectory of mental health prob­lems, deployment stress, health risk behaviors, andhealthcare utilization over a four-year period. CSTS
is actively analyzing this comprehensive dataset toaddress the health and resilience factors and experi­
ences of the RC personnel. This past year, the Center
examined the relationship of social support trajec­
tories and mental health problems, including PTSD
and suicidal ideation. Four distinct social support
trajectories (low, medium, high-low, and high-high)were identified and associated with both baseline
and follow-up mental health problems. On the one
hand, there were significant pairwise differences
between any two trajectories on having subsequent
PTSD or suicide ideation. On the other hand, having
a baseline mental health problem increased the riskof having a low or medium social support trajectory.

In addition, having baseline PTSD was associatedwith a higher risk of having a high-low social sup­port trajectory. These results highlighted the impor­tance of including social support in prevention andintervention programs to mitigate risks of adverse
mental health outcomes in RC personnel.
The Army STARRS project and the follow-on
STARRS-LS have provided a wealth of data about
RC Soldiers. The team continued to study thelong-term health of RC Soldiers, using administra­
tive datasets as well as data collected as part of the
STARRS survey research. Recent work used admin­
istrative records from 2004-2009 to examine the pat­terns and predictors of RC suicide attempts during
deployment to the wars in Iraq and Afghanistan, andto determine whether they differ from the patterns
and predictors of suicide attempts in the Active
Component (AC). The suicide attempt rate for RC
Soldiers during deployment (81 per 100,000 per­son-years) was about half that of AC Soldiers (157
per 100,000 person-years). The lower RC rate waspresent among both men and women and across age
groups. RC Soldiers were less likely than AC Soldiers
to attempt suicide even after accounting for differ­ences in socio-demographic and Army career char­acteristics. The lower suicide attempt rate among RC
Soldiers persisted over the course of deployment.
Importantly, the time course of risk was similar
for the RC and AC Soldiers, with risk increasing
during the initial months in-theater, peaking around
mid-deployment, and then decreasing through theend of deployment. Overall, the results suggest that
RC and AC Soldiers have similar patterns and pre­dictors of suicide attempt during deployment, but
RC Soldiers have lower risk even after controllingfor important risk factors. The team will continue tofocus on the RC as a population of special interest,
using the ongoing STARRS-LS surveys and more
recent administrative data.

National Guard COVID-19 Response
In 2020, the National Guard (NG) deployed in
unprecedented numbers across numerous states tosupport civilian healthcare systems overwhelmedby COVID-19. NG personnel performed a range of
operational activities, such as work within hospitals
2020 ANNUAL REPORT | 9and neighborhoods, which included exposure tohuman remains. Due to the unique stressors of thisdomestic response, the New York NG, in conjunc­tion with the National Guard Bureau, requested
support from CSTS to better understand the impact
of COVID-19 on the well-being and readiness ofService members.

New York National Guard Warfighter
Readiness and Resilience Assessment
The U.S. National Guard is a critical element of
the Nation’s response to the COVID-19 pandemic.
Identifying, monitoring, and understanding the NG’s
resilience and risk factors related to the COVID-19
pandemic are central to sustaining force readiness.
Given the immediate need for information on force
health and readiness, CSTS collaborated with the
New York National Guard (NYNG) to develop a
rapid public health surveillance assessment to identi­
fy stressors, resilience factors, and behavioral healthoutcomes among NG personnel in response to
COVID-19. The assessment, conducted from August
to November 2020, was successful, with participa­tion from more than 4,000 NYNG personnel. This
assessment identified pandemic-related stressors
and experiences among Guard members who did
and did not activate in response to the pandem­
ic. CSTS will produce a rapid report that provides
NYNG leadership with actionable recommenda­
tions. This assessment will inform the developmentof future assessments of the National Guard.

National Guard COVID-19 Operations
Working with Human Remains
NG personnel were activated in many U.S.
states to assist with COVID-19 support activities,
including handling the remains of the dead. They
worked closely with hospitals, emergency services,and offices of the Chief Medical Examiner and were
frequently tasked with collecting and transporting
remains. When activated under Title 32, NG person­nel can enter private residences to assist emergency
services and medical examiner personnel in col­lecting remains. Most NG personnel are untrained
and inexperienced in operations that involve humanremains, and performing these activities is extremely
10 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

stressful and increases the risk for adverse reaction
during and after operations. In order to addressthese needs, CSTS produced training guidelines
designed to reduce distress and increase resiliencein NG personnel and other populations who must
work with the dead without specialized training. The
content of the training materials was divided into
three operation phases: prior to, during, and after
mortuary affairs operations, and was designed to beunderstandable to those without specialized training
in working with remains. CSTS provided actionable
recommendations and training guidelines to the
National Guard Directors of Psychological Health,National Guard Bureau for immediate use.

RESEARCH IN THE CHILD AND FAMILYPROGRAMThe Child and Family Program (CFP) conducts
research to better understand the needs of all chil­dren and families affected by traumatic events, withspecial emphasis on the needs of U.S. military fam­ilies. Military children and families possess uniquestrengths, but can also be affected by combat-related
illness and injury, bereavement, child maltreatment
and family violence that result in vulnerabilities. CFP
maintains collaborative relationships with faculty
and students within other departments at USU (e.g.,doctoral dissertation graduate students, Departmentof Pediatrics researchers, Capstone program partic­
ipants), other academic institutions, and commu­
nity organizations. The products of CFP’s research
program inform scientists, clinicians, and thegeneral public about the impact of stress and trauma
on children and families through scientific publi­
cations, national and international presentations,and hardcopy/web-based resources. CFP’s pioneer­ing research is also translated into actionable andeducational materials for military and government
stakeholders, clinicians, and community leaders. In
addition, CFP consults with military and govern­
ment leadership, informs national media outlets,and conducts projects that promote a deeper under­
standing of children in the U.S. and throughout theworld.

Bereavement
The National Military Family Bereavement
Study (NMFBS)
The NMFBS was the first large, systematic study
to examine the impact of U.S. military Service mem­ber death on surviving family members. The goal of
the study was to build upon existing bereavement
research by determining how psychological, physi­cal, and behavioral outcomes of grief are influenced
by the experiences of military family members. The
study included archival data analyses, a longitudi­
nal survey study, biosample (saliva) collections, andfocus group qualitative data. The longitudinal study
included approximately 850 adults and 120 children,and 981 participants provided saliva samples foranalysis of biomarkers associated with bereavement.
Findings have informed development of diagnostic
criteria for a condition of impairing grief. As part ofthis groundbreaking work, CSTS partnered with col­leagues at Columbia University, New York Univer­sity, University of Pittsburgh, and the University ofCalifornia, San Diego to develop a proposal for clini­cally-relevant criteria of a persistent grief disorder tobe included in future editions of the Diagnostic andStatistical Manual of Mental Disorders (DSM), anddiscussed in a publication in Psychological Medicine
in 2020. CSTS Scientists found a higher prevalenceof depression, PTSD, and adjustment disorder postdeath, and an increase in mental healthcare utilizationin military widows. Another publication highlighted
the independent contributions of complicated grief,
depression, and anxiety to cognitive failures in be­reaved individuals, and a third publication describeda codebook developed to analyze qualitative focus
group data from family member survivors of mili­tary-related deaths. The NMFBS has identified theneed of military family survivors to access healthcare
services that can treat loss-related conditions.

Stepping Forward in Grief (SFG) Study
A virtual app that addresses grief adaptation may
be a helpful resource for bereaved military family
members. CFP formed a partnership with the Cen­
ter for Complicated Grief at Columbia University toadapt principles from ComplicatedGrief Therapy (CGT), found tobe helpful in civilian popula­tions, for a digital interven­tion aimed to assist with grief
integration and decrease risk
for long-term problems. The
goal of SFG, a randomized con­trolled trial, was to compare the effectiveness of two
digital programs (GriefSteps and WellnessSteps) in
helping those bereaved by military service-related
death. More than 550 participants were randomized
to one of the two conditions and completed baseline,
three-month, and six-month follow-up assessments
about their current mental health and experience withthe program. CSTS Scientists are currently conduct­
ing analyses to determine the impact of GriefStepsand WellnessSteps on grief adaptation.

Study of Long-Term Outcomes ofTerrorismRelated Grief
CFP partnered with Voices of September 11(VOICES), a nonprofit organization that aids 9/11-af­
fected families, and the Canadian Resource Centre
for Victims of Crime (CRC), an organization support­
ing family members who were bereaved by the Air
India Flight 182 bombing, to investigate long-term
bereavement outcomes in family members (e.g., grief,traumatic symptoms, resilience, and posttraumatic
2020 ANNUAL REPORT | 11growth) following a terrorism-related death. Morethan 400 bereaved family members completed
online questionnaires about their experiences. Twomanuscripts were published; the first identified
three groups of bereaved family members who weredifferentiated according to patterns of depression,anxiety, and grief. The second manuscript examinedthe effect of receiving multiple notifications about
the identification of fragmented remains of a family
member. Results indicated that multiple notifica­
tions were differentially associated with posttrau­
matic stress, but not grief severity. Results from thispublication were also described on the International
Society for Traumatic Stress Studies’ (ISTSS) Trauma
Blog and were used to develop an interactive fact
sheet for healthcare providers about death notifica­tion within healthcare facilities.

Bereavement Coping Study
The goal of this study was to determine wheth­er military family survivors of suicide, accident,
and combat deaths use similar or different coping
strategies following bereavement and to examine
associations between risk factors (hopelessness andreasons for living), specific coping strategies, andoutcomes (grief, depression). Approximately 230
individuals participated. Analyses will identify 1)
associations between different coping strategies andgrief, depression, and posttraumatic growth and 2)changes between previously collected baseline andcurrent coping data. This information will identify
actionable targets for intervention programs. A pub­lication from this study used data from NMFBS to
examine differential contributions of specific coping
strategies and their relationships with cause of deathin contributing to grief severity, depression, andposttraumatic growth.

Disenfranchised Grief
Through its collaborations with Sons and Daugh­ters in Touch (SDIT), an organization composedof children whose fathers died or were missing inaction (MIA) in the Vietnam War, CFP noted theconsistency with which this population felt their loss
was not acknowledged or rejected. This phenome­
non was consistent with the concept of disenfran­
12 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

chised grief (DG), which describes the experiences of
bereaved persons whose grief was not or could not be
openly acknowledged, publicly mourned, or social­
ly supported by others. In response and recognitionof the importance of DG, particularly in light of the
COVID-19 pandemic, CFP is currently developing re­search on DG to include developing a measure of DG.
CFP is refining and testing this instrument in the SDIT
population, as well as among individuals who sufferedlosses due to perinatal death, suicide, substance abuse,criminal activity, and HIV.

Child Maltreatment in U.S. MilitaryCommunities and Families
Another focus of the CFP is the identification of risk
factors for child maltreatment in military families inorder to inform prevention and intervention strategies
that strengthen military family health, well-being, andresilience. CFP’s initial work focused on child neglect,
the child maltreatment type most commonly reported
in the U.S. and most frequently associated with childfatality. The aim was to identify factors that increaserisk of child neglect by examining characteristics ofsubstantiated child neglect cases in U.S. Army families.
Data were collected from records of 400 cases fromfour high operational tempo Army installations in thecontinental U.S. Multiple manuscripts describing find­ings from this project have been published in Military
Medicine and Child Maltreatment.
CFP Scientists are currently participating in a
Congressionally mandated study designed to advanceunderstanding of risk and protective factors for all

types of child maltreatment (i.e., neglect, physicalabuse, sexual abuse, and emotional abuse) in mil­itary families from all service branches. Phase I of
the project involved a case-control study of militaryfamilies with dependent children to identify thefamily, service member, and military characteristics
associated with heightened and diminished risk of
substantiated child maltreatment incidents. In Phase
II, survival analyses will be conducted to investigate
the contribution of family demographic characteris­
tics, family events, military events, and family health
events to the timing of the first incident of substanti­
ated child maltreatment. Results will identify charac­
teristics of the military family life course associatedwith child maltreatment in order to inform DoD’schild maltreatment prevention efforts.

Combat Injured Families
CFP Scientists conducted three studies to exam­
ine the impact of combat injury on military families.
These studies included families participating in
Operation Purple Healing Adventures (OPHA), an
annual summer camp program for combat-injured
Service members and their families sponsored by
the National Military Family Association (NMFA),
families of patients at WRNMMC and San Antonio
Military Medical Center affected by combat injury,
and families participating in Families OverComing
Under Stress-Combat Injury (FOCUS-CI), a fami­
ly-centered, strength-based, and evidence-informed
preventive intervention. Ongoing data analyses will
help to better understand combat injury’s impact on
Service members and their families and inform in­terventions that more effectively address their needs.

Family Violence
The COVID-19 pandemic and associated stay-at­home orders raised concerns among Army Family
Advocacy Program (FAP) leaders that family vio­
lence may increase during this period. School clo­sures, limited medical services (e.g., routine care likewell-baby checks), and service delivery changes (e.g.,increased reliance on telehealth platforms) would all
potentially reduce visibility of child maltreatment
and spouse abuse. As a result, Army FAP leadership

requested increased (quarterly) monitoring of instal­lation-level FAP report changes throughout 2020. The
CSTS Family Violence and Trauma Project (FVTP)
helped meet Army FAP needs by assessing Army-wide
and installation-level FAP reporting changes through­out the year. Also new in 2020, Army FAP requested
assistance with monthly analysis of data related toproblematic sexual behavior incidents among children
and youth. Collectively, these analytical findings helped
inform family violence prevention efforts across Army
FAP.
Highlights of CSTS knowledge products in 2020
included the publication of two newsletters on family
violence: Joining Forces Joining Families (JFJF) andResearch Review (RR).
n JFJF presents an interview with a subject matter
expert on topics of interest to the Army family
violence community. In 2020, two newsletters were
produced that featured (1) in-depth coverage of
DoD’s child abuse pediatrics capabilities; and(2) traumatic brain injury among survivors of inti­
mate partner violence (IPV).
n RR consists of summaries of research on IPV andchild maltreatment. Summaries of IPV-related top­
ics included the association of coercive control withwomen’s experience of violence, the health risks of
strangulation, how the lack of adequate food in ahousehold can be associated with IPV, and residen­tial mobility and how it can increase or decrease
the risk of child maltreatment. Child maltreat­ment-related summaries included child shame fromphysical and sexual abuse, the possible relationshipbetween suicidal feelings and social connections,the importance of parental supervision to preventchild neglect, and the association between children’s
report card release date and corporal punishment.
n Army family violence fatality review board reportthat summarized the demographics of victims offamily violence-related fatality victims and perpe­
trators, risk factors for fatal events, and case char­acteristics of Army fatalities compared to reports
from international literature on fatalities.
n Military Health System Research Symposium poster
presentation (virtual) on same-day domestic vio­
lence and child maltreatment allegations.

2020 ANNUAL REPORT | 13

RESEARCH IN NEUROSCIENCE AND
NEUROBIOLOGYLaboratory Research in Neuroscience and
Neurobiology
Genetics and Biomarkers
In early 2020, with shutdowns due to the
COVID-19 pandemic, the Center’s biomarker re­search encountered significant challenges to con­ducting in-person lab research. Despite these obsta­
cles, the team has been able to adapt and overcome
these challenges to further its research goals. CSTS
Scientists examined a hypothesis that a sex-relat­
ed difference of mitochondrial DNA copy number(mtDNAcn) may potentially be a biomarker for
PTSD. CSTS laboratory personnel used the TaqMan
assay as well as blood samples and scores on the
PTSD Checklist (PCL) from male and female Service
members to identify the potential biomarkers. This
study demonstrated that female subjects with PTSD
showed significantly higher mtDNAcn comparedwith either male/female non-PTSD control subjects
or male subjects with PTSD. However, there was no
significant difference of mtDNAcn between maleswith PTSD and male/female non-PTSD controls.
The findings suggested that mtDNAcn may begender dependent in PTSD, at least among Service
members, and sex-related impairment of the mito­
chondria may play a role in PTSD pathophysiology
and serve as a biomarker for PTSD in female Service
members.

Drug Development for the Treatment of PTSD
The Center, in collaboration with the Universityof California, Irvine (UCI), established a multi-spe­
cies methodology for evaluating potential new com­pounds to treat PTSD. This effort uses a non-mam­malian model (zebrafish) for high-throughput
screening in conjunction with a long-establishedrodent model. The zebrafish colony provides anabundance of potential research opportunities indrug development and beyond. The zebrafish lab
continues testing large chemical libraries to bothcreate standard drug profiles within the zebrafish
system, and to find promising candidates for drug
14 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

CSTS staff conducting zebrafish testing and care.
repurposing. Experimental progress was slowed in2020 due to COVID-19, but high-throughput testingis expected to resume, and chemical libraries withdrug candidates potentially targeting a wide range of
biological processes will be tested for neuroactivity.

Chronobiology, Light, and Sleep Research
The overarching goal of the Chronobiology, Light,
and Sleep (CLAS) lab research program is to further
understand sleep, circadian rhythms, and light inorder to maximize human health and well-being. To
that end, the program takes two major research ap­
proaches. From a basic science perspective, we focus
on the neural mechanisms underlying the modulationof photic sensitivity for the biological effects of light.
From a translational perspective, the program exam­
ines how the basic science of this primitive sensory
system can guide the rational development of clinicaltherapies and architectural lighting strategies. One
key aspect of a successful transition to application
includes a carefully developed, tailored, and test­
ed educational component, which has become an
emerging priority for the CLAS lab. Since methods
for examining circadian rhythms in humans undermore naturalistic conditions are quite limited andcontrolled laboratory studies are impractical for many
populations of interest, parallel work includes thevalidation of novel strategies for assessing sleep andcircadian health in the home environment.
Early in 2020, the CLAS lab made a strategic

pivot from examining hospital shiftworkers over toshiftworkers in other operational settings that havenot been impacted by COVID-19 in the same way.
This move required a no-cost extension, Institutional
Review Board (IRB) modifications, and establish­
ment of new study site partners. In addition, the lab
developed several health tip sheets that describe
how to optimize sleep in order to boost the immune
system and maximize vaccination efficacy; thesewere provided to local area hospitals in an effort
to help during the pandemic. In collaboration with
an immunologist, a commentary was written andsubmitted for publication on the same topic. Due to
COVID-19 restrictions, the CLAS lab’s in-person,
expert-led sleep education program was adapted fora virtual format and IRB approval was obtained sothat pilot data could be collected, which confirmed
both feasibility and efficacy of the new remoteadministration. A grant was awarded to the CLAS
lab for a study of the temporal dynamics of the acutealerting properties of light. This research will takeplace in the newly renovated laboratory that can now
support the work. Two grant proposals were submit­
ted, and seven peer review publications have comeout, including original research articles on studies ofshiftworkers and review articles on the physiologicaleffects of light.

Clinical Research in Neuroscience and
Neurobiology
Riluzole Augmentation Treatment forComplicated Combat-Related PTSD
The Center recently published promising resultsfrom a multi-site clinical trial testing the efficacy ofriluzole for treatment of combat-related PTSD. The
study demonstrated that veterans who experienced
continued PTSD symptoms despite treatment withevidence-based medications for PTSD, showed
greater improvement in hyperarousal symptoms,
such as exaggerated startle responses and hypervig­
ilance, when treated with riluzole when comparedto placebo. Riluzole did not demonstrate significant
adverse effects. This study was funded by the U.S.
Army Military and Operational Medical Readiness
Program and enrolled participants at WRNMMC

and the Syracuse Veterans Affairs Medical Centerfrom 2014 to 2017. Riluzole alters activity of gluta­
mate, the primary excitatory neurotransmitter in thebrain and is currently FDA-approved for treatmentof amyotrophic lateral sclerosis. In addition to data
on PTSD and other psychiatric symptoms, the study
collected magnetic resonance spectroscopy in the
amygdala and anterior cingulate cortex before andafter treatment as a potential biomarker of illness andtreatment response. CSTS Scientists have collaborat­
ed with researchers at Brigham and Women’s Hospi­
tal and Draper Laboratory to identify brain metabo­lites in the areas of interest and their association withimprovement in PTSD symptoms.

Enhancing Fear Extinction via Angiotensin
Type 1 Receptor Inhibition: A Randomized
Controlled Trial in PTSD
CSTS completed its collaboration with UCSD as
part of a multi-site clinical trial testing the efficacy ofthe blood pressure medication losartan for treatment
of PTSD. Losartan is an angiotensin receptor blocker,
currently FDA-approved for treatment of high bloodpressure. This trial compared treatment with losar­
tan to placebo as mono-therapy for over 10 weeks of
PTSD treatment. The primary outcome of this study
was improvement in PTSD symptoms as measured
by the Clinician Administered PTSD Scale (CAPS) at
the beginning and end of treatment. This study also
examined the influence of a specific angiotensin con­verting enzyme (ACE) gene as a potential biomarkerof treatment response. Data from this study are inpreparation for publication.

2020 ANNUAL REPORT | 15

Nightmare Deconstruction and Reprocessing
for Treatment of PTSD-related Nightmares
Nightmares and insomnia are among the mostcommon and debilitating re-experiencing symp­
toms of PTSD, and for many patients they are themost resistant to evidence-based treatment. CSTS
is continuing a clinical pilot trial of Nightmare
Deconstruction and Reprocessing (NDR), an expo­
sure-based psychotherapy for PTSD-related night­
mares and insomnia. NDR is an adaptation of the
Hill cognitive-experiential model for working withdreams in psychotherapy. Participants work withtherapists to recall their most distressing nightmare
images and their associated distressing thoughts
and feelings in order to facilitate reconsolidationof trauma-related memories. CSTS partnered with
WRNMMC, Naval Medical Center San Diego, andthe National Institutes of Health to test a range ofpotential psychometric, physiologic, and biochemi­
cal markers of NDR’s tolerability and feasibility as atreatment for military Service members and veter­ans. In addition to assessing nightmare and insomnia
severity, suicidality, and PTSD symptoms, the study
is testing several potential biomarkers of treatment
response. The study team is analyzing genetic andinflammatory biomarkers at various points in treat­ment as potential indicators of treatment response,
and also collecting continuous physiologic indicatorsof stress, such as heart rate variability and skin con­ductance using wearable technology. The study has
been enrolling participants since 2019, with expect­
ed continued enrollment through 2021. As a resultof precautions required by the COVID-19 pandemic,
this study transitioned to virtual encounters for moststudy visits and continues to enroll
participants.

The Veterans Affairs (VA)
National PTSD Brain BankThe VA National PTSD Brain
Bank is the first human tissue biore­
pository dedicated to supporting
neurophysiological research on thecauses, progression, and treatment of
traumatic stress. The VA’s National
Center for PTSD leads this consor­
16 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

tium with participating VA medical centers and otherinstitutions, including CSTS. Since its establishment in2014, the Brain Bank has obtained 281 tissue donations,with an additional 163 living persons presently enrolled
to serve as future donors. Donors receive comprehen­sive longitudinal assessment via clinical interview fromthe time of enrollment until the time of their death,when their brain tissue is donated to the Brain Bank.
The Brain Bank collects, processes, and stores theclinical and biological information which can thenbe distributed to investigators nationwide and afford
researchers the opportunity to examine the molecular,
morphological, and biochemical effects of traumaticstress on the brain and generate proposed mechanismsof PTSD, develop pharmacological interventions, andstudy for biomarkers and endophenotypes.
CSTS Scientists serve on the Brain Bank’s Scientific
Advisory Board and direct the Brain Bank’s Assessment
Core. The Assessment Core developed a postmortem
diagnostic assessment protocol which delineates astandardized process to conduct comprehensive psy­
chiatric and medical record reviews and corroborationof medical record information via interviews with nextof kin and/or others familiar with a donor’s life histo­
ry. Through CSTS, the Brain Bank also collaborated
with the Lieber Institute for Brain Development, the
USU Collaborative Health Initiative Research Program(CHIRP), and Yale University to perform whole genome
sequencing and methylation studies.
In 2020, CSTS was preparing to begin recruitment
for the Brain Bank at the Armed Forces Retirement
Home in Washington, DC; however, recruitment was
postponed due to the COVID-19 pandemic. Despite
COVID-19 restrictions, the Brain Bank was able toenroll 54 potential donors and received
15 tissue donations from other partici­
pating sites. CSTS also began working
with Duke University to help conduct
third-party interviews for their postmortem diagnostic assessment of tissue donors. Brain Bank investigators at
CSTS also collaborated on numerous
scientific articles published in 2020,
including the first complete transcrip­
tomic analysis of human brain prefrontal cortex in PTSD.

Florida Department of Health Response toMultiple Hurricanes
CSTS Scientists continued to examine psycho­
logical and behavioral responses following natu­
ral disasters, including posttraumatic disorders,
psychological distress, and health risk behaviors.
Further, during the past year, the Center specificallyexamined protective factors that promote recovery
and resilience following disaster exposure, includ­ing collective efficacy, social support, and hurricane
preparedness. This work is particularly important as
the world has experienced multiple disasters during
2020, including the COVID-19 pandemic, the devas­
tation and destruction caused by the wildfires in thewestern United States, bushfires in Australia, and arecord number of hurricanes globally.
During 2020, Center Scientists identified factorsthat play a role in recovery from multiple hurricane
exposure by examining the behavioral responses andtime to recovery in Florida Department of Healthworkers who were both first responders to, andpersonally affected by, an unprecedented series ofhurricanes that occurred in 2004 and 2005. In two
studies, CSTS: 1) examined the influence of individual
perceived collective efficacy prior to the 2005 hurri­canes on community residents’ self-reports of hurri­cane preparedness; and 2) examined pre-hurricane
individual and interpersonal factors that influence
time to recovery following the 2005 hurricanes. Nota­
bly, higher perceived collective efficacy was associatedwith greater hurricane preparedness nine months
after the hurricanes, even after adjusting for individu­
al and community socio-demographic characteristics,
personal injury/damage, community storm damage,and hurricane preparedness prior to the hurricanes.
Importantly, less social support from respondents’
spouse, friends, and family, more work presenteeism(e.g., lack of concentration or productivity at work),
higher levels of personal injury/damage as a result of
the hurricanes, and higher emotional response during
the hurricanes were associated with a longer time torecovery following the hurricanes. This research sug­gests the importance of neighborhood cohesion, so­cial support, work performance, and peritraumatic fac­
tors such as emotional response and extent of hurricane
injury/damage in promoting resilience. Action-oriented
strategies include community-level interventions andprograms focused on enhancing social and workplace
support, and attention to peritraumatic responses.

Washington Navy Yard Shooting Study
The Center completed data collection at the Wash­
ington Navy Yard in Washington, DC, as part of amulti-site study in collaboration with the Universityof California, Los Angeles (UCLA) and funded by the
National Institute of Justice. This study was designed tobetter understand risk and protective factors associatedwith response efforts following community mass vio­
lence. The first phase of the study involved performing
assessments at the sites of five school mass shootings.
The second phase focused on six community violence
events, including the Washington Navy Yard workplacemass shooting in 2013, to examine the impact of thisincident. This collaboration leveraged a long-standing
relationship with Naval Sea Systems Command (NAV­
SEA) to provide a better understanding of the socialand occupational difficulties still impacting personnel
following the event. The Center and UCLA will con­duct analyses of this qualitative data to develop a reportthat will inform public policy on future interventions
following mass violence events. CSTS has submitted amanuscript which describes methodology with disastersurvivors — both military and civilian — and captures
critical lessons learned in conducting research on
behavioral health impacts of mass violence in militarycommunities that will serve as a seminal publication tobetter inform the field in support of future efforts.

© Copyright Getty Images

RESEARCH ON DISASTERS ANDTERRORISM

2020 ANNUAL REPORT | 17

Education and Training
An essential element of the Center’s work is
training and education. Center Scientists provide
education and training to USU medical students
committed to service in the nation’s Air Force, Navy,
Army, and Public Health Service. CSTS educates
healthcare personnel and community leaders at the
local, state, and federal levels, as well as national,
global, and private sector settings. CSTS also spon­sors conferences, symposia, seminars, and forums on
numerous areas including disasters, terrorism, war,and other aspects of trauma. CSTS advances mili­tary and disaster psychiatry through presentations,training, outreach, and participation in conferences,collaborations, and workshops throughout the U.S.
and global community. CSTS also expands knowl­edge and provides education through public healthefforts and interventions before, during, and after abroad range of disaster events.
One of the Center’s instrumental public healtheducation tools is development and disseminationof educational materials to inform stakeholders, in­cluding: healthcare personnel, families, community

CSTS Scientist, Dr. Hamaoka speaking at aconference.
18 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

and organizational leaders, first responders, publichealth emergency workers, teaching professionals,
and policy makers. For more than two decades,
CSTS created and disseminated just-in-time, cus­
tomized, highly actionable, easy-to-read educa­
tional fact sheets in order to aid national and global
stakeholders in mitigating adverse effects of disasters
through optimized preparedness, response, andrecovery efforts.
In 2020, the Center’s primary focus was on
the COVID-19 pandemic. This included provid­
ing COVID-19 educational resources to partners
throughout the DoD, other federal agencies, stateand local agencies, professional associations, andinternational partners. CSTS also responded toother disaster events, including ongoing wildfires in
California and Hurricane Laura, which impacted thesoutheastern United States.

DISASTER RESPONSE AND PUBLICEDUCATION
Since its inception in 1987, the Center has been
providing disaster preparedness and response ed­
ucation and consultation in a variety of forms andin many situations. CSTS personnel have provid­
ed on-the-ground education and consultation in
response to extreme national and global disasters, aswell as immediate and long-term online, video, andtelephonic support to assist response and recovery
efforts following a wide range of disaster events,
which have impacted various organizations andcommunities.
The Center’s Assistant Director serves as Chairof the Disaster Committee for the American Psy­
chiatric Association, the world’s largest professionalorganizing body of psychiatrists. Current and former
CSTS personnel have been sought out to provide
guidance on disaster preparedness, response, andrecovery efforts as a result of the experience andsubject-matter expertise obtained while working at
the Center.

In early 2020, the Center provided ongoing con­sultation and remote training for medical personnel
in the Puerto Rico Veterans Administration health­care system to address the stress and trauma of
exposure to recurrent earthquakes, which took place
while the island was still rebuilding following the2017 devastation caused by Hurricane Maria. CSTS
also provided global disaster mental health support
to colleagues in Australia with educational materials
and consultative efforts in response to massive wild­
fires. Following the deadly mass shootings in Nova
Scotia, Center Scientists provided ongoing consulta­
tion and resources to support local response efforts
in this more remote and rural region of Canada.
Within the United States, CSTS also provided edu­
cational resources and support to the State Mental
Health Directors, state-level District Branches of theAmerican Psychiatric Association, and the Office of
the Assistant Secretary for Preparedness and Re­
sponse in support of the devastating wildfires thatravaged the West Coast of the United States, as wellas Hurricane Laura, which resulted in widespread
damage and the dislocation of tens of thousands ofcitizens from the Gulf Coast region.
In mid-March of 2020, the Center took a leader­
ship role in global disaster mental health response
to COVID-19 in support of numerous stakeholders
at the local, state, federal, national, and internation­
al levels. CSTS rapidly developed and distributed
numerous easy-to-read, actionable fact sheets thatwere widely disseminated to critical partners in needof resources early in the pandemic. CSTS mem­bers provided education and training to numerous
healthcare organizations and federal interagency
partners on the unique mental health effects of pan­demics on individuals and communities. Center Sci­
entists delivered nearly 50 presentations in support
of a broad range of stakeholders that were involvedin pandemic response and published more thana dozen manuscripts to better inform the field on
addressing mental health challenges and enhancing
resilience for Service members, healthcare workers,families, patients, and community leaders.
The following are additional examples of Center
disaster response and education activities in 2020:
n Center Scientists provided educational support

to the USU Master of Public Health Program bydelivering educational seminars on domestic andinternational disaster behavioral health.
n A CSTS Associate Director conducted a classtitled, “Behavioral Health and Leadership” at
George Washington University (GWU). It waspart of a course in Leadership in Crisis & Ca­
tastrophe in GWU’s Crisis, Emergency & Risk
Management Program.
n For the fifth consecutive year, a Center Scien­tist was invited to provide disaster psychiatry
training for the fourth-year psychiatry residents
at the University of Maryland/Sheppard Pratt
Psychiatry Residency Program.

NEUROSCIENCE AND BEHAVIORMODULE FOR PRE-CLERKSHIP USU
MEDICAL STUDENTS
The eight-week Neuroscience & Behavior Mod­ule is an annual, required multidiscipinary coursefor 180 first year USU School of Medicine (SoM)
students. The module teaches medical students
the principles of neuroscience through integrat­
ed content across a range of disciplines. From thisfoundation, students learn to recognize, describe,and diagnose common neuroscience-related medical
conditions with a focus on effective management ofa wide variety of neurologic and psychiatric condi­
tions. Effective, safe, and patient-centered clinicalskills, including the performance of neurologic andmental status examinations, were developed throughsimulated patient experiences. Topics related to mil­itary medicine, medical history, and health systems
2020 ANNUAL REPORT | 19

science are integrated throughout the module withthe goal of fostering a robust and well-rounded edu­
cation for future military medical officers.
The module has 177 contact hours and involves
more than 100 faculty from every department in
the SoM. Only 48% of contact hours in the module
are lecture-based; the remaining contact hours arefilled with small groups, dissections, labs, simulated
patient events, reviews, and of course — examina­
tions. The module is highly regarded by students
and faculty alike as one of the best modules in the
pre-clerkship curriculum. In 2019, the module
was recognized for pre-recording all lectures intoa higher-quality format that was more accessible
to students than recording live lectures. In prepa­
ration for 2020, the module continued to enhance
online lecture delivery by improving and re-record­ing 52/137 (37%) video lectures. In collaboration
with the Dean’s Office, the module also embedded
questions (checks for understanding) into 85/137(62%) of video content using Panopto’s built-in quizfeature. Module instructors expanded the flippedclassroom approach from five to six weekly ses­
sions. These flipped classrooms required students toattend a live session to answer questions based onclinical cases that wove together the lecture con­tent they independently watched from that week.
A weekly series of operational vignettes was also
incorporated. These vignettes, collected from USU
graduates and faculty, were intended to demonstrate
the operational importance of the material thestudents were learning each week. Lastly, based on
consultation with the Assessment Sub-Committee
and the Associate Dean for Assessment, every mod­ule exam question was carefully blueprinted, down
to the objective.
Then, during the first week of the module,
COVID-19 infections in the U.S. reached a pointthat required the University to transition to 100%
distance learning. Due to this transition, module
instructors needed to convert all of the other content
online, which included the following: Pharmacology
Case-Based Learning, Pathology Small Groups/Labs,
Anatomy Dissections, Clinical Reasoning Small
Groups, Mental Status Examination Small Groups,
Neurology Examination Small Groups, Biostatistics
20 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Journal Club, Reflective Practice, Communication
Workshop, Interactive Reviews, and Summative
Quizzes and Exams.
In response to these efforts in transitioning all
program elements to distance learning, the Neu­
roscience Module was awarded the Teaching withTechnology Award.

CSTS staff conducting online assessment training.

CSTS INTERNATIONAL FELLOWSHIPThe Center welcomed LTC (Dr.) Teck Hwee Soh,
who is a psychiatrist and medical director within
the Singapore Armed Forces. Dr. Soh joined CSTS
in February 2020 to start a nine month CSTS fel­lowship. This fellowship was created with the goalof promoting high-level cross collaboration andlearning between different international partners
and CSTS. Dr. Soh’s predecessor, Dr. John Wong
(former Surgeon General of Singapore) was the firstrecipient of this international fellowship. Due to the
COVID-19 pandemic, Dr. Soh was recalled backto Singapore in early 2020 to support his country’s
response efforts.

EDUCATION AND TRAINING IN
COMBAT AND OPERATIONAL STRESSCONTROL: OPERATION BUSHMASTER
CSTS Scientists offer training in Combat andOperational Stress Control (COSC) as a corecomponent in military medical education. In linewith USU’s mission to prepare uniformed healthprofessionals to support the readiness of the U.S.
Armed Forces, CSTS Scientists engaged in curric­ulum preparation, faculty development, and directteaching as part of the annual medical field training
exercise, OPERATION BUSHMASTER. This train­
ing exercise challenged senior medical and graduate
nursing students to operate in forward medical units
in a complex battlefield simulation over four days.
Students evaluated and treated a continuous streamof battlefield casualties and non-battle injuries, andconducted public health and health outreach activi­
ties while on a simulated combat deployment. Evalu­
ation and treatment of combat and operational stress
reactions were core skills taught and evaluated aspart of the exercise. CSTS faculty collaborated withthe psychiatry residency programs of the National
Capital Consortium and the San Antonio Uniformed
Services Health Education Consortium to provide an
opportunity for resident physicians to develop theirteaching skills and understanding of COSC as part oftheir core military-unique curriculum. This exercise
was canceled in 2020 due to COVID-19. However,it will resume in 2021.

EDUCATIONAL CONFERENCES
Amygdala, Stress, and PTSD Conference
In 2020, the 15th Annual Amygdala Conference,sponsored by CSTS in collaboration with the USU
Department of Psychiatry, USU Neuroscience Pro­
gram, USU Department of Family Medicine, and the
WRNMMC Department of Psychiatry, was post­
poned due to COVID-19 restrictions. For 2021, theplanning committee has been fortunate to secure thesame speakers from the Salk Institute, WRNMMC,
Phoenix Australia Centre for Posttraumatic Mental
Health, Icahn School of Medicine at Mount Sinai,
and the Uniformed Services University for 2021’s
virtual conference. The speakers plan on presenting
and discussing such topics as fMRI-guided transcra­nial magnetic stimulation treatment for depressive
symptoms, COVID-19 behavioral health assessment
teams, evidence-based treatments for PTSD, thetranscriptional and epigenetic basis of stress effects

on the brain, and neural circuit mechanisms ofemotional and social processing.

TRAINING TO SUPPORT RESEARCH
The Center trains and educates its own staff,
including research support staff such as Research
Assistants (RAs). RAs play an important role insupporting research at CSTS, and are provided
with opportunities to learn by working closely with
CSTS Scientists and staff. The RAs contribute toCenter research in many ways, including conduct­
ing literature searches, data collection, data entry
and quality control, producing tables and graphic
representations of study findings, and writing sum­mary reports of meetings. RAs acquire valuable
research skills at CSTS, including developing slides
and posters for research presentations, and pre­senting research findings to professionals as wellas the general public. In addition, RAs are offeredprofessional development opportunities, including
attending, presenting posters, and representing
CSTS at professional conferences, and assistingwith manuscript preparation for publication in
peer-reviewed scientific journals. Many RAs moveon to further their education by pursuing advanced
degrees. Others advance to careers in research andother related fields. CSTS RAs have furthered theireducation at institutions including Yale, Notre
Dame, Johns Hopkins, Duke, Columbia, George­
town, London School of Hygiene and Tropical
Medicine, University of Maryland, George Wash­
ington University, Catholic University, and USU.
Opportunities that RAs have pursued following
their experience at CSTS have included:
n Ph.D. programs in psychology and related
fieldsn Medical schooln Law schooln Master’s degree programs in psychology, coun­
seling, public health, and social workn Training positions at the NIMH and otherinstitutes at the NIH
n Careers with the FBI

2020 ANNUAL REPORT | 21

DISSEMINATION AND
IMPLEMENTATION OF HEALTH AND
RESEARCH KNOWLEDGE
Fact Sheets and Infographics
Fact sheets are a highly regarded and long-stand­ing communication tool of CSTS. They are easy tounderstand, topic-focused, and actionable educa­tion resources developed using expert knowledge
to communicate essential behavioral health content
on difficult and/or crisis-related issues. Fact sheets
and infographics address the needs of a broad rangeof partners and stakeholders, including healthcare
providers, first responders and emergency workers,family members, community leaders, and policy
makers. CSTS fact sheets, which are developed,
updated, disseminated, and maintained in an online
repository, address a wide range of issues pertaining
to preparedness and response for disasters, such as
mass violence, natural disasters, and pandemics; risk
and crisis communication; elements of crisis leader­
ship; family health behaviors; and health risk edu­
cation. CSTS fact sheets and infographics provide
readers with resources tailored to the unique aspects
of disaster events and the disaster community. The
Center develops and rapidly disseminates fact sheets
in real time, following major disasters and traumatic

Publications (37)

Presentations (52)CSTS
KNOWLEDGEPRODUCTS
Fact Sheets (32)Newsletters (4)22 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

events such as community violence, terrorism andbioterrorism, and public health threats.
In 2020, in response to COVID-19, the Center
developed and disseminated 32 unique fact sheets
and infographics addressing mental health aspects ofthe pandemic and its impact on families and patients,
healthcare workers, and community and military lead­ers. Content addressed unique issues including finding
the right words to talk with children, supporting
family members during quarantine, optimizing sleep
for healthcare workers, aiding healthcare personnel
in making death notifications, assisting personnel andleaders in addressing challenges of exposure to humanremains, and how leaders can address community andorganizational grief during the pandemic. The fact
sheets were distributed around the world and be­came essential education resources in the COVID-19
behavioral health response for the United Nations,
NATO ally nations, National Academies of Sciences,
Engineering, and Medicine, American Medical Asso­
ciation, National Association of State Mental Health
Program Directors, Assistant Secretary for Prepared­
ness and Response, Centers for Disease Control andPrevention, American Psychiatric Association, andnumerous others.

WebsiteThe CSTS website (www.CSTSonline.org) is a pri­mary tool that is used to further the goal of dissemi­
nating relevant and timely information to a wide rangeof stakeholders. Throughout the year, CSTS personnel
continually added content and made content moreaccessible. Material available on the website includes
summaries of current research activities, publica­tion citations, newsletters, conference reports, and asearchable repository of CSTS disaster mental healtheducation fact sheets. The website includes a “What’sNew” section to highlight recent disaster educationmaterials, research initiatives, publications, conference
summaries, and announcements of upcoming events.
In 2020, the CSTS website saw 106,317 users from192 countries around the world. On average, 8,860 us­
ers visited the site daily throughout the calendar year.
Most website visitors were from the U.S. at 78,660(74.0%). The top 10 countries with the highest number

of visitors included more than 800 users per country.
The top five countries with the highest number ofvisitors had more than 1,500 users. Japan had 8,199
users (7.7%), Mexico had 2,229 (2.1%), Canada had
2,057 (1.9%), and China had 1,851 (1.7%). Desktop
utilization remained the most used viewing style on
the website at 77,294 (73.3%) users. Mobile accesshad 26,091 (24.5%) users, up from 22.0% in 2019.
The most viewed section in 2020 was the
COVID-19 Pandemic Response Resources webpage(https://bit.ly/32BXp61) that was created in February
2020. This page had a total of 61,578 users throughthe year, with an average length of time on the pageof 3 minutes 49 seconds. The most views in a monthand on a single day were both in March 2020, which
had 2,382 users visit the page in a single day, and had
25,693 total monthly users. The Spanish language
version of the page was the fourth most visited pageon the CSTS site and had 3,450 users. The Japa­
nese language version of the site was the fifth mostviewed, with 3,221 users.

Social MediaIn 2020, the Center continued to grow its online
presence through the use of social media. These so­cial media resources allowed for the timely dissem­
ination of relevant content to our partners and the
public. New in 2020 was the addition of COVID-19
infographics. CSTS Twitter followers increased by
34% and CSTS Facebook followers increased by 34%
in the past year. The Center encourages people tovisit and follow CSTS postings via Twitter and Facebook to stay up-to-date on new CSTS activities andpublications. “Like” CSTS on Facebook at Center for
the Study of Traumatic Stress and follow CSTS on
Twitter @CSTS_USU.

In response to the COVID-19 crisis, CSTS
produced dozens of knowledge products for medical
professionals, mental health workers, DoD, USU,
researchers, government officials, citizens, and first
responders. (https://bit.ly/32BXp61)

2020 ANNUAL REPORT | 23

Consultation
Consultation has always been and remains a corefunction of the Center. It is a primary mechanism
through which CSTS staff share research findings
and apply the deep and broad experience of CSTS
staff and leadership. The fact that consultations aresought from CSTS, rather than sought by CSTS, isa testament to the respect that the Center receives
from around the world. In addition, consultation isa valuable mechanism to assure that CSTS staff areaware of, and responsive to, those who face chal­lenges and opportunities related to trauma of many
types. The Center has developed relationships with,and provides consultation to, many agencies andorganizations throughout the DoD and other federal
agencies, as well as with state, local, and national
agencies, professional associations, and internation­
al organizations. The Center has established many
long-standing organizational relationships and iscontinuously increasing its consultative activities
with new organizations. 2020 was no exception.
New consultative relationships were establishedand existing relationships continued to strengthen.
The following are examples and updates of somelong-standing CSTS consultations as well as somenew activities.
The long-standing relationships CSTS enjoys
both inside the U.S. and beyond helped facilitate
rapid, high quality, and creative contributions in thewake of the COVID-19 pandemic. These activities
spanned information, education, and consultative
efforts. CSTS developed a resource website with cus­
tomized, just-in-time, public mental health educa­tion fact sheets to help families, healthcare person­nel, military and community leaders, and businesses
plan for, and respond to, the COVID-19 global
outbreak. These resources were shared with national,
federal, and international organizations, including
those listed in the following pages, and were widely
disseminated by them throughout their networks. In
addition to the international organizations described
below, global entities utilizing the resources included
the Ministries of Defense (Canada, the Netherlands,
24 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Australia, the United Kingdom, and New Zealand),the Japan Self Defense Force, and the Pacific Rim
College of Psychiatrists. The resources were included
in EvidenceAid, an international organization thatcollects and disseminates evidence-based best prac­
tices in response to humanitarian crises and disasterevents.

DEPARTMENT OF DEFENSECSTS was sought out by Directors of Psycholog­
ical Health at the Defense Health Agency (DHA) toprovide guidance and resources on mitigating risks
and promoting resilience for Service members de­ployed in support of civilian COVID-19 operations.
Critical information was provided to help better pre­pare Service members for these activities, which hadfeatures of humanitarian and other civilian disasters,
as well as to guide recovery efforts.
Scientists at CSTS also supported DHA lead­ership in a collaboration among the White House,
HHS Innovations, and the National Association of
Broadcasters to develop public health messages fora variety of target audiences intended to assist withovercoming barriers and facilitating health behaviors
to more effectively control the pandemic.
The Center was asked to speak on the mental
health impact of the COVID-19 pandemic to DoD’s
Joint Trauma System, a multi-national coalition ofhealthcare personnel involved in the management
and movement of trauma patients around the globe.
The presentation was delivered to hundreds of per­sonnel in the U.S. and around the globe and served
to enhance force readiness and global health security
during the pandemic response.
Medical Affairs at DHA invited the CSTS Assis­
tant Director to speak to the Chief Medical Officers(CMO) and Chief Nursing Officers (CNO) team,comprised of CMOs and CNOs from all Medical
Health System installations and systems, about
adverse mental health effects and optimizing Service
member sustainment during response to COVID-19.

CSTS and the USU Department of Psychiatry
leadership served as expert consultants at a Health
Affairs/Defense Health Agency media roundtable
regarding the impact of COVID-19 on military fam­ilies, which resulted in the publication of numerous
media reports.
The Center has a long relationship with the
Joint Mortuary Affairs Center (JMAC) and broad­er mortuary affairs community, providing ongoingeducation and training post-deployment to mitigate
adverse effects of exposure to human remains formilitary personnel. CSTS authored an OperationalStress chapter in the JMAC manual used to guide
doctrine and preparedness for Service members.
Importantly, the chapter was updated to reflect
unique aspects of exposure to remains in the context
of COVID-19. In addition, CSTS Scientists provid­
ed consultation to leaders before, during, and after
COVID-19 missions to help guide resilience andsustainment efforts for Service members exposed tohigh volumes of deceased remains, often in conjunc­tion with deployment to support civilian healthcare
and other facilities during the pandemic.
The USU Psychiatry Department Chair, CSTS
Director, and a senior CSTS Scientist consulted
with the Behavioral Health team at Fort Bliss, TX toprovide resources and guidance on the developmentof assessment instruments in order to better under-

CSTS Scientist and staff members on data collection
trip to Fort Hood, TX (February 2020).

stand the impact of COVID-19 stressors on military
warfighter and healthcare personnel.
The Center developed a new collaboration with
the U.S. Military Academy at West Point to explore
issues of insider threats and the psychological effects
on current Service members. Three Center Scien­tists delivered a seminar on “Psychological Impact ofDisasters and Various Threats” to the Center for theDevelopment of Security Excellence to assist theirmembers in better understanding psychologicalaspects of security.

U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES (DHHS)
DHHS disaster and trauma responsibilities over­lap with the activities of CSTS. The Center works
with the Assistant Secretary for Preparedness andResponse (ASPR) and the Substance Abuse andMental Health Services Administration (SAMHSA).

Assistant Secretary for Preparedness andResponse (ASPR)
During 2020, CSTS continued and expanded its
collaboration with ASPR staff and leadership. This
long-standing relationship allowed the Center togain awareness of new and existing federal issues
and initiatives, and to provide consultation and in­formation sharing on disaster and emergency issues.
Throughout the year, two senior CSTS leadersactively participated in regular meetings with an
ASPR-led group representing many federal agen­cies, all of which were engaged in missions related
to the behavioral health sequalae of COVID-19. The
purpose of these meetings was to identify resources
developed by all the parties for integration into acommon location. In addition, the group identified
gaps in resources that can direct future efforts ofmember institutions. This activity was significant in
the government-wide scope of CSTS activities andconsultations. This interaction provided the oppor­
tunity to share CSTS expertise with various federal
stakeholders and to help influence the work of theparticipating departments and agencies.
Two CSTS leaders wrote an article for the ASPR/
Technical Resources, Assistance Center, and In­
2020 ANNUAL REPORT | 25

formation Exchange quarterly publication, The
Exchange, addressing concerns for healthcare
personnel at risk for adverse behavioral health con­sequences during the COVID-19 pandemic. The
collaboration resulted in a widely disseminated andwell-received article (Supporting Healthcare Profes­
sionals in Times of Disaster: Reflections on “At-Risk
Employees”): https://bit.ly/2QK0MoS

Substance Abuse and Mental HealthServices Administration (SAMHSA)The Center and SAMHSA have been working to­gether since SAMHSA’s founding in 1992. SAMHSA
is the lead federal agency responsible for support­
ing and improving national mental health services.
CSTS provided emerging evidence-based articles
and materials to assist SAMHSA in their national
leadership role. In 2020, three CSTS senior leaders
led a presentation at an All-Hands meeting of SAM­
HSA’s Center for Mental Health Services (CMHS)
entitled, “Challenges and Hope in a Time of Chaos.”This presentation included a broad range of topics
highlighting the complexity of the current disasterenvironment and explored several special challeng­es, requested by CMHS, including grief, leadership,
and individual, and organizational approaches toenhance well-being.

Centers for Disease Control and Prevention(CDC)
A CSTS Associate Director conducted a 12-ses­sion weekly training series on stress and resiliencefor public health department personnel. The series
was funded by the CDC and conducted throughthe Hurricane Response Hub, National Network of
Public Health Institutes. Presentations were sharedwith Joseph Barbara, MD, an emergency medicine
physician at George Washington University. While
the series was initiated to address hurricane-related
stress and resilience, it expanded to address any
long-lasting disaster response. As a result of topics
generated by COVID-19, the organizers broadened
the invitation by increasing participation from theinitial 15 participants to approximately 80 partici­
pants per session.

26 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

VETERANS AFFAIRS (VA)
CSTS leadership provided a remote video pre­sentation followed by dial-in discussion with amulti-disciplinary group of approximately 40 mental
health providers (psychiatrists, psychologists, andsocial workers) in Puerto Rico as part of the VA
Caribbean Healthcare System that provided clin­
ical care and outreach to communities impacted
by severe earthquakes and tremors throughout theisland. This educational and consultative meeting
established the groundwork for ongoing consultation
work to support the personnel responding to thisdisaster event as well as annual remote tele-educa­tion that will be incorporated into the VA Caribbean
Healthcare System training for mental health pro­viders in order to enhance their ability to prepare,
respond, and recover from disasters.
The Assistant Director at CSTS provided con­sultation and education to the VA’s Mental Illness
Research, Education, and Clinical Center on issues
related to stress and trauma for healthcare workers
during COVID-19. The discussions and webinar
presented to hundreds of personnel served as partof ongoing efforts to enhance well-being for VA
personnel and optimize healthcare to their patient
population.

THE NATIONAL CENTER FOR DISASTER
MEDICINE AND PUBLIC HEALTH(NCDMPH)
CSTS maintained a strong and growing relation­
ship with NCDMPH. In 2020, a major collaboration
between these two USU Centers was completed. In
July, the second edition of the Curriculum Recom­
mendations for Disaster Health Professionals: Disas­
ter Behavioral Health was published. It was designed
as a guidance document to provide a frameworkfrom which to develop future disaster behavioral
health curricula and to provide resources to support
these curricula. This second edition has been consid­
erably enhanced with expanded resources, the addi­
tion of hyperlinks to free access material throughout
the publication, and includes an additional section
with resources dedicated to the COVID-19 pan­demic. The document can be accessed at: https://bit.
ly/2QF9Ueu
Following publication, both Centers jointly pre­sented a webinar entitled, “New Behavioral HealthTool for the COVID-19 Era.” The goal was to increaseawareness and utilization of the newly publishedguidance. Approximately 100 participants attended.
In keeping with a long-standing collaboration,
CSTS leaders presented seminars on, “Critical
Concepts in Disaster Behavioral Health,” and “In­ternational Disaster Mental Health: Victims andResponders,” to approximately 15 joint, military,interdisciplinary MPH students.
As in prior years, two members of the Center’s
leadership team served as Associate Editors for thejournal, Disaster Medicine and Public Health Pre­
paredness, a publication affiliated with NCDMPH.

PROFESSIONAL ORGANIZATIONSNATIONAL ASSOCIATION OF
STATE MENTAL HEALTH PROGRAMDIRECTORS (NASMHPD)The Center’s nearly two-decade-long relationshipwith NASMHPD continued to thrive. NASMHPD
is a membership organization representing state
mental health authorities (Commissioners) respon­sible for preparedness, response, and recovery fromlarge- and small-scale disasters. CSTS assisted theCommissioners in addressing the many challenges
inherent in those systems, including issues faced bymilitary families and veterans who are served by thestate public mental health systems. In 2020, NASM­
HPD continued to facilitate CSTS consultation to
specific states and localities following disasters andcommunity violence events. CSTS and NASMHPD
leadership were in frequent contact throughout theyear to identify and address information on disaster
response. NASMHPD remained a key distribution
and utilization vehicle for the Center’s targeted pub­lic information products.
The relationship with NASMHPD became evencloser during 2020 in response to COVID-19 andthe challenges faced by the states. Two CSTS leadersparticipated in multiple meetings with the leader­

ship of NASMHPD and the leadership of ASPR tobetter understand and assist the state mental healthauthorities.
As a result of these consultations, two CSTS
leaders were the key presenters in a meeting orga­
nized by NASMHPD to all of the state and territorial
mental health directors and their medical directors.
The topic was focused on enhancing general disas­
ter behavioral health in the states and how that may
relate to pandemics in particular.

NATIONAL CHILD TRAUMATIC STRESSNETWORK (NCTSN)The Center continued to work with NCTSN
in collaboration with the Network’s Military and
Veteran Families Program to develop and implement
trauma-informed, evidenced-based interventions
and approaches for military children and families.
A senior CSTS leader served as a panelist for an
NCTSN webinar titled, “COVID-19 Discussion Ad­
dressing Grief and Traumatic Grief.” Approximately
40 NCTSN members participated.
A CSTS Scientist served as the incoming Chair of
the NCTSN Military and Veteran Families Collabo­
rative Group. The Collaborative Group is a venue for
NCTSN staff, leaders from the DoD and SAMHSA,
as well as academic experts, to develop and shareresources to advance understanding of child trauma
among military and veteran children.

2020 ANNUAL REPORT | 27

MILITARY CHILD EDUCATIONCOALITION (MCEC)MCEC’s mission is to support the educational,
developmental, and social-emotional needs of mili­tary-connected children worldwide. CSTS has had along and productive relationship with MCEC.
In 2020, a CSTS Associate Director conducted awebinar, “COVID-19: Supporting Families and Chil­dren,” for MCEC, which was attended by approxi­
mately 350 military parents and service providers.
This webinar resulted in the development of a podcast episode, “Helping Kids Cope with the COVID-19
Pandemic,” which was made available to the public
for MCEC’s “For the Sake of the Child” podcast. In
addition, a CSTS Associate Director presented a
Parent to Parent Webinar, “PTSD and the Military/
Veteran Family,” to more than 160 MCEC members.

tion’s workshop in November 2019, to examine howhealth professions education and practice organiza­
tions and programs were addressing social determi­
nants that contributed to mental health disparities
across the lifespan. The workshop introduced topics
for ongoing discussions on how disparities can affectthe mental health and well-being of patients, families,
communities, and care providers across the learn­
ing continuum. The proceedings of the workshop
were published in April, 2020: https://bit.ly/2JTJT4o.
The workshop resulted in new efforts to develop
instruments to assess knowledge, skills, and practiceability related to social determinants of mental healthamong healthcare professionals.

NATIONAL ACADEMIES OF SCIENCES,
ENGINEERING, AND MEDICINE(NASEM)
The CSTS Assistant Director presented to the
National Academy of Medicine’s (NAM) Action
Collaborative on Clinician Well-Being and Resil­
ience to address “Supporting Clinician Well-Being
During COVID-19.” The NAM is one of the threeacademies that comprise the NASEM. This activity
was a collaboration with the Accreditation Council
for Graduate Medical Education, American Hospital
Association, and Association of American Medical
Colleges, and served to inform policy and the knowl­edge base.
A CSTS Associate Director and members of the
NASEM Committee on Military Family Well-Being
co-presented findings and recommendations fromthe recent NASEM report, “Strengthening the Mili­tary Family Readiness System for a Changing Amer­ican Society” (published September 2019) to the
spouse of the Chairman of the Joint Chiefs of Staff,
Mrs. Holly Milley, and other senior service spouses,
at General Mark Milley’s quarters, Fort Myer, VA.
The CSTS Director and a CSTS Associate Direc­
tor served on the Planning Committee for the Global
Forum on Innovation in Health Professional Educa­
28 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

THE AMERICAN PSYCHIATRICASSOCIATION (APA)
CSTS personnel assisted in the initiation of the
APA’s efforts in disaster psychiatry by establishing
the Committee on Disaster Psychiatry in 1992 andthe Center has continued to be actively involved inthis and other APA activities. CSTS worked with
the APA and other national medical associations to
educate and train health professionals on disastermental health.
During 2020, CSTS leadership continued tostrengthen the APA’s role in disaster mental health.
The Center’s Assistant Director continued to serve
as Chair of APA’s Disaster Committee and oversaw
the work of the APA Caucus on Climate Change andMental Health.

In response to the global COVID-19 pandemic
and its profound impact on mental health, the APA
President elevated the Disaster Committee to thelevel of Task Force in support of national and global
health. Under the leadership of the CSTS Assistant
Director, the Disaster Committee provided consulta­
tion and subject-matter expertise to APA leadership,a number of district branches, inter-component col­laborations within the APA, and Congressional in­quiries and requests related to the pandemic as well
as issues of structural racism and civil unrest in the
United States. The Disaster Committee sponsoredmore than a dozen educational events as part of the
APA’s Annual Meeting, and disseminated 13 guid­ance documents on pandemic response to support
APA members, district branches, and leadership in
support of the health and safety of the nation. The
CSTS Assistant Director was selected to serve as a
distinguished speaker for the APA Spring Highlights,
an online two-day education activity delivered to alive audience of more than 12,000 psychiatrists andother mental health professionals from around theworld.
Several CSTS leaders were presenters and pan­elists on the APA webinar, “COVID-19 and Men­tal Health: Caring for the Public and Ourselves.”
The webinar was held early in the first year of the
COVID-19 pandemic to address feelings of emotion­
al distress due to the uncertainty around the impact,spread, and scope of the disease. Psychiatrists played
an important role in supporting patient managementof psychosocial issues and responses that arise fromthe disease’s impact on them, their families, andtheir community. This free webinar delineated how
psychiatrists can support patients, communicate
with family members and children, and be a resource
to other providers during the COVID-19 pandemic.
The COVID-19 pandemic has brought new andexpanded contributions to the APA by CSTS lead­ers. In response to COVID-19, a senior CSTS leader
made several contributions to an APA blog, includ­ing, “Coronavirus and Mental Health: Taking Careof Ourselves During Infectious Disease Outbreaks:”
https://bit.ly/2SCH0wk. The content was accessed by
25,278 users on social media, with 729 total engage­ments and 428 link clicks. In addition, several invitedarticles were published in APA News on the topics
of leadership during the pandemic, and behavioral
health strategies to support vaccine acceptance.
A senior CSTS leader was invited to present at
the first ever, “Fellows Town Hall” hosted by the APA
Foundation, bringing together psychiatrists from allof the APA fellowship training programs for a brief
didactic presentation and extended, interactive Q&A
to support trainees dealing with the personal andprofessional challenges of the pandemic.

COLLEGE FOR BEHAVIORAL HEALTHLEADERSHIP (CBHL)
CSTS entered into a new relationship with the
CBHL in 2020. It was facilitated by the relationshipwith the International Initiative of Mental Health
Leadership (IIMHL). CBHL is composed of public andprivate leaders in behavioral health across the nation.
Two senior CSTS Scientists were the lead presentersand small group discussants for the webinar, “Disasters
and Behavioral Health in Today’s World: Implications
for Leadership.” There were approximately 90 partici­
pants representing both public and private organiza­
tions. The content included trends in disaster behav­
ioral health and challenges facing behavioral healthleaders in the age of the COVID-19 pandemic.

FEDERATION OF ASSOCIATIONS IN
BEHAVIORAL AND BRAIN SCIENCES(FABBS)A CSTS Scientist attended the annual FABBS
meeting as a Member-At-Large on the Board of
Directors. The goal of the meeting was to (a) iden­
tify research in behavioral and brain sciences that
addresses the four priorities of the incoming 2021
presidential administration; (b) advance strategies forincreasing funding for the behavioral and social sci­
ences at the National Science Foundation; (c) evaluate
the interface between behavioral and brain sciences
as articulated in the NIMH Strategic Plan; and (d)discuss the role of federal funding, scientific societies,
and academic departments in increasing diversity andaddressing systemic racism. Other meeting attendees
included representatives of the Office of Behavioral
2020 ANNUAL REPORT | 29

and Social Science Research, National Institutes of
Health; the Social, Behavioral, and Economic Sci­
ences Directorate, National Science Foundation; andrepresentatives of the 26 scientific societies compris­
ing FABBS.

SESAME WORKSHOPA CSTS Associate Director participated in a
Sesame Workshop Advisory teleconference on strat­egies to address challenges to young children result­ing from the COVID-19 pandemic, and produced awebinar on the development of materials to support
young children affected by COVID-19. In addition,
CSTS Scientists provided consultation to Sesame
Workshop focused on topic updates for the Sesame
Street for Military Families (SS4MF) website, includ­ing deployment, military homecoming, injuries, andgrief.

WELLCOME LEAP
The Psychiatry Department Chair and CSTS
Director were part of a USU team that consulted
with Wellcome Leap in discussing cutting-edge areasof science. They presented on the STARRS researchand its use of predictive analytics and machinelearning to identify those at highest risk for suicide,suicide-related behavior, and other mental/behavior­al health issues.

STATE AND CITY CONSULTATIONS
California
At the request of the State of California, three
CSTS leaders provided review, comment, andconsultation on the California Disaster Behavior­al Health Plan. The development of the plan is an
ongoing process. It provided a good opportunity
to better understand the challenges faced by states
as they prepare for, and respond to, disasters. It
also provided a vehicle to expand the application ofscience to practice, system, and policy development.
CSTS provided consultation to California in their

30 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

ongoing development of the plan and the planning
process.

New York City
CSTS Scientists were asked by the Mayor of New
York City (NYC) and the USNORTHCOM Com­
mander to support NYC during their COVID-19
surge in the spring of 2020. This collaboration
involved development of a long-standing relation­
ship with NYC Health + Hospitals, Greater New
York Healthcare Association, Department of Mental
Health and Hygiene, and the NYC Fire Department.
In collaboration with these organizations, CSTS
made vital contributions to the development of afive-module resilience training program. This “train
the trainer” program was delivered to more than
1,000 personnel within the NYC healthcare system.
These personnel used the training to serve as resil­
ience champions and peer coaches to help facilitate
well-being and help-seeking, as well as promoteleadership and organizational interventions. These
interventions seek to provide help to caregivers as
a way of conserving vital human capital resources
and protect public health. CSTS provided extensive
subject matter expertise in the development of NYC
healthcare system resilience and sustainment assess­ment practices that aim to gather critical informa­tion to enhance leadership and organizational deci­sion-making in support of the healthcare workforce.
In addition, CSTS Scientists served as panelists forresilience presentations and provided ongoing guid­ance and support for NYC data gathering efforts.
Center Scientists provided consultation to the Mt
Sinai Health System in addressing early and evolving
challenges for healthcare workers during initial andsubsequent waves of the COVID-19 pandemic. CSTS
provided guidance on the adverse mental healtheffects of exposure to trauma, unique effects of thepandemic in a high impact “hotspot” zone, and in­terventions to support mental health well-being andsustain workforce performance. A CSTS Assistant
Director was invited to speak on “Grief Leadership”
as part of the Mt Sinai Leadership Series.

INTERNATIONAL OUTREACH
The reach of CSTS consultation activities extends
beyond the nation’s borders to the international
community. The following are examples of CSTS
international activities in 2020.

International Ministerial 5-Eyes Alliance
The Center continued to collaborate with the
Mental Health Research Innovation Collaborative(MHRIC) of the International Ministerial 5-Eyes
Alliance. The MHRIC is a mental health-focusedtask group comprised of military- and veteran-relat­
ed centers from Australia, the United Kingdom, New
Zealand, Canada, and the United States (the mem­ber nations of the 5-Eyes Alliance). This core groupof centers and departments joined together to workon defense and veteran mental health. Throughout
the COVID-19 pandemic, Center Scientists collabo­
rated with colleagues from the 5-Eyes MHRIC to de­velop and disseminate educational resources, shareknowledge and best practices, and develop researchin critical domains to optimize response and recov­
ery to the global pandemic. This consortium focusedon high-risk populations, such as healthcare workers
and military personnel serving on the frontlines of
the COVID-19 pandemic response.

North Atlantic Treaty Organization (NATO)The CSTS Assistant Director spoke at the NATO
Symposium, “Confronting the Pandemic: A Mental

Health Perspective and Maintaining Operational
Readiness of NATO Forces.” The information pre­sented served as the foundation for a NATO reportto the Committee of Chiefs of Military Medical
Services (COMEDS) that informs NATO force
protection efforts throughout the global pandemic.
CSTS Senior Scientists were invited speakers at a
Disaster and Military Medicine (DiMiMED) annu­
al international military conference, “Coping with
COVID - Combating the Catastrophe and Dealing
with the Disruption,” an international education andinformation sharing event of NATO nations, which
disseminated emerging knowledge and best practic­
es in addressing the range of challenges posed by the
COVID-19 pandemic.

Defense Institute for Medical Operations(DIMO)A CSTS Scientist supported DIMO by par­ticipating as a subject matter expert at a five-day
course on military mental health in Nigeria. The
U.S. five member team, comprised of active duty
mental health providers, trained 26 students inthe tenets of military psychiatry with a focus on
combat stress and PTSD. The Nigerian learners
were highly skilled psychiatrists, clinical psychol­ogists, social workers, and psychiatric nurses withextensive combat experience, as well as emergency
responders from the National Fire Service and the
Nigeria Security and Civil Defense Corps (NSC­
DC). The course helped initiate Nigeria’s tri-ser­
vice, multi-disciplinary collaboration, to increaseawareness of capabilities and operational approach­es, with the goal of ongoing project planning andsupport. The instruction also created interest in
training Service members and emergency respond­
ers in Psychological First Aid (PFA). Cultural­ly-specific tool development, including screening
questionnaires and treatment protocols will beincorporated into clinical interviews. In addition,a CSTS Scientist helped update the DIMO Mili­tary Mental Health Course over a period of several
months, resulting in a new up-to-date interactive,
comprehensive course.

2020 ANNUAL REPORT | 31

Outcomes from the meeting included:
1. Increased collaboration between the tri-service,
multi-disciplinary students, many of who had
never interacted with each other prior to this ex­perience. These students worked collaboratively
throughout the course to increase awareness ofeach other’s missions and operational approach­es.
2. Leaders from the Federal Fire Service and NSC­
DC were present and discussed plans to train
emergency responders in PFA and to develop
relationships with local mental health providers
to help care for responders.
3. Multiple Nigerian military mental health pro­viders/leaders reported a desire to train more,
and potentially all, Nigerian Service members in
PFA.
4. Several students expressed an interest in devel­
oping tools (e.g., screening questionnaires, treat­ment protocols, etc.) that are culturally specificto Nigeria, along with incorporating the Cultural
Formulation Interview (CFI) into their clinicalinterviews.

International Initiative of Mental Health
Leadership (IIMHL)
In 2020, CSTS established a new international
relationship with IIMHL, representing senior public
mental health leadership in member countries focus­
ing on improving mental health services. Member
countries are the U.S., Canada, England, Scotland,
the Republic of Ireland, Australia, New Zealand, andSweden.
At the request of IIMHL, CSTS developed anddelivered two consultation documents to assist
members with broadening their knowledge regard­
ing disaster mental health resources to address
building and enhancing national preparedness andresponse to disaster.
In addition, two senior CSTS leaders conducteda series of web-based consultations with IIMHL
member countries on leadership issues for the public
mental health sector in the era of COVID-19.

32 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

CSTS Scientist, Dr. Dempsey presenting at a priorAmygdala Conference.

CanadaA senior CSTS leader presented a webinar at the“Mental Health in the COVID-19 Pandemic” annual
conference, Disaster Psychiatry Canada. Approxi­
mately 2,000 participants attended from 16 countries
representing mental health, 13 other medical disci­plines, as well as professionals in the fields of disaster
response and public health emergency work.
CSTS leadership provided consultation to senior
representatives from the Mental Health Commissionof Canada to enhance national preparedness andresponse capacity for extreme events such as naturaland human-caused disasters, terrorism, mass vio­
lence, and epidemics. CSTS provided the Canadian
representatives with key documents and resources toassist in developing a national strategy. This con­sultation strengthened existing relationships withmental health stakeholders in Canada.
CSTS provided education materials and consul­
tation to the Canadian military to assist with their
response to the mass shooting in Nova Scotia. The
materials included resources to assist first respond­
ers, healthcare personnel, families, and community
leaders.

SCIENTIST PROFILE: GARY H. WYNN, MD
GARY H. WYNN, MD, Colonel in the Unit­
ed States Army, Professor and Assistant Chair,
Department of Psychiatry, and CSTS Senior
Scientist. After 29 years
on active duty in theArmy, he will be retiringin early 2021 to pursue
the next chapter of his
career. Below are Dr.
Wynn’s reflections on
his long career, and how
COVID-19 has affected his approach to researchand collaborations.
What are your thoughts upon looking back at
your substantial career?
It’s interesting to look back at my 29 year
career, starting at West Point. Many things havechanged, much for the better. One key change
has been the evolution of how mental health isaddressed within the military. There used to be
substantial stigma around mental health. How­ever, while there is still stigma, there is muchless than before and many structural aspects ofstigma have faded, for example, policies like los­ing your security clearance if you are diagnosed
with PTSD or depression. I have also noticed
changes in leadership regarding mental healthstigma.
In addition, we’ve come a long way toward un­
derstanding military-relevant mental health con­ditions such as PTSD. While we still have muchwork to do, I believe there is reason for optimism
and hope in the new treatments and approaches
that are being developed and studied.
For much of my career, the Iraq and Afghani­
stan Wars have dominated the military’s atten­
tion. It is hard to think of a time when we were
not on some form of war footing. I do worry
about the long-term effects on our military andour society from many years of involvement
in war. That being said, it has been an absoluteprivilege to serve in the United States Army. I
have been afforded many opportunities during
my time in service. USU is the place where I
started my medical career 25 years ago andwhere I will end my active-duty career as a Col­onel, a Professor, and an Assistant Department

Chair. I will always cherish my experience at
USU moving forward.
Are there lessons to be learned from the
COVID-19 impact on research in 2020?
It is hard to think of anything in my career,or the careers of my mentors, that has affected
research as much as the COVID-19 pandemic.
USU underwent a near total shutdown with the
exception of animal care and COVID-related
research. Placing research activities in a holding
pattern was difficult, and slowly opening things
up forced us to develop new processes thatincorporated social distancing requirements anda reimagining of research tasks. This also camewith an associated change in daily personal inter­actions, a loss that had been a source of enjoy­
ment and new ideas. These changes were reflect­
ed on the national stage when many conferenceswere canceled or moved online. While online
conferences are better than cancellation, the lackof socialization and potential for new collabora­
tions and investigations was a loss.
How have your international collaborations
fared considering the impact of the pandemic?
Over the past five years, I have served as the
U.S. representative to NATO, through which I
have gained a good deal of experience working
with international collaborations prior to 2020.
Like much of the rest of the world, COVID-19
halted most international meetings and trav­
el. Initially, the crisis within the U.S. turned
our attention closer to home and decreased
the frequency of interaction with internation­
al colleagues. However, after the first wave of
COVID-19, there was a noticeable increase incommunication among many of my international
colleagues. In an unexpected way the pandem­
ic, which forced us to work primarily online,
resulted in closer connections between overseas
colleagues. My Canadian and Dutch colleagues
were now just as close as my day-to-day workcolleagues. This resulted in spending more timetalking, collaborating, and writing with myNATO and 5-Eyes colleagues than at any otherpoint in my career. I considered this to be one of
the few silver linings to 2020.

2020 ANNUAL REPORT | 33

Publications(Names in bold text are CSTS personnel)
JOURNAL ARTICLES
Biggs, Q. M., Ursano, R. J., Wang, J., Wynn, G.
H., Carr, R. C., & Fullerton, C. S. (2020). Post
traumatic stress symptom variation associatedwith sleep characteristics. BMC Psychiatry, 20(1),174. doi: 10.1186/s12888-020-02550-yCampbell-Sills, L., Flynn, P. J., Choi, K. W., Ng, T.,
Aliaga, P. A., Broshek, C., Jain, S., Kessler, R.
C., Stein, M. B., Ursano, R. J., & Bliese, P. D.
(2020). Unit cohesion during deployment andpost-deployment mental health: Is cohesion
an individual- or unit-level buffer for combatexposed soldiers? Psychological Medicine, 1-11.
doi: 10.1017/S0033291720001786
Chu, C., Zuromski, K. L., Bernecker, S. L., Gutierrez,
P. M., Joiner, T. E., Liu, H., Naifeh, J. A., Stein,
M. B., Ursano, R. J., & Nock, M. K. (2020). A testof the interpersonal theory of suicide in a large,
representative, retrospective and prospective
study: Results from the Army Study to Assess
Risk and Resilience in Servicemembers (ArmySTARRS). Behaviour Research and Therapy, 132,103688. doi: 10.1016/j.brat.2020.103688
Chu, C., Wilks, C. R., Zuromski, K. L., Bernecker,
S. L., King, A., Gutierrez, P. M., Joiner, T. E.,
Nock, M. K., Ursano, R. J., & Kessler, R. C.
(2020). Psychological problems among 12th­
grade students predicting military enlistment:
Findings from the Monitoring the Future
Survey. Psychiatry, 83(3), 244–258. doi:
10.1080/00332747.2020.1794191
Cozza, S. J., Fisher, J. E., Hefner, K. R., Fetchet,
M. A., Chen, S., Zuleta, R. F., Fullerton, C.
S., & Ursano, R. J. (2020). Human remains
identification, grief, and posttraumatic stressin bereaved family members 14 years after the
September 11, 2001, terrorist attacks. Journal ofTraumatic Stress, 33(6), 1137-1143. doi: 10.1002/
jts.2254
Dalvie, S., Maihofer, A. X., Coleman, J. R. I.,
Bradley, B., Breen, G., Brick, L. A., … Ursano,R. J., … Nievergelt, C. M. (2020). Genomic
influences on self-reported childhood
maltreatment. Translational Psychiatry, 10(1), 38.
34 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

doi: 10.1038/s41398-020-0706-0
Fisher, J. E., Zhou, J., Liu, A. G., Fullerton, C. S.,
Ursano, R. J., & Cozza, S. J. (2020). Effect ofcomorbid anxiety and depression in complicatedgrief on perceived cognitive failures. Depression
and Anxiety, 37(1), 54-62. doi: 10.1002/da.22943
Fisher, J. E., Zhou, J., Zuleta, R. F., Fullerton, C.
S., Ursano, R. J., & Cozza, S. J. (2020). Coping
strategies and considering the possibility of deathin those bereaved by sudden and violent deaths:
Grief severity, depression, and posttraumatic
growth. Frontiers in Psychiatry, 11, 749. doi:
10.3389/fpsyt.2020.00749
Gewirtz, A. H., Cozza, S. J., & Kizer, K. W. (2020).
The need for clinicians to recognize militaryconnected children. JAMA Pediatrics. doi:
10.1001/jamapediatrics.2020.2548
Harrison, E. M., Schmied, E. A., Easterling, A. P.,
Yablonsky, A. M., & Glickman, G. L. (2020).
A hybrid effectiveness-implementation studyof a multi-component lighting intervention for
hospital shift workers. International Journalof Environmental Research and Public Health,17(23), 9141. doi: 10.3390/ijerph17239141
Harrison, E. M., Schmied, E. A., Yablonsky, A. M.,& Glickman, G. L. (2020). Implementationof interventions designed to promote healthy
sleep and circadian rhythms in shiftworkers.
Chronobiology International, 38(4), 467–479. doi:
10.1080/07420528.2020.1845190
Kennedy, K. G., Wichers, I. R., & Vance, M.
C., (2020). COVID-19 pandemic presents
timely opportunity to become involved in
advocacy. Psychiatric News. doi: 10.1176/appi.
pn.2020.6a25
Letkiewicz, A. M., Silton, R. L., Mimnaugh, K. J.,
Miller, G. A., Heller, W., Fisher, J., & Sass, S. M.
(2020). Childhood abuse history and attention
bias in adults. Psychophysiology, 57(10), e13627.
doi: 10.1111/psyp.13627
Lind, M. J., Brick, L. A., Gehrman, P. R., Duncan, L.
E., Gelaye, B., Maihofer, A. X., Nievergelt, C. M.,
Nugent, N. R., Stein, M. B., Amstadter, A. B., &Psychiatric Genomics Consortium PosttraumaticStress Disorder (2020). Molecular genetic overlapbetween posttraumatic stress disorder and sleep
phenotypes. Sleep, 43(4), zsz257. doi: 10.1093/
sleep/zsz257
Mash, H. B. Herberman. (2020). Book
review: She has her mother’s laugh by Carl
Zimmer. Psychiatry: Interpersonal andBiological Processes, 83(2), 197-201. doi:
10.1080/00332747.2020.1767992
Mash, H. B. Herberman, Fullerton, C. S., &Ursano, R. J. (2020). Safety and confidence inlocal law enforcement and government during
serial shooting events: Association with daily life
activities. Disaster Medicine and Public HealthPreparedness, 1–7. doi:10.1017/dmp.2020.285
Mash, H. B. Herberman, Naifeh, J. A., &Gonzalez, O. I. (2020). Shame: Conceptual
complexity and influence on mental health inmilitary populations. Psychiatry: Interpersonaland Biological Processes, 83(1), 40-46. doi:
10.1080/00332747.2020.1717315
Morganstein, J. C. (2020). Annals for hospitalists
inpatient notes - preparing for battle:
How hospitalists can manage the stress of
COVID-19. Annals of Internal Medicine, 172(10),
HO2–HO3. doi:10.7326/M20-1897
Morganstein, J. C., & Flynn B. W. (2020).
Supporting healthcare professionals in times ofdisaster: Reflections on “at-risk employees.” The
Exchange.
Morganstein, J. C., & Ursano, R. J. (2020).
Ecological disasters and mental health: Causes,
consequences, and interventions. Frontiersin Psychiatry, 11(1), 1-15. doi: 10.3389/
fpsyt.2020.00001
Morganstein, J. C., West, J. C., Schimmels, J.,& Benedek, D. M. (2020). Response to andrecovery from the COVID-19 pandemic:
What will it take? Psychiatry, 20(4), 1–6. doi:
10.1080/00332747.2020.1750928
Naifeh, J. A., Nock, M. K., Dempsey, C. L., Georg,
M. W., Bartolanzo, D., Ng, T. H. H., Aliaga,
P. A., Dinh, H. M., Fullerton, C. S., Mash, H.
B. H., Kao, T. C., Sampson, N. A., Wynn, G.
H., Zaslavsky, A. M., Stein, M. B., Kessler, R. C.,& Ursano, R. J. (2020). Self-injurious thoughts
and behaviors that differentiate soldiers who
attempt suicide from those with recent suicide
ideation. Depression and Anxiety, 37(8), 738–746.
doi: 10.1002/da.23016

Ogle, C. M., Liu, A. G., Fisher, J. E., Ali,
B., Rasmussen, A., & Cozza, S. J. (2020).
Development of the Bereavement andInterpersonal Domains codebook. Death Studies,1-9. doi: 10.1080/07481187.2020.1793430
Regier, D. A. (2020). Assessing need for mental
health services. Psychiatry, 83(2), 161-165. doi:
10.1080/00332747.2020.1767990
Shigemura, J., Ursano, R. J., Kurosawa, M.,
Morganstein, J. C., & Benedek, D. M. (2020).
Understanding the traumatic experiences ofhealthcare workers responding to the COVID-19
pandemic. Nursing & Health Sciences, 23(1), 7-8.
doi: 10.1111/nhs.12766
Shigemura, J., Ursano, R. J., Morganstein, J. C.,
Kurosawa, M., & Benedek, D. M. (2020). Public
responses to the novel 2019 coronavirus (2019­
nCoV) in Japan: Mental health consequences
and target populations. Psychiatry and Clinical
Neurosciences, 74(4), 281–282. doi:10.1111/
pcn.12988
Simon, N. M., Shear, M. K., Reynolds, C. F., Cozza,
S. J., Mauro, C., Zisook, S., & Lebowitz, B. (2020).
Commentary on evidence in support of a griefrelated condition as a DSM diagnosis. Depression
and Anxiety, 37(1), 9-16. doi: 10.1002/da.22985
Smith, N. B., Sippel, L. M., Rozek, D. C., Spangler, P.
T., Traber, D., Straud, C. L., Hoff, R., & HarpazRotem, I. (2020). Courses of suicidal ideation
among military veterans in residential treatment
for posttraumatic stress disorder. Depression andAnxiety, 37(3), 273-284. doi: 10.1002/da.22993
Snijders, C., Maihofer, A. X., Ratanatharathorn,
A., Baker, D. G., Boks, M. P., Geuze, E., Jain, S.,
Kessler, R. C., Pishva, E. Risbrough, V. B., Stein,
M. B., Ursano, R. J., Vermetten, E. Vinkers, C.
H., PGC PTSD EWAS Consortium, Smith, A.
K., Uddin, M., Rutte, B. P. F., & Nievergelt, C. M.
(2020). Longitudinal epigenome-wide association
studies of three male military cohorts reveal
multiple CpG sites associated with post-traumaticstress disorder. Clinical Epigenetics, 12(1), 11. doi:
10.1186/s13148-019-0798-7
Spangler, P. T., West, J. C., Dempsey, C. L.,
Possemato, K., Bartolanzo, D., Aliaga, P.,
Zarate, C., Vythilingam, M., & Benedek, D.
M. (2020). Randomized controlled trial of
Riluzole augmentation for posttraumatic stressdisorder: Efficacy of a glutamatergic modulator
2020 ANNUAL REPORT | 35

for antidepressant-resistant symptoms. Journalof Clinical Psychiatry, 81(6), 20m13233. doi:
10.4088/JCP.20m13233
Ursano, R. J., Mash, H. B. H, Kessler, R. C., Naifeh,
J. A., Fullerton, C. S., Aliaga, P. A., Stokes, C.
M., Wynn, G. H., Ng, T. H. H., Dinh, H. M.,
Gonzalez, O. I., Zaslavsky, A. M., Sampson,
N. A., Kao, T. C., Heeringa, S. G., Nock, M.
K., & Stein, M. B. (2020). Factors associatedwith suicide ideation in US Army soldiersduring deployment in Afghanistan. JAMA
Network Open, 3(1):e1919935. doi: 10.1001/
jamanetworkopen.2019.19935
Ursano, R. J. (2020). Much to change, muchto learn. Psychiatry, 83(3), 207. doi:
10.1080/00332747.2020.1804780
Ursano, R. J., & Naifeh, J. A. (2020). TBI
and suicidality: A story of stress, risk, andresilience. Military Medicine. doi: 10.1093/
milmed/usaa452
Vance, M. C., & Howell, J. D. (2020). Shell shock
and PTSD: A tale of two diagnoses. Mayo Clinic
Proceedings, 95(9), 1827–1830. doi: 10.1016/j.
mayocp.2020.06.002
Vance, M. C., & Kennedy, K. G. (2020). Developing
an advocacy curriculum: Lessons learned
from a national survey of psychiatric residency
programs. Academic Psychiatry, 44(3), 283–288.
doi: /10.1007/s40596-020-01179-z
Vance, M. C., & Morganstein, J. C. (2020). The
doctor-public relationship: How physicians cancommunicate to foster resilience and promotemental health during COVID-19. Journal of
General Internal Medicine, 35(12), 3697–3698.
doi: 10.1007/s11606-020-06243-w
Vance, M. C., Riano, N. S., Jagsi, R., Guzman, M.
J., Beeler, W., Linos, E., & Mangurian, C. (2020).
Assessment of paid childbearing and family leave
policies for administrative staff at top US medical
schools. JAMA Internal Medicine, 180(4), 589–
592. doi: 10.1001/jamainternmed.2019.6653
Wang, J., Ursano, R. J., Gifford, R. K., Dinh,
H., Farooq, S., Broshek, C. E., Cohen, G. H.,
Sampson, L., & Fullerton, C. S. (2020). Mental
health and suicidality in separating U.S. Reserve
and National Guard personnel. Psychiatry, 83(2),166–175. doi: 10.1080/00332747.2020.1715162
Wei, E. K., Segall, J., Linn-Walton, R., Eros-Sarnyai,M., Fattal, O., Toukolehto, O., Barron, C.,
Burke, A., Benedek, D. M., West, J. C., Fisher,M., Shmerler, D., & Cho, H. J. (2020). Combat
36 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

stress management and resilience: Adapting
Department of Defense combat lessons learned
to civilian healthcare during the COVID-19
pandemic. Health Security. doi: 10.1089/
hs.2020.0091
Wynn, G. H., Morganstein, J. C., Jetly, R., Ford,
S. C., Vance, M. C., Meyer, E. C., West, J. C.,
Benedek, D. M., & Ursano, R. J. (2020). Military
mental health and COVID-19. Journal of Military,
Veteran and Family Health, 6(S2), 21-26. doi:
10.3138/jmvfh-6.s2-2020-0048
Zhang, L., Hu, X. Z., Li, X., Chen, Z., Benedek, D.
M., Fullerton, C. S., Wynn, G., Biomarker Team,& Ursano, R. J. (2020). Potential chemokine
biomarkers associated with PTSD onset, risk
and resilience as well as stress responses in
US military service members. Translational
Psychiatry, 10(1), 31. doi: 10.1038/s41398-020­
0693-1
Zhang, L., Hu, X. Z., Yu, T., Chen, Z., Dohl, J., Li,
X., Benedek, D. M., Fullerton, C. S., Wynn, G.,
Barrett, J. E., Li, M., Russell, D. W, & Ursano, R. J.
(2020). Genetic association of FKBP5 with PTSD
in US service members deployed to Iraq and
Afghanistan. Journal of Psychiatric Research, 122,
48-53. doi: 10.1016/j.jpsychires.2019.12.014

BOOKS AND BOOK CHAPTERS
Regier, D. A., Goldberg, D. P., Ustun, B. T., &Reed, G. M. (2020). DSM-5 and ICD-11
classifications. In J. R. Geddes, N. C. Andreasen,& G. M. Goodwin (Eds.), New oxford textbook of
psychiatry (3rd ed). Oxford University Press.
Ursano, R. J., Morganstein, J. C., & West, J. C.
(2020). Essential issues on terrorism: Planning for
acute response and intervention. In E. Vermetten,
I. Frankova, L. Carmi, O. Chaban, & J. Zohar(Eds.), NATO science for peace and security series:
Risk management of terrorism induced stress —Guidelines for the golden hours (Vol. 148, pp. 3-9).
IOS Press.
Vance, M. C., Kennedy, K. G., Wiechers, I. R., &Levin, S. (Eds.). (2020). A psychiatrist’s guideto advocacy. American Psychiatric Association
Publishing.
West, J. C., Hamaoka, D. A., & Ursano, R. J. (2020).
Outpatient treatment of the suicidal patient. In L.
H. Gold & R. Frierson (Eds.), Textbook of suicide
risk assessment and management. American
Psychiatric Publishing.

Presentations, Blogs, Interviews, Briefings,
Awards, and Appointments(The names in bold text are CSTS personnel.)

PRESENTATIONS
Covid-19 and mental health: Caring for the public
and ourselves. Morganstein, J. C., Cozza, S.
J., West, J. C., Koyfman, S., & Ursano, R. J.
Webinar presented to the membership, American
Psychiatric Association, March 2020.
Disaster Psychiatry and Behavioral Health From War
and Terrorism to Earthquakes... and Coronavirus,
Finding Structure in Chaos. Ursano, R. J. Webinar
presentation given for Boston Veterans Affairs,
Grand Rounds. Boston, MA, March 2020.
Disasters and mental health in today’s world:
Implications for state mental health authorities.
Flynn, B. W., & Morganstein, J. C. Webinar
presented at the State Commissioners monthly
meeting, National Association of State Mental
Health Program Directors, March 2020.
COVID-19 and mental health: How Army
psychiatrists can help. Morganstein, J.C. Webinar
presented at the United States Army Psychiatrists“All Call”, United States Army Medical Command,
Defense Health Agency, April 2020.
Disasters and mental health in today’s world:
Implications for mental health leadership. Flynn,
B. W., & Morganstein, J. C. Webinar presented to
the National Representatives for the International
Initiative for Mental Health Leadership, April
2020.
Preparing for a marathon: Caring for patients andsustaining the well-being of healthcare workers
during COVID-19. Morganstein, J. C. Webinar
presented at the Annual Spring Highlights,
American Psychiatric Association, April 2020.
Sustaining healthcare worker & organizational
wellbeing in a prolonged crisis: Challenges andopportunities during COVID-19. Morganstein, J.
C. Webinar presented at the Wellbeing Committee
meeting, Accreditation Council of Graduate
Medical Education, April 2020.
Caring for ourselves and patients during prolonged
crisis: Challenges and opportunities in public

mental health. Morganstein, J. C. Webinar
presented at Fellows Town Hall, American
Psychiatric Association Foundation, May 2020.
Clinician well-being during COVID-19: Challenges
and opportunities. Morganstein, J. C. Webinar
presented at “Supporting Clinician Well-Being
During COVID-19”, National Academies ofMedicine’s Action Collaborative on Clinician
Well-Being and Resilience in partnership with
the Accreditation Council on Graduate Medical
Education, American Hospital Association, andAssociation of American Medical Colleges, May
2020.
COVID-19: Supporting families and children. Cozza,
S. J. Webinar presented at the Military Child
Education Coalition, May 2020.
COVID-19: Supporting families and children. Cozza,
S. J. Webinar presented at Berkshire Community
College, MA, May 2020.
Death notification, grief, and posttraumatic stress:
Implications for COVID-19 deaths. Cozza, S. J.
Webinar presented at the National Child TraumaticStress Network: Child Traumatic Grief-Traumatic
Separation Committee Journal Club, May 2020.
Stepping Forward in Grief: An online selective
intervention for bereaved military families. Cozza,
S. J. & Shear, M. K. Webinar presented at the VA/
DoD Survivors Forum, May 2020
Sustaining the well-being of healthcare workers during
COVID-19. Morganstein, J. C. Webinar presented
at Health & Wellness Grand Rounds, Texas A&M
University Health Science Center College ofMedicine, May 2020.
Sustaining a healthcare workforce during prolonged
crisis: Challenges & opportunities for high-risk
occupations. Morganstein, J. C. Webinar presented
at the COVID-19 Town Hall, American Society ofAnesthesiologists, May 2020.
Addressing and supporting physician mental healthduring challenging times. Morganstein, J. C.
Webinar presented at Well-being and Professional
Fulfillment Program, American College of2020 ANNUAL REPORT | 37

Physicians, June 2020.
COVID-19 and mental health: Crisis leadership andhealthcare workforce resilience. Morganstein,
J. C. Webinar presented at the Virtual Learning
Hour Special Series, Institute for Healthcare
Improvement and Well Being Trust, June 2020.
Disaster Psychiatry and Behavioral Health From War
and Terrorism to Earthquakes... and Coronavirus.
Ursano, R. J. Virtual presentation at the Universityof North Carolina, Chapel Hill Department of
Psychiatry, Grand Rounds. Chapel Hill, NC, June
2020.
Healthcare worker sustainment and patient careduring prolonged crisis: Finding structure inchaos. Morganstein, J. C. Webinar presented atthe “Mental Health in the COVID-19 Pandemic”
annual conference, Disaster Psychiatry Canada,
June 2020.
Integrative lighting and measurement in domestic
and workplace settings: It gets more complicated.
Glickman, G., & Bessman, S. Presentation
at the 34th Annual Meeting of the AssociatedProfessional Sleep Societies (virtual), Philadelphia,
PA, June 2020.
Illuminating measures in the field: Quantifying photic
intensity and spectral quality in applied researchsettings. Bessman, S., Snider, M., Wilkerson, A.,
Davis, R., Herf, M., Spitschan, M., & Glickman,
G. Presentation at the Society for Research on
Biological Rhythms (virtual), Amelia Island, FL,
June 2020.
Mental health in the COVID-19 pandemic. Ursano,R. J. Webinar presented at the “Mental Healthin the COVID-19 Pandemic” annual conference,
Disaster Psychiatry Canada, June 2020.
Photoreceptor mediation of the accelerating effectof dim light on behavioral adjustment to shiftingschedules. Glickman, G., Harrison, E., Evans,J., & Gorman, M. Presentation at the Society for
Research on Biological Rhythms (virtual), Amelia
Island, FL, June 2020.
Sustaining the well-being of healthcare workers
during COVID-19. Morganstein, J. C. Webinar
presented at Caregiver Grand Rounds, Tufts
Medical Center, June 2020.
Personal and professional wellness. Fattal, O., ErosSarnyai, M., Salway, J., Morganstein, J. C. Webinar
panelist presentation at Module 2 (of 5), Healing,
Education, Resilience and Opportunity for New
York’s Frontline Workers, Greater New York
Hospital Association, June 2020.
38 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

PTSD and the military/veteran family. Cozza, S. J.
Webinar presented to the Military Child Education
Coalition, June 2020.
Wellbeing of healthcare workers during COVID-19.
Benedek, D. M. Webinar panelist presentation
at the National Center for Disaster Medicine andPublic Health, Bethesda, MD, June 2020.
Challenges and hope in a time of chaos. Flynn, B.
W., Vance, M. C., & Morganstein, J. C. Webinar
presented at the All-Hands meeting for the Center
for Mental Health Services, Substance Abuse andMental Health Services Administration, July 2020.
Disasters and behavioral health in today’s world:
Implications for leadership. Flynn, B. W., &Morganstein, J. C. Webinar presented to theCollege of Behavioral Health Leadership andthe International Initiative for Mental Health
Leadership, August 2020.
Nightmare deconstruction and reprocessing:Integrating collection of physiologic stressindicators via wearable technology and genomic
analyses in piloting a psychotherapy for traumarelated nightmares. Spangler, P., Azad, A., West,J., Benedek, D., Zhang, L., Gill, J., Dempsey, C.,
Paxton, M., Phares, A., Mai, J. Virtual poster
presentation at the American Psychological
Association’s 2020 Virtual Convention, August
2020.
Predicting clinically significant response to primarycare treatment for depression in veterans using
electronic health records. Vance, M. C., Chang, M.
M., Sussman, J. B., Zivin, K., & Pfeiffer, P. N.Virtual
poster presentation at the Academy Health Annual
Research Meeting, August, 2020.
Enhancing sustainment and fostering resilience
for military health care workers responding to
COVID-19. Morganstein, J. C., Wynn, G. H., &Benedek, D. M. Webinar presented for the ClinicalCase Conference series, Joint Trauma System,
Defense Health Agency, Department of Defense,
September 2020.
Finding structure in chaos: Leadership, risk, andvirtual care during COVID-19. Morganstein, J. C.
Webinar presented at the symposium “Confronting
the Pandemic: A Mental Health Perspective andMaintaining Operational Readiness of NATO
Forces,” North Atlantic Treaty Organization,
September 2020.
Risk and resilience of lifetime stressful experiencesamong US Army Soldiers at risk for suicide.
Dempsey, C. L., Benedek, D. M., Zuromski, K.,

Nock, M. K., Aliaga, P., Ao, J., Georg, M. W.,
Broshek, C., Mullins-Hussain, B., Weinberg, A.,& Ursano, R. J. Virtual poster presentation at theAmerican Psychological Association’s 2020 Virtual
Convention, August 2020.
Relationship of social networks to hurricane
preparedness behaviors. Liu, A. G., Mash, H. B.
H., Fullerton, C. S., Morganstein, J. C., Vance,
M. C., Wang, L., Mullins-Hussain, B., & Ursano,R. J. Virtual presentation at the 30th Annual
Neuroscience Program Open House, Uniformed
Services University, October 2020.
The role of child and adolescent psychiatrists whendisasters strike: A training course in the age of
COVID-19. Cozza, S. J. Workshop presentation at
the Disaster Workshop AACAP virtual meeting,
October 2020.
COVID-19 & public mental health: Enhancing
resilience for patients & healthcare workers during
prolonged crisis. Morganstein, J. C. Webinar
presented at the Mental Illness Research Education
and Clinical Center, Veterans Administration,
October 2020.
Enduring through disillusionment: Finding structurein the chaos of a prolonged global health crisis.
Morganstein, J. C. Webinar presented at the
Well-Being Committee, Accreditation Council of
Graduate Medical Education, October 2020.
Finding structure in chaos: Sustainment for healthcare
workers and patients during COVID-19.
Morganstein, J. C. Webinar presented at the 24th
Annual Speakers Forum, Pro Bono Counseling
Project, October 2020.
How are (and are not) psychodynamic concepts andtreatment effective in the treatment of trauma?
Ursano, R. J. Webinar presented at Trauma andMind in War and Life, Understanding and Treating
Trauma: A Psychoanalytic Psychodynamic
Philosophical Perspective, The Contemporary
Freudian Society, October, 2020.
Psychosocial impacts of crisis and disaster events:
How individuals, organizations, and leaders canhelp. Morganstein, J. C. Webinar presented at
the Federal Workforce Summit, Government
Executive and Graduate School USA, October
2020.
Psychological and behavioral impact of disasters
in COVID-19. Morganstein, J. C. Webinar
presented at Trauma and Mind in War andLife, Understanding and Treating Trauma: A
Psychoanalytic Psychodynamic Philosophical

Perspective, The Contemporary Freudian Society,October 2020.
Holiday wellness: Fostering well-being during
challenging times. Benedek, D. M. Virtual panelist
presentation at the Walter Reed Army Institute of
Research, November 2020.
Relationship of collective efficacy to perceived
hurricane preparedness. Liu, A. G., Mash, H.
B. H., Fullerton, C. S., Mullins-Hussain, B., &Ursano, R. J. Virtual poster presentation at thevirtual 36th Annual Meeting of the International
Society for Traumatic Stress Studies, November
2020.
Relationship of social networks to hurricane
preparedness behaviors. Liu, A. G., Mash, H. B.
H., Fullerton, C. S., Morganstein, J. C., Vance,
M. C., Wang, L., Mullins-Hussain, B., & Ursano,R. J. Virtual poster presentation at the virtual 36th
Annual Meeting of the International Society forTraumatic Stress Studies, November 2020.
Risk and resilience of lifetime stressful experiencesamong US Army Soldiers at risk for suicide.
Dempsey, C. L., Benedek, D. M., Zuromski, K.
L., Nock, M. K., Aliaga, P., Ao, J., George, M. W.,
Broshek, C., Mullins-Hussain, B., Weinberg, A.,& Ursano, R. J. Virtual poster presentation at thevirtual 36th Annual Meeting of the International
Society for Traumatic Stress Studies, November
2020.
Crisis leadership in COVID-19: Impact on healthcare
workers, sustaining well-being & leading throughgrief. Morganstein, J. C. Webinar presented
at Michigan Health & Hospital Association,
November 2020.
Enhancing mental health force protection in
COVID-19: Impact, risk & interventions.
Morganstein, J. C. Webinar presented at the
Combat Casualty Care Conference, Joint Trauma
System, Defense Health Agency, November 2020.
Grief leadership during crisis events. Morganstein,
J. C. Webinar presented at “Insights For Leaders”,
Mount Sinai Health System, November 2020.
Integrating physiologic assessment of sleep
disturbance and in-session stress in a pilot trial ofan exposure-based treatment for trauma-relatednightmares and insomnia. Spangler, P., Azad,
A., West, J., Zhang, L., Gill, J., Benedek, D.,
Dempsey, C., Paxton, M., Phares, A., Hillman,
K., & Pujol, J. Virtual poster presentation at thevirtual 36th Annual Meeting of the International
Society for Traumatic Stress Studies, November
2020 ANNUAL REPORT | 39

2020.
Leadership, risk, and interventions: Enhancing
military readiness and sustainment during
COVID-19. Morganstein, J. C. Webinar presented
at the DiMiMed International Conference on
Disaster and Military Medicine, November 2020.
Posttraumatic stress disorder and sleep disorders:
Effects on cardiovascular disease risk in active
duty U.S. Army enlisted Servicemembers. Belleau,E. A., Krantz, D. S., Gabbay, F. H., Aliaga, P. A.,
Ursano, R. J., & Wynn, G. H. On demand oralpresentation at the virtual 129th annual meeting of
AMSUS, December 2020.
COVID-19 & public mental health: Enhancing
resilience for patients & healthcare workers during
prolonged crisis. Morganstein, J. C. Webinar
presented at General Medical Staff meeting,Thomas Jefferson University Hospital, December
2020.
COVID-19 & public mental health: Enhancing
resilience for patients & healthcare workers during
prolonged crisis. Morganstein, J. C. Webinar
presented at Saint Luke Institute, December 2020.
Supporting the well-being of Servicemembers andfamilies during COVID-19. Morganstein, J.
C. Webinar presentation for the Chief Medical
Officers and Chief Nursing Officers, Medical
Affairs, Defense Health Agency, December 2020.
BLOGS
Cozza, S. J., Fisher, J. E., Morganstein, J. C., Flynn,
B. W., Biggs, Q. M., Zuleta-Miranda, R.,
Fullerton, C. S., Benedek, D. M., & Ursano, R.
J. (2020, April 20) Death notification, grief, andposttraumatic stress: Implications for COVID-19
deaths. International Society for Traumatic StressStudies Blog. https://istss.org/public-resources/
trauma-blog/2020-april/death-notification,-grief,­
and-posttraumatic-stres
Jacobs, J. & Vance, M. C. (2020, August 17).
Advocacy as antidote to burnout: Perspectives
from intern year. Psychiatric News. https://psychnews.psychiatryonline.org/doi/10.1176/appi.
pn.2020.8b18
Morganstein, J. C. (2020, February 19). Coronavirus
and mental health: Taking care of ourselves during
infectious disease outbreaks. American Psychiatric
Association. https://www.psychiatry.org/news­
room/apa-blogs/apa-blog/2020/02/coronavirus­
and-mental-health-taking-care-of-ourselves­
40 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

during-infectious-disease-outbreaks
Morganstein, J. C. (2020, March 4). The role ofpsychiatrists during the coronavirus outbreak.
Psychiatric Times. https://www.psychiatrictimes.
com/view/role-psychiatrists-during-coronavirus­
outbreakMorganstein, J. C. (2020, March 23). PsychPearls:
Battling loneliness during the COVID-19 pandemic.
Psychiatric Times. https://www.psychiatrictimes.
com/view/psychpearls-battling-loneliness-during­
covid-19-pandemic
Morganstein, J. C. (2020, March 24). PsychPearls:
Battling anxiety during the COVID-19 pandemic.
Psychiatric Times. https://www.psychiatrictimes.
com/view/psychpearls-battling-anxiety-during­
covid-19-pandemic
Morganstein, J. C. (2020, March 25). PsychPearls:
Identifying at-risk patients during the pandemic.
Psychiatric Times. https://www.psychiatrictimes.
com/view/psychpearls-identifying-risk-patients­
during-pandemic
Morganstein, J. C. (2020, March 26). PsychPearls:
COVID-19, a critical time for self-care. PsychiatricTimes. https://www.psychiatrictimes.com/view/
psychpearls-covid-19-critical-time-self-careMorganstein, J. C. (2020, March 27). PsychPearls:
Supporting the health of the nation during thecoronavirus pandemic. Psychiatric Times. https://www.psychiatrictimes.com/view/psychpearls­
supporting-health-nation-during-coronavirus­
pandemic
Naifeh, J. A., & Herberman Mash, H. B. (2020,
September 17). Lessons from suicide attempts
among U.S. Army soldiers during deployment.
Psychological Health Center of Excellence Clinician’sCorner Blog. https://www.pdhealth.mil/news/blog/
lessons-suicide-attempts-among-us-army-soldiers­
during-deployment
Wang, J., & West, J. C. (2020, May). The mental healthand service utilization among Reserve and National
Guard forces study: A summary of key findings.
StressPoints: ISTSS Trauma Blog. https://istss.org/
special-pages/login.aspx?returnurl=%2fpublic­
resources%2ftrauma-blog%2f2020-may%2fmilitary­matters-the-mental-health-and-service-uti

INTERVIEWS AND BRIEFINGS
n Dr. Morganstein was interviewed by Yale Climate

Connections (https://www.yaleclimateconnections.
org/) to provide information about the adverse

n

n

n

n

n

n

psychological and behavioral effects of climaterelated disasters.
Dr. Ursano was interviewed by Reuters Healthon the STARRS paper, “Factors associated withsuicide ideation in US Army soldiers during
deployment in Afghanistan.” The article can befound here: https://www.reuters.com/article/us­
health-military-suicide/many-soldiers-thinking­about-suicide-show-no-signs-idUSKBN1ZS32M
Dr. Stephen Cozza was interviewed bydocumentary filmmaker Ms. Elisa Gambino, fromOne Production Place, as part of her project with
Stars and Stripes to create a series of eight video
stories about trends in military family life to be
published on the Stars and Stripes website. The
discussion revolved around the different issues
military families face and how policies, programs,
and services are being used as potential solutions.
Dr. Stephen Cozza and Dr. Benedek answeredquestions at a Health Affairs/Defense HealthAgency media roundtable regarding the impact of
COVID-19 on military families, which led to the
publication of numerous media reports.
Dr. Benedek was interviewed by Francis Rose
of WJLA TV for a segment on military medical
preparedness for an increase in mental health caredemand, access to care, and self-care tips which
aired on WJLA Government Matters TV and 80
affiliates cross the nation.
Dr. Vance was interviewed for the podcast
Psychiatry Unbound about her recently released
book, A Psychiatrist’s Guide to Advocacy.
The Army News Service published an article on
the Army website (army.mil) titled “VA joins
Army in major DoD research effort to prevent
suicides.” The article announced the VA joined theArmy, DoD, and NIMH in support of the STARRS
research program that has been ongoing since2009 under the leadership of Principal Investigator
Dr. Ursano at USU/CSTS. The STARRS program,which is the largest mental health program everconducted on military personnel, was funded by
the DoD for another five years. Dr. Richard W.
Thomas, President of USU, was quoted in thearticle: “The STARRS study is leading us to new
approaches to sustain the health and readiness ofour service members. Its findings have contributed
to new approaches for prevention, treatment, andhealth care policies for the entire Military Health
System and for the nation. STARRS represents yet
another way that military medicine contributes

to the health and wellbeing of our troops and theirfamilies.” The link to the article is: https://www.army.
mil/article/238093

AWARDS AND APPOINTMENTS
n The USU Department of Psychiatry created

n

n

n

n

n

an award in honor of Dr. Ursano, who was thelongest serving Chair of the Department and thefounder of CSTS. The Robert J. Ursano Award will
be given to the graduating medical student who
demonstrates the greatest potential to become aclinician-educator-researcher. Judging will be doneby the Department Education Committee based
upon student participation in psychiatry-related
educational projects, research, psychiatry capstone
projects, educational innovations, presentations, andacademic performance.
Dr. Vance was appointed as a member of the APA
Committee on the Psychiatric Dimensions ofDisasters.
Maj Meyer and MSgt Steward were recipients of the
1st Quarter Air Force Element Award. Maj Meyer
was awarded the Field Grade Officer (FGO) of theQuarter and MSgt Steward was awarded the Senior
Noncommissioned Officer (SNCO) of the Quarter.
The poster, “Nightmare Deconstruction andReprocessing: Integrating Collection of Physiologic
Stress Indicators via Wearable technology and
Genomic Analysis in Piloting a Psychotherapy forTrauma-Related Nightmares,” by Dr. Spangler andthe CSTS Clinical Team, was awarded the Jeremy
Safran Poster Award during the APA 2020 Virtual
Convention, sponsored by the APA Division 29 andthe Society for the Exploration of Psychotherapy
Integration.
Dr. Glickman and Dr. Morganstein were selected as
Dean’s Impact Award winners from the Psychiatry
Department. The Dean recognized their respective
contributions to USU’s ongoing response to
COVID-19 through their selections.
Dr. Ursano was designated a 2020 Clarivate Web of
Science Highly Cited Researcher. Fewer than 6,200,
or about 0.1%, of the world’s researchers, in 21
research fields and across multiple fields, have earned
this exclusive distinction in 2020. This elite group isrecognized for their exceptional research influence,
demonstrated by the production of multiple highlycited papers that rank in the top 1% by citations forfield and year in the Web of Science.

2020 ANNUAL REPORT | 41

Directors, Scientists, Science Collaborative
Members, and Staff
DIRECTORS

Uniformed Services University

Robert J. Ursano, MD
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Director
Center for the Study of TraumaticStress
Uniformed Services University

Joshua C. Morganstein, MD
CAPT, USPHSAssociate Professor/Assistant Chair
Department of Psychiatry
Assistant Director
Center for the Study of TraumaticStress
Uniformed Services University

David M. Benedek, MD
COL, MC, USA
Chair, Professor
Department of Psychiatry
Associate Director, Consultation and
Education
Center for the Study of TraumaticStress
Uniformed Services University

SCIENTISTS

Stephen J. Cozza, MD
Professor of Psychiatry and Pediatrics
Department of Psychiatry
Associate Director, Child and Family
ProgramCenter for the Study of TraumaticStress
Uniformed Services University
Brian W. Flynn, EdD
Adjunct Professor
Department of Psychiatry
Associate Director, Health Systems
Center for the Study of TraumaticStress
Uniformed Services University
Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
Scientific Director
Center for the Study of TraumaticStress
Uniformed Services University
Robert K. Gifford, PhD
Assistant Professor
Department of Psychiatry
Executive Officer and Associate
Director, Homeland Security Studies
Center for the Study of TraumaticStressAlvi Azad, DO, MBA, MC, FS
Lt Col, USAF
Assistant Professor of Psychiatry and
Pediatrics
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
David M. Benedek, MD
COL, MC, USA
Consultant to the U.S. Army
Surgeon General for Forensic
Psychiatry
Chair, Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Quinn M. Biggs, PhD, MPH
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Robert Bossarte, PhD
Associate Professor
Department of Behavioral Medicine
and Psychiatry
West Virginia University
Director
West Virginia University Injury
Control Research Center
Adjunct Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

42 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Maria Braga, DDS, PhD
Associate Professor
Department of Anatomy,
Physiology and Genetics
Center for the Study of TraumaticStress
Uniformed Services University
Shenglin Chen, PhD
Biostatistician
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Kwang Choi, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Kelly L. Cozza, MD, DFAPA, FAPM
Associate Professor
Clinical Clerkship Director
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Stephen J. Cozza, MD
Professor of Psychiatry and Pediatrics
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Brian Crowley, MD
Adjunct Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Catherine L. Dempsey, PhD, MPH
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Connie C. Duncan, PhD
Research Associate Professor
Department of Psychiatry

Center for the Study of TraumaticStress
Uniformed Services University
Joscelyn E. Fisher, PhD
Research Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Brian W. Flynn, EdD
Adjunct Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Michael C. Freed, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Frances Gabbay, PhD
Research Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Robert K. Gifford, PhD
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Gena L. Glickman, PhD
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Oscar I. Gonzalez, PhD
MAJ, USA
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Derrick Hamaoka, MD
Col, USAF, MC, FS
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Harry C. Holloway, MD
Professor Emeritus
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Marjan G. Holloway, PhD
Professor
Department of Medical & ClinicalPsychology
Center for the Study of TraumaticStress
Uniformed Services University
Edmund G. Howe III, MD, JD
Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Luke Johnson, PhD
Associate Professor
Department of Psychology
University of Tasmania, Australia
Tzu Cheg Kao, PhD
Professor
Department of Preventive Medicine
and Biometrics
Center for the Study of TraumaticStress
Uniformed Services University
David S. Krantz, PhD
Professor
Department of Medical and ClinicalPsychology
Center for the Study of TraumaticStress
Uniformed Services University
He Li, MD, PhD
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Xian Liu, PhD
Research Professor

Deployment Health Clinical Center
Walter Reed Army Medical Center
Holly H. Mash, PhD
Research Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
James E. McCarroll, PhD, MPH
Research Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Eric Meyer II, MD
Maj, USAF, MC
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Joshua C. Morganstein, MD
CAPT, USPHSAssociate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
James A. Naifeh, PhD
Research Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Christin M. Ogle, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Darrel A. Regier, MD, MPH
Adjunct Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Dori B. Reissman, MD, MPH
RADM, USPHS
Medical Director
World Trade Center Responder Health
Program
Senior Medical Advisor
2020 ANNUAL REPORT | 43

National Institute of Occupational
Safety and Health
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Dale Russell, PhD
Behavioral Science Researcher
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Patcho N. Santiago, MD, MPH
CAPT, MC, USN
Psychiatry Residency Program
Director
Walter Reed National Military Medical
Center
Associate Dean for Diversity andInclusion
School of Medicine
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Patricia Spangler, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Madeline Teisberg, DO
LCDR, MC, USN
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
E. Fuller Torrey, MD
Associate Director of Research
Stanley Medical Research Institute
Robert J. Ursano, MD
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Director
Center for the Study of TraumaticStress
Uniformed Services University
Mary C. Vance, MD, MSc
LCDR, USPHS
United States Coast Guard
Assistant Professor of Psychiatry
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Jing Wang, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Maree J. Webster, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Director
Laboratory of Brain Research
Stanley Medical Research InstituteLars Weisaeth, MD
Professor
Division of Disaster Psychiatry
University of Oslo
Oslo, Norway
James (Curt) West, MD
CAPT, MC, USN (Ret.)
Deputy Chair
Associate Professor
Clerkship Director
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Ronald Whalen, PhD, LMSW
Senior Research Social Worker
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Kathleen Wright, PhD
Former Director (Ret.)
Force Health Protection Program
USAMRU-E
Walter Reed Army Institute of
Research
Gary H. Wynn, MD
COL, MC, USA
Professor
Department of Psychiatry
Senior Scientist
Center for the Study of TraumaticStress
Uniformed Services University
Lei Zhang, MD
Associate Professor
Department of Psychiatry

44 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Center for the Study of TraumaticStress
Uniformed Services University

SCIENCE COLLABORATIVEMEMBERSJames E. Barrett, PhD
Emeritus Professor and Former
Chairman
Department of Pharmacology andPhysiology
Drexel University
College of Medicine
Paul D. Bliese, PhD
Associate Professor
Department of Management
University of South Carolina
Darla Moore School of Business
Robert Bossarte, PhD
Associate Professor
Department of Behavioral Medicine
and Psychiatry
Director
West Virginia University Injury
Control Research CenterWest Virginia University
David Brody, MD, PhD
Professor
Department of Neurology Director
Center for Neuroscience andRegenerative Medicine
Uniformed Services University
M. Richard Fragala, MD
COL, USAF, MC, FS (Ret.)
Professor
Department of Psychiatry
Uniformed Services University
Matthew J. Friedman, MD, PhD
Professor
Department of Psychiatry
Professor
Department of Pharmacology &Toxicology
Dartmouth University
Geisel School of Medicine
Director
Leahy-Friedman National PTSD BrainBank
Senior Advisor
National Center for Post-traumaticStress Disorder
U.S. Department of Veterans Affairs
Harry C. Holloway, MD
COL, MC, USA (Ret.)
Professor EmeritusDepartment of Psychiatry
Uniformed Services University
Ronald C. Kessler, PhD
McNeil Family Professor
Department of Health Care Policy
Harvard Medical School
Craig H. Llewellyn, MD
Professor
Department of Military andEmergency Medicine
Uniformed Services University
Irwin Lucki, PhD
Professor and Chair
Department of Pharmacology &Molecular Therapeutics
Uniformed Services University
Matthew K. Nock, PhD
Edgar Pierce Professor and Chair
Department of Psychology
Harvard University
Francis O’Conner, MD, MPH
COL, MC, USA
Professor and Chairman
Department of Military andEmergency Medicine
Uniformed Services University
Harvey B. Pollard, MD, PhD
Professor and Chair
Department of Anatomy, Physiology
and Genetics
Director
Collaborative Health Initiative
Research Program (CHIRP)
Uniformed Services University

Robert M. Post, MD
HeadBipolar Collaborative Network
Former Chief
Biological Psychiatry Branch
National Institute of Mental HealthDavid Riggs, PhD
Professor and Chair
Department of Medical ClinicalPsychology
Executive Director
Center for Deployment Psychology
Uniformed Services University
Arieh Y. Shalev, MD
Professor
Department of Psychiatry
New York University Professor
Department of Psychiatry
Hadassah University School of
Medicine
Jerusalem, Israel
Murray B. Stein, MD, MPH
VA San Diego Healthcare
SystemDistinguished Professor
Department of Psychiatry
Distinguished Professor
Department of Family Medicine andPublic Health
University of California, San
Diego
Lars Weisaeth, MD
Professor
Division of Disaster Psychiatry
University of Oslo
Oslo, Norway

DISTINGUISHED FORMERSCIENCE COLLABORATIVEMEMBERS & EMERITUS
FRIENDS OF CSTS
Herbert A. Hauptman, PhD(1917-2011)1985 Nobel Laureate, Chemistry
President
Hauptman-Woodward Medical
Research InstituteResearch Professor
Department of Biophysical Sciences
Adjunct Professor
Department of Computer Science
University of Buffalo
Joshua Lederberg, PhD,
ForMenRS(1925-2008)
1958 Nobel Laureate, Physiology or
Medicine
Professor Emeritus
Department of Molecular Genetics andInformatics
Rockefeller University
Founder, Department of Medical
Genetics
University of Wisconsin, Madison
David H. Marlowe, PhD(1931-2014)
Senior Lecturer
Department of Psychiatry
Uniformed Services University
Former Chief
Department of Military Psychiatry
Walter Reed Army Institute of
Research Fellow
American Anthropological Association

STAFF
Deborah Probe Adams
Jingning Ao
Pablo Aliaga
Eva Asabre
Jared Axelowitz
Sara Bessman
Marita Bolis
Catherine Broshek
Alexandra Burris
Madeline Crissman
Victoria DeHoyos

Hieu Dinh
Benjamin Garcia
Matthew Georg
Katherine Hillman
Xianzhang Hu
Paul Hurwitz
Abeer Iqbal
Alex Liu
Jacqueline Mai
Diana Monday
Ami Neiberger-Miller

Gale Morgan
Britany Mullins-Hussain
Stanley Ng
Julia Petrini
Ashley Phares
Joseph Piemontese
Katherine Pokorny
Jacqueline Pujol
Charlotte Riggs-Donovan
Joshua Ruff
Michelle Snider

MSgt Amy Steward
Tung Tu
Leming Wang
Alysse Weinberg
Shemsiya Yimam
Michael Zhang
Jing Zhou
Rafael Zuleta

2020 ANNUAL REPORT | 45

Funded Grants
AWARDS (Jan-Dec 2020)

FUNDING INSTITUTION

Evaluation of the Safety and Pharmacokinetics of the FAAH Inhibitor URB597

USAMRMC

Brain Bank Project: Consortium for the Translational Neuroscience and Treatment of Stress and PTSD
(VA Biorepository Brain Bank: PTSD Brain Bank Protocol)

VA

Study to Assess Risk and Resilience in Servicemembers — Longitudinal Study (STARRS-LS)

DHP

Continuation of the Army Study to Assess Risk and Resilience in Servicemembers (ARMY STARRS)

DHP

Family Violence and Trauma Project

IMCOM

GREAT-SF (Grief-Focused Resilience Activities and Training for Surviving Families):
An Online Selective Intervention for Bereaved Military Families

CDMRP

Military-Related Risk for Child Neglect in DoD Families: A Population Study to Inform
Future DoD Child Neglect Prevention Efforts

MCFP

Enhancing Fear Extinction via Angiotensin Type 1 Receptor Inhibition: A Randomized Controlled Trial in
Posttraumatic Stress Disorder

UCSD

Pilot Trial of Nightmare Deconstruction and Reprocessing, a Novel Treatment for PTSD-Related
Nightmares and Insomnia

USAMRMCContinuation Pilot Trial of Nightmare Deconstruction and Reprocessing, a Novel Treatment for
PTSD-Related Nightmares and Insomnia

USAMRMC

Identifying Predictors of Treatment Response in Service-members with Posttraumatic Stress Disorder
Related Sleep Disturbances: Use of Large Datasets to Improve Treatment Selection over the
Military Lifecycle
USAMRMC
Support for Voices of September 11th - Public Safety Canada

Voices of September 11th

Center for the Study of Traumatic Stress (CSTS) Program

DHP

Coping Strategies Used by Survivors of Suicide Loss

AFSP

Personalized Medicine Approach to Light Treatment for Increasing Alertness and Performance inOperational Settings
Identifying Motivations for Service Members and Veterans Owning Firearms, Storing Them in Unsafe
Conditions and Using Them to Hurt Others or Themselves

46 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

ONR Global

CDC

Federal, State, Academic, Non-Profit,and other Organizations
CSTS has interacted over time withnumerous federal, state, academic, andnon-profit organizations in fulfillmentof the Center’s research and public
purpose missions. CSTS would liketo acknowledge and thank theseorganizations.
5-Eyes Mental Health ResearchInnovation Consortium
Accreditation Council for Graduate
Medical Education
Alfred P. Sloan Foundation
Alliance of Hope
American Academy of Child andAdolescent Psychiatry
American Association of Suicidology
American College of Physicians
American Gold Star Mothers
American Psychiatric Association
American Psychological Association
Architect of the Capitol
Armed Forces Retirement Home
Army Analytics Group, Department of
DefenseAssistant Secretary for Preparedness
and Response, Department of
Health and Human Services
Association for Death Education andCounseling
Broad Institute
California Mental Health Services
Authority
The Carter Center
Canadian Embassy, Washington, DC
Canadian Forces Health Services
Captain Scott Corwin Foundation
Catholic University of America
Center for Complicated Grief,
Columbia University
Center for Forensic Behavioral
Sciences
Center for Health Disparities Research,
Medical University of South
Carolina
Centers for Disease Control andPrevention, Department of Healthand Human Services
Collaborative Health Initiative
Research Program, Uniformed
Services University

College for Behavioral Health
Leadership
Columbia University
Connecticut Department of Mental
Health and Addiction Services
Cornell University
Critical Incident Analysis Group,
University of Virginia
Dartmouth University
Defense Centers of Excellence
for Psychological Healthand Traumatic Brain Injury,
Department of Defense
Defense Health Agency, Department of
Defense
Department of Mental Health, Districtof Columbia
Disaster Mental Health Institute,
University of South Dakota
Dover Air Force Base
Drexel University
Drug Enforcement Administration,
Department of Justice
Emory University
ETS Sponsorship Program
Fallen Patriots
Family Advocacy Program,
Department of Defense
Federal Bureau of Investigation,
Department of JusticeFlorida Department of Health
Ft. Bragg, North Carolina
Ft. Detrick. Maryland
Ft. Hood, Texas
Ft. Lee, Virginia
Ft. Stewart, Georgia
George C. Marshall Center for
European Security
George Washington University
George Washington University, Schoolof Medicine and Health SciencesGold Star Families
Gold Star Wives of America
Greater New York Hospital
Association
Hadassah Medical Organization,
Jerusalem, Israel
Harvard Medical School
Harvard University, School of Public
HealthHenry M. Jackson Foundation for the

Advancement of Military Medicine
Honor and Remember
Honoring Our Fallen
Institute for Disaster Mental Health,State University of New York, New
Paltz
International Initiative for Mental
Health Leadership
International Society for TraumaticStress Studies
Inter-university Consortium for
Political and Social Research
Italian Embassy, Washington, DC
Joint Base Lewis-McChord,
Washington
Joint Mortuary Affairs Center andSchool, Ft. Lee, Virginia
Joint Trauma System, Department of
DefenseKnights of Heroes
Las Vegas Psychiatric Association
Maryland Emergency Management
Authority
Massachusetts General Hospital
McLean HospitalMichigan Department of Health andHuman Services
Michigan Psychiatric Society
Military Child Education Coalition
Military Families United
Military OneSource, Department of
DefenseMiller School of Medicine, Universityof Miami
Missouri Department of Mental HealthMount Sinai Health System
National Academies of Science,
Engineering, and Medicine
National Association for PTSD
National Association of Social Workers
National Association of State Mental
Health Program Directors
National Center for Disaster Medicine
and Public Health, Uniformed
Services University
National Center for PTSD, Department
of Veterans Affairs
National Child Traumatic Stress
Network
National Committee for Employer
Support of the Guard and Reserve
2020 ANNUAL REPORT | 47

National Defense Medical College,Japan
National Fallen Firefighters Foundation
National Guard Bureau, Department of
DefenseNational Intrepid Center of Excellence,
Department of Defense
National Institute for Occupational
Safety and Health, Department of
Health and Human Services
National Institute of Mental Health,National Institutes of HealthNational Institutes of Health,
Department of Health and Human
Services
National Institute of Justice,
Department of JusticeNational Military Family Association
National Network of Public HealthInstitutes
Natural Resources Canada, Earth
Sciences Sector
Naval Sea Systems Command, U.S.
Navy
New Jersey Division of Mental Healthand Addiction Services
New York City Health + Hospitals
New York University
North Atlantic Treaty Organization
Psychiatric Genomics Consortium
Psychological Health Center of
Excellence, Department of Defense
Rockefeller University
Rutgers University, Cell and DNA
Repository
Rutgers University, School of Social
Work

Schwartz Center for Compassionate
Healthcare
Sesame Workshop
Sheppard Pratt Health System
Snowball Express
Sons and Daughters in Touch
Stanford University
Substance Abuse and Mental
Health Services Administration,
Department of Health and Human
Services
Suicide Awareness Voices of Education
Syracuse University
Syracuse VA Medical Center
The Compassionate Friends
Tragedy Assistance Program for
Survivors
Travis Manion Foundation
Tulane University, School of Social
Work
Uniformed Services University
Union Pacific Railroad
University of California, Irvine
University of California, Los Angeles
University of California, San Diego
University of Maryland
University of Melbourne, Australia
University of Michigan
University of Minnesota
University of Pennsylvania
University of Pittsburgh
University of South Carolina
University of Virginia
University of Washington
University Medical Center Utrecht,
Netherlands
U.S. Air Force48 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

U.S. Army
U.S. Army Family Advocacy Program
U.S. Army Family Programs
U.S. Army Installation Management
Command
U.S. Army Medical Research andDevelopment Command
U.S. Department of Agriculture
U.S. Department of Defense
U.S. Department of Energy
U.S. Department of Health and Human
Services
U.S. Department of Homeland Security
U.S. Department of Justice
U.S. Department of State
U.S. Department of Veterans Affairs
U.S. Military Academy at West Point
U.S. Navy
U.S. Postal Service
Veterans Administration Medical
Center of DC
Veterans Affairs (VA) Connecticut
Healthcare System
Veterans Affairs/Department of
Defense Survivors Forum
Virginia Commonwealth University
Voices of September 11, Inc.
Walter Reed Army Institute of
Research, Department of Defense
Walter Reed National Military Medical
Center, Department of DefenseWest Virginia University
Western New York Psychiatric Society
Wright State University
Yale University
Yellow Ribbon Reintegration Program
Zero to ThreeSnapshot of CSTS

CSTS 2020 Holiday Party.

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