Center for the Studyof Traumatic Stress2021 Annual Report

CONTENTS
From the Director ............................................................................... 1
Our Mission........................................................................................ 3
COVID-19 Response Highlights.......................................................... 3
Research............................................................................................. 5
Education and Training ..................................................................... 19
Consultation ..................................................................................... 24
Publications ...................................................................................... 32
Presentations, Blogs, Briefings, Interviews, and Appointments .......... 35
Directors, Scientists, Science Collaborative Members, and Staff......... 40
Funded Grants.................................................................................. 45
Partnerships...................................................................................... 46“…As variants emerge, we all remain
vigilant — for the health of ourCenter members, the Departmentof Defense (DoD), and the nation.
The Center for the Study ofTraumatic Stress (CSTS) continues its
consultation and research to better
understand the effect of COVID-19
on civilian populations globally, as
well as on the active duty and the
National Guard components thatwere activated across the UnitedStates in support of the response to
the COVID-19 pandemic.”— Dr. Robert J. Ursano

From the Director
Dear Center Colleagues and Friends,
In 2021, we continued our
focus on and attention to
COVID-19. Its impact on
the nation and the world
has been unprecedent­ed, with nearly a million
deaths resulting in de­creased life expectancy
in the United States. As
variants emerge, we all remain vigilant — for thehealth of our Center members, the Departmentof Defense (DoD), and the nation. The Center for
the Study of Traumatic Stress (CSTS) continues its
consultation and research to better understand theeffect of COVID-19 on civilian populations globally,
as well as on the active duty and the National Guard
components that were activated across the UnitedStates in support of the response to the COVID-19
pandemic. CSTS has developed numerous support
materials that have been widely disseminated andrecognized across the nation and throughout na­
tional and international medical organizations. The
Center’s work to sustain the resilience of health care
workers has been an important model of medical
support.
CSTS is an integral part of the Department of
Psychiatry, Uniformed Services University (USU)
School of Medicine (America’s Medical School). As
many of you know, CSTS was established in 1987
and has been fulfilling our mission to mitigate theimpact of trauma, from exposure to war, disasters,
terrorism, community violence, and public healththreats. The Center is fully engaged in activities
that support the Strategic Framework and missionof USU, as well as the Military Health System, andthe broader mission of the 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, particularly during the
COVID-19 pandemic.

The Center’s mission is accomplished througha multi-faceted approach that includes leadership,
research, training, education, service, outreach,collaboration, consultation, and global healthengagement. CSTS continues to have an outstanding
multi-disciplinary and collaborative team ofscientists, educators, clinicians, staff, and leaders
to carry out these activities and advance our goals
and our mission, as well as enhance national
preparedness.
While remaining focused on responding to the
COVID-19 pandemic, the Center has continued
our ongoing work on posttraumatic stress disorder(PTSD), traumatic brain injury (TBI), suicide andsuicide-related behavior, suicide prevention, anddisaster response and preparedness. CSTS helps
inform our nation’s policies and responses totrauma from natural and human-made disasters
and, especially at this time, the health emergency
response to COVID-19.
The Center’s work begins in our laboratories andextends to our communities, nation, and across theglobe. Importantly, we bridge science from the gene,to the person, to the world. We translate knowledge
to action by providing rapid consultation, education,and knowledge support to personnel who respondto the health needs of Service members, theirfamilies, and personnel who respond to disasters,
public health threats, and global crises, such as the
COVID-19 pandemic. CSTS is uniquely situated tobridge the fields of military psychiatry and disaster
psychiatry.
The Center uses groundbreaking approaches
to neuroscience, and conducts innovative researchon relevant and timely topics, such as the current
pandemic, suicidal behavior in the Army, the impact
of death and bereavement on military families, novel
treatments for PTSD, and the role of ketamine intreatment. Our advanced analytic activities involve
using innovative techniques, such as machinelearning, complex algorithms, predictive analytics,
Continued on page 22021 ANNUAL REPORT | 1

From the Director, continued from page 1

and, more recently, whole genome sequencing incollaboration with the Center for Military Precision
Health (CMPH) of USU. We use data mining
techniques and state-of-the-art statistical methods
to analyze previously untapped data sources
independently and jointly with other data to gain
new insights, resulting in better and faster decisionmaking and improved health.
CSTS has provided just-in-time educational
resources and surveillance assessments for DoD
and our nation’s health care. The Center has also
developed collaborations with the New York National
Guard as they respond to the effects of COVID-19.
Since the fall 2020 surge in COVID-19 cases, wehave been engaged as subject matter experts andadvisors to the New York City health care system.
We have engaged with our partner and stakeholder
organizations to collaborate and provide resources
and assistance in responding to COVID-19.
Further, Center personnel continued to engage
with their professional contacts and networks,
disseminate resources, and provide consultation
when needed. We also participated in assessing theimpact of COVID-19 at USU. This culminated in
the development and release of a resilience survey.
The results of the resilience survey helped inform
USU leadership. Please visit the Center’s website(www.cstsonline.org) and the Center’s dedicated
COVID-19 response page (https://www.cstsonline.
org/resources/resource-master-list/coronavirus-and­emerging-infectious-disease-outbreaks-response) forthe latest updates in our COVID-19 activities. This
work started in 2020 and is ongoing.

In this Annual Report, you can read summaries
of our contributions to enhance psychologicalhealth and resilience, and our work to prevent andmitigate the negative consequences of trauma on
individuals, families, communities, and the nation,and in particular, learn about our COVID-19
consultation and research initiatives. Our goal is toimprove 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 ourmilitary and civilian health care systems.
As we develop this report in early 2022, CSTS
is closely involved with providing support for
those delivering mental health care in Ukraine.
This support now represents substantial materials
translated into both Ukrainian and Russian, as
well as several other languages. Through our workwith the American Psychiatric Association andour colleagues at Walter Reed Army Institute of
Research and in the Netherlands, as well as thosein Ukraine, we are directly supporting those who
deliver care.
On behalf of everyone at CSTS, I extend ourappreciation to all of our colleagues and friends who
have collaborated with us and assisted us throughout
2021 to help us support the Military Health System,
the DoD, and our nation, and with our COVID-19
response.
Robert J. Ursano, MD
Professor of Psychiatry and Neuroscience
Department of Psychiatry
Director, Center for the Study of Traumatic Stress
Uniformed Services University

While remaining focused on responding to the COVID-19
pandemic, the Center has continued our ongoing workon posttraumatic stress disorder (PTSD), traumatic brain
injury (TBI), suicide and suicide-related behavior, suicide
prevention, and disaster response and preparedness.
— Robert J. Ursano, MD
2 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Our Mission
As an integral part of USU, CSTS’ activities sup­port the USU Strategic Framework and themission of the DoD. CSTS is com­mitted to advancing trauma-in­
formed care and is dedi­
cated to furthering thenation’s understand­ing of the impact of
trauma on individ­
uals, families, andcommunities.
As part of ournation’s fed­
eral medical
school (Amer­
ica’s Medical
School) at USU,
the Center iswell-positioned to
rapidly respond to
DoD mission-rele­vant activities.
The Center’s work
includes a broad range oftrauma exposures, including
combat, terrorism, natural and hu­
man-made disasters, public health threats, such as
the COVID-19 pandemic, and humanitarian opera­
tions. CSTS has been involved in nearly every majordisaster our nation has experienced in the past 35
years. The Center helps to ensure that behav­
ioral health is addressed in the faceof public health threats, disas­
ter planning, and disasterrecovery.
Mitigating theeffects of disaster andtrauma in militaryand civilian pop­
ulations is partof the effort tofoster commu­
nity and nation­
al resilience.
The Center
informs andeducates com­munity, regional,
state, national, andglobal stakeholders ingovernment, industry,health care, public health,and academia. CSTS con­tributes to advancing trauma-in­
formed care by providing leadership in
research, education, training, consultation, global
health, and service.

COVID-19 Response Highlights
The Center continues to be involved with the
DoD’s COVID-19 pandemic response. CSTS Scientists and staff developed and maintain key collaborations with the National Guard Bureau (NGB) andother entities within New York City. In addition,
the Center has been critical in the development of
COVID-19 knowledge products, such as fact sheets,
pocket cards, and infographics 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 has been
instrumental in helping USU leadership assess theimpact of COVID-19 on the USU workforce andstudents through consultation on the USU Resilience
Operational Assessment.
2021 ANNUAL REPORT | 3

HIGHLIGHTS OF THE CENTER’S COVID-19 RESPONSE
Activities with the National Guard Bureau
The Center worked with the NGB to help the
New York National Guard (NYNG) develop a rapid
public health surveillance assessment to inform
leadership and provide action-oriented recom­
mendations related to stressors, resilience factors,
and behavioral health responses. In addition, CSTS
Scientists developed training materials designed toreduce distress and increase resiliency in NG per­sonnel who were called upon to handle the remainsof the dead. CSTS continues to collaborate with theCenter for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
www.CSTSOnline.org

MA-STAR

Mortuary Affairs – Select, Train, Assist, Reset

Leader Support for Service Members
Working with Human Remains

PRE-DEPLOYMENTS elect■■

Select the teamAssign Service Memberswith recent death or serious
stressors to other duties if
possible■

T rainExplain the mission, tasks,
and safety considerations■ Prepare for the expectedmission■DURING DEPLOYMENT

A ssistWalk around and talk withteam members■ Watch for signs of distress■ Encourage unit members to
support each other■ Support team members who
have difficulty■ Remind the team of thevalue of their work■

Tell the team:“Feeling upset because it
is ugly means you are aService Member who cares”» “Try not to look at the faces
and hands of the deceased”» “Use masking smells or
breath through your mouth
to avoid the odors”»

POST-DEPLOYMENTR esetDiscuss and shareaccomplishments■ Provide resources and time
for the team to support eachother
■ Encourage the team tocomplete the PDHA &PDHRA to protect theirhealth
■4 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

NGB and NYNG with education, consultation, andongoing surveillance.

Activities with New York City
The Mayor of New York City (NYC) and theUnited States Northern Command (NORTHCOM)
Commander requested support from CSTS toassist NYC during the initial COVID-19 case surge.
The 5-module resilience training program contin­
ued being delivered in 2021 within the NYC healthcare system. Center Scientists also continued toprovide consultation support to the Mount Sinai
Health System in addressing initial and ongoingchallenges for health care workers during the pan­demic.

Uniformed Services University COVID-19
Resilience Operational Assessment
CSTS assisted in the development of the opera­
tional assessment of students and personnel work­
ing at USU to better understand USU operations
during the COVID-19 pandemic. The assessment
examined factors pertaining to the experiences ofstudents and personnel, 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 pandem­
ic on work and morale, support, and health. In
particular, the assessment informed work taskingsand organizational support and resources. CSTS
developed a follow-up assessment, administered in
2021, in order to further support the USU mission.
These highlights demonstrate some, but not all,of the Center’s substantial contributions to mitigate
the impact of COVID-19. In the following pages,
we detail the Center’s research, teaching, and con­sultation.

Research
CSTS is involved in a broad range of research,
including epidemiological, clinical, and laboratory
research designed to support the Military Health
System in its efforts to promote military readinessfor both peacetime and wartime, and to deliver inte­
grated, affordable, effective, and high quality healthservices. CSTS research encompasses investigations
ranging from the causes of suicide in Service mem­bers, to the psychological responses to trauma anddisasters, to the symptomatology and treatment of
PTSD.

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
in 2015 and ended in 2020. The current STARRS­
LS continuation project began in 2020 and will
run through 2025 and possibly beyond. The Army
STARRS and STARRS-LS projects were designed
and conducted under the scientific direction andproject management oversight of CSTS through acollaborative effort involving USU, the Universityof California, San Diego (UCSD), Harvard Medical
School, and the University 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 a 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 ofmore than 100,000 active duty Soldiers throughout
the U.S. and overseas. The studies included admin­
istering questionnaires and neurocognitive tests,
collecting blood samples, and performing state-of­
the-art data analyses and genetic studies.
CSTS is expanding the size, extending the timeframe, and enhancing the Army STARRS researchthrough a five-year DoD-funded project, STARRS­
LS. Under STARRS-LS, the Center is continuing to
use the Army STARRS platforms, systems, and datato conduct further analyses and to collect addition­
al follow-up data for three cohorts of Soldiers. The
historical cohort established under Army STARRS
has been expanded in size and extended in duration
by including additional Soldiers and obtaining an
additional ten years of Army/DoD administrative
data for the period from 2010 to 2019. This historicalcohort follow-up study now includes all active duty
Soldiers (approximately 3 million) across the sixteen-year period from 2004 to 2019.
For another STARRS-LS cohort, the researchteam has been locating, contacting, and collecting
survey data every two years from a representative
sample of approximately 15,000 Soldiers who partici­
pated in Army STARRS. A total of four survey waves
will be collected from this cohort over an eight-year
period. Since one of the survey data collection waves
began in 2021 during the COVID-19 pandemic, theresearch team designed and added a COVID-19 sec­tion to the survey that included 22 questions about
the respondents’ experiences during the pandemic
2021 ANNUAL REPORT | 5and the impact it may have had on them. This offersa unique opportunity that will allow the researchteam to assess and compare the mental health andbehavioral health effects among a representative
sample of Soldiers, both pre-pandemic and, eventu­
ally, post-pandemic.
Due to the abundance of actionable findings
produced by the STARRS research, the Army
established a workgroup called the STARRS Re­
search Advisory Team (SRAT). The SRAT comprises
Army 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 Principal Investigators continued to meetwith the SRAT on a quarterly basis throughout 2021
to present STARRS findings and discuss how to besttranslate the research findings into Army and DoD
actions.
The Army and DoD also brought the Department
of Veterans Affairs (VA) into STARRS-LS because
over the years, an increasing number (now a major­ity) of the STARRS-LS participants have separated
from the Army and transitioned to civilian life. The
STARRS research team has been collaborating with
VA scientists to examine subgroups of importanceand outcomes of interest to the VA.
Throughout 2021, the research team continued to
publish actionable findings for the Army and DoD,
and conducted briefings of the research progress
and findings. These include briefings to the STARRS
Government Steering Committee and to senior DoD
and Army leadership. As of the end of 2020, theresearch team had published a total of 97 STARRS
publications in peer-reviewed scientific journals.
During 2021, the team published an additional 11
publications, for a total of 108 publications. A sum­mary of all of the STARRS publications can be foundon the CSTS website at https://www.cstsonline.org/
whats-new/wn-armystarrs.
During 2021, the Army and DoD continued touse STARRS findings and knowledge to develop
reports, publications, leadership tools, and risk mit­
igation strategies. The STARRS research is among
the first in the nation to demonstrate the value ofmachine learning and predictive models as clinicaltools for military health care.
6 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Psychological Stress and Resilience in
Mortuary Affairs (MA) Soldiers: Longitudinal
Study
U.S. Army Mortuary Affairs (MA) Soldiers
represent a unique population of Soldiers who areexposed to death, deployment-related stressors, andwork in combat and other extreme environments.

Drs. Biggs and Cabrera at the Grady Early Forensic
Anthropology Laboratory (GEFARL).
Their role is to collect, tentatively identify, and evac­uate the remains of the deceased from the theater of
war and other mission sites. These activities increase
their risk for trauma-related distress and disorders.
This is the longest ongoing study to examine theindividual, unit, and family stressors, risk factors,
and resiliency of MA Soldiers. The study includes
quantitative data collected through questionnaires,
qualitative data collected through semi-structured
interviews, and biomarker data collected throughsaliva samples. Questionnaires are group-admin­
istered to MA detachments approximately one
week before and after deployment to the Middle
East. Empirical and descriptive data are collected
on factors such as PTSD, depression, distress (e.g.,anger, hostility, somatization), substance use, andinstrumental and emotional support. Interviews are
conducted after humanitarian and Defense Supportof Civil Authorities (DSCA) missions in order tolearn about the challenges of working with humanremains in diverse disaster situations. Biomarker
data are analyzed for potential DNA- and RNA-re­lated indicators of stress and resiliency. In 2021,

Reserve MA Soldiers from the 673rd Quartermaster
Company (QM CO) (Dover, Delaware), 387th QM
CO (Costa Mesa, California), and 246th QM CO(Mayaguez, Puerto Rico) participated in the study
by completing deployment-related questionnaires.
A total of 237 questionnaires were collected in 2021.
All questionnaires were administered online due tothe COVID-19 pandemic. Overall, the study ques­tionnaire has been administered 77 times, and morethan 3,600 questionnaires have been collected since
the study began in 2005.
Findings from the MA study target resiliency,
preparation, training, and education of Soldiers for
deployment and working with the deceased. In 2021,
quantitative data analyses included an examinationof deployments, traumatic exposures, and PTSD
and depression symptoms and probable disorder. A
current manuscript addresses these topics as wellas health risk behaviors such as alcohol and tobaccouse. Study findings inform education, trainings, andconsultations related to death and MA operations.
In 2021, this included support to the Joint Mor­tuary Affairs Center (JMAC), with whom we haveworked for over 20 years, as well as establishingand strengthening relations with the Central Joint
Mortuary Affairs Board, DSCA, the U.S. Northern
Command (USNORTHCOM), the United States
Army North (ARNORTH), the North American
Aerospace Defense Command (NORAD), and the
NGB. Principal topics included the lessons learned
from interviews with MA Soldiers who deployed insupport of the 2020 fatality surge operations in New
York City and Washington, DC. Products developed
included the Mortuary Affairs — Select, Train, Assist,
Reset (MA-STAR) Pocket Card, a just-in-time resil­
ience support resource for National Guard personnel
and other military and civilian personnel who are
untrained and inexperienced in handling human re­mains. In addition, posters describing the MA-STAR
Pocket Card, pre- and post-deployment depressionin MA Soldiers were presented.
New in 2021, in order to better understandhow MA Soldiers are trained for work with humanremains, a CSTS study investigator observed theMortuary Affairs Specialist Advanced Individual

Training (AIT) courses, which were conducted at
the USU Anatomical Laboratory. The lab experienceaddresses a primary aim of the AIT course, whichis to gradually expose and acclimate MA Soldiers
to work with remains. For many MA Soldiers, thisis their first hands-on exposure to human remains.
Also, scientists from CSTS attended workshops at
the Forensic Anthropology Center at Texas State(FACTS) in order to learn more about what happens
to a body after death and the methods available for
identifying partial remains.

Troop Education for Army Morale (TEAM)TEAM is a novel stress management and resil­
ience-building early intervention program designed
to improve post-deployment readjustment. It has
been offered to U.S. Army MA Soldiers, a groupat high risk for psychological distress due to their
exposure to human remains and the combat envi­
ronment. The intervention is based on the five evi­
dence-informed principles of Psychological First Aid(PFA): safety, calming, connectedness, self-efficacy,
and hope/optimism, and is delivered through fourgroup workshops, informational handouts, a dedi­
cated website, and phone and email support services.
A total of 125 MA Soldiers in 10 cohorts participat­
ed in the study. Although the intervention did not
reduce rates of PTSD, higher workshop participation
was associated with fewer posttraumatic symptoms
and higher satisfaction with the TEAM program.
Of the variety of skills that the trainings offered,calming (relaxation training) and problem solving
were two of the skills reported to be most helpful.
Importantly, the TEAM intervention materials wererecently adapted to an online format that allows forremote video conferencing and sharing of materials
electronically when individuals are not able to meetin person. The online TEAM intervention content
can be delivered through group sessions at specified
intervals (e.g., once a week) or posted on a dedicatedwebsite for 24/7 access. The intervention content has
been adapted for use in other military and civilian
populations, including medical personnel, police,
firefighters, disaster workers, mortuary personnel, orothers who work with the dead.

2021 ANNUAL REPORT | 7

Ecological Momentary Assessment of PosttraumaticStress Symptoms in U.S. Military Service
Members (Daily Diary Study)
The Daily Diary Study tracks real-time changes
in posttraumatic stress symptoms of U.S. Service
members. This is accomplished using a novel eco­logical momentary assessment methodology that
captures symptom change within and across days.
The Daily Diary Study represents the cutting-edge in
psychological assessment methodology, measures,
equipment, technology, and research design. The
study examines the relationship between variability
in posttraumatic stress symptoms and psychiatricdisorders, sleep, health risk behaviors (e.g., alcoholand tobacco use), pain, and other areas of health andfunctioning. Participants complete daily assessmentsof posttraumatic stress symptoms four times dailyfor 15 consecutive days on electronic tablets, using
a sophisticated software application developed foruse in this study. PTSD and depression are assessedat baseline and in one- and three-month follow-up
assessments. Participants have the option to wear
a wrist actigraph to objectively measure sleep andcomplement self-reports of sleep during the daily
assessment period. Participants also have the option
to donate saliva and/or blood samples for genetic
analysis to identify potential genetic biomarkers andgene-environment interactions that may distinguish
and/or mediate stress responses and resilience tostress-related disorders. Recruitment is conductedwithin a military medical treatment facility, and in
2021, recruitment was paused to protect the safetyof participants and study staff due to the COVID-19
pandemic. In total, 183 subjects have been recruit­ed since the study began. In 2021, data analyses
included an examination of daily variation in PTSD
symptom clusters as well as suicidal ideation in indi­viduals with and without PTSD. A manuscript was
published in BMC Psychiatry examining night-to­night and weekday versus weekend variation in sleep
disturbances (i.e., short sleep duration, poor sleep
quality, trouble falling asleep, and difficulty staying
asleep) in individuals with and without PTSD. In
addition, in 2021 all study questionnaires were re­viewed and updated to ensure that the assessments
remain at the forefront of trauma research.
8 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Firearm Behavioral Practices in U.S. Army
Service Members and Veterans
CSTS Scientists, along with collaborators from
Harvard University and University of South Florida,
were awarded a two-year R01 grant from the Centers
for Disease Control and Prevention (CDC) to study
firearm behavioral practices in U.S. Army Service
members and veterans and their impact on suicidal
behaviors. The focus of this study is to develop adetailed understanding of Service members’ fire­arms attitudes and behaviors and suicide risk, todetermine whether there is a relationship between
local gun laws and military suicide rates, to identify
the principal reasons for keeping a gun and relatedsuicide risk, and to establish whether there is a rela­tionship between storage practices and personality
characteristics. The study is a secondary analysis ofdatasets obtained from STARRS and STARRS-LS.
An in-depth analysis of the interactions among
personality characteristics, reasons for gun owner­
ship, gun use and storage practices, and local gun
laws will identify potential medical, psychosocial,public policy, and command interventions to miti­
gate the relationship of firearm ownership to sui­cide. The broader impact of this study will enhance
our understanding of risk and protective factors offirearm-related violence. This study examines factors
related to suicide in a controlled setting among a
population of men and women in the age range forwhich suicide is most prevalent in the general pop­
ulation, and provides opportunities for new insightsthat can assist the military in suicide prevention,
which can be applied more generally to civiliansociety.
The preliminary results from this study suggest
the importance of safe storage practices among gunowners and the need to develop interventions fo­
cused on ownership for safety and protection, stor­
age practices, and suicide risk. In the year ahead, we
intend to conduct longitudinal analyses of soldiers
through their military careers and civilian life, toidentify changes in behavioral risk factors, specifical­
ly related to changes in local gun laws, as these may
be associated with suicide.

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 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 this effort to identify factorsthat predict variation in sleep disorder treatment
response. The research, done in collaboration with
Harvard Medical School, utilizes data from Army
STARRS, as well as interview and polysomnogra­
phy data from the Sleep Disorders Center at the
Walter Reed National Military Medical Center(WRNMMC). By including a large sample of Service
members with sleep disturbances and an abundanceof diverse predictors for Heterogeneity of Treatment
Effects (HTE) analyses, the approach circumvents
issues that have plagued prior studies. The teamhas now built an observational longitudinal dataset
comprising >26,000 individuals diagnosed with andtreated for an ICD9/10 sleep disorder and for whom
pre- and post-treatment outcomes measures areavailable. HTE analyses conducted on this data­
set will form the basis for clinical tools to improvetreatment selection for individuals with PTSD-re­lated and other sleep disturbances. This goal is moreurgent given evidence that sleep disorders are among
the long-term sequelae of COVID-19, and an effectof the social isolation, disruptions in daily routines,
and other stressors that have occurred in response to
the pandemic.

Reserve Components of the U.S. Armed
ForcesThe 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, including during disasters and situations
such as COVID-19, or providing support to civil
authorities during times of unrest. CSTS is strongly
committed to supporting the RC through the fullrange of their activities and providing understand­ing of their unique stressors and how they affect thehealth and performance of the RC. This commit­
ment extends to addressing the needs not only of RC
members, but also their families. CSTS fulfills thiscommitment to the RC through research to better
understand their 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

National Guard Longitudinal Study
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 (NGR)
Service members, this study specifically addresses
the epidemiology and trajectory of mental healthproblems, deployment stress, health risk behaviors,and health care utilization over a four-year period.
CSTS is actively analyzing this comprehensive data­
set to address the health and resilience factors andexperiences of the RC personnel. This past year, theCenter examined the association of separating frommilitary service with a variety of adversities. Those
who left the military were more likely to reportfinancial and health care access problems comparedto those who stayed in the military. The associationof transition status and having any adversity differedby gender. Among male Service members, there wasno difference in reported adversity among those who
left the military as compared with those who stayedin the military; whereas among female Service mem­bers, those who left the military were more likely
to experience an adversity than those who stayed in
the military. These results highlight that transition
from military to civilian life may be a critical period
for interventions to address the unique needs of theRC’s citizen-soldiers and reduce their risk of adverse
mental health outcomes.
2021 ANNUAL REPORT | 9

New York National Guard Warfighter
Readiness and Resilience Assessment
The U.S. NG is a critical element of the nation’s
response to the COVID-19 pandemic. Identifying,monitoring, and understanding the NG’s resilienceand risk factors related to the COVID-19 pandemic
are central to sustaining force readiness. Given theimmediate need for information on force healthand readiness, CSTS collaborated with the NYNG
to develop a rapid public health surveillance assess­ment to identify stressors, resilience factors, andbehavioral health responses among NG personnel
in response to COVID-19. Based on this assess­ment, which was conducted with over 4,000 NYNG
personnel from August to November 2020, Center
Scientists began identifying pandemic-related stressors and experiences among Guard members who did
and did not activate in response to the pandemic, as
well as post-activation psychological and behavioral
responses.
In 2021, Center Scientists produced a rapid re­port based on the 2020 COVID-19 assessment find­ings that provided NYNG leadership with actionable
recommendations. Further, CSTS began specificallyexamining COVID-19-related work assignmentsthat were associated with high stress activations andtheir relationship to post-activation PTSD, anxiety
and depression symptoms, sleep difficulties, andincreased substance use, including alcohol, tobac­
co, and caffeine/energy drink use. Study findings
will inform work assignment recommendations forleadership to promote mental and behavioral healthand readiness among Guard personnel during andfollowing disaster response.

National Guard COVID-19 Operations
Working with Human Remains
The National Guard (NG) activated in supportof COVID-19, with jobs that included handling theremains of the dead. NG members were tasked withcollecting and transporting human remains, working
with hospitals, emergency services, and Offices of
the Chief Medical Examiner. Importantly, most NG
personnel are untrained and inexperienced in oper­
ations that involve human remains, and in addition,
10 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

New York National Guard COVID­19
Warfighter Resilience & Readiness Survey
National Guard Bureau and the Uniformed Services University
Center for the Study of Traumatic Stress surveyed NYNG
Soldiers and Airmen from August to December 2020 about theirexperiences with COVID­19 and related activations.

3,993
respondents

1 in 3 reported personal
experience with COVID­19
e.g., self/family sick, someone close died

Key Takeaways
Support from leaders, peers, friends, and family contributes to better health outcomes.

High unit leader /supervisor support

current stress += Lower
fewer bad physical /mental health days

Low unit leader /supervisor support

25% more stress += 50%
more bad physical/ mental health days

Findings

22%

reported increased
alcohol use

Health outcomes among thoseon high­stress assignments
following personal experience
with COVID­19:

16%

10%

felt quite a bit /extremely stressed

felt that poor physical ormental health kept themfrom usual activities

75%

75%

2x

more likely to reportworse mental healthmore likely to seek
mental health support

increased alcohol use

Implications• Higher alcohol use may increase personal safety risks (e.g., motor vehicle accidents)• Stress may increase potential for relationship impacts and conflict among living partners• High­stress assignments may worsen health outcomes for those with personal COVID­19 experience• Time outdoors, exercise, daily routines, and talking to friends and family helps manage stress

What Can Leaders Do?
 Provide opportunities to promote strong connections, open dialogue, and access to resources(e.g., Behavioral Health Officers, Chaplains) Provide regular time to decompress through staying connected with friends and family, and exercising Be vigilant toward those with personal COVID­19 experience and assign to lower stress assignments, when possible
 Praise Guard members for handling challenges and their contribution to mission
 Reduce uncertainty (clarify length of activation and tasks)
For additional actions leaders can take to support Guard members working during
COVID­19, download the Pandemic Activations – Select, Train, Assist, Reset (PA­STAR)
Pocket Card: https://www.cstsonline.org/education­and­training/health­campaigns/
leader­support­for­service­members­working­during­covid­19

performing these activities is extremely stressful andincreases the risk for adverse psychological reactions
during and after operations. To address these needs,
CSTS continues to produce and distribute actionable
recommendations and training materials to addresspre-, during, and post-mortuary affairs operations.
These materials are designed to reduce distress andincrease resiliency in NG personnel and other popu­
lations without specialized training in working withthe dead. In 2021, CSTS continued this work andprovided the NG Directors of Psychological Healthwith a slide briefing. In addition, CSTS created theMA-STAR Pocket Card from the content in the NG
slide briefing for use in real-time for leadership. Post­ers describing
the MA-STAR
Pocket Card
have been pre­sented at the2021 Amygdala
Conference andthe 2021 WPAWorld Con­
gress.

RESEARCH IN THE CHILD AND FAMILYPROGRAM

understanding of children in the U.S. and through­out the world.

Bereavement
The National Military Family Bereavement
Study (NMFBS)

Dr. Cozza serving as a panelist at the Advanced
Team Physician Course.
The Child and Family Program (CFP) conducts
research to better understand the needs of allchildren and families affected by traumatic events,
with special emphasis on the needs of U.S. militaryfamilies. Although military children and families
possess unique strengths, they can be affected bycombat-related illness and injury, bereavement, childmaltreatment, and family violence. In addition to
CSTS-based work, the CFP maintains collaborative
relationships with faculty and students within otherdepartments at USU (e.g., doctoral dissertation grad­uate students, Department of Pediatrics researchers,
Capstone program participants), other academic in­stitutions, and community organizations. The prod­
ucts of CFP’s research program inform scientists,
clinicians, and the general public about the impact ofstress and trauma on children and families throughscientific publications, national and internationalpresentations, and hardcopy/web-based resources.
CFP’s pioneering research is also translated into
actionable and educational materials for military andgovernment stakeholders, clinicians, and commu­
nity leaders. In addition, CFP consults with militaryand government leadership, informs national media
outlets, and conducts projects that promote a deeper

The NMFBS is the first large, systematic study to
examine the impact of U.S. military Service member
death on surviving family members. The goal of thestudy is to build upon existing bereavement researchby determining how psychological, physical, andbehavioral outcomes of bereavement are influenced
by the experiences of military family members. The
study includes archival data analyses, a longitudinalsurvey 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 UCSD to develop
a proposal for criteria for prolonged grief disorder,
a new diagnosis now included in the Diagnostic andStatistical Manual of Mental Disorders (DSM). A
recent publication by CSTS Scientists reported ahigher prevalence of depression, PTSD, and adjust­ment disorder post-death, and an increase in mental
health care utilization in military widows. Current
work is examining physical health outcomes andhealth care utilization in military widows and bothmental and physical health outcomes in military
bereaved children. Another publication highlighted
the independent contributions of prolonged griefdisorder, depression, and anxiety to cognitive fail­ures in bereaved individuals, and a third publication
described a codebook developed to analyze qualita­
tive focus group data from family member survivorsof military-related deaths. The NMFBS has iden­tified needs of military family survivors, including
the need to access health care services that can treat
loss-related conditions.

2021 ANNUAL REPORT | 11

Stepping Forward in Grief (SFG) Study
A virtual app that addresses grief adaptation
may be a helpful resource for bereaved militaryfamily members. CFP formed a partnership with
the Center for Prolonged Grief atColumbia University to adapt
principles from ComplicatedGrief Therapy (CGT), foundto be helpful in civilian popu­
lations, for a digital interven­tion aimed to assist with grief
integration and decrease risk forlong-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
with the program. Participants were also grouped
according to whether they initially had high or low
grief scores. Results indicated that there were small,but statistically significant, improvements in grief
and in functional impairment among those in thehigh grief group. In addition, a smaller proportion ofGriefSteps participants, compared to WellnessSteps
participants, met a threshold indicator for prolonged
grief disorder (while adjusting for baseline grief )after use of the program. Both programs were rated
favorably by participants. These results can be seen
as proof of concept for a novel modality requiring
little oversight or cost, which can markedly increase
the ability to reach bereaved family members.

Study of Long-Term Outcomes of TerrorismRelated Grief
CFP partnered with Voices of September 11(VOICES), a nonprofit organization that aids
9/11-affected families, and the Canadian Resource
Centre for Victims of Crime (CRC), an organization
supporting family members who were bereavedby the Air India Flight 182 bombing, to investigate
long-term bereavement outcomes in family mem­bers (e.g., grief, traumatic symptoms, resilience, andposttraumatic growth) following a terrorism-related
12 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

death. More than 400 bereaved family members
completed online questionnaires about their ex­periences. Two manuscripts have been published;
the first identified three groups of bereaved fami­
ly members that were differentiated according topatterns of depression, anxiety, and grief. The second
manuscript examined the effect of receiving multiple
notifications about the identification of fragmented
remains of a family member. Results indicated thatmultiple notifications were differentially associatedwith posttraumatic stress, but not grief severity.
Results from this publication were also described on
the International Society for Traumatic Stress Stud­ies’ (ISTSS) Trauma Blog and were used to develop
an interactive fact sheet for health care providers
about death notification within health care facilities.

Bereavement Coping Study
The goal of this study was to determine whether
military family survivors of suicide, accident, andcombat deaths use similar or different coping strat­egies following bereavement and to examine asso­
ciations between risk factors (i.e., hopelessness andreasons for living), specific coping strategies, andoutcomes (i.e., 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 identi­
fy actionable targets for intervention programs. A
publication from this study used data from NMFBS
to examine differential contributions of specificcoping strategies and their relationships with causeof death in contributing to grief severity, depression,and posttraumatic growth. A related manuscript wasalso published that discussed the use of bereavement
coping strategies in the context of the COVID-19
pandemic.

Disenfranchised Grief
Through its collaborations with Sons and Daugh­ters in Touch (SDIT), an organization composedof children whose fathers died or were MIA in the
Vietnam War, CFP noted the consistency with which
this population felt their loss was unacknowledged

or rejected. This phenomenon is consistent withthe concept of disenfranchised grief (DG), whichrefers to the experiences of bereaved persons whose
grief was not or could not be openly acknowledged,
publicly mourned, or socially supported by others.
In response to and recognition of the importanceof DG, particularly in the context of the COVID-19
pandemic, CFP is conducting research on DG, which
includes developing a measure of DG. CFP is refin­
ing and will test this instrument in the SDIT pop­
ulation, as well as among individuals who sufferedlosses due to perinatal death, suicide, substanceabuse, criminal activity, and HIV.

the family, Service member, and military characteris­tics associated with heightened and diminished riskof substantiated child maltreatment incidents. In
Phase II, survival analyses were conducted to inves­tigate the contribution of Service member socio-de­mographic characteristics, family characteristics,
military characteristics, and family life events to thetiming of the first incident of substantiated childmaltreatment. Results will identify characteristics
of military family life that are associated with childmaltreatment in order to inform the DoD’s childmaltreatment prevention efforts.

Child Maltreatment in U.S. MilitaryCommunities and Families
Another focus area of the CFP involves theidentification of risk factors for child maltreatment
in military families, in order to inform prevention
and intervention strategies that strengthen militaryfamily health, well-being, and resilience. CFP’s initial
work focused on child neglect, the child maltreat­ment type most commonly reported in the U.S. andmost frequently associated with child fatality. The
aim of this initial work was to identify factors that
increase risk of child neglect by examining char­acteristics of substantiated child neglect cases infamilies of U.S. Army Service members. Data werecollected from records of 400 substantiated casesof child neglect from four high operational tempo
Army installations in the continental U.S. Multiple
manuscripts describing findings from this project
have been published in Military Medicine and Child
Maltreatment. Current work focuses on identifying
patterns of co-occurring neglect incident character­istics and associated risk factors to advance under­
standing of the phenomenology of child neglecttypes.
CFP Scientists are currently participating in acongressionally-mandated study designed to ad­vance understanding of risk and protective factors
for all types of child maltreatment (i.e., neglect,
physical abuse, sexual abuse, and emotional abuse)in military families from all service branches. Phase
I of the project involved a case-control study ofmilitary families with dependent children to identify

Combat Injured Families
CFP Scientists conducted three studies to examine
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 focus
on the impact of Service member combat injury on
spouses’ mental health outcomes. The aim of thiswork is to help us better understand the impact of
combat injury on Service members and their fami­
2021 ANNUAL REPORT | 13

lies and inform interventions that more effectively
address their needs.

Family Violence
As the COVID-19 pandemic continued through­out 2021, we focused our Research Review (RR) on
the pandemic’s effects on children and families. RR
consists of summaries of research on intimate part­ner violence and child maltreatment. Scientific andmedical publications reviewed for summaries in RR
tended to agree that reports of child abuse to police
departments and child protective services decreased
in 2020. The severity of maltreatment increased,
parents used harsher parenting, and felt less close
to their children. Particularly disturbing injuries
to children were often due to abusive head trauma(AHT). Family risk factors for children hospitalizedwith AHT were intimate partner violence, substanceabuse, an unknown number of adults living in thehousehold, and prior police involvement. In addition
to the cited risk factors for hospitalized children,
there are family vulnerabilities that can be addressedin preventing AHT: socioeconomic deprivation,
criminal behavior, mental health disorders, andfinancial concerns. We also noted that vulnerabilities
were increased under lockdown measures.
We also featured summaries of literature on
intimate partner violence during the pandemic. We
reported that parents who lost their jobs were more
likely to physically and psychologically maltreat theirchildren and to be depressed. A risk factor resulting
from job loss that puts significant stress on families
is financial instability: how long could they remain attheir address and maintain their standard of living?
However, in the face of such challenges, positive
cognitive reframing of challenges can make themmore manageable through reappraising and redefin­
ing stressors. Other significant individual stressors
in today’s society are isolation and loneliness. Withmandatory lockdowns of whole sectors of societies,
both in the U.S. and internationally, isolation andloneliness have increased, particularly among thevulnerable. Isolation also can increase other risk
factors for child abuse and intimate partner violence
as well as influence health: substance abuse, smok­
ing, self-medication, and overeating. A challenge for
14 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

mental health and social service providers following
the lifting of lockdowns is helping people consider
how to address persistent problems that they en­
countered during and after lockdown.
In addition to RR, we also published Joining Forc­
es Joining Families (JFJF), in which we interviewed asubject matter expert on the treatment of perpetra­
tors of intimate partner violence. A key focus of thisissue of JFJF was the importance of trauma-informedcare in the treatment of victims and perpetrators of
intimate partner violence.
We continued to provide the Army Family Ad­
vocacy Program (FAP) with quarterly statistical data
monitoring of installation-level FAP report changes
throughout 2021. We also began to address the prev­
alence of problematic juvenile sexual behavior on
Army installations by reporting monthly statistics.
This is a new area of inquiry that poses many chal­lenges to Army families, but prevention efforts are
ongoing across the Army.
We also participated in the annual Army Family
Violence Fatality Review Board and drafted a reportthat summarized the characteristics of child abuse
and intimate partner violence-related fatalities,
including the demographics of victims and perpetra­
tors, risk factors for fatal events, and comparisons ofArmy fatality cases with reports from international
literature on fatalities.

RESEARCH IN NEUROSCIENCE AND
NEUROBIOLOGYLaboratory Research in Neuroscience and
Neurobiology
Genetics and Biomarkers
Although we have faced significant challenges
during the COVID-19 pandemic, the laboratory has
continued to conduct biomarker research. CSTS
Scientists hypothesized that certain gene variants
might contribute to susceptibility to smoking inindividuals with PTSD and that these genes might
be more frequently present in patients with PTSD incomparison to healthy subjects. The laboratory usedpolymerase chain reaction (PCR) amplification ge­
notyping and the PTSD Checklist (PCL) to examinethe association of brain-derived neurotrophic factor(BDNF) and smoking behavior in Service members
to identify potential biomarkers. We found that
total PCL scores were significantly higher in daily
cigarette smokers compared to non-daily smokers,
whereas total PCL scores were marginally higher
in daily cigar smokers compared to non-daily cigar
smokers. In non-PTSD controls, FKBP5, but not
p11, COMT, and BDNF, was positively associat­
ed with smoking. In those with PTSD, BDNF, but
not FKBP5, COMT, and P11, was associated withsmoking. Smoking amount was negatively correlat­
ed with gender and age, but positively correlatedwith the total PCL score. These data indicated thatsmoking behavior was related to higher PCL scoresin both those with and without PTSD. To the bestof our knowledge, this is the first report showingthat FKBP5 and BDNF were associated with smok­
ing behavior in non-PTSD controls and those with
PTSD, respectively. This research may facilitate
better understanding of the molecular mechanisms
involved in the gene-environment (G x E) interaction
to develop evidence-based treatments for smokers.

Chronobiology, Light, and Sleep Research
The overarching goal of the Chronobiology,
Light, and Sleep lab research program is to further
understand sleep, circadian rhythms, and light inorder to maximize human health and well-being.
From a basic science perspective, our research
focuses on the neural mechanisms underlying themodulation of photic sensitivity for the biologicaleffects of light, including circadian resetting, neu­roendocrine regulation, alerting effects, and moodenhancement. This year, the lab was set up and Insti­
tutional Review Board approval was put in place toenable studies that will help us to better understandthe acute alerting properties of light. An upcoming
controlled laboratory study will provide insight into
the photoreceptor physiology underlying this acuteresponse to light while also serving to inform directtranslational efforts wherein light treatment will be
used to increase alertness in the field. Data collec­
tion for that work is slated to begin in the coming
months.
From a translational perspective, our studies

examine how the basic science of this primitive
sensory system can guide the rational develop­
ment of clinical therapies and architectural lighting
strategies. Due to the pandemic, in 2020-2021, ourteam made a strategic pivot from plans to test novel
lighting countermeasures in shiftworkers in a hos­pital setting over to those on a high-security watchfloor. In that study, we examined the efficacy of two
distinct spectrally-engineered lighting technologies
for increasing alertness, performance, and/or sleepin Service members who necessarily work rotatingnightshift schedules. The aim of one lighting condi­tion was to optimize the physiological effects of lightin general, whereas the other was intended to focus
the effects on only one physiological response with­out influencing others. Data collection followed bypreliminary findings have been reported, and further
analyses are ongoing.
In order to successfully transition new evi­
dence-based lighting applications to domestic andworkplace settings, there is a need for a well-de­signed educational component that will ultimately
serve to increase investment and facilitate adoptionof interventions that target sleep, circadian health,and other physiological effects of light. Thus, thedevelopment of such a program has become an
emerging priority for our team. To that end, we havecontinued to study and evolve our sleep-focused ed­
ucation program, Circadian, Light, and Sleep Skills(CLASS), which was tailored specifically for ship­board Service members (CLASS-SM). The efficacy ofthe program was studied in crew members on three
U.S. Navy ships during an underway (at sea) periodof 2-4 months. Longitudinal data demonstrated thatparticipation in CLASS-SM, on its own, resulted
in increased sleep quality, which also led to bettermental health outcomes. More detailed findings areincluded in associated manuscripts that are currently
under review, and initial plans for transitioning the
program are being made in collaboration with theConsortium for Health and Military Performance(CHAMP).
Beyond those research efforts, our lab was in­volved in a variety of related outreach initiatives. For
example, we joined the Student Wellness Advisory
Board and the Sleep Medicine Fellowship Program
2021 ANNUAL REPORT | 15

at WRNMMC to coordinate and produce a series ofpresentations and materials meant to educate medical
students on why and how they should prioritize theirown sleep health. In separate work, a commentary
piece was written with Dr. Rachel Lee, who leads thevaccination program at WRNMMC. In it, we describe
how sleep, circadian health, and melatonin might beused to boost the immune system and maximize vac­cination efficacy in the context of COVID-19.
In total, five peer-reviewed publications havecome out from our group this year, including origi­
nal research articles on studies of Service members
and hospital shiftworkers as well as review articles
on the physiological effects of light. Additionally,
three grant proposals have been developed andsubmitted in collaboration with colleagues at various
institutions, in an effort to obtain support for futurestudies of light, circadian rhythms, melatonin, sleep,and other associated health issues.

Clinical Research in Neuroscience and
Neurobiology
Riluzole Augmentation Treatment forComplicated Combat-Related PTSD
The Center continued analysis of imaging datafrom our recently published multi-site clinical
trial testing the efficacy of riluzole for treatment of
combat-related PTSD. The study demonstrated thatveterans who experienced continued PTSD symp­
toms despite treatment with evidence-based med­
ications for PTSD, showed greater improvement in
hyperarousal symptoms, such as exaggerated startle
responses and hypervigilance, when treated withriluzole as compared to placebo. CSTS researchers
collected proton magnetic resonance spectroscopy(1H-MRS) of the amygdala and anterior cingulate
cortex before and after treatment as a potential bio­
marker of illness and treatment response. CSTS Sci­
entists, in collaboration with researchers at Brigham
and Women’s Hospital, have identified discernible
changes in brain metabolites in the areas of interest,
which were associated with improvement in PTSD
symptoms. These findings are under preparation for
publication. This study was funded by the U.S. Army
Military and Operational Medical Readiness Pro­
16 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

gram and enrolled participants at WRNMMC andthe Syracuse Veterans Affairs Medical Center from2014 to 2017. Riluzole alters activity of glutamate,
the primary excitatory neurotransmitter in the brain,
and is currently FDA-approved for treatment of
amyotrophic lateral sclerosis.

Enhancing Fear Extinction via Angiotensin
Type 1 Receptor Inhibition: A Randomized
Controlled Trial in PTSD
CSTS recently collaborated with UCSD in a
multi-site clinical trial testing the efficacy of losartan
for treatment of PTSD. Losartan is an angiotensin
receptor blocker, currently FDA-approved for treat­ment of high blood pressure. This trial comparedtreatment with losartan to placebo as mono-thera­py for over 10 weeks of PTSD treatment. The final
results of the study were published in BiologicalPsychiatry, with losartan failing to achieve treatment
results better than placebo and no discernible in­fluence of a specific angiotensin converting enzyme(ACE) gene as a biomarker of treatment response.
Although the study failed to support use of a new
medication for treatment of PTSD, it did provide
valuable evidence.

Nightmare Deconstruction and Reprocessing
for Treatment of PTSD-related Nightmares
Nightmares and insomnia are among the mostcommon and debilitating re-experiencing symptomsof PTSD, and for many patients they are the mostresistant to evidence-based treatment. Sleep distur­bance and associated fatigue represent a threat toreadiness. CSTS is conducting a pilot trial of Night­
mare Deconstruction and Reprocessing (NDR), an
exposure-based psychotherapy for trauma-relatednightmares and insomnia. NDR is an adaptation of
the Hill cognitive-experiential model for working
with dreams in psychotherapy. Participants workwith therapists to recall their most distressing night­
mare images and their associated thoughts and feel­ings in order to facilitate reconsolidation of trauma
memories. CSTS is partnering with WRNMMC and
Naval Medical Center San Diego to test this inter­
vention in 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 multiple points in treat­ment as potential indicators of treatment response,
and also collecting continuous physiologic indica­
tors of stress, such as heart rate variability and skinconductance using wearable technology. Ultimately,
findings from this study will be used to design a fullscale randomized, controlled trial to demonstrateefficacy and validate biomarkers. The study has beenenrolling participants since 2019, with expected
continued enrollment through 2022. COVID-19
presented unique challenges to recruitment andtreatment of study participants, but the study has
successfully transitioned to primarily virtual therapy
sessions and assessments.

The Veterans Affairs (VA) National PTSD
Brain Bank
In 2014, a consortium led by the Department
of Veterans Affairs National Center for PTSD andco-founded by CSTS Scientists established the firsthuman tissue biorepository—or “Brain Bank”—
dedicated to examining the impact of trauma andstress on human body tissues, with the objectives ofidentifying biomarkers of susceptibility and resilience
to trauma, and assisting in targeting new treatments.
The Brain Bank collects, processes, and stores clin­
ical and biological information, which can then be
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 mecha­
nisms of PTSD, develop pharmacological interven­tions, and study biomarkers and endophenotypes.
Since its inception, the Brain Bank has acquired
tissue from existing collections and also enrolled
donors through collaborating institutions. Living
persons can enroll to serve as future tissue donors
and, furthermore, provide comprehensive longitu­
dinal assessment data via clinical interview fromthe time of enrollment until the time of their death,when their tissue is donated to the Brain Bank. In
2021, the Brain Bank obtained 36 tissue donations
and enrolled 46 additional future donors, and, todate, the Brain Bank has obtained 320 tissue dona­tions and enrolled 198 additional future donors.
During 2021, CSTS Scientists continued to serveon the Brain Bank’s Steering Committee, Tissue
Access Committee, and Diagnostic Assessment
Core, and have collaborated with other Brain Bank
investigators on several manuscripts. CSTS has also
been prepared to establish a recruitment site at theArmed Forces Retirement Home in Washington,
DC. While safety precautions related to COVID-19
have precluded large gatherings at this location andrestricted visitors, including those who might pro­vide information on research, when conditions per­mit, CSTS will be poised to help identify and assist
veterans at this site who are interested in supporting
the Brain Bank by becoming future tissue donors
and providing their physical and mental health data.

RESEARCH ON DISASTERS ANDTERRORISM
Florida Department of Health Response toMultiple Hurricanes
CSTS Scientists continued to examine psycho­
logical and behavioral responses following natural
disasters, including psychological distress, posttrau­
matic disorders, health risk behaviors, and function­
al/occupational impairment. In particular, during
the past year, the Center examined predictive factorsthat influence recovery and resilience following
disaster exposure, which can be targeted for preven­tive interventions in first responders who are ex­
posed to multiple disasters. This work is particularly
important globally, as the world has experienced a2021 ANNUAL REPORT | 17

hurricanes that occurred in 2004 and 2005. CSTS
examined pre-hurricane individual and interperson­
al factors that influenced time to recovery following
the 2005 hurricanes. Importantly, less social support
from respondents’ spouses, friends, and family, morework presenteeism (i.e., reduction in work perfor­
mance and 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 to recovery
following the hurricanes. This research suggests theimportance of social support, work performance,and peri-traumatic factors, such as initial emotional
response and extent of hurricane injury/damage, in
promoting resilience. Action-oriented strategies in­clude community-level interventions and programs
focused on enhancing social and workplace support,
and attention to peri-traumatic responses.
18 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU© Copyright Getty Images

wide range of disasters during 2021, including the
COVID-19 pandemic, the devastation and destruc­tion caused by a 7.2 magnitude earthquake in Haiti,
multiple tornadoes in the southern and midwestern
United States, flooding in the U.S., Asia, and Europe,
wildfires and extreme heat in the western UnitedStates, freezing and disruption to the power grid in
Texas, and hurricane and cyclone activity globally.
During 2021, 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, and werepersonally affected by, an unprecedented series of

Washington Navy Yard Shooting Study
The Center collected qualitative data at the Wash­
ington Navy Yard as part of a multi-site collaborative
study with the University of California, Los Angeles(UCLA) that was funded by the National Institute ofJustice (NIJ). This study data will improve the un­derstanding of risk and protective factors impacting
community recovery following response to mass
violence. The first phase of the study involved assess­ments following five school mass shootings. The sec­
ond phase focused on six community violence events,
including the Washington Navy Yard workplace mass
shooting in 2013. This collaboration benefited froma long-standing relationship with Naval Sea Systems
Command (NAVSEA) to examine persistent socialand occupational challenges for personnel. The data
have been analyzed and a report provided to the NIJ
that will guide policy for the federal government’s fu­
ture response and recovery efforts following incidents
of mass violence. CSTS published a manuscript that
captured critical lessons learned in methodology for
conducting research on behavioral health impacts ofmass violence in military communities that will serve
as a seminal publication to better inform the field in
support of future efforts.

Dr. Morganstein speaking at a conference.

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
health care personnel and community leaders at the
local, state, and federal levels, as well as in nation­al, global, and private sector settings. The Center
also sponsors conferences, symposia, seminars, andforums on numerous areas, including disasters,
terrorism, war, and other aspects of trauma. CSTS
advances military and disaster psychiatry throughpresentations, training, outreach, and participa­tion in conferences, collaborations, and workshops
throughout the U.S. and global community. The
Center also expands knowledge and provides educa­tion through public health efforts and interventions
before, during, and after a broad range of disasterevents.
One of the Center’s instrumental public healtheducation tools is development and disseminationof educational materials to inform stakeholders, in­cluding: health care personnel, families, communityand organizational leaders, first responders, publichealth emergency workers, teaching professionals,
and policy makers. For more than two decades,
CSTS has created just-in-time, customized, highly
actionable, and easy-to-read educational fact sheets

Dr. Ursano speaking at a conference.

in order to aid national and global stakeholders in
mitigating adverse effects of disasters through opti­
mized preparedness, response, and recovery efforts.
A primary focus at CSTS has been the
COVID-19 pandemic. COVID-19-related efforts
have included providing COVID-19 educational
resources to partners throughout the DoD, other
Federal agencies, state and local agencies, profes­
sional associations, and international partners.

DISASTER RESPONSE AND PUBLICEDUCATION
Since its inception in 1987, the Center has pro­vided disaster preparedness and response educationand consultation in a variety of forms and situations.
CSTS personnel have provided on-the-groundeducation and consultation in response to extreme
national and global disasters, as well as immediateand long-term online, video, and telephonic support
to assist response and recovery efforts following awide range of disaster events, which have impacted
various organizations and communities. Current
and former CSTS personnel have been sought
out to provide guidance on disaster preparedness,
response, and recovery efforts because of the expe­
rience and subject-matter expertise obtained whileworking at the Center. The Center’s Deputy Director
also serves as Chair of the Disaster Committee for
the American Psychiatric Association, the world’s
largest professional organizing body of psychiatrists.
Throughout 2021, the Center provided consul­
tation and education in response to the COVID-19
pandemic as well as numerous converging disasters.
Center Scientists were asked to serve as ongoing
subject-matter experts advising on psychologicaland behavioral health impacts for National Guardand other personnel who responded to the riotsat the Capitol Building in Washington, DC. Guard
members from nearly a dozen states and personnel
from other federal agencies were mobilized during
and after the riots to protect the nation’s capital and
2021 ANNUAL REPORT | 19

community members from injury and further at­tacks. The Center provided months of ongoing guid­ance on policy and practices to protect the health of
responders and community members. The Deputy
Director was sought out following the deadly Surfside Condominium collapse in Surfside, FL, to serve
as a consultant for the health consortium establishedby the Office of the Mayor to provide mental healthcare throughout the community. This partnershipof public and private entities delivered a range ofservices to community members and their families,
as well as responders and emergency workers.
The Center also supported response efforts toa range of climate-related disasters, including the
Boulder City wildfires and the extreme tornadoes
that devastated numerous states across the Midwest.
In response to these events, the Center developed
just-in-time education fact sheets and disseminatedthem to stakeholders involved in disaster response,
including the National Association of State Mental
Health Program Directors, the Office of the Assis­
tant Secretary for Preparedness and Response, as
well as national medical organizations providing
local response support, such as the American Psy­
chiatric Association. The Center also developed a re­source page and worked with partner organizations
to support military and civilian communities in thewake of Hurricane Ida, which caused over $75 billion
in damages and killed nearly a hundred people, mak­ing it the fourth costliest hurricane in United States
history and the deadliest since Hurricane Katrina.
In the summer of 2021, the Center worked withmilitary medical partners around the world to
support communities impacted by the evacuation of
Afghanistan citizens and military troops. The Center
provided resources and developed collaborations
between response stakeholders in the DoD as well as
the U.S. Department of Health and Human Services
to enhance synergy of effort and dissemination ofcritical, actionable resources to support displacedcommunity members, local residents, responders,
health care workers, and community leaders. The
Center also shared resources with partners within
the 5-Eyes Mental Health Research International
Collaboration (MHRIC) to provide resources andpublic education about the range of impacts on
20 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

active Service members as well as veterans who wereinvolved in the war in Afghanistan.
Throughout 2021, the Center continued its lead­ership role in global disaster mental health response
to COVID-19 in support of numerous stakeholders
at the local, state, federal, national, and international
levels. CSTS rapidly developed numerous actionablefact sheets that were timely, topical, and easy-to­
read, and were widely disseminated to critical part­ners who needed resources addressing current andemerging challenges at various stages throughout
the pandemic. CSTS members provided educationand training to numerous national health care or­
ganizations, professional organizations, and federal
interagency and global partners on the unique psy­chological and behavioral effects of a protracted andevolving pandemic on individual and community
health. Center Scientists delivered nearly 650 pre­sentations in support of a broad range of stakehold­ers involved in pandemic response, and publishednearly 20 manuscripts to better inform the field on
addressing mental health challenges and enhancing
resilience for Service members, health care workers,families, patients, and community leaders.
The following are additional examples of contin­
ued Center disaster response and education activi­ties:
n Center Scientists continue to provide education­
al support to the USU Master in Public Healthprogram by delivering educational seminars on
domestic and international disaster behavioral
health.
n The Deputy Director again delivered a course indisaster behavior health for the Disaster Fellow­
ship at George Washington University. Attendees
were primarily Emergency Physicians, and thiscourse provided a foundation for understanding
the psychological and behavioral responses ofdisaster survivors in crisis.
n An Associate Director delivered ongoing training
at George Washington University (GWU) as partof a course in Leadership in Crisis & Catastrophe
in GWU’s Crisis, Emergency, & Risk Manage­
ment Program.
n Again, a Center Scientist was invited to provide
disaster and preventive psychiatry training for thefourth-year psychiatry residents at the Universityof Maryland/Sheppard Pratt Psychiatry Residen­cy Program.

NEUROSCIENCE AND BEHAVIORMODULE FOR PRE-CLERKSHIP USU
MEDICAL STUDENTS
The Neuroscience & Behavior Module is an
8-week, annual, required multidisciplinary course
for the first year USU School of Medicine (SoM)
students. As in past years, the module teaches med­
ical students the principles of neuroscience throughintegrated content across a range of disciplines.
With a focus on effective management of a varietyof neurologic and psychiatric conditions, students
learn to recognize, describe, and diagnose common
neuroscience-related medical conditions. Throughsimulated patient experiences, effective, safe, andpatient-centered clinical skills, including the per­formance of neurologic and mental status examina­
tions, are developed and practiced. With the goal of
fostering a robust and well-rounded education for
future military medical officers, topics related to mil­itary medicine, medical history, and health systems
science are integrated throughout the module.
In 2021, due to COVID-19, the University con­tinues to provide distance learning, adding somein-person classes and simulations. Importantly, themodule continues to be highly regarded by students
and faculty alike as one of the best modules in the
pre-clerkship curriculum. In 2019, the module wasrecognized for pre-recording all lectures into ahigher-quality format that was more accessible tostudents than recording live lectures. In preparationfor 2020 and 2021, the module continued to enhance
online lecture delivery by improving and re-record­ing 52/137 (37% of ) 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 continue in the expand­ed flipped classroom approach and continue tocontain 6 weekly sessions. These flipped classrooms
required students to attend a live session to answer
questions based on clinical cases that wove togeth­
er the lecture content they independently watchedfrom that week. A weekly series of operational vi­
gnettes continue to be incorporated. These vignettes,
collected from USU graduates and faculty, wereintended to demonstrate the operational impor­tance of the material the students were learning eachweek. Lastly, based on consultation with the Assess­ment Sub-Committee and the Associate Dean for
Assessment, every module exam question continues
to be carefully blueprinted, down to the objective.

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 linewith 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 ac­
tivities while on a simulated combat deployment.
Evaluation and treatment of combat and operational
stress reactions were core skills taught and evaluated2021 ANNUAL REPORT | 21

as part of the exercise. CSTS faculty collaborate 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.
The COVID-19 pandemic brought uniquechallenges to BUSHMASTER, and CSTS Scientists
adapted teaching methods to achieve comparable
learning objectives with smaller, safer groups ofstudents in the field. With the advent of widespread
vaccination among faculty and staff, we have since
been able to return to full-scale exercise operations
and teaching.

EDUCATIONAL CONFERENCES
Amygdala, Stress, and PTSD Conference
In 2021, the 15th Annual Amygdala Conference:Stress and the Mind, sponsored by CSTS in collabo­
ration with the USU Department of Psychiatry, USU
Neuroscience Program, USU Department of Fam­
ily Medicine, and the WRNMMC Department of
Psychiatry, transitioned to a virtual format. The Con­
ference featured several world-renowned scientists,
including Eric J. Nestler, MD, PhD (Icahn School of
Medicine at Mount Sinai), Kay M. Tye, PhD (Salk
Institute), David Forbes, PhD (Phoenix Australia,
Centre for Posttraumatic Mental Health), David
Brody, MD, PhD (Uniformed Services University),
and Vincent F. Capaldi, II, MD (Walter Reed Army
Institute of Research).

TRAINING TO SUPPORT RESEARCH
The Center trains and educates research support
staff, such as Research Assistants (RAs). RAs support
research at CSTS, and have the opportunity to learn
by working with CSTS Scientists. The RAs conduct
literature searches and participate in data collection,
data entry and quality control, and in addition, devel­op tables and graphic representations of study find­ings. RAs also write summary reports of meetings.
RAs acquire valuable research skills at CSTS, includ­ing poster development for research presentations,and presenting research findings to professionals aswell as the general public. RAs are offered profession­
al development opportunities, including attending,presenting posters, and representing CSTS at pro­fessional conferences, and assisting with manuscript
preparation for publication in peer-reviewed scien­tific journals. RAs further their education by pursu­
ing advanced degrees. Center RAs have furthered
their education at institutions including: Yale, Notre
Dame, Johns Hopkins, Duke, Columbia, Georgetown,
London School of Hygiene and Tropical Medicine,
University of Maryland, George Washington Univer­sity, Catholic University, University of Nebraska–Lin­
coln and USU. Opportunities that RAs have pursued
following their experience at CSTS have included:
n Ph.D. programs in psychology and related fields
n Medical schooln Law schooln Master’s degree programs in psychology, counsel­
ing, public health, and social workn Training positions at the NIMH and other insti­
tutes at the NIH
n Careers with the FBI

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
22 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

on difficult and/or crisis-related
issues. Fact sheets and infograph­
ics address the needs of a broad
range of partners and stakehold­ers, including health care provid­ers, first responders and emer­
gency workers, family members,
community leaders, and policy
makers. CSTS fact sheets, which
are developed, updated, andmaintained in an online reposito­
ry, address a wide range of issues pertaining to pre­paredness and response for disasters, such as mass
violence, natural disasters, and pandemics; risk andcrisis communication; elements of crisis leadership;
family health behaviors; and health risk education.
CSTS fact sheets and infographics provide readerswith resources tailored to the unique aspects ofdisaster events and disaster community. The Center
develops and rapidly disseminates fact sheets in realtime, following major disasters and traumatic events
such as community violence, terrorism and bioter­rorism, and public health threats.
In 2021, the Center developed and disseminated
10 unique fact sheets and infographics address­
ing mental health aspects of the pandemic and its
impact on health care workers, families and pa­
tients, and community and military leaders. These
fact sheets addressed unique issues, including
reintegration and recovery of health care workers
after COVID-19 operations, managing grief andstress during the holiday season, and support fromsupervisors in assisting workers returning to theworkplace. These fact sheets continued to serve
as essential education resources to support global
mental health response to COVID-19 for the United
Nations, NATO ally nations, National Academiesof Sciences, Engineering, and Medicine, American
Medical Association, National Association of State
Mental Health Program Directors, Assistant Sec­
retary for Preparedness and Response, Centers for
Disease Control and Prevention, American Psychiat­
ric Association, American College of Physicians, andnumerous others.

WebsiteThe CSTS website is a primary
tool that is used to further the goalof disseminating relevant and timely
information to a wide range ofstakeholders(www.CSTSonline.org). Throughout
the year, CSTS personnel continual­ly added content and made content
more accessible. Material available
on the website includes summaries
of current research activities, publication citations,newsletters, conference reports, and a searchable re­pository of CSTS disaster mental health education fact
sheets. The website includes a “What’s New” section tohighlight recent disaster education materials, research
initiatives, publications, conference summaries, andannouncements of upcoming events.
In 2021, the CSTS website had 40,720 users from167 countries around the world, with 29,330 (72%) ofusers from the U.S. On average, 112 users visited thesite daily throughout 2021. The top 5 countries each
had over 650 users visit in 2021. Desktop viewership
remained the most used viewing style on the website,
at 32,396 users. Mobile devices were used to view thewebsite by 7,697 users and tablets had 455 users.
The most viewed section in 2021, other than themain page, was the COVID-19 Pandemic Response Re­
sources section, which was also the most popular pagein 2020 and beat the main page in views for the firsttime that year. That page had a total of 7,774 users in
2021, with an average length time on the page being 3
minutes and 25 seconds.

Social MediaIn 2021, the Center continued to grow its online
presence through the use of social media. Social media
resources allow for the timely dissemination of relevant
content to our partners and the public. CSTS Twitter
followers increased by 8% and CSTS Facebook fol­lowers increased by 10% in the past year. The Centerencourages people to visit and follow CSTS postings via
Twitter and Facebook to stay up-to-date on new CSTS
activities and publications. “Like” CSTS on Facebook
at Center for the Study of Traumatic Stress and follow
CSTS on Twitter @CSTS_USU.
2021 ANNUAL REPORT | 23

Consultation
Consultation has 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. These consultations serve as avaluable mechanism to ensure that CSTS staff areaware of, and responsive to, those who face chal­lenges and opportunities related to trauma of many
types. Since its inception, the Center has developed
and maintained partnerships with, and provides
consultation to, many agencies and organizations
throughout the DoD and other federal agencies, aswell as with state, local, and national agencies, pro­fessional associations, and international organiza­
tions. The Center has established many long-stand­ing organizational relationships and is continuously
increasing its consultative activities with newpartners. The following are examples and updates ofsome long-standing CSTS consultations as well assome new activities.
COVID-19 has remained a critical source of trau­
ma and stress in every part of the world, and a cen­tral focus of CSTS’ work. The work has been facili­tated by the many long-standing relationships CSTS
has developed both inside the U.S. and internation­
ally. These consultations have facilitated rapid, highquality, and creative contributions in the wake of thepandemic. CSTS continues to provide a resource
website with customized, just-in-time, public mental
health education fact sheets to help families, healthcare personnel, military and community leaders, andbusinesses plan for, and respond to, the COVID-19
global outbreak. These resources have been sharedwith national, federal, and international partners andare widely disseminated throughout CSTS networks.
Examples of the key national and international enti­
ties with which CSTS work are described below.

U.S. GOVERNMENTCSTS leadership is frequently asked to consult
with a variety of federal entities. These consultations
24 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

continued in 2021. As a reflection of the credibility
and reputation of CSTS personnel, CSTS leadership
was invited to provide novel consultation. For exam­
ple, following the January 6, 2021 violence at the U.S.
Capitol, at the request of the Attending Physician of
the U.S. Congress, CSTS leaders conducted a consul­
tation with the Democratic Spouses Forum to discuss
normal responses to stress and trauma.

DEPARTMENT OF DEFENSECSTS continues to provide leadership and consul­
tation within the DoD. Materials developed by CSTS
are heavily utilized by many components of the DoD
and those it serves. For example, military families area core focus for CSTS and those efforts are discussed
in detail in other parts of this report.
The Center has a long partnership with the Joint
Mortuary Affairs Center and broader mortuary affairs
community, providing ongoing education and training
post-deployment to mitigate adverse effects of expo­
sure to human remains for military personnel. Thoseefforts continued in full force during 2021. A CSTS
Scientist gave a presentation titled “Stress and resil­
iency in U.S. Army mortuary affairs operations: War
fighting and humanitarian missions” to the Central
Joint Mortuary Affairs Board (CJMAB). The presenta­tion was at the Board’s request for information com­paring mortuary affairs war fighting/OCONUS op­
erations and Humanitarian/Defense Support of Civil
Authorities/CONUS operations. The presentation wasdelivered virtually and there were approximately 50
individuals (military and civilians) in attendance.
That same Scientist participated in a consultation
discussing just-in-time training in handling humanremains for inexperienced personnel. Participants in­cluded individuals from the Defense Support of Civil
Authorities (DSCA), ARNORTH, NORAD, NGB, U.S.
Marine Corps (USMC), and Joint Mortuary AffairsCenter (JMAC).
In addition, consultation, guidance, and recom­
mendations for mortuary affairs operations in war

fighting, defense support of civil authorities, andhumanitarian missions was provided. The results
will be included in an upcoming publication titled“NORAD and USNORTHCOM Instruction XX-XX,
Operational Mortuary Affairs Support in the Home­
land.”The CSTS Deputy Director was sought out by
the Defense Threat Reduction Agency as a DoD
subject matter expert in response to a request fromthe Indonesian Army to present at their conference“Lessons Learned from COVID-19” on the issue ofsustaining health care workers and military per­sonnel during COVID-19. He was the sole repre­
sentative from DoD at the conference that brought
together more than 600 military leaders in theIndonesian Army, including the current and former
Surgeons General and numerous other flag officers.
The presentation resulted in nearly 50 questions
from audience members that led to more than anhour of discussion and engagement on matters of
psychological health and military readiness during
global disasters.
Center Scientists were sought out by the Joint
Theatre System (JTS), a multi-national consortium
led by the United States. The JTS works to ensure
the safe and timely care and movement of military
personnel requiring aerovacuation for medicalcare, and educate JTS personnel from over a dozen
nations on the psychological and behavioral effectsof trauma in order to enhance care of military per­sonnel during evacuations. This consultation led to
the JTS development of a Behavioral Health Clin­
ical Practice Guideline to optimize health care formilitary personnel as well as those providing care forindividuals experiencing mental health concerns.
Another CSTS Scientist provided consultation in
the Military Operational Research Program PTSD
treatment portfolio virtual Interim Progress review.
The Center Director was asked to serve as amember of a distinguished work group to revise the
VA/DoD Clinical Practice Guideline on the Man­
agement of Acute Stress Disorder and PosttraumaticStress Disorder. This guideline document is the mostcontemporary, seminal global document guiding thecare of trauma-related disorders for both militaryand civilian personnel.

United States Agency for International
Development (USAID)
In 2021, CSTS leadership was asked to consult withleaders of the U.S. Agency for International Develop­
ment (USAID) to explore a variety of interests regard­
ing their need to optimize crisis services to USAID
workers in the field. USAID has staff located through­out the world, often in austere and distant locations. In
addition to their usual activities, USAID has Disaster
Assistance Response Teams (DART) that respond toa wide variety of international disasters (e.g., earth­quakes). Providing services in the event of acute andongoing stressors (e.g., death of a colleague) presents
numerous policy and practical challenges. Several
senior USAID leaders, including U.S. Forest Service andState Department Medical representatives, participate
in this ongoing consultation. This consultation is in its
early stages and is expected to continue and expand
going forward.

United States Coast Guard (USCG)
A former CSTS Scientist is now a USPHS psychia­
trist serving in the USCG. Her transition has provided
the opportunity for regular, diverse, and sometimes
specialized consultation. As an example of the impor­tance of this relationship, CSTS was contacted regard­
ing a particularly complex mental health issue aboard
a vessel. Center Scientists provided education, consul­
tation, and resources to senior Coast Guard behavioral
health leaders to optimize response, enhance readiness,and promote recovery in support of homeland security.

The National Center for Disaster Medicine andPublic Health (NCDMPH)
CSTS maintained a strong and growing partnershipwith NCDMPH. The major collaboration between thesetwo USU Centers, completed in 2020, was the second
edition of the Curriculum Recommendations for Disas­ter Health Professionals: Disaster Behavioral Health,which remains a seminal resource actively utilized as
the de facto guidance on disaster behavioral health ed­
ucation curriculum throughout the global community.
A Center Scientist served as an Associate Editor for thejournal Disaster Medicine and Public Health Prepared­
ness, a publication affiliated with NCDMPH.
2021 ANNUAL REPORT | 25

U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES (DHHS)
The national leadership role of CSTS in disasterbehavioral health response and the impact of psy­
chosocial factors on workers in extreme events ismade possible by our links to federal entities outsideof the DoD. Several of these entities reside within
DHHS. DHHS disaster and trauma responsibilities
overlap with and are a complement to the activities
of CSTS. The primary DHHS partner of CSTS is theAssistant Secretary for Preparedness and Response(ASPR).

Assistant Secretary for Preparedness andResponse (ASPR)
During 2021, CSTS continued and expanded its
collaboration with ASPR staff and leadership. This
long-standing relationship allows the Center toenhance awareness of existing and emerging federal
issues and initiatives and to provide evidence-based
consultation and information sharing of issues relat­
ed to disasters and emergencies.
The continuing challenges of COVID-19
throughout the year have intensified these relation­
ships and have included partners from an expanded
variety of federal departments and agencies. Twosenior CSTS leaders actively participate in regularmeetings with an ASPR-led group representing
many federal agencies, all of which are engaged in
missions related to the behavioral health sequelae
of COVID-19. The purpose of these meetings is to
identify resources developed by all of the parties for
integration into a common location. In addition, thegroup identified gaps in resources that can direct
future efforts of member institutions. This activity issignificant in the government-wide scope of CSTS
activities and consultations. This provides the oppor­
tunity to share CSTS expertise with various federal
stakeholders and to help influence the work of theparticipating departments and agencies. Participantsin the group now typically include: the CDC, FEMA,
ACF, FBI, and Vibrant Emotional Health (providerof federally-supported disaster distress and suicide
prevention helplines).
26 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Substance Abuse and Mental Health Services
Administration (SAMHSA)SAMHSA has been one of the Center’s partners
since SAMHSA’s founding in 1992. SAMHSA is thelead federal agency responsible for supporting andimproving national mental health services. CSTS
leadership has continued to provide regular consul­
tation to the SAMHSA Emergency Coordinator andthe Regional Coordinators, as well as advice to theagency’s Technical Assistance efforts.

Centers for Disease Control and Prevention(CDC)
Center Scientists have worked with CDC
partners addressing the psychological impactsof COVID-19 on communities as well as agency
responders, who have been tasked with extremes ofstress in the work setting, resulting from constantand ongoing deployments, uncertainty surround­ing the pandemic, and negative response in somecommunities to CDC recommendations. In addi­tion, CSTS has provided consultation and support to
the CDC’s Community Vaccine Engagement team,providing guidance on psychological factors related
to COVID-19, in order to optimize communicationand messaging that enhance health behavior engage­
ment across a broad range of communities.

INAUGURAL SUPPORTIn light of the community concerns and threatsof violence in the nation’s capital and around thecountry, the CSTS Director and Deputy Director
were consulted by representatives from the National
Guard of NY, NV, TN, MI, NH, and DC to explore
ways to assist Service members who were activat­
ed in support of the Presidential Inauguration activ­
ities. This collaboration involved sharing education
resources from the Center as well as assisting the
National Guard with efforts to prepare Guard mem­bers to manage unique exposures during activationand how to support Service members and their fami­lies following return from activations.

PROFESSIONAL ORGANIZATIONSNational Association of State Mental Health
Program Directors (NASMHPD)The Center’s nearly two-decade-long relationshipwith NASMHPD continues to thrive and expand.
NASMHPD is a membership organization repre­
senting state mental health authorities (Commis­
sioners) responsible for preparedness, response, andrecovery from large- and small-scale disasters. CSTS
assists the Commissioners in addressing the many
challenges inherent in those systems, including
issues faced by military families and veterans whoare served by the state public mental health systems.
Leaders of both organizations are in frequent andregular contact throughout the year to share con­cerns and strategies together. NASMHPD remains a
key distribution and utilization vehicle for the Cen­
ter’s targeted public information products.
The relationship with NASMHPD became evencloser during 2020 in response to COVID-19 andthe challenges faced by the states. This continued in
2021.
In 2021, the Deputy Director and an Associ­ate Director responded to a request for consulta­
tion from NASMHPD regarding supporting state
mental health authorities. A senior representativefrom DHHS ASPR joined the consultation thatcovered topics including practical advice regarding
state mental health activation of emergency plans,
inclusion in state Continuity of Government (COG)
and Continuity of Operations Plan (COOP) plans,leadership roles, support of staff, monitoring ofservice recipients, and the relationship to January
6 events. This request resulted in CSTS and ASPR
leading a national webinar entitled, “Leadershipduring COVID-19, Vaccine Distribution, and the
Unrest.” Participants included the Authorities
themselves as well as their Medical Directors andother senior staff. The presentation focused on
the complexity and interaction of ongoing events,
their personal and programmatic implications forsenior leaders, and potential considerations in the
future. This represents the second such presenta­tion NASMHPD has requested from CSTS for theirmembership in the era of COVID-19.
Currently, NASMHPD hosts monthly meetings
that include CSTS leaders, ASPR, and others as ap­
propriate to identify challenges, share resources, andpromote harmonization of federal behavioral healthefforts germane to the public mental health system,with an ongoing focus on the mental health impactsof the COVID-19 pandemic, and other disaster eventson community members and organizations.

National Child Traumatic Stress Network(NCTSN)The Center has been an integral partner with
NCTSN since its inception. This close relationshiphas continued during 2021. As an example, a CSTS
Associate Director was a central member of a NCTSN
group to discuss COVID-19, grief, and loss in chil­dren. This group included 16 experts in the field ofchild grief and trauma.

Military Child Education Coalition (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 partnership with MCEC.

National Academies of Sciences, Engineering,and Medicine (NASEM)
The Deputy Director was invited to deliver apresentation entitled “Climate-Related Disasters andMental Health: Impact, Risk, and Interventions” aspart of an activity on “The Interplay Between Envi­ronmental Exposures and Mental Health Outcomes.”
This activity was hosted by the NASEM Standing
Committee on Emerging Science for Environmental
Health Decisions, to better understand the impact ofenvironmental disasters on communities, including
specific effects on marginalized populations that may
be exacerbated by underlying health inequities andsystemic racism.

The American Psychiatric Association (APA)
CSTS personnel assisted in the initiation of the
APA’s efforts in disaster psychiatry by establishing theCommittee on the Psychiatric Dimensions of Disas­2021 ANNUAL REPORT | 27

ter in 1992. The Center has continued to be actively
involved in this and other APA activities for the
past three decades. CSTS works with the APA andother national medical associations to educate andtrain health professionals on disaster and preventive
psychiatry.
During 2021, CSTS leadership further strength­
ened the APA’s role in disaster and preventive psy­
chiatry, with the Center’s Deputy Director continu­
ing to serve as Chair of APA’s Disaster Committee
and two CSTS Scientists serving as members of thecommittee in positions of leadership. Center Scien­tists provided consultation to APA leadership on is­sues of national mental health related to the colliding
disasters that occurred against the backdrop of the
global COVID-19 pandemic.
The CSTS Deputy Director and a Senior Scientist
presented an invited Distinguished Lecture during
the APA’s 2021 Annual Meeting on individual andcommunity trauma. The meeting was attended by
586 APA members and included a Q&A session after
the presentation. The talk highlighted the work of
CSTS in better understanding the broad impact of
trauma on individuals and communities in which
they live and work, from the neurobiological changes
to the expression of distress, risky health behaviors,and psychological disorders. The presentation also
addressed the broad range of interventions delivered
immediately following trauma as well as following
the onset of clinical disorders.

American Association of Directors of
Psychiatry Residency Training
Four CSTS Scientists delivered a workshop formembers of the American Association of Directorsof Psychiatry Residency Training on training resi­
dents in core principles of disaster and preventive
psychiatry. This interactive workshop drew nearly
50 Psychiatry Residency Program Directors fromaround the country. The workshop highlighted im­
portant principles of disaster and preventive psy­
chiatry, highlighting how many of these principles
build on existing skills already taught in Psychiatry
training programs. The workshop was followed bygroup discussions regarding current training efforts,
barriers to training, and other aspects of how to
28 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

implement this training and education to prepare
future generations of psychiatrists to support theirpatients and communities through effective disaster
preparedness, response, and recovery.

College for Behavioral Health Leadership(CBHL)The CBHL comprises public and private lead­ers in behavioral health across the nation. The
CSTS Deputy Director was invited by CBHL lead­ership to consult on concerns being expressed bymember organizations regarding stress related tothe transition back to the workplace during the
COVID-19 pandemic. The CSTS Deputy Director
also delivered a presentation on understanding
the effects of prolonged crisis events and how toprotect mental health, well-being, and functioning
during COVID-19 to the largest CBHL organizationconsisting of over 800 personnel working in over adozen countries. CBHL has disseminated numer­
ous CSTS fact sheets to all member organizations,
including fact sheets on managing the stress of
returning to work as well as issues of grief and stressduring the holiday season during the pandemic.

Tragedy Assistance Program for Survivors(TAPS) Institute
CSTS has been a partner and advisor to TAPS
for many years. In 2021, an Associate Director
co-presented a webinar entitled “Grief Leadership:
What Can We Learn From the Story of the Life andService of Captain America?” to the TAPS Institutefor Hope and Healing. The webinar was open to thegeneral public and approximately 75 individuals
attended.
A CSTS Scientist consulted on the TAPS Scientif­
ic Advisory Board for their virtual quarterly gather­ing. The goal of this meeting was to inform advisoryboard members of the TAPS mission, discuss theircurrent initiatives, and identify opportunities forscientists to further engage with military survivors.

First Responder Center of Excellence
The First Responder Center of Excellence is a na­
tional organization dedicated to protecting the livesof first responders nationwide. Since its inception,

it has had a significant focus on behavioral healthfactors impacting their members.
At its 2021 Annual Meeting, a CSTS Associate
Director gave the initial keynote address to its vir­tual Fire Service Behavioral Health Symposium.
His address was titled “Public Health, Behavior­al Health, and the First Response Community:
Exploring the Intersections.” There were approxi­
mately 1,700 participants.
Another CSTS Senior Scientist spoke at thesame symposium with an address entitled “Pre­paring Clinicians for our Nation’s Military.” Hepresented an overview of the training of military
physicians and mental health providers from a his­
torical and contemporary perspective. The points
he emphasized were the need for clinical compe­
tence, cultural competence, and understanding
operational support.

Accreditation Council on Graduate Medical
Education
The Accreditation Council on Graduate Med­
ical Education asked the Deputy Director to serve
as a subject matter expert and consultant in theirestablishment of a well-being curriculum to en­
hance education, protect health, and reduce inci­
dence of long-term burnout in resident physicians.
In addition, they sought to fully leverage his role as
Chair of the Disaster Committee for the APA in ad­
dressing issues of well-being and sustainment of theworkforce through COVID-19 and other disasters.

Federation of Associations in Behavioral
and Brain Sciences (FABBS)A CSTS Scientist attended the annual meetingsof the FABBS Board of Directors and Council (heldvirtually). In her role as Member-at-Large on the
Board, she co-led breakout sessions on (1) Con­necting Science to Policy and (2) Advocating for
the Behavioral and Cognitive Sciences at NIH. Also
attending were representatives of the Office ofBehavioral and Social Science Research, National
Institutes of Health, National Science Foundation,
American Psychological Association, Government
Accountability Office, and representatives of the 29
scientific societies comprising FABBS.

Mount Sinai Health System
Center Scientists were consulted by the Well-Be­
ing Center for the Mount Sinai Health System todiscuss adapting military principles to enhance
resilience for health care workers during times ofincreased stress resulting from COVID-19 as wellas increased episodes of interpersonal violence inthe workplace. Mount Sinai subsequently developed
a peer support program modeled after the military“Battle Buddy” concepts in order to promote safe­ty, social support, and self-efficacy and enhancewell-being and sustain operational performance
during acute and prolonged crisis events.

STATE AND CITY CONSULTATIONS
California
A CSTS Associate Director was asked by acoalition of California organizations, an integrated
effort between University of California, San Fran­cisco (UCSF), The California Department of Health,and UCLA, to advise on stress-related issues of
COVID-19 case-finders and contract-tracers. As aresult of those discussions, he was invited to pres­ent a webinar entitled “Disaster Behavioral Health& COVID-19: Applied History & Novel Challeng­es.” It was presented at a Town Hall meeting of the
UCSF Communities of Practice. A question-and-an­
swer period followed the presentation, and he re­sponded in writing to questions remaining from thewebinar. There were 228 people in attendance.

New York City
CSTS Scientists have been very involved in the
New York City response to the COVID-19 pandem­
ic, and these relationships have continued in 2021.
The Department Chair and a CSTS Senior Scientist
facilitated focus groups with wellness leaders frommultiple hospitals in New York City as part of the
HERO-NY project.

MissouriAt the request of the Missouri Department of
Mental Health, a CSTS Associate Director provided
consultation on conceptualization and developmentof the State’s and Department’s approach to ad­
2021 ANNUAL REPORT | 29

dress the psychosocial responses to multiple andsimultaneous stressors, such as natural disasters,
pandemics, social unrest, community violence andeconomic hardship.

FloridaThe CSTS Deputy Director was contacted by
the Florida Blue health insurance provider, whichis leading a coalition of organizations at the gov­
ernor’s request to support community health andrecovery following the Surfside condominium
collapse. This coalition includes the Florida state
emergency management and mental health au­
thorities, the governor’s office, Health and Human
Services, the Red Cross, and other private sec­
tor organizations providing a range of resources
to victims and other community members. He
engaged with the group to better understand theirfocus and goals, and provided consultation regard­
ing the range of impacts, populations at risk, andapproaches to interventions throughout the disas­
ter life cycle. He also provided them with CSTS
resources to support their efforts.

INTERNATIONAL OUTREACH
The reach of CSTS consultation activities
extends beyond the nation’s borders to the interna­
tional community. The following are examples of
CSTS international activities in 2021.

International Ministerial 5-Eyes Alliance
The Center Director and Deputy Director con­tinued work with the 5-Eyes Mental Health ResearchInternational Collaboration (MHRIC). The 5-Eyes
MHRIC met to share evolving challenges and bestpractices around mental health and force protection
related to COVID-19 and other converging disasters.
The group collaborated on sharing resources andpractices following the withdrawal of troops andresettlement of citizens from Afghanistan, including
publishing an article in a respected international
journal on important aspects of supporting men­tal health and well-being of Service members who
may have fought in or during Operation Enduring
Freedom and for whom the transition of militaryforces out of Afghanistan may have a range of psy­chological and behavioral effects. In addition, the5-Eyes MHRIC authored a scholarly review article ofpathways to mental health care for military Service
members and veterans, similarities and differencesin these across nations, and how they have evolved
over time.

World Psychiatric Association (WPA)

Dr. Morganstein speaking at an international
conference.

30 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

A CSTS Scientist participated in the 20th WPAWorld Congress of Psychiatry Panel Discussion 04,
entitled “Classification of Mental Disorders: Un­resolved Issues.” The Panel included experts from
Germany, Thailand, Russia, Mexico, Morocco, andthe U.S. The audience for this virtual conference
included more than 3,000 viewers from 108 different
countries.

This CSTS Scientist made a presentation that was
included in a WPA webinar series entitled “Meet theExpert.” The topic was “The Interaction of Psychi­
atric Classification and Epidemiology Develop­
ments.” It focused on the influence of classificationon the ability to identify mental disorder cases in
populations and the reciprocal impact of epidemio­
logical findings on classifications over the past 100
years. The webinar had an international audience of
650 attendees.
The Center Deputy Director was invited to talk on
the impact of COVID-19 on global mental health witha focus on health care workers. The presentation ad­
dressed the broad mental health impact of COVID-19
and unique effects and exposures for the health care
workforce, groups at elevated risk for adverse out­
comes and various protective factors, and a frame­
work for public mental health interventions by indi­viduals, organizations, and leaders that can promote
well-being and sustain operations during prolonged
crisis events, such as the COVID-19 pandemic.

International Initiative of Mental Health
Leadership (IIMHL)
In 2021, the Center continued its partnershipwith IIMHL. IIMHL represents senior public mental
health leadership in member countries focusing on
improving mental health services. Member countries
are the U.S., Canada, England, Scotland, the Repub­
lic of Ireland, Australia, New Zealand, and Sweden.

European College of Neuropharmacology(ECNP)The CSTS Director was an invited speaker for the
ECNP Traumatic Stress Network “Hot Topics” virtual
meeting. During the meeting, he presented an over­view of the Army STARRS based on previous publi­
cations. Attendees included students, trainees, andpsychiatrists from more than 30 countries.

Germany Ministry of Defense
The Department Chair and a CSTS Scientist met witha delegation from the German Ministry of Defense
visiting USU, WRNMMC, and the DHA HQ to
exchange information regarding ongoing research on
identification of risk and protective factors related tosuicide in Service members, as well as treatments forcombat-related behavioral health disorders.

IsraelThe Department Chair participated in a workshop
at the Israeli Embassy, entitled “Introduction to Oper­
ational Stress Management: Equipping Our Frontline
Heroes with Tools for Resilience.” The workshop wassponsored by the Israeli Embassy and the Israeli NGO
NATAL, and participants were 18 invited internationallaw enforcement leaders and stakeholders. Topics of
discussion included implementation and developmentof wellness and resilience training for law enforcement
personnel and other first responders.

The Netherlands
The CSTS Deputy Director presented on the
topic of leadership issues related to reintegration andrecovery at a multi-national event established by the
Netherlands Ministry of Defense and the Invictus
Games, entitled “Warrior Care in the 21st Century.”
The event brought together global leaders in mili­tary health to discuss current and emerging issuesof readiness and force health protections in orderto facilitate recovery from COVID-19, and includ­ed representatives from the U.S., United Kingdom,
the Netherlands, Australia, and New Zealand. The
lessons learned will inform global health security
measures pertaining to COVID-19 and future global
health emergencies.
2021 ANNUAL REPORT | 31

Publications(Names in bold text are CSTS personnel)
JOURNAL ARTICLES
Biggs, Q. M., Ursano, R. J., Wang, J., Wynn, G.
H., Amin, R., & Fullerton, C. S. (2021). Daily
variation in sleep characteristics in individuals
with and without post traumatic stressdisorder. BMC Psychiatry, 21(292). doi: 10.1186/
s12888-021-03282-3
Bossarte, R. M., Ziobrowski, H. N., Benedek, D.
M., Dempsey, C. L., King, A. J., Nock, M. K.,
Sampson, N. A., Stein, M. B., Ursano, R. J., &Kessler, R. C. (2021). Mental disorders, gunownership, and gun carrying among soldiers after
leaving the Army, 2016-2019. American Journal of
Public Health, 111(10), 1855–1864. doi: 10.2105/
AJPH.2021.306420
Campbell-Sills, L., Kautz, J. D., Choi, K. W., Naifeh,
J. A., Aliaga, P. A., Jain, S., Sun, X., Kessler, R. C.,
Stein, M. B., Ursano, R. J., & Bliese, P. D. (2021).
Effects of prior deployments and perceived
resilience on anger trajectories of combatdeployed soldiers. Psychological Medicine, 1–10.
doi: 10.1017/S0033291721003779
Dempsey, C. L., Benedek, D. M., Nock, M. K.,
Zuromski, K. L., Brent, D. A., Ao, J., Aliaga, P.
A., Heeringa, S. G., Kessler, R. C., Stein, M. B., &Ursano, R. J. (2021). Social closeness and support
are associated with lower risk of suicide among
U.S. Army soldiers. Suicide and Life-Threatening
Behavior. doi: 10.1111/sltb.12778
Fikretoglu, D., Sharp, M.-L., Adler, A. B., Bélanger,
S., Benassi, H., Bennett, C., Bryant, R., Busuttil,W., Cramm, H., Fear, N., Greenberg, N., Heber,A., Hosseiny, F., Hoge, C. W., Jetly, R., McFarlane,A., Morganstein, J., Murphy, D., O’Donnell, M.,
Phelps, A., Richardson, D. J., Sadler, N., Schnurr,
P. P., Smith, P., Ursano, R., Hooff, Wessely, S.,
Forbes, D., & Pedlar, D. (2021). Pathways tomental health care in active military populations
across the Five-Eyes nations: An integrated
perspective. Clinical Psychology Review, 91,
102100. doi: 10.1016/j.cpr.2021.102100
Flynn, B. W., Vance, M. C., West, J. C.,
Morganstein, J. C., & Fullerton, C. S. (2021).
32 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Disaster behavioral health research involving
military facilities and populations after mass
violence: Insights from the 2013 Washington
Navy Yard Shooting. Disaster Medicine andPublic Health Preparedness, 1-6. doi: 10.1017/
dmp.2021.64
Giannakopoulou, O., Lin, K., Meng, X., Su, M. H.,
Kuo, P. H., Peterson, R. E., Awasthi, S., Moscati,A., Coleman, J., Bass, N., Millwood, I. Y., Chen,
Y., Chen, Z., Chen, H. C., Lu, M. L., Huang, M.
C., Chen, C. H., Stahl, E. A., Loos, R., Mullins,
N., … 23andMe Research Team, China Kadoorie
Biobank Collaborative Group, and Major
Depressive Disorder Working Group of thePsychiatric Genomics Consortium (2021). The
genetic architecture of depression in individualsof East Asian ancestry: A genome-wide
association study. JAMA Psychiatry, 78(11), 1258­
1269. doi: 10.1001/jamapsychiatry.2021.2099
Harrison, E. M., Easterling, A. P., Schmied, E.
A., Hurtado, S. L., & Glickman, G. L. (2021).
Chronotype and self-reported sleep, alertness,and mental health in U.S. sailors. Military
Medical Research, 8(1), 43. doi: 10.1186/s40779­
021-00335-2
Hunter, M. T., & Morganstein, J. C. (2021). Reviewof the book Irresistible: The rise of addictive
technology and the business of keeping us
hooked by A. Alter. Psychiatry: Interpersonal andBiological Processes, 84(2), 204-206.
Hupalo, D., Forsberg, C., Goldberg, J., Kremen, W. S.,
Lyons, M. J., Soltis, A. R., Viollet, C., Ursano, R.
J., Stein, M. B., Franz, C. E., Sun, Y. V., Vaccarino,
V., Smith, N. L., Dalgard, C. L., Wilkerson, M. D.,& Pollard, H. B. (2021). Rare variant association
study of Veteran twin whole-genomes links
severe depression with a nonsynonymouschange in the neuronal gene BHLHE22. World
Journal of Biological Psychiatry, 1–18. doi:
10.1080/15622975.2021.1980316
Khan, A. J., Campbell-Sills, L., Sun, X., Kessler, R. C.,
Adler, A. B., Jain, S., Ursano, R. J., & Stein, M.
B. (2021). Association between responsibility forthe death of others and postdeployment mental
health and functioning in U.S. Soldiers. JAMA
Network Open, 4(11), e2130810. doi: 10.1001/
jamanetworkopen.2021.30810
Kim, S. Y., Buckenmaier, C. C., Howe, E. G., &Choi, K. H. (2021). The newest battlefield opioid,sublingual sufentanil: A proposal to refine opioid
usage in the U.S. Military. Military Medicine,
usab395. doi: 10.1093/milmed/usab395
Knox, D. M., Leshen, G. E., & Teisberg, M. B. (2021).
Pandemic impacts on Cluster B personality
disorders in the U.S. Navy: A case study incontext. Military Medicine, usab441. doi: 10.1093/
milmed/usab441
Lee, R. U., & Glickman, G. L. (2021). Sleep, circadian
health and melatonin for mitigating COVID-19
and optimizing vaccine efficacy. Frontiersin Neuroscience, 15, 711605. doi: 10.3389/
fnins.2021.711605
Maihofer, A. X., Choi, K. W., Coleman, J., Daskalakis,
N. P., Denckla, C. A., Ketema, E., Ursano, R. J.,
Nievergelt, C. M. (2021). Enhancing discovery ofgenetic variants for posttraumatic stress disorderthrough integration of quantitative phenotypes
and trauma exposure information. BiologicalPsychiatry, S0006-3223(21)01632-2.
Mash, H. B. H., Fullerton, C. S., Morganstein, J.
C., Vance, M. C., Wang, L., Liu, A. G, MullinsHussain, B., & Ursano, R. J. (2021). Longitudinal
study of hurricane preparedness behaviors:
Influence of collective efficacy. Disaster Medicine
and Public Health Preparedness. doi: 10.1017/
dmp.2020.504
Mash, H., Ursano, R. J., Kessler, R. C., Naifeh, J. A.,
Fullerton, C. S., Aliaga, P. A., Riggs-Donovan,
C. A., Dinh, H. M., Vance, M. C., Wynn, G. H.,
Zaslavsky, A. M., Sampson, N. A., Kao, T. C., &Stein, M. B. (2021). Predictors of suicide attempt
within 30 days after first medically documented
suicidal ideation in U.S. Army Soldiers. American
Journal of Psychiatry, 178(11), 1050-1059. doi:
10.1176/appi.ajp.2021.20111570
Morganstein, J. C., & Flynn, B. W. (2021).
Enhancing psychological sustainment &promoting resilience in healthcare workers
during COVID-19 & beyond: Adapting crisis
interventions from high-risk occupations. Journalof Occupational and Environmental
Medicine, 63(6), 482-489. doi: 10.1097/
JOM.0000000000002184
Morganstein, J. C., Wynn, G. H., & West, J. C.
(2021). Post-traumatic stress disorder: Update on
diagnosis and treatment. BJPsych Advances, 27(3),184-186. doi: 10.1192/bja.2021.13
Mullins, N., Kang, J., Campos, A. I., Coleman, J.,

Edwards, A. C., Galfalvy, H., . . ., Ursano, R.
J., … Ruderfer, D. M. (2021). Dissecting theshared genetic architecture of suicide attempt,
psychiatric disorders, and known risk factors.
Biological Psychiatry, 91(3), 313–327. https://doi.
org/10.1016/j.biopsych.2021.05.029
Naifeh, J. A., Mash, H., Stein, M. B., Vance, M. C.,
Aliaga, P. A., Fullerton, C. S., Dinh, H. M.,
Wynn, G. H., Kao, T. C., Sampson, N. A., Kessler,
R. C., & Ursano, R. J. (2021). Sex differences in
US Army suicide attempts during the wars in Iraq
and Afghanistan. Medical Care, 59(2 Suppl), S42–
S50. doi: 10.1097/MLR.0000000000001425
Naifeh, J. A., Nock, M. K., Dempsey, C. L., Georg,
M. W., 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. (2021). Associationof emotion reactivity and distress intolerance withsuicide attempts in U.S. Army soldiers. Suicideand Life-Threatening Behavior. doi: 10.1111/
sltb.12821.
Naifeh, J. A., Ursano, R. J., Stein, M. B., Mash, H.,
Aliaga, P. A., Fullerton, C. S., Dinh, H. M.,
Vance, M. C., Wynn, G. H., Kao, T. C., Sampson,
N. A., & Kessler, R. C. (2021). Risk of suicide
attempt in reserve versus active component
soldiers during deployment to the wars in Iraq
and Afghanistan. Suicide and Life-Threatening
Behavior, 52(1), 24–36. doi: 10.1111/sltb.12770
O’Donnell, C. J., Schwartz Longacre, L., Cohen, B. E.,
Fayad, Z. A., Gillespie, C. F., Liberzon, I., Pathak,G. A., Polimanti, R., Risbrough, V., Ursano, R. J.,
Vander Heide, R. S., Yancy, C. W., Vaccarino, V.,
Sopko, G., & Stein, M. B. (2021). PosttraumaticStress Disorder and cardiovascular disease: Stateof the science, knowledge gaps, and research
opportunities. JAMA Cardiology, 6(10), 1207–
1216. doi: 10.1001/jamacardio.2021.2530
Paxton Willing, M. M., Tate, L. L., Spangler, P. T.,
Benedek, D. M., Riggs, D. S. (2021). Anxiety
and depression mediate the relationship of
medication-resistant PTSD to quality of life inservice members. Military Behavioral Health. doi:
10.1080/21635781.2021.2013352
Polimanti, R., Levey, D. F., Pathak, G. A., Wendt,
F. R., Nunez, Y. Z., Ursano, R. J., Kessler, R.
C., Kranzler, H. R., Stein, M. B., & Gelernter, J.
(2021). Multi-environment gene interactions
2021 ANNUAL REPORT | 33

linked to the interplay between polysubstancedependence and suicidality. Translational
Psychiatry, 11(1), 34. doi: 10.1038/s41398-020­
01153-1
Shigemura, J., Ursano, R. J., Kurosawa, M.,
Morganstein, J. C., & Benedek, D .M. (2021).
Understanding the traumatic experiences ofhealthcare workers responding to the COVID-19
pandemic. Nursing & Health Sciences, 23(1), 7-8.
doi: 10.1111/nhs.12766
Smith, D. M., Meruelo, A., Campbell-Sills, L., Sun,
X., Kessler, R. C., Ursano, R. J., Jain, S., Stein,
M. B., & Army STARRS Team (2021). Pre­enlistment anger attacks and post-enlistment
mental disorders and suicidality among US Army
Soldiers. JAMA Network Open, 4(9), e2126626.
doi: 10.1001/jamanetworkopen.2021.26626
Soumoff, A. A., Clark, N. G., Spinks, E. A., Kemezis,
P. A., Raiciulescu, S., Driscoll, M. Y., Kim, S. Y.,
Benedek, D. M., & Choi, K. H. (2021). Somatic
symptom severity, not injury severity, predicts
probable Posttraumatic Stress Disorder andMajor Depressive Disorder in wounded Service
members. Journal of Traumatic Stress, 35(1),210–221. doi: 10.1002/jts.22722
Spangler, P. T. (2021). Reflections on the plague year:
Conducting psychotherapy research during the
COVID-19 pandemic. Psychotherapy Bulletin,
56(2), 18-22.
Stein, M. B., Jain, S., Campbell-Sills, L., Ware, E. B.,
Choi, K. W., He, F., Ge, T., Gelernter, J., Smoller, J.
W., Kessler, R. C., & Ursano, R. J. (2021). Polygenic
risk for major depression is associated withlifetime suicide attempt in US soldiers independentof personal and parental history of major
depression. American Journal of Medical Genetics.
Part B, Neuropsychiatric Genetics, 186(8), 469–475.
doi: 10.1002/ajmg.b.32868
34 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Ursano, R. J. (2021). Child psychotherapy before,
during and after COVID-19: Working with the
big kids…parents. Psychiatry, 84(2), 109. doi:
10.1080/00332747.2021.1924549
Vance, M. C., Mash, H. B. H., Ursano, R. J.,
Zhao, Z., Miller, J. T., Clarion, M., West, J. C.,
Morganstein, J. C., Iqbal, A., & Sen, S. (2021).
Exposure to workplace trauma and posttraumaticstress disorder among intern physicians. JAMA
Network Open, 4(6), e2112837. doi: 10.1001/
jamanetworkopen.2021.12837
Wang, J., Naifeh, J. A., Mash, H. B. H.,
Morganstein, J. C., Fullerton, C. S., Cozza, S.
J., Stein, M. B., & Ursano, R. J. (2021). Parental
suicide attempt and subsequent risk of pre­enlistment suicide attempt among male andfemale new soldiers in the U.S. Army. Suicideand Life-Threatening Behavior, 52(1), 59–68. doi:
10.1111/sltb.12772

BOOKS AND BOOK CHAPTERS
Morganstein, J. C., Mash, H. H., Vance, M. C.,
Fullerton, C. S., & Ursano, R. J. (2021). Public
mental health interventions following masscasualties. In M. J. Friedman, T. Keane, P. Schnurr(Eds.), Handbook of PTSD: Science and practice,
3rd ed (pp. 570-588). Guilford Press.
West, J. C., Wynn, G. H., & Benedek, D. M. (2021).
Pharmacotherapy for PTSD. In J. G. Beck & D. M.
Sloan (Eds.), The oxford handbook of traumaticstress disorders (2nd ed). Oxford University Press.
Zhang, L., Hu, X., Li, X., & Ursano, R. J. (2021).
Chemokines as potential biomarkers for PTSD
in military population. In N. V. Gorbunov (Ed.),
Current Topics on Military Medicine, (pp. 1-10)
IntechOpen, doi: 10.5772/intechopen.96133.

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

PRESENTATIONS
Burned out by wellness: What’s missing in theconversation about clinician wellness (Grand
Rounds). Vance, M. C., & Bumgardner, A.
Webinar presented at Walter Reed National
Military Medical Center, January 2021.
Leadership during COVID-19, vaccine distribution,and the unrest. Flynn, B. W., Kaul, R., &Morganstein, J. C. Webinar presentation for
the State Directors Monthly Call, National
Association of State Mental Health Program
Directors, January 2021.
Preparing residents for disaster response: COVID-19
and beyond. Morganstein, J. C., Vance, M.
C., West, J. C., & Santiago, P. N. Workshop
presentation for the American Association of
Directors of Psychiatry Residency Training,
January 2021.
Stress and resiliency in U.S. Army mortuary affairs
operations: War fighting and humanitarian
missions. Biggs, Q. M., McCarroll, J. E., Ursano,R. J., Fullerton, C. S., Mullins-Hussain, B., &Petrini, J. Virtual oral presentation to the Central
Joint Mortuary Affairs Board, January 2021.
Climate-related disasters and mental health: Impact,risk, and interventions. Morganstein, J. C.
Webinar presentation at the Interplay between
Environmental Exposures and Mental Health
Outcomes, Standing Committee on Emerging
Science for Environmental Health Decisions,
National Academy of Sciences, Engineering, andMedicine, February 2021.
Disaster psychiatry and behavioral health: From war
and terrorism to earthquakes and coronavirus.
Ursano, R. J. Virtual presentation at Cherry
Hospital (Goldsboro, NC), February 2021.
Seeing light at the end…Promoting resilience inthe workforce while leading toward recovery
from COVID-19. Morganstein, J. C. Webinar
presentation at the Winter Meeting on“Embracing Intentional, Compassionate
Leadership,” North Carolina Healthcare

Association, February 2021.
Classification of mental disorders: Unresolved
issues. Regier, D. A. Virtual panelist participant
at the World Psychiatric Association’s 20th World
Congress of Psychiatry, March 2021.
Promoting workforce resilience while leading toward
recovery from COVID-19. Morganstein, J. C.
Webinar presentation at “Emotional Well-being
and Recovery Town Hall,” University of Illinois
Health, March 2021.
Sustaining the healthcare workforce in the COVID
era: What can we learn from combat andoperational stress control? West, J. C. Virtualpresentation at the Arkansas Psychiatric Society’s
Annual Conference, March 2021.
The role of grief leaders. Cozza, S. J., & Harrington,
J. Virtual presentation at the VA/DoD Survivors
Forum, March 2021.
A comprehensive prevention matrix to address
risk factors for child neglect types in U.S. Armyfamilies. Miller, T. L., Ogle, C. M., Zuleta, R. F., &Cozza, S. J. Virtual poster presentation at the 15th
Annual Amygdala, Stress, and PTSD Conference:Stress and the Mind, April 2021.
A pilot study of app-based biofeedback in activeduty Servicemembers. Richardson, K., Phares,
A. M., Peechatka, A., Kahn, J., Aliaga, P., Azad,
A., & Teisberg, M. Virtual poster presentation
at the 15th Annual Amygdala, Stress, and PTSD
Conference: Stress and the Mind, April 2021.
Effect of individual and interpersonal factors
on recovery time following multiple Florida
hurricanes. Liu, A. G., Mullins-Hussain, B.,
Mash, H. B. H., Fullerton, C. S., Morganstein,
J. C., Wang, L., & Ursano, R. J. Virtual poster
presentation at the 15th Annual Amygdala, Stress,
and PTSD Conference: Stress and the Mind, April
2021.
Longitudinal neurochemical changes of Riluzole
augmentation in Posttraumatic Stress Disorder
treatment in a veteran sample. Phares, A. M.,
West, J. C., Spangler, P. T., Dempsey, C. L.,
Jiang, S. H., Lin, A. P., Hillman, K. I., Bolis, M.
2021 ANNUAL REPORT | 35

A., & Benedek, D. M. Virtual poster presentation
at the 15th Annual Amygdala, Stress, and PTSD
Conference: Stress and the Mind, April 2021.
National Guard and Reserve Soldiers: Social
support trajectories and suicide ideation. Wang,
J., Ursano, R. J., Gifford, R. K., Dinh, H.,
Weinberg, A., Cohen, G. H., Sampson, L., &Galea, S. Virtual poster presentation at the 15th
Annual Amygdala, Stress, and PTSD Conference:Stress and the Mind, April 2021.
Nightmare deconstruction and reprocessing fortrauma-related nightmares in military Service
Members and veterans: Preliminary pilot
results. Azad, A., Benedek, D. M., Bolis, M. A.,
Dempsey, C. L., Gill, J., Hillman, K. I., Phares,
A. M., West, J. C., Zhang, L., Hu, X., & Spangler,
P. T. Virtual poster presentation at the 15th
Annual Amygdala, Stress, and PTSD Conference:Stress and the Mind, April 2021.
Psychological resilience support material for Service
Members working with human remains: The MA­
STAR pocket card. Biggs, Q. M., Morganstein,J., Mullins-Hussain, B., Petrini, J., McCarroll, J.
E., Fullerton, C. S., & Ursano, R. J. Virtual poster
presentation at the 15th Annual Amygdala, Stress,
and PTSD Conference: Stress and the Mind, April
2021.
RECONsolidation of traumatic memories to ResOLve
Posttraumatic Stress Disorder (RECONTROL):
Preliminary results. Dunbar, K. E., O’Malley, H. S.,
Bellini, P. G., Spangler, P. T., Probe Adams, D.,
Dempsey, C. L., Gray, R. M., & Roy, M. J. Virtual
poster presentation at the 15th Annual Amygdala,Stress, and PTSD Conference: Stress and theMind, April, 2021.
Social closeness and support are associated withlower risk of suicide among U.S. Army Soldiers.
Dempsey, C. L., Benedek, D. M., Zuromski, K.
L., Nock. M. K., Aliaga, P., Ao, J., Georg, M. W.,
Mullins-Hussain, B., Weinberg, A., & Ursano,R. J. Virtual poster presentation at the 15th
Annual Amygdala, Stress, and PTSD Conference:Stress and the Mind, April 2021.
Mental health & COVID-19: Promoting resilienceand sustaining healthcare workers. Morganstein,
J. C. Grand Rounds presentation at Nemours/
Alfred I. DuPont Hospital for Children, April
2021.
Seeing light at the end…Promoting resilience inthe workforce while leading toward recovery
36 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

from COVID-19. Morganstein, J. C. Webinar
presentation at the Physician Business Leadership
Program, Iowa Hospital Association, April 2021.
Depression in U.S. Army Soldiers who handle theremains of the dead. Biggs, Q. M., McCarroll,J. E., Fullerton, C. S., Mullins-Hussain, B.,
Petrini, J., Steward, A. E., Wang, L., & Ursano,R. J. Virtual poster presentation at the Association
for Psychological Science Virtual Convention,
May 2021.
Effect of individual and interpersonal factors
on recovery time following multiple Florida
hurricanes. Fullerton, C. S., Liu, A. G., MullinsHussain, B., Mash, H. B. H., Morganstein, J.
C., Wang, L., & Ursano, R. J. Virtual poster
presentation at the Association for Psychological
Science Virtual Convention, May 2021.
Social closeness and support are associated withlower suicide risk among US Army Soldiers.
Dempsey, C. L., Benedek, D. M., Zuromski, K.,
Nock, M. K., Brent, D. A., Ao, J., Aliaga, P. A.,
Weinberg, A., Mullins-Hussain, B., Heeringa,
S. G., Kessler, R. C., Stein, M., & Ursano R.
J. Virtual poster presentation at the Association
for Psychological Science Virtual Convention,
May 2021.
Sex differences in U.S. Army suicide attempts during
the wars in Iraq and Afghanistan. Naifeh, J. A.,
Mash, H. B. H., Dinh, H. M., Fullerton, C. S.,& Ursano, R. J. Virtual poster presentation at
the Association for Psychological Science Virtual
Convention, May 2021.
Moral injury and COVID-19: Challenges for today,
implications for tomorrow. Maass-Robinson,
S., Yellowlees, P., Gise, L., & Morganstein, J. C.
Webinar presentation for the Annual Meeting of
the American Psychiatric Association, May 2021.
Identifying factors creating the historically unequal
impact of disasters including COVID-19 upon
marginalized communities. Bailey, R. K., Shear,
M. K., Gise, L., Robinson, S., & Morganstein, J. C.
Webinar presentation for the Annual Meeting of
the American Psychiatric Association, May 2021.
Individual and community trauma: Impact, risk, andinterventions. Morganstein, J. C., & Wynn, G.
H. Distinguished Lecture presented at the Annual
Meeting of the American Psychiatric Association,
May 2021.
Depression in U.S. Army Mortuary Affairs Soldiers.
Steward, A. E., Mullins-Hussain, B., Petrini,

J., Biggs, Q. M., McCarroll, J. E., Fullerton,
C. S., Wang, L., & Ursano, R. J. Virtual poster
presentation at Research Days, USUHS, May 2021.
Enhancing sustainment and mental health force
protection for military personnel during
COVID-19 and beyond. Morganstein, J. C.
Virtual presentation at the Pandemic COVID-19:
Lessons Learned and Efforts to Reinforce Health
Security to Accelerate COVID-19 Handling
Conference, Indonesian Army, May 2021.
Grief leadership: What can we learn from the story of
the life and service of Captain America? Cozza,
S. J., Carey, D. F., & Harrington, J. A. Webinar
presentation at the Tragedy Assistance Programfor Survivors (TAPS) Institute for Hope andHealing, May 2021.
Preparing clinicians for our nation’s military. West,
J. C. Keynote address at the virtual National
Fire Service Behavioral Health Symposium, First
Responder Center of Excellence, May 2021.
Public health, behavioral health, and the first
response community: Exploring the intersections.
Flynn, B. W. Keynote address at the virtual
National Fire Service Behavioral HealthSymposium, First Responder Center of Excellence,
May 2021.
Disasters & mental health: Protecting health andpromoting recovery in pandemics, terrorism,
war, & beyond. Morganstein, J. C. Presentation
at “Disaster Management 2021 and Beyond:Lessons Learned from Israeli, Canadian, and US
Experience,” American Healthcare Professionals
and Friends for Medicine in Israel, June 2021.
Enhancing mental health and recovery for militaryand civilian communities during COVID-19 andother disasters: The critical role of grief leadership.
Morganstein, J. C. Presentation at “Warrior
Care in the 21st Century,” Invictus Games andNetherlands Ministry of Defense, June 2021.
Enhancing well-being and sustainment for
healthcare workers during COVID-19 andbeyond. Morganstein, J. C. Presentation at
Annual Meeting, Society for Nuclear Medicine
and Molecular Imaging, June 2021.
Finding structure in chaos during COVID: Enhancing
psychological health for the military and beyond.
Morganstein, J. C. Presentation at “COVID-19
Research Day,” Uniformed Services University,
Henry Jackson Foundation for the Advancementof Military Medicine, and the Walter Reed Army

Institute of Research, June 2021.
Mental health in the COVID-19 pandemic (II).
Ursano, R. J. Webinar panelist presentation for
Disaster Psychiatry Canada, June 2021.
Stimulant sensitivity is associated with alcohol use
in women but not men. Fisher, V. L., Keppler, E.,
Wu, C. Y., Allen, K. J. D., & Gabbay, F. H. Virtual
poster presentation at the Annual Meeting of the
Research Society on Alcoholism, June 2021.
Strategies to provide meaningful application
information to program directors in a Step 1
pass/fail world. West, J. C. Presentation at the
Association of Directors of Medical Student
Education in Psychiatry, June 2021.
Seeing light at the end… Promoting resilience inthe workforce while leading toward recovery
from COVID-19. Morganstein, J. C. Webinar
presentation at Summer Conference Series,
Behavioral Health Affiliate of Iowa, July 2021.
The impact of COVID-19 on grief and loss. Cozza,
S. J. Panel presentation at the Child Trauma and
COVID-19: An NCTSN Summit supporting
the long-term recovery of our nation’s children
and families, National Child Traumatic Stress
Network, July 2021.
Challenges in handling human remains after the
September 11, 2001 World Trade Center attack
and the June 24, 2021 Florida condominium
collapse. Biggs, Q. M. Oral presentation (virtual)
at the Defense Support of Civil Authorities(DSCA) Mortuary Affairs Synchronization,
August 2021.
A Curriculum for Clerkship Students on Stress
and Coping in the Time of COVID. West, J.
C., Vance, M. C., & Morganstein, J. C. Virtual
poster presentation at Association for Academic
Psychiatry, September 2021.
Disaster mental health: From 9/11 to COVID-19
and beyond. Morganstein, J. C. Presented at
Grand Rounds, SUNY Downstate Health Sciences
University, September 2021.
Light at the end of COVID-19: Where are we now
and what’s needed to protect health and sustain
operations. Morganstein, J. C. Presented to the
Well-Being Committee, Accreditation Council of
Graduate Medical Education, September 2021.
Protecting the mental health of communities during
COVID-19 and other disasters: Finding structurein chaos. Morganstein, J. C. Presented at Hero’s
Journey Home Symposium, John P. Mayhugh2021 ANNUAL REPORT | 37

Foundation, September 2021.
Protecting mental health in COVID-19 and Beyond:
What have we learned and how do we prepare for
future disasters? Morganstein, J. C. Presentation
at the 62nd Annual Conference, The National
Dialogues in Behavioral Health, sponsored by
National Association of County Behavioral Healthand Developmental Disability Directors, WesternInterstate Commission for Higher Education
Behavioral Health Program, and National
Association of State Mental Health Program
Directors, September 2021.
The MA-STAR pocket card: psychological resilience
resources for leaders of personnel working
with human remains in COVID-19 pandemic
and other mass fatality events. Biggs, Q. M.,
Morganstein, J. C., Petrini, J., Mullins-Hussain,B., McCarroll, J. E., Fullerton, C. S., & Ursano,R. J. Virtual poster presentation at the 21st World
Psychiatric Association, World Congress of
Psychiatry, October 2021.
Association of high-risk firearm storage with PTSD
in U.S. Army soldiers and veterans with children.
Cozza, S. J., Fisher, J. E., Ogle, C. M., Zhou,
J., Zuleta, R. F., West, J. C., Fullerton, C. S., &Ursano, R. J. Virtual presentation at American
Academy of Child and Adolescent Psychiatry’s
68th Annual Meeting, October 2021.
A discussion on the global pandemic and mental
health. Morganstein, J. C., Sridhar, D., Hassan,
I. Panel discussion for Dentons Global Law Firm,
October 2021.
Five latent classes of child neglect and associated risk
factors. Ogle, C. M., Zhou, J., Miller, T., & Cozza,
S. J. Virtual presentation at the International
Society for Traumatic Stress Studies’ 37th Annual
Meeting, November 2021.
Post-traumatic stress disorder and family structure
in deployed U.S., Army mortuary affairs Soldiers.
Biggs, Q. M., McCarroll, J. E., Fullerton, C.
S., Petrini, J., Mullins-Hussain, B., Steward,
A., Wang, L., & Ursano, R. J. Virtual poster
presentation at the 37th Annual Meeting of theInternational Society for Traumatic Stress Studies,
November 2021.
Predictors of suicidal ideation in individuals bereavedby combat, accident or suicide. Fisher, J. E.,
Zhou, J., Probe Adams, D., Zuleta, R. F., &Cozza, S. J. Virtual presentation at the 37th
Annual Meeting of the International Society for
38 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Traumatic Stress Studies’ 37th Annual Meeting,
November 2021.
Preventing and Responding to Mass Violence,
Domestic Terrorism, and Hate Crimes - What
Works and Why. Flynn, B. W. Virtual panelpresentation at the 37th Annual Meeting of theInternational Society for Traumatic Stress Studies,
November 2021.
Risk of suicide attempt in reserve versus active
component soldiers during deployment to the wars
in Iraq and Afghanistan. Naifeh, J. A., Herberman
Mash, H. B., Dinh, H. M., Fullerton, C. S., &Ursano, R. J. Virtual poster session presented at the37th Annual Meeting of the International Society
for Traumatic Stress Studies, November 2021.
Social closeness and support are associated withlower risk of suicide among U.S. Army Soldiers.
Dempsey, C. L., Benedek, D. M., Nock, M. K.,
Zuromski, K. L., Brent, D. A., Ao, J., Aliaga, P. A.,
Mullins-Hussain, B., Weinberg, A., Heeringa,
S. G., Kessler, R. C., Stein, M. B., & Ursano, R. J.
Virtual poster session presented at the 37th Annual
Meeting of the International Society for TraumaticStress Studies, November 2021.
Enhancing well-being and sustainment for healthcare
workers during COVID-19 and beyond.
Morganstein, J. C. Presentation at Physician Grand
Rounds, Billings Clinic, November 2021.
Grief leadership to enhance military readiness andprotect mental health in disasters. Morganstein,
J. C. Webinar presented at the DiMiMed
International Conference on Disaster and Military
Medicine, November 2021.
Adapting military lessons to enhance psychologicalresilience and operational sustainment of thehealthcare workforce in a prolonged global disaster.
Morganstein, J. C. Presented for the Jennings
Lecture Series, Northeast Georgia Medical Center,
December 2021.
Climate-related disasters & mental health: Impacts,
risks, and interventions. Morganstein, J. C.
Presented at the Annual Conference titled “TheIntersection of Disaster Medicine and Public Healthwith Climate and Health,” Society for Disaster
Medicine and Public Health, December 2021.
Promoting workforce resilience and operationalsustainment in COVID-19. Morganstein, J. C.
Town Hall and Psychiatry Grand Rounds, Rhode
Island Hospital and Hasbro Children’s Hospital,
December 2021.

INTERVIEWS AND BRIEFINGSn Drs. Ursano and Morganstein were highlighted
in a Psychiatric News article, “Aftermath of
9/11 Attacks Helped Crystallize Principles of
Psychological First Aid”.
n The USU Pulse Blog highlighted Dr. Ursano and
Dr. Morganstein in their article, “20 Years Later:
How 9/11 Shaped ‘Disaster Psychiatry’.”n Dr. Benedek was interviewed by Hamazi Barma­da, host of the Finding Humanity podcast, for a
podcast on combat-related PTSD. The Finding
Humanity podcast has an audience of more than
500,000 persons.
n Dr. Morganstein was interviewed by HCPLive fora podcast on dealing with mental health effects ofdisasters such as COVID-19. This 30-minuteinterview was featured and shared at APA 2021
and explored a broad range of issues such as thepsychological and behavioral impacts of disas­
ters, who is at risk, and ways to help individuals
and communities improve function and recovery
more quickly.
n Dr. Stephen Cozza participated in a One in
Ten podcast presentation for the National Chil­dren›s Alliance (NCA) discussing child maltreat­ment in military families.
n Drs. Benedek and Naifeh met with a delegationfrom the German Ministry of Defense visiting
USU, WRNMMC, and the DHA HQ to exchange
information regarding ongoing research on iden­tification of risk and protective factors related tosuicide in Service members, as well as treatments
for combat-related behavioral health disorders.
n Dr. Stephen Cozza and Dr. Ogle provided a brief­
ing of the Center, the Child and Family program,and the ongoing Maltreatment study to Lee
Kelley and David Julian of the Military Com­munity and Family Policy (MCFP). The goal ofthis briefing was to identify key areas of interest
for MCFP, as well as potential collaboration andfunding opportunities.
n Dr. Morganstein was interviewed by TIME Mag­azine about ways to manage the stress of holiday
gatherings during the COVID-19 pandemic. The
story addressed issues of planning in advance toconsider personal priorities as well as anticipating
challenging interactions with family members
and how to respond to foster connections andenhance self-care. The story was read by 83 mil­lion people on TIME’s website and affiliated newssites.
n The USU Pulse featured a blog interview with Dr.
Morganstein on the topic of managing the stressof social gatherings during the holidays, and high­lighted CSTS and the Department of Psychiatry
resources, including an educational fact sheet toaid in planning and decision-making that fosters
health and well-being when planning for holiday
gatherings during the COVID-19 pandemic.

AWARDS AND APPOINTMENTS
n

n
n

n

n

n

Dr. Ursano was appointed as the USU represen­tative on the Military Health System After Action
Review (AAR) panel. This panel is mandated by
the NDAA-21, Section 731.
Dr. Mash was appointed as a Guest Editor for Di­
saster Medicine and Public Health Preparedness.
Dr. Mash was appointed as an Associate Editor
for Disaster Medicine and Public Health Pre­
paredness. In this Associate Editor role, she iden­tified submitted COVID-19-related manuscripts
with a behavioral and/or mental health focus forreview consideration.
Dr. Morganstein was selected to receive the na­
tional Bruno Lima Award in Disaster Psychiatry,which recognizes outstanding contributions of
APA members in the care and understanding of
the victims of disaster. This includes membersof APA District Branches and State Associations
who epitomize the APA’s highest ethical, clinical,
and professional standards, while engaged in one
or more of the following activities: Providing
consultation, education, training, and awarenesson mental health and disaster issues; Providing
direct service delivery as part of a disaster re­sponse team; Designing disaster response plans.
The Accreditation Council on Graduate Medi­
cal Education asked Dr. Morganstein to serve asa subject matter expert and consultant in theirestablishment of a well-being curriculum toenhance education, protect health, and reduceincidence of long-term burnout in resident physi­
cians.
Dr. Scharf received the 2021 Sigourney Award.
The Sigourney Award annually rewards outstand­ing work that advances psychoanalytic thought
and practice with international recognition.

2021 ANNUAL REPORT | 39

Directors, Scientists, Science Collaborative
Members, and Staff
DIRECTORS
Robert J. Ursano, MD
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Director
Center for the Study of TraumaticStress
Uniformed Services University
David M. Benedek, MD
COL, MC, USA (Ret.)
Chair, Professor
Department of Psychiatry
Associate Director, Consultation and
Education
Center for the Study of TraumaticStress
Uniformed Services University
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 TraumaticStress
Uniformed Services University
Joshua C. Morganstein, MD
CAPT, USPHSAssociate Professor/Vice Chair
Department of Psychiatry
Deputy Director
Center for the Study of TraumaticStress
Uniformed Services University

SCIENTISTS
Alvi Azad, DO, MBA
COL, USAF
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
David M. Benedek, MD
COL, MC, USA (Ret.)
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
Adjunct Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

40 | 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
Oscar A. Cabrera, PhD
LTC, MS, USA
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Vincent F. Capaldi, II, ScM, MD
LTC, MS, USA
Vice Chair
Associate Professor
Program Director, Combined Internal
Medicine / Psychiatry Residency
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
Elle S. Cleaves, MD
Maj, USAF, MC, FS
Assistant Professor
Assistant Director, Psychiatry
Clerkship
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Kelly L. Cozza, MD, DFAPA, FAPM
Vice Chair
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

Frances Gabbay, PhD
Research Associate Professor
Department of Psychiatry
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

Brian Crowley, MD
Adjunct 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

Luke Johnson, PhD
Adjunct Assistant 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

Gena L. Glickman, PhD
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

Oscar I. Gonzalez, PhD
MAJ, USA
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Tzu Cheg Kao, PhD
Professor
Department of Preventive Medicine
and Biometrics
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

Elizabeth A. Greene, MD
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Derrick Hamaoka, MD
Col, USAF, MC, FS (Ret.)
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

Elie Karam, MD
Professor and Chairman
Department of Psychiatry
American University, Beirut
Beirut, Lebanon
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

2021 ANNUAL REPORT | 41

James E. McCarroll, PhD, MPH
Research Professor
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

Eric Meyer II, MD
Maj, USAF, MC
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Patcho N. Santiago, MD, MPH
CAPT, MC, USN
Associate Dean for Diversity andInclusion
School of Medicine
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 (Ret.)
Medical Director
World Trade Center Responder Health
Program
Senior Medical Advisor
National Institute of Occupational
Safety and Health
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
Executive Director
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
Assistant Professor of Psychiatry
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Adam Walsh, PhD, LCSW
Senior Scientist, Suicide Prevention
Program
Department of Psychiatry

42 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

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 (Ret.)
Professor
Department of Psychiatry

Senior Scientist
Center for the Study of TraumaticStress
Uniformed Services University
Lei Zhang, MD
Associate Professor
Department of Psychiatry
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

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

Paul D. Bliese, PhD
Associate Professor
Department of Management
University of South Carolina
Darla Moore School of Business

Craig H. Llewellyn, MD
Professor
Department of Military andEmergency Medicine
Uniformed Services University

Robert Bossarte, PhD
Associate Professor
Department of Behavioral Medicine
and Psychiatry
Director
West Virginia University Injury
Control Research CenterWest Virginia University

Irwin Lucki, PhD
Professor and Chair
Department of Pharmacology &Molecular Therapeutics
Uniformed Services 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

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
2021 ANNUAL REPORT | 43

Joshua Lederberg, PhD,
ForMenRS(1925-2008)
1958 Nobel Laureate, Physiology or
Medicine
Professor Emeritus
Department of Molecular Genetics
and Informatics
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
Rina Berman
Sara Bessman
Alexandra Blumhorst
Marita Bolis
Alexandra Burris
Hieu Dinh
Benjamin Garcia
Matthew Georg
Kathleen Haller

Katherine Hillman
Xianzhang Hu
Paul Hurwitz
Abeer Iqbal
Jamiere JefferiesAlex Liu
Jacqueline Mai
Diana Monday
Ami Neiberger-Miller
Britany Mullins-Hussain
Glory Owe
Julia Petrini

44 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Ashley Phares
Joseph Piemontese
Joshua Ruff
Michelle Snider
MSgt Amy Steward
Leming Wang
Alysse Weinberg
Aaron Weingrad
Michael Zhang
Jing Zhou
Rafael Zuleta

Funded Grants
AWARDSFUNDING 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)
Study to Assess Risk and Resilience in Servicemembers – Longitudinal Study (STARRS-LS)

VA
DHP

Family Violence and Trauma Project

IMCOM

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

MCFP

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
Center for the Study of Traumatic Stress (CSTS) Program

DHP

Personalized Medicine Approach to Light Treatment for Increasing Alertness and Performance inOperational Settings

ONR Global

Identifying Motivations for Service Members and Veterans Owning Firearms, Storing Them in Unsafe
Conditions and Using Them to Hurt Others or Themselves

CDC

Suicide Prevention Program (SPP)

DHP

Responder Organizations & COVID: Coping with Trauma & Promoting Resilience. A Survey of
NIOSH COVID-19 Responders

NIOSH

2021 ANNUAL REPORT | 45

Partnerships
CSTS would like to acknowledge andthank our partners and collaborators.
The Center has worked with organiza­
tions in the public and private sector
through research partnerships, project
collaborations, consultations, andtrainings.
5-Eyes Mental Health ResearchInnovation Consortium
Accreditation Council for Graduate
Medical Education
The Administration for Children andFamilies
Alfred P. Sloan Foundation
Alliance of Hope
Alto Neuroscience
American Academy of Child andAdolescent Psychiatry
American Association of Suicidology
American College of Physicians
American Gold Star Mothers
American Medical Association
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
Association of American Medical
Colleges
Association of Directors of Medical
Student Education in Psychiatry
Gun Violence Center, University ofColorado
BIOS Lighting
Blue Star Families
Boston University
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
College for Behavioral Health
Leadership (CBHL)
Center for Circadian Biology,

University of California San Diego
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
Clemson University
Cohen Veterans Network
Collaborative Health Initiative
Research Program, Uniformed
Services University
College for Behavioral Health
Leadership
Columbia University School of Social
Work
Connecticut Department of Mental
Health and Addiction Services
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 International Medical
Operations
Department of Mental Health, Districtof Columbia
Design Interactive
Disaster Mental Health Institute,
University of South Dakota
Dover Air Force Base
Drexel University
Drug Enforcement Administration,
Department of JusticeDuke University
Eindhoven University of Technology
Emory University
ETS Sponsorship Program
Fallen Patriots
Family Advocacy Program,
Department of Defense
Federal Bureau of Investigation,
Department of JusticeFederal Emergency Management
AgencyFlorida Department of Health46 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

f.lux
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 Federation of Red Cross
and Red Crescent Societies
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
Max Plank Institute
McLean Hospital
Medical Research Command, Ft.
Detrick, Maryland
Michigan Department of Health andHuman Services
Michigan Psychiatric SocietyMilitary Child Education Coalition
Military Community and Family Policy
Military Family Advisory Network
Military Families United
Military OneSource, Department of
DefenseMiller School of Medicine, Universityof Miami
Missouri Department of Mental HealthMonash University Malaysia
Mount 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 Cancer InstituteNational Center for Disaster Medicine
and Public Health, Uniformed
Services University
National Center for PTSD, Department
of Veterans Affairs
National Child Traumatic Stress
Network
National Children’s Alliance
National Committee for Employer
Support of the Guard and Reserve
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 Institute of Neurological
Disorders and Stroke
National Institutes of Health,
Department of Health and Human
Services
National Institute of Justice,
Department of JusticeNational Military Family Association
National Network of Public HealthInstitutes
National Shooting Sports Foundation
Natural Resources Canada, Earth
Sciences Sector
Naval Health Research Center
Naval Medical Center San Diego
Naval Sea Systems Command, U.S.
Navy

Naval Support Activity Hampton
Roads
Neuromotion Labs
New Jersey Division of Mental Healthand Addiction Services
New York City Health + Hospitals
New York University Grossman Schoolof Medicine
North Atlantic Treaty Organization
Ohio State University, Department ofMedicine
Oxford University
Psychiatric Genomics Consortium
Psychological Health Center of
Excellence, Department of Defense
Rockefeller University
Rush University
Rutgers University, Cell and DNA
Repository
Rutgers University, Gun Violence
Research Center
Rutgers University, School of SocialWork
San Diego State University
Schwartz Center for Compassionate
Healthcare
Sesame Workshop
Sheppard Pratt Health System
Snowball Express
Society for Disaster Medicine andPublic HealthSociety for Research on Biological
Rhythms
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
Thomas Jefferson University
Tragedy Assistance Program for
Survivors
Travis Manion Foundation
Tulane University, School of Social
Work
Uniformed Services University
Union Pacific Railroad
University of Arizona
University of British Columbia,
Department of Educational andCounseling Psychology, and Special
Education
University of Buffalo

University of California, Irvine
University of California, Los Angeles
University of California, San Diego
University of California, San Francisco
University of Colorado, Boulder
University of Maryland
University of Melbourne, Australia
University of Miami
University of Michigan
University of Minnesota
University of Pennsylvania
University of Pittsburgh School of
Medicine
University of South Carolina
University of Texas Health Science
Center at San Antonio
University of Toledo, Department of
Psychology
University of Virginia
University of Washington
University Medical Center Utrecht,
Netherlands
U.S. Air Force
U.S. Agency for International
Development
U.S. Army
U.S. Army 377th TSC / Defense
Support of Civil Authorities
U.S. Army Family Advocacy Program
U.S. Army Family Programs
U.S. Army Installation Management
Command
U.S. Army Joint Mortuary AffairsCenter
U.S. Army Medical Materiel
Development Activity
U.S. Army Medical Research andMateriel Command
U.S. Army Medical Research
Directorate
U.S. Coast Guard
U.S. Department of Agriculture
U.S. Department of Defense
U.S. Department of Energy
U.S. Department of Health andHuman 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. Navy
U.S. Postal Service
U.S. Public Health Service, Medical
Affairs
Veterans Administration Medical
Center of DC
2021 ANNUAL REPORT | 47

Veterans Affairs (VA) Connecticut
Healthcare System
Veterans Affairs/Department of
Defense Survivors Forum
Virginia Commonwealth University
Voices Center for Resilience
Walk the Talk America

Walter Reed Army Institute of
Research, Department of Defense
Walter Reed National Military Medical
Center, Department of Defense
Weill Medical College of Cornell
University
WELL Building InstituteWest Virginia University

Retirement ceremony for Drs. Benedek, Hamaoka, and Wynn.

48 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Western New York Psychiatric Society
White House Medical Unit
World Trade Center Health Registry
Wright State University
Yale University
Yellow Ribbon Reintegration Program
Zero to ThreeCenter for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org