Center for the Studyof Traumatic StressEmerging Horizons

2022 Annual Report

CONTENTS
From the Director................................................................................ 1
Our Mission......................................................................................... 3
What’s New in 2022............................................................................ 4
Research.............................................................................................. 8
Education and Training...................................................................... 20
Consultations..................................................................................... 26
Publications....................................................................................... 31
Presentations, Interviews and Briefings, Awards and Appointments... 35
CSTS Personnel.................................................................................. 40
Funded Grants................................................................................... 46
Partnerships....................................................................................... 47

The Center’s activities bridge across the science ofthe gene, the person, the community, and moves
from this knowledge to action. CSTS scientists scanthe emerging horizon to identify psychological andbehavioral health threats to provide responsive andresearch-based solutions.
— Dr. Robert J. Ursano

From the Director
This year, 2022, the Center for the Study ofTraumatic Stress (CSTS) completed its 35th year of
national and international contributions as one of
the leading organizations in the
Nation, focused on applying
science to the psychological andbehavioral health care needs ofthose exposed to trauma and disaster. Established in 1987, CSTS
continues to fulfill its mission
in support of the Uniformed
Services University (USU) andthe Department of Defense (DoD) to mitigate theimpact of trauma, exposure to war, disasters, terrorism, community violence, and public health threats.
The Center’s activities bridge across the science ofthe gene, the person, the community, and moves
from this knowledge to action. CSTS scientists scanthe emerging horizon to identify psychological andbehavioral health threats to provide responsive andresearch-based solutions. Through the Center’s work,
we sustain national readiness, enhance national
security, and serve an essential role to the Nation andglobal community as a world-renowned leading Center in trauma and disaster psychiatry.
In the past year, our focus, like the Nation’s andthe world’s, has been on COVID-19. The pervasive
effects of the virus continue to reach across the Nation and the globe. The Center provided COVID-19
support at numerous levels — with consultation, research, and knowledge tools disseminated nationallyand internationally.
In addition to the Center’s real-time COVID-19
response, the Center provided support to ourallies in Ukraine since the March 2022 invasion.
Our colleagues in Ukraine and throughout Europe
are working tirelessly to support their citizens andmilitary units in the wake of the Russian invasion. The
Center’s response has been rapid, comprehensive andtargeted. CSTS has produced specific, requested, andextensive knowledge products in support of Ukraine,
including fact sheets, pocket cards, leader guides, andeducational support. Many of these resources havebeen translated into multiple languages. In our support, we also partnered with NATO colleagues, theFive Eyes Nations (United States, United Kingdom,
Canada, Australia, and New Zealand), and the World
Health Organization in consultations and development of app-based support and research to identify
needs.
Informed by the CSTS’s leadership and the CSTS
research findings from Army STARRS (Study toAssess Risk and Resilience in Servicemembers), a
new program in suicide prevention, the CSTS Suicide
Prevention Program (SPP) was established. The SPP
translates science into actionable, evidence-based
resources for military and non-military populations
to reduce suicidal behavior and promote protective
environments. The SPP has 12 lines of effort in collaboration with multiple research partners.
The SPP and the Center’s support of Ukraine highlight the reach and impact the Center has built by its
collaborative, matrixed response model in providing
psychiatric and behavioral health solutions. While
supporting contemporary challenges, like COVID-19
and the war in Ukraine, the Center has continued towork addressing persistent challenges such as suicide,Continued on page 2

Our overarching goal is to improve trauma-related carethrough prevention, early intervention and preparing healthcare providers and community leaders with tools to address
the impact of trauma and its far-reaching effects.
2022 ANNUAL REPORT | 1

From the Director, continued from page 1acute stress reactions, posttraumatic stress disorder(PTSD), traumatic brain injury (TBI), and disaster
response and preparedness.
The CSTS mission is accomplished throughleadership, research, training, education, service,outreach, collaboration, consultation, and global
health engagement. The Center has an outstanding
multi-disciplinary and collaborative team of scientists, educators, clinicians, staff, and thought leaders
to carry out these activities, advance our goals andour mission, and enhance national preparedness.
The Center continues its groundbreaking approaches to examining the impact of death andbereavement on military families, novel treatments
for PTSD, the role of ketamine in treatment and collaborating in the development of genetic markers of
disease. Our advanced analytic approaches include
big data analytic approaches from phenotype togene, focusing on personalized medicine to identify
at-risk individuals for early intervention, and to identify disease course, phases, and targets for intervention. Our big data approaches, in collaboration withnational leaders in these approaches, use machinelearning methodologies and predictive analytics for
identifying those at risk and the right treatment for
the right person. Our whole genome sequencing
work spans a wide array of international collaborations often related to STARRS, and in USU ourcollaboration with the Center for Military Precision
Health. We use data mining techniques and stateof-the-art statistical methods to gain new insights,

resulting in better and faster decision-making support
tools and improved health.
In 2022, CSTS scientists published approximately 50 peer-reviewed manuscripts in leading national
and international journals. Center scientists also gavedozens of presentations at conferences and professional meetings to enhance discussions, collaborations,and networking, as well as science. CSTS has extensive
collaborations within DoD and with other federal andstate agencies, as well as with academic and international partners. In 2022, we, again, expanded ourpartnership network at all levels.
In this Annual Report, you will find summaries of
our new areas of focus as well as our ongoing activities. Our overarching goal is to improve trauma-related care through prevention, early intervention
and preparing health care providers and community
leaders with tools to address the impact of trauma andits far-reaching effects. Building a trauma-informed
approach to sustaining readiness, resilience and health,
CSTS continues to look into the future across horizons
that many do not yet see.
On behalf of CSTS, I extend our appreciation to
our colleagues and friends with whom we have collaborated as we continue our watch of the emerging horizons of psychological and behavioral health needs for
our Military Health System, the DoD, and the Nation.
Robert J. Ursano, MD
Professor of Psychiatry and Neuroscience
Department of Psychiatry
Director, Center for the Study of Traumatic Stress
Uniformed Services University

The CSTS mission is accomplished through leadership, research,training, education, service, outreach, collaboration, consultation,and global health engagement. The Center has an outstanding multidisciplinary and collaborative team of scientists, educators, clinicians,
staff, and thought leaders to carry out these activities, advance ourgoals and our mission, and enhance national preparedness.

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Our Mission
CSTS supports the USU Strategic Framework andthe mission of the DoD. The Center is committed toadvancing trauma-informed care and isdedicated to furthering the Nation’s
understanding of the impactof trauma on individuals,
families, and communities. As part of our
Nation’s federal
medical school(America’s Medical School) at
USU, the Center’s mission iswell-positioned
to rapidly respond to DoD
mission-relevant
activities.
The Center’s
work spans a broad
range of trauma
exposures, including
combat, terrorism, naturaland human-made disasters,
public health threats, such as the
COVID-19 pandemic, and humanitarian operations. CSTS has been involved in nearly every

CSTS CAPABILITIESCSTS is a multidisciplinary
and multifaceted research center
that possesses the capabilities tostudy psychiatric and psychological phenomena and their sequelae
at the molecular, individual, organization, national and international levels. Our core and focused
capabilities illustrate the key
ways that CSTS ensures relevant
research and consultation for our
stakeholders.

major disaster our Nation has faced over the past
35 years. The Center works to ensure that behavioral health is addressed in the face of publichealth threats, disaster planning, anddisaster recovery.
Mitigating the effects ofdisaster and trauma in
military and civilian
populations builds
community andnational resilience. The Center
informs andeducates community, regional,
state, national, and global
stakeholders
in government,
industry, healthcare, public health,and academia. CSTS
advances trauma-informed care by providing
leadership in research, education, training, consultation, global
health, and service.

Core Capabilities
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Rapid Response to
Psychological Impact ofEmerging Threats
Disaster Psychiatry
Public Health
Laboratory Neuroscience
Translational Science
Randomized Clinical Trials
Applied Military Research
Cutting-Edge Statistics &Methodologies

Focused Capabilities
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Big Data & Machine
Learning
Early Emotional
Response to Trauma &StressEvent-Related Disorders
Mental Health Sequelae
Treatment
Sleep & Performance(Lab & Field)
Genomics
2022 ANNUAL REPORT | 3

What’s New in 2022
Ukraine Response

On February 24th, 2022, Russia launched aninvasion of Ukraine. The ensuing war resulted incountless casualties, displaced millions, and has led
to widespread exposure to extreme and traumatic
events. CSTS was sought out by colleagues within
Ukraine and around the world to provide resources, consultation and education in support of communities to help protect mental health and foster
resilience by addressing the unique effects of war on
military and civilian populations. CSTS collaborated
with American Psychiatric Association leadershipto develop and disseminate the organization’s global
health statement and resource page in support ofthose affected by the war in Ukraine. (https://www.
psychiatry.org/news-room/news-releases/apa-statement-and-resources-on-the-mental-health-i).
The Center rapidly developed and disseminated ajust-in-time resource page (https://www.cstsonline.
org/resources/resource-master-list/war-in-ukrainemental-health-resources) that included mental
health education fact sheets with evidence-based,actionable guidance for Service members, families,
military and community leaders, as well as healthcare providers and other global responders. CSTS
developed pocket cards to provide quick actions
to help calm acute stress reactions among militaryand civilians, as well as rapid implementation of key
actions that foster Psychological First Aid (PFA).
4 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

The Center translated the resources into Ukrainian,Russian, and Polish to optimize their utility in thecommunities most heavily affected by the war andrefugee displacement. CSTS disseminated these fact
sheets and pocket cards to DoD and other federal agencies, and widely around the globe throughNATO partner nations, the United Nations, theWorld Health Organization, and the Five Eyes international collaboration.
CSTS consultations included ongoing support to
the President of the Association of Neuropsychologists of Ukraine (ANU), where Center Scientists
assisted the ANU with obtaining information andmedical screening materials to more effectively
evaluate the impact of blast injuries and comorbid illnesses on Ukrainian military and civilians.
CSTS collaborated with colleagues at the Harvard
Global Mental Refugee Trauma Program and theWalter Reed Army Institute of Research (WRAIR)
to provide ongoing weekly tele-consultation andpeer support. The Center also provided support toRealis, a global mental healthcare organization thatprovided support within and around Ukraine to
war-affected communities. CSTS Scientists sharedevidence-based practices and optimal methods ofadapting traditional mental health care to the settingof war.

Colleagues of CSTS in Ukraine.

The Center Director played an integral role on
the “International Consortium on Digital Psychological Aid for Ukraine,” which built the ‘digital stressbuddy’ to engage with military and civilian community members who were encountering stressors
and challenges related to the war in Ukraine. The
digital stress buddy, which responded to user queries in multiple languages, directed users to timely
and appropriate resources to address their uniquemental and behavioral health challenges, using
evidence-based principles and regional support
resources. Moreover, in collaboration with our Five
Eyes partners and fellow U.S. colleagues, the Center
Director helped develop early response recommendations for NATO Service members supporting
Ukraine (see Adler, Forbes, & Ursano, 2022).
Early in the war, the European College of Neuropsychopharmacology (ECNP) Traumatic Stress
Network, comprised of long-time NATO colleagues,
reached out to CSTS and requested support for a new
education series called “Hot Topics,” that was rapidly
developed to support dissemination of information
about current events unfolding during the war in
Ukraine and best practices to support mental healthof military and civilian communities. Center leadership delivered talks on the impact of war on communities, evidence-based interventions, and leadership
actions to protect health. These talks became part ofan online education series, ultimately reaching thousands of mental health professionals and community
lay people who were offering aid to those affected by
the war. (https://www.youtube.com/playlist?list=PLGgouusCzgnWPBApVxogTR59qH2oQwqIs).
The Defense Institute for Medical Operations
and the University of New Mexico’s Project ECHO
requested support from Center Scientists in developing the Armed Conflict Trauma Training (ACTT)
program to bring basic principles of trauma care
to non-emergency trained health care workers in
Ukraine. CSTS helped in developing and delivering
the content for a 16-module course and a mental
health trauma lecture that follows the World HealthOrganization and International Confederation of
the Red Cross Basic Emergency Care content. This
online lecture series was made available to all healthcare workers in Ukraine and was widely disseminat-ed through global outreach. (https://www.youtube.
com/playlist?list=PLM3v2ae2FB_xGA9dOP9LQ9vIsQ0e_xCQv).

Suicide Prevention Program
During 2022, CSTS established the Suicide Prevention Program (SPP) (https://www.cstsonline.org/
suicide-prevention-program/overview), in partnership with other DoD and academic partners. Informed by CSTS research findings from the STARRS
project, the SPP translates science into actionable,
evidence-based resources for military and non-military populations to reduce suicidal behavior andpromote protective environments.

SPP aims to:
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Collaborate with military and non-militarycommunities to address suicide and related risk
factors
Leverage existing promising practices anddata-informed interventions to enhance synergyof effort
Develop data-informed practices, action tools,
and resources for pre-, during, and post-suicide
eventsEnsure development for, dissemination to, andevaluation of at-risk and hard-to-reach populations
2022 ANNUAL REPORT | 5

The 12 SPP projects are summarized below andcan be found here: https://www.cstsonline.org/suicide-prevention-program/projects
n Family Health & Safety to Prevent Suicidality:
This project creates and evaluates educational
materials for health care providers to: (1) advance understanding of families with members
who are at risk of suicide; and (2) inform providers about available prevention and intervention
services to reduce suicide risk in vulnerable
families.
n Mental Push-Ups: Mindfulness in the Military
Application: In partnership with the WRAIR
this project adapts evidence-informed mindfulness techniques into an easily accessible mobile
app to encourage daily engagement and practiceof mindfulness. The mobile app is contextualized for the military as a prevention tool and for
improving mental health and wellness.
n Sustaining Resilience in Battle: In partnershipwith WRAIR, this project produces videos thatmodel resiliency skills and techniques in realistic
battle scenarios. The videos demonstrate five key
areas: (1) What’s Important Now; (2) Deliberate
Breathing; (3) Acceptance; (4) Grounding; and(5) Self-talk. The videos incorporate positive
psychology skills to manage real time extreme
stress and ultimately protect from negative
health outcomes following combat.
n Project Safeguard: With our National Guard(NG) partners, Project Safeguard develops a
training model for the NG on lethal means andvoluntary reductions in firearm access during
at-risk periods. Peer-to-peer counseling incorporates principles of motivational interviewing
to encourage secure storage of personal firearms
to decrease the risk of death by suicide or othermeans.
n Essentials of Ethical Research with Participants at Risk for Suicide: This project designs
and deploys a robust e-learning curriculum to
educate researchers within diverse settings on
the topic of suicide risk determination and management. The course improves knowledge on
how to identify and address suicidal risk identi-

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fied during human subjects research.
Let’s Talk About Your Guns: This project develops a podcast series that connects listeners withexperts on secure firearm storage. The aim of the
podcast series is to strengthen the communication skills and confidence of healthcare providers, military leaders, family members, and peers
to enable conversations with Service members
about safely storing their personal firearms toprevent death and injury.
Psychiatry Electronic Modules: This projectbuilds and deploys self-learning electronic
modules for early in training medical personnel. eModules provide training on suicide risk
assessment and related risk factors for suicide,including body dysmorphic disorder and eating
disorders.
Bereavement Adaptation: Learning And Navigating Coping Essentials (BALANCE): This
project creates an interactive tool for bereaved
individuals to learn about and practice effective
coping strategies. This user-friendly platform
allows bereaved individuals to: (1) inventory current coping skills; (2) learn about various coping
strategies and their possible effects; (3) practice skills to manage ineffective coping; and (4)expand current coping skills in order to increase
sense of control over ability to cope.
The Military Survivor Family Safety Toolkit:
This toolkit promotes positive family safety
practices for military family members who lost a
loved one. The Military Survivor Family Safety Toolkit supports peer-to-peer discussions
around family health and safety, well-being,potential harmful behaviors, and suicidality.
Finding the Words: This project develops aseries of video simulations to demonstrate andteach skills in help-seeking and combat barriers
to care. The videos build confidence in key stakeholders to select and deliver the best words toencourage people to seek behavioral health careor other support services.
Brain Hijack: This series of podcasts provides
information for military and nonmilitary communities regarding drivers of suicide risk andnpresents a public health approach to action. This
series features expert recommendations for special populations and communities at large.
Supporting Our Shipmates: Gatekeeper Trainer Project: In partnership with the U.S. Coast
Guard, this project facilitates a LivingWorks
Training for Trainers (T4T) mentoring model within the U.S. Coast Guard and conducts
evaluation on the impact of mentoring on trainer
candidates’ willingness and readiness to provide
interventions to those having thoughts of suicide.

During 2022, SPP developed and delivered education and leadership products including fact sheets:
Suicide Prevention Strategies for Leaders, Leader
Action Checklist: Preventing & Responding to Suicide
Events, and the Firearm Leadership to Reduce Risk of
Suicide and Harm.

COVID-19 Response
The Center supports and expands the DoD’s
COVID-19 pandemic response. CSTS Scientists andstaff developed and maintained key collaborations
with the National Guard Bureau (NGB) and hospitaland community agencies within New York City. The
Center is part of the national action to develop anddisseminate COVID-19 knowledge products including fact sheets, pocket cards, and infographics onimportant health topics such 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 assisted USU leadership in assessing theimpact of COVID-19 on the USU workforce andstudents through the USU Resilience Operational
Assessment. Ongoing activities have included supporting the NGB in the development a rapid publichealth surveillance assessment to inform leadership and provide action-oriented recommendations
related to stressors, resilience factors, and behavioral
health responses. CSTS scientists developed training
materials to reduce distress and increase resiliencein NG personnel activated in response to COVID-19
including those tasked to handle the remains of thedead. CSTS continues to collaborate with the NGB
and the NG with education, consultation, and ongoing surveillance. CSTS Scientists were also requested
as consultants in the development of a survey that
was administered to a sample of National Institute ofOccupational Safety and Health (NIOSH) personnel
who deployed in support of NIOSH, Center for Disease Control (CDC), and Health and Human Services(HHS) efforts to respond to the COVID-19 pandemic.

Research Sync
In 2022, the USU Department of Psychiatry initiated a monthly “Research Sync” meeting to connect
researchers from within and outside of USU, andbetween clinical and pre-clinical researchers. Thisvenue allows local and global faculty who are interested in research to engage in a scientific discourse. In
2022, scientists from academia, military, and industry
presented on topics such as biomarker development,
the use of psychedelics in active duty populations, andvagal nerve stimulation. In 2023, CSTS is looking to
expand the reach of this forum as a supplement to the
CSTS annual Amygdala, Stress, and PTSD Conference.

A CSTS meeting during the COVID-19 pandemic.
2022 ANNUAL REPORT | 7

Research
CSTS has a broad range of research projects
and programs, including epidemiological, clinical,
and laboratory research designed to support the
Military Health System in its efforts to promote
military readiness for both peacetime and wartime,
and to deliver integrated, affordable, effective, andhigh-quality health services. CSTS research encompasses investigations ranging from the causesof suicide in Service members, to the psychologicalresponses to trauma and disasters, to the symptomatology and treatment of PTSD and the neurobiology of these disease processes.

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

Since 2009, CSTS has been at the forefront of research designed to help the Army and DoD address
the long-standing problem of suicide among active
duty Soldiers. The research programs, called Army
STARRS (2009-2015) and STARRS-LS (2016 onward), apply state-of-the-art machine learning techniques and predictive analytics to better understandand predict suicide and suicide-related behavior.
Both Army STARRS and STARRS-LS 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 is comprised of a series of distinct
but integrated studies, including large, representative samples of Soldiers and targeted cohort studies,
8 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

designed to comprehensively examine the mental
health and resilience of active duty Soldiers, including
Regular Army, Army National Guard, and activatedArmy Reserve. These studies included the Historical
Administrative Data Study (HADS), which uses a vast
range of existing Army/DoD administrative data for
all Soldiers (more than 1.6 million) on active duty
from 2004-2009. Army STARRS also involved collecting data directly from a combined total of more than
100,000 active duty Soldiers throughout the U.S. andoverseas. The research included administering questionnaires, conducting neurocognitive tests, collecting
blood samples, and performing a broad range of dataand genetic analyses.
Under STARRS-LS, the research team has continued and enhanced the Army STARRS research by
expanding the sample size, extending the follow-up,
further developing the STARRS platforms and systems, and conducting additional data analyses of Army
STARRS and STARRS-LS data. STARRS-LS expanded the size and extended the duration of the HADS
cohort by including additional Soldiers and obtaining
an additional twelve years of Army/DoD administrative data for the period of 2010-2021. This study now
includes all active duty Soldiers (more than 3 million)
across the eighteen-year period of 2004-2021. For the
STARRS-LS longitudinal cohort, the research teamhas been locating, re-contacting and collecting survey
data every two years from a representative sample ofapproximately 15,000 Army STARRS participants. A
total of four survey waves will be collected from thiscohort over an eight-year period.
Since the survey data collection waves began
during the COVID-19 pandemic, the research teamdesigned and added a COVID-19 section that included 22 questions about the respondents’ experiences
during the pandemic and the impact it had on them.
This offers a unique opportunity to assess and compare mental health and behavioral health prior to andafter the onset of COVID-19, therefore examining theeffects of the pandemic in a well-characterized, representative sample of Soldiers.

The Army/DoD recently added the Veterans
Administration (VA) as a STARRS-LS partner. Overthe long duration of the follow-up period, a majority of the participants have now separated from the
Army and transitioned to civilian life. The STARRS
research team has been collaborating with VA scientists on subgroups and outcomes of importance tothe VA. During 2022, the Army and DoD continued
to use STARRS findings and knowledge to develop
products such as reports, publications, leadership
tools and risk mitigation strategies. The STARRS
studies have informed the present VA suicide outreach program for post-hospitalization intervention.
The STARRS research team is also one of the leadersin the nation at demonstrating the value of machinelearning and predictive analytic models as clinicalcare tools.
Throughout 2022, the research team publishedscientifically important and potentially actionablefindings for the Army/DoD. In addition, the teamhas continued to brief the research progress andfindings to senior Army/DoD leaders. As of the endof 2022, the research team had 115 STARRS publications in high-impact, peer-reviewed scientificjournals. A summary of all the STARRS publications
can be found on the CSTS website at: (https://www.
cstsonline.org/assets/media/documents/Army_
STARRS_Fact_Sheet_V6_I2_20220906.pdf).

Psychological Stress and Resiliencein Mortuary Affairs (MA) Soldiers:
Longitudinal Study
U.S. Army MA Soldiers recover, identify, andevacuate the remains of the dead from warzones,
disasters, and other sites. MA Soldiers experience
direct exposure to death and the dead as well as
deployment-related stress and work in combat andother extreme environments, which increase theirrisk for trauma-related distress and disorders. This
longitudinal research study examines the individual,
unit, and family stressors, risk factors, and resiliencyof MA Soldiers. Questionnaires are group-administered to MA detachments approximately one week
before and after deployment. Data are collected
on factors such as PTSD, depression, distress (e.g.,anger, hostility, somatization), substance use, andinstrumental and emotional support. Soldiers also
have the option to donate saliva samples, which will
be analyzed for potential DNA- and RNA-related
biomarkers of stress and resiliency.
In 2022, Reserve MA Soldiers from the 387th
Quartermaster (QM) Company (CO) (Costa Mesa,
California) and 246th QM CO (Mayaguez, Puerto
Rico) and active-duty MA Soldiers from the 54th
QM CO participated in the study by completing deployment-related questionnaires. In total, 187 questionnaires were collected in 2022. Overall, the study
questionnaire has been administered 81 times and3,880 questionnaires have been collected since thestudy began in 2005. Data analyses in 2022 included an examination of traumatic exposures within
and across deployments and PTSD and depression
symptoms and probable disorder. Manuscripts addressing these topics are now in progress. In addition, poster presentations on traumatic exposures,
stressors of humanitarian versus war deployments,
and the MA-STAR (Mortuary Affairs-Select, Train,
Assist, and Reset) Pocket Card supervisor support
tool were presented at local and national scientificconferences. Study findings inform the educationand training of Soldiers and other groups for deployment and work with human remains.

Troop Education for Army Morale
Troop Education for Army Morale (TEAM) is an

Dr. Biggs and members of the CSTS Research Teamat the 54th QM CO for data collection.
2022 ANNUAL REPORT | 9innovative stress management and resilience-building early intervention. It was designed to improve
post-deployment readjustment in U.S. Army mortuary affairs (MA) Soldiers, a group at high riskfor psychological distress due to their exposure tohuman remains and the combat environment. The
TEAM intervention is based on the five evidence-informed principles of PFA: safety, calming, connectedness, self-efficacy, and hope/optimism. TEAM isdelivered through four group workshops, informational handouts, a dedicated website, and phone andemail support services. A total of 125 MA Soldiersparticipated in the study. Baseline questionnaires indicated that MA Soldiers had a high number of traumatic exposures and rates of PTSD and depression
similar to combat troops. While the intervention
did not specifically reduce rates of PTSD, the TEAM
intervention was well-accepted and the majorityof Soldiers (89%) reported that TEAM was helpful
for them. Soldiers who attended more workshops
reported fewer symptoms and were more likely torate TEAM as helpful. During the COVID-19 pandemic, TEAM intervention materials were adapted
for an online format using video conferencing andsharing materials electronically when individuals are
not able to meet in person. The online intervention
content can be delivered through group sessions at
specified intervals (e.g., once a week) or posted on a
dedicated website for 24/7 access. The online adaptation of TEAM broadened the application of theintervention for use in a variety of military and civilian populations, including medical personnel, police,
firefighters, disaster workers, mortuary personnel,
and others who work with the dead.

Ecological Momentary Assessment (EMA)
of Post-Traumatic Stress Symptoms in U.S.
Military Service Members (Daily Diary Study)
The Daily Diary Study research is designed
to improve our understanding of the day-to-day
changes in post-traumatic stress symptoms of U.S.
military Service members. The study uses a novel
EMA methodology coupled with portable electronic
assessment devices to track symptoms in real time.
Study participants completed symptom assessments
four times daily for 15 consecutive days using a
10 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

sophisticated software application that was developed
specifically for use in this study. Psychiatric disorders(e.g., PTSD, depression) were assessed at baseline
and in one- and three-month follow-up assessments.
Participants had the option to wear a wrist actigraphto objectively measure sleep and complement self-reports of sleep during the 15-day daily diary assessment
period. Participants also had the option to donate
saliva and/or blood samples for genetic analysis to
identify potential biomarkers and gene-environment
interactions that may distinguish and/or mediate stressresponses and resilience to stress-related disorders. In
total, 183 subjects have been recruited since the study
began. Importantly, this study collected data on daily
suicidal ideation, which is rare among EMA studies.
Data analyses in 2022 included examinations of
day-to-day variation in suicidal ideation as well as
within-day variation in post-traumatic stress symptoms. Study findings on daily variation in suicidal
ideation were disseminated in a poster presentation ata scientific conference and a manuscript for publication in a scientific journal is underway. In addition, aposter describing barriers to seeking health care waspresented at a scientific conference in 2022. The Daily
Diary Study represents the cutting-edge in psychological assessment methodology, measures, equipment,
technology, and research design to better understandpost-traumatic stress symptoms and improve thewell-being of Service members.

Firearm Behavioral Practices in U.S. Army
Service Members and VeteransFirearm suicides are the 10th leading cause ofdeath in the U.S., reaching epidemic proportionsin the last decade. CSTS Scientists, and collaborators from Harvard University and Universityof South Florida, were awarded a two-year R01
grant from the CDC to study firearm behavioral
practices and suicide risk in U.S. Army Service
members. The study objective is to develop anunderstanding of Service members’ firearm
behavioral practices and suicidal behaviors, andto identify actionable targets for suicide intervention using data from both a case-control psychological autopsy study and a large, longitudinalsample from the Army STARRS and STARRS-LSresearch projects, respectively.
An in-depth analysis of the interactions
among personality characteristics, reasons forgun ownership, gun use and storage practices,and local gun laws will identify potential medical, psychosocial, public policy, and commandinterventions to mitigate the relationship offirearm ownership to suicide. The broader impact of this study will enhance our understanding of risk and protective factors of firearm-related violence. This study examines factors
related to suicide in a controlled setting among
a population of men and women in the age
range for which suicide is most prevalent in thegeneral population, and provides opportunities
for new insights that can assist the military insuicide prevention, and can be applied moregenerally to civilian society.
In 2022, CSTS and Harvard scientists presented at the inaugural National Research Conference on Firearm Injury Prevention in Washington, D.C. to disseminate research findings
from this study. Key findings presented focusedon unsafe storage practices and suicide risk,
and the need to develop interventions focusedon gun ownership for safety and protection,
unsafe storage practices, and suicide risk. In
the year ahead, we intend to focus on dissemination of findings and to conduct longitudinal
analyses of Soldiers’ experiences through theirmilitary careers and civilian life, to identify
changes in behavioral risk factors specificallyrelated to changes in local gun laws, as these
may be associated with suicide.
Toward Personalized Care for Insomnia:
Machine Learning Algorithms to Predict
Response to Insomnia Therapy
Insomnia is prevalent among U.S. Army Soldiers,
especially those with combat exposure. Insomnia
affects performance and well-being in the immediate term and is associated with a wide range ofother negative consequences in the longer term,
including depression, hospitalizations, disability, andsubstantially decreased life expectancy. Moreover,sleep disorders are among the long-term sequelae ofDr. Dempsey and Research Assistant Ms. Dhanraj
presenting a poster at the National Conference on
Firearm Injury Prevention.
COVID-19 and an effect of the social isolation, disruptions in daily routines, and other stressors that haveoccurred in response to the pandemic. No treatment
for insomnia is universally effective, and while certain
pharmacologic and behavioral therapies may treat
insomnia effectively for some individuals, there is little
basis for identifying those individuals before initiating
therapy.
The Center led a research effort to address thisknowledge gap. In collaboration with Harvard Medical
School, our research team is developing a strategy to
predict the likelihood that a patient will respond toa therapy for insomnia before initiating that therapy.
Starting with a consolidated administrative data system developed as part of the Army STARRS, the teambuilt an observational longitudinal dataset simulating aclinical trial. The sample represented in this constructed dataset comprised nearly 5,000 U.S. Army Soldiers
diagnosed with an ICD-9/-10 sleep disorder, treatedwith an insomnia medication, and assessed before
and 6-12 weeks after initiating treatment. Using thisdataset, the team developed a machine learning modelthat improves the ability to identify individuals likely
to respond to pharmacologic treatment for insomnia.
Next, the team will build a parallel observational longitudinal dataset to develop a machine learning modelthat predicts response to Cognitive Behavior Thera2022 ANNUAL REPORT | 11

py for Insomnia (CBT-I). Finally, the research will
expand the set of potential predictors, using clinical interview and polysomnography data from the
Sleep Disorders Center at the Walter Reed National
Military Medical Center (WRNMMC) to predict
response to insomnia therapy.
By allowing health care providers to informpatients of the likelihood they will respond to atherapeutic approach before a therapy is prescribed,
the models developed in this research will enhanceclinical decision- making. Improving clinical decisions will help reduce negative sequelae of insomnia
and avoid adverse consequences of therapy whenthat therapy is likely to be ineffective for an individual. The results of this collaborative research will
constitute an important step toward personalized
treatment planning for Soldiers as well as civilians
with insomnia.

Reserve Components of the U.S. Armed
ForcesNational Guard and Reserve Longitudinal
Study
Conducted in collaboration with Dr. Sandro
Galea at Boston University, the Mental Health andService Utilization among Reserve and NG Forces
study addresses the epidemiology and trajectory ofmental health problems, deployment stress, healthrisk behaviors, and health care utilization over afour-year period among Reserve Component (RC)members. Using a representative national cohort of
2,003 RC members, CSTS has been actively analyzing this comprehensive dataset. In 2022, the Center examined a variety of adversities faced by RC
members who transitioned out of the service and theassociation among transition, adversities and suicide
ideation. Five types of adversities were identified:health, job/employment, interpersonal, financial,and healthcare access adversities. Compared tothose who stayed in the military, those who left the
military were more likely to report financial andhealth care access problems. Further, among those
who left the military, female Service members werefour times more likely to experience interpersonal
adversity. Army and Marine Service members were12 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

five to six times more likely to experience job/employment and financial adversities compared to their counterparts who had not left the military. Transitioningout of service and adversities both increased the risk
for suicide ideation. These results highlight that transition from military to civilian life is a critical period forinterventions to address the unique needs of the RC’s
Citizen-Soldier.

New York National Guard (NYNG) Warfighter
Readiness and Resilience Assessment
The U.S. NG served as a critical component of
the Nation’s response to the COVID-19 pandemic.
Identifying, monitoring, and understanding the NG’s
resilience and risk factors related to the COVID-19
pandemic are central to sustaining force readinessand preparing for subsequent disasters. To address
the immediate need for information on force healthand readiness, CSTS collaborated with the NYNG todevelop a rapid public health surveillance assessment,
which was completed by almost 4,000 NYNG Service
members between August and December 2020. The
assessment identified stressors and COVID-19-related
concerns, resilience factors, and psychological and behavioral health responses among NG personnel during
the COVID-19 pandemic. Based on this assessment,
Center Scientists have identified pandemic-related
stressors and experiences, protective factors, andpsychological and behavioral responses among Guard
members who did and did not activate in response to
the pandemic.
In 2022, Center Scientists began a series of examinations that identified: (1) the relationship of
COVID-19-related work tasks that were associatedwith high stress activations to post-activation PTSD;(2) the association of unit cohesion and leadershipsupport with PTSD, clinically significant anxiety and depression symptoms, and anger; and (3)COVID-19-related concerns, strategies to help manage stress, the extent of sleep difficulties, and increased
substance use, including alcohol, tobacco, and caffeine/
energy drink consumption during the pandemic. Study
findings will inform recommendations for leadershipto promote mental and behavioral health and readinessamong NG personnel during and following disaster response.

Bereavement
Grief and Health-Related Quality of Life inWorld Trade Center 9/11 Survivors StudyRESEARCH IN THE CHILD AND FAMILYPROGRAM (CFP)
CFP conducts research to better understand theneeds of all children and families affected by traumatic events, with special emphasis on the needs of
U.S. military families. Although military children
and families possess unique strengths, they can beaffected by combat-related illness and injury, bereavement, child maltreatment, and family violence.
Currently, there are five CFP project areas: bereavement, child maltreatment, combat-injured families,
family violence, and suicide prevention. In addition
to CSTS-based work, the CFP maintains collaborative relationships with other departments at USU,
other academic institutions, and community organizations. The products of CFP’s research program
inform scientists, clinicians, and the general public
about the impact of stress and trauma on children
and families. CFP’s pioneering research is alsotranslated into actionable and educational materials
for military and government stakeholders, clinicians,
and community leaders. For example, one recent collaborative CFP and USU medical student Capstone
project this past year examined the intersectionof suicide risk for military LGBTQ+ children, andresults were presented at the American Academy ofChild and Adolescent Psychiatry annual meeting.
In addition, CFP consults with military and government leadership, informs national media outlets, andconducts research that promote a deeper understanding of children in the U.S. and throughout theworld.

In late 2022, the CFP received funding from the
CDC to examine outcomes associated with trauma
and bereavement in 9/11 survivors, in collaboration
with colleagues at Columbia University, the World
Trade Center Health Registry (WTCHR) and Voices
Center of Resilience. Despite 9/11 survivor’s highrates of losses on and after 9/11, minimal research
has focused on the examination of grief responses
and their effects on mental health in this population.
Using existing and newly-collected data, we will
examine the complex inter-relationships of bereavement burden and physical and mental health burden
in order to better inform WTCHR programming.

The National Military Family Bereavement
Study (NMFBS)
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 examine how psychological, physical, andbehavioral outcomes of bereavement are influenced
by the experiences of military family members.
Findings have informed development of diagnostic
criteria for a condition of impairing grief. CSTS partnered with colleagues at Columbia University, NewYork University, University of Pittsburgh, and UCSD
to develop a proposal for criteria for prolonged griefdisorder, a new diagnosis included in the Diagnostic
and Statistical Manual of Mental Disorders (DSM).
A recent publication by CSTS Scientists reported increased rates of both ill-defined conditions and mental health diagnoses and healthcare utilization following bereavement. These findings suggest a needfor proactive health monitoring of military widows
2022 ANNUAL REPORT | 13

to identify and treat mental health conditions andrecognize manifestations of physical symptoms.

Stepping Forward in Grief (SFG) Study
An online program that addresses grief adaptation may be a helpful resource for bereaved militaryfamily members. CFP formed a partnership with theCenter for Prolonged Grief atColumbia University to adapt
principles from ComplicatedGrief Therapy (CGT), foundto be helpful in civilian populations, 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. Results indicated that there were small, but
statistically significant, improvements in grief and infunctional impairment among those in the high griefgroup. These results indicate that a novel modality,
requiring little oversight or cost, can markedly increase the ability to reach bereaved family members.

tional 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 associations between risk factors (i.e., hopelessness andreasons for living), specific coping strategies, andoutcomes (i.e., grief, depression, suicidal ideation).
This information will identify actionable targets forintervention programs. A related publication fromthis study used data from the NMFBS to examine
differential contributions of specific coping strategies and their relationships with cause of deathin contributing to grief severity, depression, andposttraumatic growth. More recent analyses resulted
in two scientific poster presentations; one was about
predictors of suicidal ideation and the second described a comparison of two commonly-used indicesof suicidal ideation.

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 following a terrorism-related death. The teampublished two manuscripts. The first manuscript
identified three groups of bereaved family membersthat were differentiated according to patterns of depression, anxiety, and grief. The second manuscript
examined the effect of receiving multiple notifications about the identification of fragmented remainsof a family member. Results indicated that multiple
notifications were differentially associated with posttraumatic stress, but not grief severity. Results fromthis publication were also described on the Interna14 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Disenfranchised Grief
Through its collaborations with Sons and Daughters in Touch (SDIT), an organization of 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 with the concept ofdisenfranchised grief (DG), which refers to the expe-

riences of bereaved persons whose grief was not or
could not be openly acknowledged, publicly mourned, or socially supported by others. In response tothis, particularly in the context of the COVID-19
pandemic, CFP is conducting research on DG, which
includes developing a measure of DG. CFP is refining and will test this instrument in the SDIT population, as well as among individuals who sufferedlosses due to perinatal death, suicide, substanceabuse, criminal activity, and HIV.

Child Maltreatment in U.S. MilitaryCommunities and Families
Another focus area of the CFP involves the identification of risk factors for child maltreatment inmilitary families in order to inform prevention andintervention strategies that promote military family
health, well-being, and resilience. CFP’s work has
primarily focused on child neglect, the child maltreatment type most commonly reported in the U.S.
and most frequently associated with child fatality.
The aim of this work was to identify factors that increase risk of child neglect by examining characteristics of substantiated child neglect cases in familiesof U.S. Army Service members. These data have led
to multiple publications in high-impact scientificjournals (Child Maltreatment, Military Medicine),
research presentations at scientific conferences andfact sheets for professional and lay audiences. A new
analysis of these data, published this year in Child
Abuse & Neglect, focused on identifying the types ofneglect and abuse that are likely to occur concomitantly and associated risk factors. Recent analyses
examining child protective actions in substantiatedchild neglect incidents involving different neglecttypes will be presented at an upcoming scientificmeeting. This collective work advances the understanding of the phenomenology of child neglecttypes and the characteristics of families at-risk forparticular classes of co-occurring neglect.
CFP Scientists also conducted a congressionally-mandated study designed to advance understanding of risk and protective factors for all types of childmaltreatment (i.e., neglect, physical abuse, sexual
abuse, and emotional abuse) in military families.
Phase I of the project involved a case-control studyof military families with dependent children to
identify the family, Service member, and militarycharacteristics associated with risk of substantiatedchild 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 the timing of the firstincident of substantiated child maltreatment. Results
inform DoD’s child maltreatment prevention efforts.
A report summarizing our findings was written incollaboration with the Office of Military Communityand Family Policy.

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 family-centered, strength-based, and evidence-informed
preventive intervention. A recent publication in Depression and Anxiety described the impact of combat
injury and military deployment on mental healthsymptoms in a sample of military wives. The aim of
CFP’s work in this area is to help us better understand the impact of combat injury on Service members and their families and inform interventions that
more effectively address their needs.

Family Violence
In 2022, CSTS focused on supporting the Army
Office of the Deputy Chief of Staff (DCS) G-9’s
response to problematic sexual behavior in children
and youth (PSB-CY), and reviewing family violence-related deaths in the Army, including suicides,of children and adults. The Center’s approach has
two components: the design and production of
resources, including fact sheets describing the DoD’s
approach to PSB-CY and producing monthly reports
2022 ANNUAL REPORT | 15

for Army DCS based on data received from Army
installations. The Center participated in the annual
Headquarters Department of the Army (HQDA)
Army Family Violence Fatality Review Board (FRB)
and drafted a report that summarized the characteristics of child abuse and intimate partner violence-related fatalities including recommendations
to prevent these fatalities.
Also in 2022, the Center redesigned the formats
for two regular CSTS publications, Research Review(RR) and Joining Forces Joining Families (JFJF). Thesepublications report research-based information for
the Army Family Advocacy Program (FAP) community, with interpretations that are useful for theirwork. CSTS is currently reviewing literature on
nonfatal firearm violence and discussing contributing factors, such as coercive control as a method ofdomestic violence and the safe storage of firearms.
CSTS continued to provide the FAP with quarterly statistical data monitoring of installation-level
FAP report changes throughout 2022. These Briefing Books are specific to 40 different Army installations and geographic areas with comparisons of
installation/area-level data to the entire Army. Data
reported included the number of incidents of abuse(physical, emotional and sexual) and neglect ofchildren. Data on adults are provided by the Defense
Manpower Data Center.

RESEARCH IN NEUROSCIENCE AND
NEUROBIOLOGYLaboratory Research in Neuroscience and
Neurobiology
Genetics and Biomarkers
Until recently, an overwhelming amount ofwork on PTSD was conducted exclusively on maleService members. This has led to a lack of understanding of sex-related differences in the disorder.
The Center’s work focuses on understanding where
sex-related differences arise and where they do not,and how the Center can use this understanding tohelp affected Service members. In 2022, CSTS examined the sex-related difference in mitochondrial
DNA copy numbers between male and female Service members with or without PTSD using conventional real-time polymerase chain reaction (PCR)
and droplet digital PCR, which provides absolute
quantification of DNA. CSTS data suggest thatmitochondrial function may be gender-dependent
in individuals with PTSD. Glucocorticoid and/or
estrogen may play an important role in the biologyof the sex-related difference in PTSD.

Chronobiology, Light, and Sleep Lab

Suicide Prevention in Families
In support of the Center’s SPP established in
2022, the CFP is developing three specific projects:
Family Health& Safety to Prevent Suicidality,
Bereavement
Adaptation:
Learning And
Navigating Coping Essentials(BALANCE),
and The Military Survivor Family Safety Toolkit. Each of theseprojects is briefly described above in the SPP section.

16 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Staff testing study equipment in the Chronobiology,
Light, and Sleep Lab.

From basic science experiments to randomized
clinical trials and implementation studies, the Chronobiology, Light, and Sleep Lab research program
focuses on sleep, circadian rhythms, and the physiological effects of light, with the ultimate goal of
maximizing human health and well-being. Specificwork in 2022 aimed to better understand the neural mechanisms underlying the modulation of thephysiological effects of light, including circadian
resetting, neuroendocrine regulation, acute alerting
properties, and mood enhancement, along with thepractical application of those findings.
In a multi-phase effort, the kinetics of the alerting response to light are being rigorously characterized via a highly controlled laboratory study thatvaries the intensity and duration of photic exposure
while holding the dose constant in a portable lightdevice. In parallel to determining an optimal photic
dosing configuration, an overlapping feasibility study
will employ the same light devices to identify thevarious barriers and facilitators to implementation,
allowing for refinement of hardware, usage guidelines, and other factors that may impact uptake andefficacy. In combination, those findings will serve
to inform direct translational work wherein lighttreatment will be used to increase performance in an
operational context.
In a separate study, two distinct spectrally-engineered lighting technologies have been developed
and tested for increasing alertness, performance,and sleep in Service members who necessarily workrotating nightshift schedules on a high-security
watch floor. Analyses reveal reductions in errors
related to sustained attention, increases in alertness,
improvements in quality of life, and overall satisfaction with the intervention conditions. Preliminary
results were presented at professional conferences,and manuscript preparation is currently underway.
In addition, discussions with leadership are ongoingfor potential implementation of related technologies
on a larger scale.
The successful transition of new, evidence-based
lighting applications in domestic and workplacesettings will require a well-designed educational
component that increases investment and facilitates
adoption of interventions that target sleep, circadian
health, and other physiological effects of light. To
that end, an original education program, Circadian,Light, and Sleep Skills (CLASS), was initially createdfor undergraduate students and subsequently tailored for military (CLASS-M) and shipboard Service
members (CLASS-SM). The efficacy of CLASS-SM
was studied in crew members on three U.S. Navy
ships during a period of two to four months at sea.
Longitudinal data demonstrated that participation in
CLASS-SM, on its own, resulted in improvements insleep quality, which also led to better mental healthoutcomes. More detailed findings were includedin publications this year in Sleep Health and theInternational Journal of Environmental Researchand Public Health. Additionally, progress has been
made in transitioning these education programs fordissemination at scale, in collaboration with the University of California, San Diego Center for Circadian
Biology (CCB) and the USU Consortium for Healthand Military Performance (CHAMP).
Finally, in 2022 the lab also teamed up withcolleagues on three major collaborative projects.
One study that is being conducted with Captain
Rachel Lee, who leads the vaccination program at
WRNMMC, is examining the effects of melatonin
supplementation on vaccination efficacy. Anothercollaboration, led by Dr. Dayna Johnson at Emory
University, will assess sleep, circadian rhythms andcardiometabolic health in African Americans. Finally,
Dr. Gena Glickman at CSTS has joined several
colleagues from the Max Plank Institute for Biological Cybernetics, Monash University, Universityof Basel, Eindhoven University, and University ofColorado Boulder, to develop a novel, self-reported
and psychometrically validated inventory to capture
light exposure-related behavior, the Light Exposure
Behavior Assessment (LEBA). Preliminary resultsof the LEBA were reported at multiple professional
conferences, and an associated manuscript is currently in preparation.

2022 ANNUAL REPORT | 17

Clinical Research in Neuroscience and
Neurobiology
Riluzole Augmentation Treatment forComplicated Combat-Related PTSD
The Center conducted a study of riluzole augmentation for treatment of veterans who experienced continued PTSD symptoms despite treatment
with evidence-based medications for PTSD. This
study was funded by the Army Military and Operational Medical Readiness Program, and enrolled
participants at WRNMMC and the Syracuse Veterans Affairs Medical Center from 2014 to 2017. The
key findings of the study were that there was greater
improvement in hyperarousal symptoms, such as exaggerated startle responses and hypervigilance, withriluzole treatment compared to placebo. In 2022, theCenter continued analysis of proton magnetic resonance spectroscopy (1H-MRS) of the amygdala andanterior cingulate cortex before and after treatment
as a potential biomarker of illness and treatment
response. CSTS Scientists, in collaboration withresearchers at Brigham and Women’s Hospital, identified discernible changes in brain metabolites in theareas of interest which are associated with changes
in PTSD symptoms. The Center is currently preparing these findings for publication.

Nightmare Deconstruction and Reprocessing
for Treatment of PTSD-related Nightmares
Nightmares and insomnia are among the mostcommon and debilitating re-experiencing symptoms of PTSD, and for many patients they are themost resistant to evidence-based treatment. Sleep
disturbance and associated fatigue represent a
threat to readiness. In 2022, CSTS completed apilot trial of Nightmare Deconstruction and Reprocessing (NDR), an exposure-based psychotherapy
for trauma-related nightmares and insomnia. NDR
is an adaptation of the Hill cognitive-experiential
model for working with dreams in psychotherapy.
Participants work with therapists to recall their most
distressing nightmare images and their associatedthoughts and feelings in order to facilitate reconsolidation of trauma memories. Initial results suggestthat NDR offers benefit for patients with trauma-re18 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

lated nightmares. Full findings of the study are still
being reviewed and prepared for publication. In addition to assessing nightmare and insomnia severity,
suicidality, and PTSD symptoms, the study evaluatedmultiple potential biomarkers of treatment response.
The study team collected genetic and inflammatory
biomarkers at multiple points in treatment as potential indicators of treatment response. Investigators
also collected continuous physiologic indicators ofstress, such as heart rate variability and skin conductance, using wearable technology. Preliminary
findings show changes in physiologic measures in
response to NDR, and these findings are currently in
preparation for publication. Findings from this study
are contributing to the design of a full-scale randomized, controlled trial to demonstrate efficacy andvalidate biomarkers. An unanticipated benefit of thisstudy was the development of remote monitoring
and assessment procedures. Initially implemented in
response to the COVID-19 pandemic, study investigators developed and implemented remote study
intervention and assessment processes, enabling
the study to proceed almost entirely virtually. These
processes will be implemented in future studies toreduce cost and expand available participant pools.
This study was closed to enrollment in 2022.

The Veterans Affairs (VA) National PTSD
Brain Bank
In 2014, a consortium led by the VA National
Center for PTSD and co-founded by CSTS Scientists
established the first human tissue biorepository — or“Brain Bank” — dedicated to examining the impact

of trauma and stress on human body tissues, withthe objectives of identifying biomarkers of susceptibility and resilience to trauma, and assistingin targeting new treatments. The Brain Bank collects, processes, and stores clinical and biologicalinformation, and distributes this to investigators
nationwide to afford researchers the opportunity
to examine the molecular, morphological, andbiochemical effects of traumatic stress on thebrain, generate proposed mechanisms 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 longitudinal assessment data via clinicalinterview from the time of enrollment until thetime of their death, when their tissue is donatedto the Brain Bank.
In 2022, the Brain Bank obtained 25 tissue
donations and enrolled 25 additional future
donors. To date, the Brain Bank has obtained atotal of 339 tissue donations and enrolled a totalof 258 additional future donors. CSTS Scientists
continued to serve on the Brain Bank’s Steering
Committee, Tissue Access Committee, and Diagnostic Assessment Core, and have collaborated
with other Brain Bank Investigators on several
manuscripts. In 2022, with COVID-19 movement
restrictions easing, CSTS opened a recruitmentsite at the Armed Forces Retirement Home in
Washington, D.C. While precautions are still inplace there, gatherings at this location once again
allow visitors, including representatives from
CSTS who provide information on the Brain
Bank. CSTS is now identifying and assisting veterans at this site who are interested in supporting
the Brain Bank by becoming future tissue donors
and providing their physical and mental healthdata. CSTS also began the process of establishinga new recruitment and enrollment site on thecampus of Joint Base San Antonio.

RESEARCH ON DISASTERS ANDTERRORISM
Florida Department of Health Response toMultiple Hurricanes
In 2022, CSTS Scientists continued to examine
psychological and behavioral responses following
natural disasters, including psychological distress,
posttraumatic disorders, health risk behaviors, andfunctional/occupational impairment. In particular,
the Center examined predictive factors that influence recovery and resilience following disaster exposure, which
can be targeted for preventive interventions in first
responders who are exposed to multiple disasters. This
work is particularly important globally, as the world
experienced a wide range of disasters during 2022,
including the COVID-19 pandemic, Hurricane Ian in
the southeastern United States, extreme heatwaves andsevere drought in Europe, the Middle East, Africa, andAsia, historic flooding in Pakistan and the United States,
wildfires in the western United States, super Typhoon
Hinnamnor in Japan, and multiple tornadoes in the
midwestern United States.
During 2022, Center Scientists identified factorsthat are important to recovery from multiple hurricane
exposure by examining the time to recovery and behavioral responses in Florida Department of Health workers
who were both first responders to, and were personallyaffected by, an unprecedented series of hurricanes that
occurred in 2004 and 2005. CSTS examined pre-hurricane individual and interpersonal factors that wereassociated with time to recovery following the 2005
hurricanes. Importantly, less social support from respondents’ spouses, friends, and family, more work presenteeism (i.e., reduction in work performance and productivity
at work), higher levels of personal injury/damage as aresult of the hurricanes, and higher emotional response
during the hurricanes were related to a longer time torecovery following the hurricanes. This research suggests
the importance 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 onenhancing social and workplace support, and attention toperi-traumatic responses.
2022 ANNUAL REPORT | 19

Education and Training
An essential element of the Center’s work is education and training. 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 carepersonnel and community leaders at the local, state,
and federal levels, as well as national, global, andprivate sector settings. The Center sponsors conferences, symposia, seminars, and forums on numerous
aspects of trauma, including disasters, terrorism, andwar. CSTS advances military and disaster psychiatry
through consultation, training, outreach, presentations, and participation in conferences, workshops,
and collaborations throughout the U.S. and global
community. The Center also expands knowledge andprovides education through public health efforts andinterventions before, during, and after numerous
disaster events.
One of the Center’s instrumental public healtheducation tools is development and disseminationof educational materials to inform stakeholders,Dr. Biggs presenting a poster at the Military Health
System Research Symposium.
20 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

including: health care personnel, community andorganizational leaders, responders and public healthemergency workers, families, teaching professionals,
and policy makers. For nearly a quarter of a century,
CSTS has created just-in-time, customized, highly
actionable, and easy-to-read educational fact sheets,
flyers, pocket cards and other resources to aid national and global stakeholders in mitigating adverse
effects of disasters by enhancing efforts at preparedness, response, and recovery.
As noted above, a primary focus at CSTS has
been the war in Ukraine and ongoing efforts in support of the COVID-19 pandemic by providing educational resources to partners throughout the DoD,
other Federal agencies, state and local agencies,
professional associations, and international partners.

DISASTER RESPONSE AND PUBLICEDUCATION
Since its inception in 1987, the Center has provided disaster preparedness and response educationand consultation in numerous forms and contexts.
CSTS personnel have provided on-the-groundeducation and consultation in response to extreme
national and global disasters, as well as immediateand long-term telephonic, online, and video support
to assist response and recovery efforts following numerous disaster events, which have impacted local,
national, and global communities. Current and former CSTS personnel have been sought out to provide guidance on disaster preparedness, response,
and recovery efforts because of the experience andsubject-matter expertise obtained while working 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.
As noted above, throughout 2022, the Center
provided consultation and education in response to
the war in Ukraine, COVID-19 pandemic, and otherconverging disasters. Though much of the world hasmade efforts to begin returning to aspects of normalcy, the global COVID-19 pandemic continued tosicken millions and kill hundreds of thousands in the
United States alone. Healthcare systems around theworld experienced massive surges in care demand,the uncertainty of new variants rapidly spreading around the world, and the stresses of a heavily
strained workforce. CSTS has been sought out by
numerous healthcare systems, professional associations, and other organizations across the UnitedStates to provide ongoing consultation and education to healthcare workers and leaders on adapting
principles of disaster response in healthcare environments. An important aspect of this work involved
education on adapting military Combat and Operational Stress Control principles for civilian workplaces to enhance well-being and promote operationaland sustainment throughout the global public healthemergency.
The Center also supported response efforts to arange of climate-related disasters, including Hurricane Ian, Hurricane Fiona, and the massive floods
across the Central states, which particularly devastated the state of Kentucky. In response to these
events, the Center developed and disseminatedjust-in-time education fact sheets and distributed
them to stakeholders involved in disaster response,
including the National Association of State Mental
Health Program Directors, the Office of the Assistant Secretary for Preparedness and Response,
as well as national medical organizations providing local response support, such as the American
Psychiatric Association. The Center also developeda resource page and worked with partner organizations to support military and civilian communities in
the wake of Hurricane Ian.
During the summer of 2022, there were threemass violence events over a period of five weeks,gripping the nation and requiring significant mental
health response to support affected communities.
CSTS provided consultation to local and nationalorganizations, as well as educational resources, tosupport community mental health in response to theshootings at a supermarket in Buffalo, New York, theparade in Highland Park, Illinois, and Robb Elementary School in Uvalde, Texas. These events each in-volved unique issues, such as racially-motivated violence and the death of children, for which the Center
provided tailored information and consultation in
support of community response and recovery.

NEUROSCIENCE AND BEHAVIORMODULE FOR PRE-CLERKSHIP USU
MEDICAL STUDENTS
The Neuroscience and Behavior Module is aneight-week, annual, required, multidisciplinary
course for the first-year USU School of Medicine
students. The module teaches medical students
the principles of neuroscience through integrated
content across a range of disciplines. With a focus oneffective management of a variety of neurologic andpsychiatric conditions, students learn to recognize,
describe, and diagnose common neuroscience-related medical conditions. Through simulated patient
experiences, effective, safe, and patient-centeredclinical skills are developed and practiced, including
the performance of neurologic and mental status
examinations. Topics related to military medicine,
medical history, and health systems science are integrated throughout the module. The goal is to fostera robust and well-rounded education for future
military medical officers.
In 2022, the University continued to provide
distance and hybrid learning, in addition to in-person classes and simulations. The Neuroscience
module continued to be highly regarded by students
and faculty alike as one of the best modules in the
pre-clerkship curriculum, pioneering new educational techniques and leading students to one of thehighest passing rates in the pre-clerkship period
while absorbing some of the most challenging material. As early as 2019, the module was recognizedfor pre-recording all lectures into a higher-quality
format that was more accessible to students thanrecording live lectures. In preparation for 2022
and 2023, the module continued to enhance online
lecture delivery by improving and re-recording 20(15%) of the 137 video lectures. In collaboration with
the Dean’s Office, the module also embedded questions (checks for understanding) into the content of
91 (66%) of the 137 video lectures using Panopto’s
2022 ANNUAL REPORT | 21

built-in quiz feature. Module instructors continued
to fully participate in the expanded hybrid flippedclassroom approach for weekly review sessions six
times throughout the module. These flipped classrooms invited students to attend a case-based review
that highlighted key learning from the week, invited
their professors to rephrase important points fromtheir lectures to illustrate case studies, and invitedongoing discussion between students and professors
in the online chat.
These vignettes, collected from USU graduatesand faculty, were intended to demonstrate the operational importance of the medical material the students were learning each week. Lastly, based on consultation with the Assessment Sub-Committee andthe Associate Dean for Assessment, every module
exam question continued to be carefully blueprinted,
down to the objectives which are also mapped to theuniversity objectives. Due to the intensive effort put
into organizing the material to correlate structureand function with anatomy, basic science and clinicallectures, the class of 2025 suffered no failures during
our 2022 module without compromising the integrity or complexity of the material.

EDUCATION AND TRAINING IN
COMBAT AND OPERATIONAL STRESSCONTROL: OPERATION BUSHMASTER
CSTS Scientists provided training in Combat
and Operational 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 called Operation Bushmaster. This training
exercise challenged senior medical and graduate
nursing students to operate in forward medical units
in a complex battlefield simulation over four days,
culminating in a mass casualty event. Students evaluated and treated a continuous stream of battlefieldcasualties and non-battle injuries, and conductedpublic health and health outreach activities while ona simulated combat deployment. Differentiating the
22 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Operation Bushmaster annual medical fieldtraining exercise.
assessment, disposition, and treatment of psychiatric illnesses from combat and operational stress
reactions were core skills taught and evaluated aspart of the exercise. CSTS faculty collaborated withthe psychiatry residency programs of the National
Capital Consortium and the San Antonio Uniformed
Services Health Education Consortium to provide an
opportunity for resident physicians to develop theirteaching and leadership skills and understand COSC
as part of their core military-unique curriculum.
Since the advent of widespread vaccination among
faculty, staff, and students, we have continued fullscale exercise operations and teaching.

EDUCATIONAL CONFERENCES
Amygdala, Stress, and PTSD Conference
In 2022, the 16th 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 Family
Medicine, and the WRNMMC Department of Psychiatry, continued in a virtual format. The Conference featured several world-renowned scientists,
including Matthew K. Nock, Ph.D. (Harvard University), Danny G. Winder, Ph.D. (Vanderbilt University), Matthew Girgenti, Ph.D. (Yale University),
Richard Bryant, Ph.D. (University of South Wales,
Sydney), and Amy Adler, Ph.D. (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 efforts at CSTS, have the opportunity to be a team member on projects and learn
by working with CSTS Scientists, biostatisticians,and program managers. The RAs conduct literature searches, participate in study recruitment
and data collection, data entry and quality control,and develop tables and graphic representations ofstudy findings. RAs also prepare summary reportsof meetings. RAs acquire valuable research skills at
CSTS, including poster development for researchpresentations, and present research findings to
professionals, such as study collaborators and thegeneral public. RAs are offered professional 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 pursuing advanced
degrees. Center RAs have engaged in graduate study
at institutions including: Yale, Notre Dame, Johns
Hopkins, Duke, Columbia, Georgetown, London
School of Hygiene and Tropical Medicine, Universityof Maryland, George Washington University, Catholic University, Florida State University and USU.
Opportunities that RAs have pursued following theirexperience at CSTS have included:
n Ph.D. programs in psychology and related fields
n Medical schooln Law schooln Master’s degree programs in psychology, coun-nnseling, public health and social work
Training positions at the NIMH and other institutes at the NIH
Careers with the FBI

In 2022, CSTS developed and implemented a
new series of within-center professional development workshops designed to educate and facilitate
discussions among the Center staff on topics critical to success, such as workplace communication,
military culture, professionalism, and conducting
applied research in DoD settings. We anticipate
holding quarterly professional development workshops moving forward.

DISSEMINATION AND
IMPLEMENTATION OF HEALTH AND
RESEARCH KNOWLEDGE
Fact Sheets and Infographics
Fact sheets are a long-standing and globally lauded
communication tool of CSTS. They are actionable,
easy to understand, and topic-focused education
resources developed using expert knowledge, which
communicate essential behavioral health content on
difficult and/or crisis-related issues. Fact sheets andinfographics address the needs of a broad range ofstakeholders and partners, including responders andemergency workers, health care providers, community
leaders, family members, and policy makers. CSTS
fact sheets, which are developed, updated, and maintained in an online repository, address a wide range ofissues in disaster preparedness and response, such as
climate-related and other natural disasters, pandemics, terrorism, and war; risk and crisis communication;
elements of crisis leadership; health risk education;and family health behaviors. CSTS fact sheets andinfographics provide readers with resources tailored tothe unique aspects of disaster events that address critical contextual factors for various communities during
any given disaster. The Center develops and rapidly
disseminates fact sheets in real time, following majordisasters and traumatic events such as hurricanes andwildfires, public health threats, mass shootings, andwar.
2022 ANNUAL REPORT | 23

In 2022, the Center developed 15 fact sheets andtwo pocket cards addressing mental health aspectsof the war in Ukraine and its impact on military personnel, children and families, aid workers, refugees,
and community and military leaders. These fact
sheets addressed unique issues, including: talking
with children about war, caring for Service members
injured in war, protecting mental health of militaryand community members, managing the emotional
reaction to human remains exposure, grief and othercrisis leadership actions, and reintegrating into acommunity after military service. These fact sheetscontinued to serve as essential education resources to support global mental health response to thewar in Ukraine for the United Nations, NATO allynations, the Five Eyes ministries, and numerous
Non-Governmental Organizations (NGOs) aroundthe globe.
ON

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FETY •• CARE•SA

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Suicide Prevention ProgramC

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CENTER FOR THE STUDY OF TRAUMATIC STRESS (CSTS) | Department of Psychiatry | Uniformed Services University | www.CSTSonline.org

LEADER ACTION CHECKLISTPreventing & Responding to Suicide Events
Early Engagement❑ Get to know your unit personally through one-on-one
❑
❑
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meetings and unit social events
Engage with people early when you think there is aproblem and follow up regularly
Model strong self-care (e.g., sleep, nutrition, stressmanagement, time off)
Identify and address unit stressors (organizational,
relationship, financial, legal, etc.)
Keep units informed of decisions that may impact them
Encourage participation in unit planning and develop astrong mentoring system
Have activities that promote unit cohesion and encourage
peer support
Ensure access to resources to improve stress andperformance (fitness, sleep, nutrition, relaxation)
Eliminate policies and procedures that stigmatize or create
barriers to help-seeking
Create a culture that encourages people to seek help early
before problems worsen
Create connections to chaplains and behavioral health andrequest prevention outreachTalk about safely storing firearms and other methods ofharm (e.g., pills, poisons)Responding to Suicide Ideation or
Attempt❑ Address gossip with information that can be shared❑ Be active in safety planning, including removal and safe

storage of lethal means❑ Do not give up on the person or label them as “weak” or “alost cause”❑ Connect with a peer or mentor to support you in theprocess of navigating a crisis

Responding to a Suicide Death❑ Immediately contact appropriate law enforcement and first

responder teams❑ Ensure notification to chain of command, chaplain, andbehavioral health team

❑ Contact behavioral health expert before announcing death

to unit❑ Lead by being PAV:

❑
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❑ Tell the person you are there to help❑

❑ Ensure immediate safety; Calmly remove any means that

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could be used for self-injury in a crisis
Directly ask the service member if they have suicidal
thoughts: “Are you thinking of killing yourself?”
Do not leave the service member experiencing a crisisalone
If time permits, consult with behavioral healthcare, other
healthcare provider, or chaplain
For immediate evaluation, escort service member to theemergency room, behavioral health, or chaplain
Share details about the situation with only those who needto know

PRESENT in your unit — more than usual
ACTIVE — walk around in the unit and events
talking to each member
x VISIBLE — let members know you are there
Consult with the chaplain about unit sponsored memorialservices
Promptly identify family & survivors for referral to mental
health & bereavement resources
Check-in and support survivors throughout grieving
Provide information that is public about the suicide; Focus
on the loss of the person vs. how they died
Address rumors and discourage gossip
Openly acknowledge grief and loss; genuine expressions ofemotion can help others heal
Remind people it’s okay to feel sad or angry
Create opportunities for unit members to be together andstay connected
Reach out to people who seem disconnected or driftingaway
Role model, encourage, and facilitate self-care to avoid
burnout & compassion fatigue
Remind people there is support available, including
chaplains and behavioral health
x
x

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https://www.cstsonline.org/suicide-prevention-program/

24 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

WebsiteThe CSTS website is a primary tool that is used tofurther the goal of disseminating relevant and timely
information to a wide range of stakeholders (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 disastermental health education fact sheets. The website
includes a “What’s New” section to highlight recent
disaster education materials, research initiatives,
publications, conference summaries, and announcements of upcoming events.
In 2022, the CSTS website saw 46,900 users from174 countries around the world. On average, 129
users visited the site daily throughout 2022. Of the46,900 users, 31,422 users (67%) were from the U.S.
The top five countries each saw more than 440 users
visit our website in 2022.
The most viewed section in 2022, other thanthe main page, was the Disaster Event page: 'War in
Ukraine Mental Health Resources'. That page saw a
total of 4,853 users in 2022 with an average lengthof time on the page of two minutes and 24 seconds.
This page also provided resources in other languages, including French, Japanese, Polish, Ukrainian andRussian. The War in Ukraine Mental Health Re-

sources Ukrainian language page saw a total of 1,864
users in 2022.
SPP was newly added to the website in 2022. Its
creation began in February and the official launch
was in September. It saw 1,243 users during its firstyear. A podcast page, which had 809 users, wascreated that will house “Brain Hijack” and “Let’s
Talk about Your Guns.” Three “Let’s Talk about Your
Guns” podcasts were made available in 2022.

Social MediaIn 2022, the Center continued to grow its online
presence through the use of social media. Social media resources allowed for the timely disseminationof relevant content to CSTS partners and the public.
CSTS social media engaged users from 10 different
countries across the globe and gained new followers
on both Facebook and Twitter. The Center is currently
developing its first Center procedural document for
submitting social media requests, synchronized with
USU. Moving forward, the Center is exploring new
ways to increase its social media presence in 2023
across multiple platforms. CSTS encourages people tovisit and follow our postings via Twitter and Facebook
to stay up to date on new activities and publications.
“Like” CSTS on Facebook and follow CSTS on Twitter@CSTS_USU.

INTERVIEW WITH COLONEL (RETIRED) JEFFREY L. THOMAS
COL (Retired) Jeffrey Thomas, Ph.D. joined CSTS
in August of 2022 as the Executive Director forCenter/Program Operations. We asked Dr.
Thomas about his background and experience, and about what led him to CSTS:
What was your background and experience
before joining CSTS?
I retired from a 28½ year Army career
this past summer. While on active duty, I wasan Army Research Psychologist and much of mycareer focused on conducting behavioral health research with Soldiers. Behavioral health issues have always
been of great consequence to DoD because these issues
have tremendous impact on Soldiers’ health, family, readiness, and performance. My Ph.D. is in social and organizational psychology. My background enabled me to consider, develop and offer evidence-based behavioral healthsolutions to support and sustain health and readiness. My
culminating assignments were as the Center Director for
Military Psychiatry and Neuroscience at the Walter Reed
Army Institute of Research (WRAIR) and as the Research
Psychology consultant to the Army Surgeon General.
What attracted you to CSTS?
CSTS has a reputation as a high-performing and professional research center with a national and international
impact. The psychiatry and psychology worlds are notthat big in DoD, so I had long been familiar with manyof the key leaders at CSTS and the USU Department of
Psychiatry. In my previous roles at WRAIR as the Department Chief for Military Psychiatry, overseas Commanderof the U.S. Army Medical Research Unit in Europe, andas a Center Director, I had been in many professional
meetings with CSTS Scientists. The Centers’ researchcapabilities and competencies were always impressive,state of the art, quick-responding, and highly relevant. Moreover, the ability of USU and CSTS
to conduct research that supports not only
Service members but also the Nation attracted me to the group. It’s been an honor tojoin the team and support all the Center’s
research initiatives.
What are your roles and responsibilities at
CSTS?
My primary responsibilities include directing Center operations to maximize Center resources effectively
and efficiently, such as personnel, finances, logistics,
planning and forecasting, while supporting the CSTS
science, education, and consultation missions. I also provide guidance to Center leaders and program leads on
conducting research in DoD, identifying strategic research
opportunities, and navigating the military’s organizational
cultures. I am also involved in the tremendous scope andcomplexities of the STARRS studies and I advise on how
best to plan, resource, execute and forecast. In addition,
I serve as the senior Henry Jackson Foundation employee
in the Center, and as such, perform supervisory duties forabout 50 HJF employees.
Would you expand on your previous statement that you
saw a tremendous opportunity at CSTS?
Dr. Ursano and his team have built an internationallyrenowned center. CSTS has been involved in providing
research, training, education and consultation to every
disaster, war and trauma faced by our Service members
and citizens since its inception. I am excited to be a partof these accomplishments where I can work to sustain it
and guide it towards continued success.

2022 ANNUAL REPORT | 25

Consultations
Since its inception, consultation has been, andremains, a core function of the Center. It is a primarymechanism through which CSTS shares researchfindings and applies the deep and broad experienceof CSTS Scientists and leadership. These consultations serve as a valuable mechanism to ensure that
CSTS staff are aware of, and responsive to, those
who face challenges and opportunities related totrauma of many types. The Center developed andmaintained partnerships with, and provides consultation to, many agencies and organizations throughout the DoD and other federal agencies, as well aswith state, local, and national agencies, professional
associations, and international organizations. In
addition to these many long-standing organizational
relationships, the Center is continuously increasing
its consultative activities with new partners as opportunities emerge and new needs develop.
COVID-19 and the war in Ukraine created important areas for CSTS consultations in 2022. Evenas cases and deaths from COVID-19 declined, theresidual trauma and grief remain and CSTS’s work inthis area continues and adjusts. The war in Ukraine
created an ongoing threat to global health security,
resulting in the need for consultation, education, andother work to support mental health and well-being
in affected communities around the world.
New and existing consultative relationships haveallowed CSTS to facilitate rapid, high quality, andcreative contributions in a wide variety of stress andtrauma-related topics. The following are examples
of some long-standing CSTS consultations as well assome new ones in 2022:

U.S. GOVERNMENT
Department of Defense
Many types of collaboration throughout DoD are
in the DNA of CSTS. The consultation is steady andongoing.
CSTS continues to be represented on the Navy
Culture of Excellence working group, established by
26 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

the Chief of Naval Operations to approach mental
health and substance abuse in the Navy with a primary prevention model. The group has created theCommanders’ Risk Mitigation Dashboard as a tool
for fleet leaders to better understand the readinessof their commands according to metrics derived
from the signature behaviors. A CSTS psychiatrist
co-chaired Operational Virtual Mental Health, an
ongoing project with the United States Navy Bureauof Medicine and Surgery (BUMED). The group identifies information from the Navy facilities that have
implemented virtual mental health, investigatedplatforms which might be feasible, and determined
cost savings. The group’s findings were presented to
the Secretary of the Navy (SECNAV). In addition,
CSTS has been the psychiatry representative to the
Neuromuscular Subcommittee for the Navy, withthe mission of improving female Service member
retention and evaluation. CSTS is working with
the Defense Health Agency (DHA) Tele-Behavioral
Health (TBH) workgroup, to develop policies.

Military Mortuary Affairs (MA)CSTS remains a global leader in the field ofmortuary affairs and exposure to human remains,a common and often overlooked aspect of disasters
and war. CSTS Scientists have had a long relationship with Military MA. This group experiences very
specialized types of stressors in both the nature andenvironments of their work. Throughout its history,
CSTS has focused on the special needs of military
management of death and the dead. This continuity
has allowed CSTS to conduct research, provide guidance and training, and provide ongoing consultation.
During 2022, a senior CSTS Scientist participatedin, and provided consultation to, a wide variety of
DoD elements operating and influencing military
MA. In addition, special consultation was provided
in the areas of contaminated remains as MA develops a resilience training module in this topic area.
CSTS provided information on stress, resiliency, andbehavioral health support for trained and untrainedpersonnel who conduct MA operations and behavioral and psychological responses to the chemical,
biological, radiological, nuclear, and explosives(CBRNE) environment.

United States Coast Guard (USCG)
In a collaboration that began in 2021 and continues today, CSTS has been working with USCG
psychiatric leadership with efforts to prepare USCG
members to manage unique exposures during activation and how to support Service members andtheir families following return from activations. A
particular challenge has been working with migrants
crossing the U.S. border, including issues of violence
toward women and children creating unique exposures for USCG members working to care for victims of violence who are entering the United States.

Defense Institute of Medical Operations(DIMO)
CSTS Scientists served as Assistant Team Leads
for a DIMO mission in Mexico City, Mexico, overseeing a global health course entitled “Fundamentals
of Military and Disaster Mental Health,” training
more than 50 psychologists, psychiatrists and medical personnel. The course was presided over by the
Mexican Army Surgeon General. A CSTS Scientist
traveled to N’Djamena, Chad as the DIMO Team
Lead in support of a global collaboration of psychologists assembled from Japan, Germany, and Washington State and conducted a course entitled “Mental Health Following Disasters and Trauma.”

Department of Health and Human Services(DHHS)
CSTS has had a long and productive relationshipwith the Substance Abuse and Mental Health Services Administration (SAMHSA). CSTS is currently
working toward broadening its relationship withseveral of SAMHSA’s programs covering a variety of
topic areas of mutual interest and concern. During2022, through the Community of Practice group,
CSTS consulted with leaders in SAMHSA’s recently
established Regional Office located in the ten DHHS
Regions, highlighting state and local behavioral
health issues, opportunities, and challenges.

Agency for International Development(USAID)
CSTS continued to provide ongoing consultation
with USAID to enhance their ability to deal withcritical incidents (especially deaths) involving USAID workers and contractors in the field. Following
an orientation to existing practices and documents,
options for modifying and enhancing both resources
and practices are currently being explored. USAID
staff continued consulting with CSTS in the adaptation of military and other disaster principles toprotect the workforce.

Department of JusticeIn 2022, the CSTS provided subject-matter expertise to the Executive Office of the Office for States
Attorneys to address requirements within Section 4
on “Mental Health and Well-Being of Law Enforcement” within the Executive Order on Advancing
Effective, Accountable Policing and Criminal Justice Practices to Enhance Public Trust and Public
Safety. CSTS provided consultation on both suicide
prevention and methods for adapting principles
and practices to optimize well-being during timesof crisis and high stress and facilitate developmentof a well-being program to protect the health of law
enforcement officers around the country.

Immigration and Customs Enforcement (ICE)The Resiliency leadership at ICE contacted CSTS
to assist with reviewing and researching the effectiveness of their current programs and practices
designed to protect the mental health of agents, analysts, and other personnel exposed to child exploitation material in the process of their investigations.
This resulted in a multi-year research collaboration
involving qualitative and quantitative assessments of
the work force in a multi-wave study. Results will inform leaders on modification of policies and procedures in order to reduce risk and optimize well-being for personnel facing unique exposures to graphic
and violent material. This includes the developmentof educational resources providing actionable recommendations for personnel, leaders, and families
to further protect health.
2022 ANNUAL REPORT | 27

PROFESSIONAL ORGANIZATIONS
American Psychiatric Association (APA)
The relationship of CSTS and APA is strong
and enduring. CSTS assisted in the initiation of
APA’s efforts in disaster psychiatry by establishing
the Committee on the Psychiatric Dimensions ofDisaster in 1992. During 2022, the Center continued to be actively involved in this and other APA
activities to educate and train health professionals
in disaster and preventive psychiatry. In addition,
CSTS consulted with the Public Health Psychiatry
sub-committee of the APA’s Task Force on Social
Determinants of Health to foster Public Health Psychiatry on training programs and professional practice. CSTS provided guidance to the APA Office ofLegal Counsel to the Board of Trustees considering
DSM-6, on the Conflict-of-Interest Guidelines used
for the DSM-5 Task Force, Workgroups, and Consultant members.

American Association for the Advancementof Science (AAAS)CSTS consulted with Section J (Psychology) of
the AAAS as a Member-at-Large of the Section J
Steering Group. The meeting focused on AAAS initiatives to promote public engagement with sciencegenerally and the use of science in policy decisions.

National Association of State Mental Health
Program Directors (NASMHPD)
The relationship between CSTS and NASMHPD has been one of our longest (more than two
decades) and most productive. The relationshipallows NASMHPD and its members ready accessto CSTS consultation and materials. The relationship also allows CSTS to stay current on issues
facing the country’s public mental health system,
its innovations, and its challenges. CSTS authoredan article for the NASMHPD annual Technical
Assistance Center on Climate-Related Disasters tobetter inform state Directors on the impact, risk,
and interventions needed to address mental healtheffects of these events. In addition, a CSTS Scientist
spoke at the NASMHPD annual Director’s conference, providing expert knowledge and education
28 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

on climate-related and other disasters and guidance
to states on how to further protect community health,particularly in marginalized groups in the wake ofthese events.

Vibrant Emotional Health
CSTS provided consultation to a group headedby Vibrant Emotional Health and the Group for the
Advancement of Psychiatry. This group considered revisions to the classic phases of disaster model to a represent the impact of successive overlapping disasters
and to account for underlying stresses within communities. The result has been the development of the“Chronic Cyclical Disaster Model,” which is scheduled
for presentations at multiple meetings in 2023.

Sesame Workshop
CSTS provided consultation to Sesame Workshop
related to supporting socioemotional developmentin children. This was attended by Dr. Jeanette Betancourt, Senior Vice President for U.S. Social Impact at
Sesame Workshop.

STATE AGENCIES
California
A CSTS Associate Director consulted with the
California Department of Health concerning the
behavioral health issues being experienced by casefinders and contact tracers throughout the state. The
consultation resulted in a presentation to, and discussion with, 440 COVID-19 responders across the state.
The presentation was entitled “Disaster Behavioral
Health and COVID-19: Applied History & Novel
Challenges.” Limited ongoing consultation has continued to address the needs of this often-overlookedgroup of public health workers. CSTS remains prepared to provide ongoing support as needed.

Colorado
At the request of the Colorado Association of
Local Public Health Officials (CALPHO), a CSTS Associate Director provided consultation regarding thespecial stressors experienced by local health authorities in Colorado during the prolonged COVID-19
pandemic, as well as other types of public healthemergencies. The consultation resulted in facilitating
two meetings with the membership, representing approximately 30 cities/counties in Colorado, focusedon the stresses of public health leadership in many
types of crisis situations.

Texas
The CSTS Deputy Director and a CSTS Associate Director were asked by NASMHPD to assist the
Texas State Behavioral Health Division of Healthand Human Services through consultation regarding
community mental health and recovery following
mass shootings. The consultation involved sharing
concepts for addressing community stress across acontinuum, systems-level challenges with community mental health in disasters, and sharing CSTS resources in response to the Robb Elementary School
shootings and the Safe School/Healthy Students
Program report to assist with their efforts to support
children, families and school personnel impacted by
the shooting.

MarylandThe CSTS Deputy Director was sought out by the
Maryland State Department of Health to speak withhealth care workers and leaders on challenges of sustainment and recovery during the COVID-19 global
pandemic and other disasters. He presented andSmall Investments/Large Benefits
From time to time, a consultative opportunity surfaces that requires little ongoing
effort and pays big dividends for both CSTS
and others involved. Such was the case with
the Community of Practice group. Originally established to share COVID-related
challenges being experienced by several
Federal entities, it matured into an active
group that collaborates on resource sharing,problem-solving and early identification ofshared interagency challenges and solutions.
This group was started by leaders at the
DHHS Assistant Secretary for Emergency
Response (ASPR).

discussed at the “Helping the Helpers and Those Who
Serve” webinar series, MED CHI (Maryland State
Medical Society) and the Behavioral Health Administration as part of the Maryland Department of Health.

GLOBAL CONSULTATIONS
Since its beginning, CSTS has been part of a global
community of individuals and organizations addressing trauma in its many forms. The following are examples of CSTS international activities in 2022:

International Ministerial Five Eyes Alliance
CSTS, in its ongoing collaboration with the Five
Eyes Alliance Advisory Group on Mental Health(consisting of the United States, United Kingdom,
Australia, New Zealand and Canada), coauthoredmultiple publications on Service member and family
well-being, including one on research priorities on
moral injury, optimizing pathways to mental healthcare across the military career life cycles. The publications included two commentaries highlighting key
issues related to the mental health consequences of
war to aid resilience among international and U.S.
forces in support of populations at risk during the war
in Ukraine.

Disaster Psychiatry Canada
CSTS provided consultation and training during
the Disaster Psychiatry Canada and Canada Psychiatric Association sponsored training course, “Psychiatric Dimensions of Disasters: 5th Annual CME
Training Course.” The CSTS Director moderated
roundtables and the CSTS Deputy Director presented
on the global mental health impacts of COVID-19,
2022 ANNUAL REPORT | 29

lessons learned from military practices to foster
resilience, and the application of these to support
community well-being during the War in Ukraine.

International Initiative on Mental Health
Leadership (IIMHL)
CSTS presented at a keynote session during theannual IIMHL conference, which brings together senior leaders in mental health and substance use from
16 partner nations. One of the other three global
hubs that were part of the conference was hosted by
Jacinda Ardern, the Prime Minister of New Zealand.
Collaborations focused on leadership in disasters,
highlighting the impact and response to the Manchester bombing in the UK.

World Psychiatric Association (WPA)CSTS assisted with the WPA position statement
on “Mental Health in the Workplace” to provide
global guidance on actions recommended for governments, organizations, leaders, and health care
workers on the importance of protecting mental
health in the workplace to enhance well-being ofworkers and global economic productivity.

European College of Neuropharmacology(ECNP)The Chair of the Department of Psychiatry, theCSTS Director, and the CSTS Deputy Director participated in a ECNP Traumatic Stress Network Hot
Topics meeting that focused on psychological firstaid for the military and actions for leaders to support
community well-being during times of war. Thesemeetings involved didactic education and case-basedlearning, as well as audience engagement, to address
current and evolving issues of concern for Service
members and the broader community.

NorwayDr. Morganstein presenting at the International
Initiative on Mental Health Leadership (IIMHL)
conference.

30 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Scientists from CSTS met with military mental health leaders in the Norwegian military, andcolleagues from WRAIR, to discuss issues of military readiness, the impact of various exposures on
psychological health outcomes, and different research activities. The group explored shared interests in exposure to death and dying, as well as facetsof preparedness that impact well-being for Service
members and others. CSTS shared resources related
to supporting leaders in war, terrorism, and otherdisasters, as well as a current resource page withtranslated materials to support families, health care
and aid workers, and community leaders involved inwork in Ukraine. Opportunities for future collaborations were explored.

Publications(Names in bold text are CSTS personnel)

JOURNAL ARTICLES
Adler, A.B., Forbes, D., & Ursano, R. J. (2022).
Sustaining NATO service member mental healthduring the crisis in Ukraine. BMJ Military Health,e002136.
Adler, A.B., Gutierrez, I.A., Gomez, S.A.Q., Beymer,
M.R., Jackson Santo, T., Thomas, J.L., Cates, D.S.,
Milliken Bell, A., & Quartana, P.J. (2022). The
role of leadership: COVID-19, mental health, andpreventive health behaviors in US soldiers. BMC
Public Health, 22, 1-9.
Benedek, D.M. (2022). Matthew J. Friedman, M.D.,
PhD and the creation of the VA National PTSD
Brain Bank. Psychiatry, 85:2, 157-160.
Betz, M.E., Stanley, I.H., Anestis, M.D., Bryan, C.J.,
Buck-Atkinson, J., Carey, N., GhahramanlouHolloway, M, Heintz Morrissey, B., Holloway,
K., Houtsma, C., Kennedy, R., Paine, C.M.,
Ramchand, R., Simonetti, J., Walsh, A., & WrightKelly, E. (2022). Firearm suicide prevention in the
U.S. military: Recommendations from a nationalsummit. Military Medicine, usac371, https://doi.
org/10.1093/milmed/usac371
Brager, A., McKeon, A., Russell, D., & Markwald,
R. (2022). Military health and performance
optimization: A circadian strategy in response togovernmental policies. F1000Research, 11, 1262.
Cabrera, O.A., Trachik, B.J., Ganulin, M.L., Dretsch,
M.N., & Adler, A.B. (2022). Factor structure andmeasurement invariance of the Brief Resilience
Scale in deployed and non-deployed soldiers.
Occupational Health Science. https://doi.
org/10.1007/s41542-022-00138-4
Chu, C., Stanley, I.H., Marx, B.P., King, A.J., Vogt,
D., Gildea, S.M., Hwang, I.H., Sampson, N.A.,
O’Brien, R., Stein, M.B., Ursano, R.J., & Kessler,
R.C. (2022). Associations of vulnerability tostressful life events with suicide attempts after
active duty among high-risk soldiers: Resultsfrom the Study to Assess Risk and Resilience inServicemembers-Longitudinal Study (STARRSLS). Psychological Medicine, 1–11. Advance online
publication.

Cozza, S.J., Ogle, C.M., Fisher, J.E., Zhou, J.,
Zuleta, R.F., Fullerton, C.S., & Ursano, R.J.
(2022). The effect of war injury and combat
deployment on military wives’ mental healthsymptoms. Depression and Anxiety, 39, 686-694.
Dempsey, C.L., Benedek, D.M., Zuromski, K.L.,
Nock, M.K., Brent, D.A., Ao, J., George, M.W.,
Haller, K., Aliaga, P.A., Heeringa, S.G., Kessler,
R.C., Stein, M.B., & Ursano, R.J. (2022). Recent
stressful experiences and suicide risk: Implications
for suicide prevention and intervention in US
Army soldiers. Psychiatric Research and Clinical
Practice. DOI: 10.1176/appi.prcp.20220027
Fisher, J.E., Krantz, D.S., Ogle, C.M., Zhou, J.,
Zuleta, R.F., Strickman, A.K., Fullerton, C.S.,
Ursano, R.J., & Cozza, S.J. (2022). Mental
health, ill-defined conditions, and health careutilization following bereavement: A prospective
case-control study. Journal of the Academy ofConsultation-Liaison Psychiatry. doi: 10.1016/j.
jaclp.2022.02.007
Fisher, J.E., Rice, A.J., Zuleta, R.F., & Cozza, S.J.
(2022). Bereavement during the COVID-19
pandemic: Impact on coping strategies and mental
health. Psychiatry: Interpersonal and Biological
Processes. doi: 10.1080/00332747.2022.2051141
Flynn, B.F., Vance, M.C., West, J.C., Morganstein,J.C., & Fullerton, C.S. (2022). Disaster behavioral
health research involving military facilities andpopulations after mass violence: Insights from the2013 Washington Navy Yard Shooting. Disaster
Medicine and Public Health Preparedness, 16(3),1215-1220.
Frankova, I., Vermetten, E., Shalev, A.Y., Sijbrandij,M., Holmes, E.A., Ursano, R., Schmidt, U., &Zohar, J. (2022). Digital psychological first aid
for Ukraine. The Lancet Psychiatry. https://doi.
org/10.1016/S2215-0366(22)00147-X
Harrison, E.M., Schmied, E.A., Hurtado, S.L.,
Easterling, A.P., & Glickman, G.L. (2022). The
development, implementation, and feasibilityof a circadian, light, and sleep skills programfor shipboard military personnel (CLASS-SM).
International Journal of Environmental Researchand Public Health, 19(5), 3093. https://doi.
org/10.3390/ijerph19053093
Hoffman, S., Taylor, C.T., Campbell-Sills, L., Thomas,
M.L., Sun, X., Naifeh, J.A., Kessler, R.C., Ursano,R.J., Gur, R.C., Jain, S., & Stein, M.B. (2022).
2022 ANNUAL REPORT | 31

Association between neurocognitive functioning
and suicide attempts in U.S. Army soldiers.
Journal of Psychiatric Research, 145, 294-301.
Katrinli, S., Maihofer, A.X., Wani, A.H., Pfeiffer, J.R.,
Ketema, E., Ratanatharathorn, A., Baker, D.G.,
Boks, M.P., Geuze, E., Kessler, R.C., Risbrough,V.B., Rutten, B., Stein, M.B., Ursano, R.J.,
Vermetten, E., Logue, M.W., Nievergelt, C.M.,
Smith, A.K., & Uddin, M. (2022). Epigenome-wide
meta-analysis of PTSD symptom severity in threemilitary cohorts implicates DNA methylation
changes in genes involved in immune system andoxidative stress. Molecular Psychiatry. https://doi.
org/10.1038/s41380-021-01398-2
Kim, S.Y., Buckenmaier, C.C., Howe, E.G., & Choi,
K.H. (2022). The newest battlefield opioid,
sublingual sufentanil: A proposal to refine opioid
usage in the U.S. military. Military Medicine,187(3-4), 77–83. https://doi.org/10.1093/milmed/
usab395
Kim, S.Y., Cohen, S.P., Rodriguez, S.E., McCabe, J.,& Choi, K.H. (2022). Central effects of stellate
ganglion block mediated by the vagus nerve? Analternate hypothesis for treating PTSD. Medical
Hypotheses, 162, 110833.
Koh, K.A., Montgomery, A.E., O’Brien, R.W.,
Kennedy, C.J., Luedtke, A., Sampson, N.A.,
Gildea, S.M., Hwang, I., King, A.J., Petriceks,
A.H., Petukhova, M.V., Stein, M.B., Ursano, R.J.,& Kessler, R.C. (2022). Predicting homelessness
among U.S. Army Soldiers no longer on active
duty. American Journal of Preventive Medicine.
https://doi.org/10.1016/j.amepre.2021.12.028
Kotov, R., Cicero, D. C., Conway, C. C., DeYoung,
C. G., Dombrovski, A., Eaton, N. R., First, M.
B., Forbes, M. K., Hyman, S. E., Jonas, K. G.,
Krueger, R. F., Latzman, R. D., Li, J. J., Nelson, B.
D., Regier, D. A., Rodriguez-Seijas, C., Ruggero,C. J., Simms, L. J., Skodol, A. E., . . . Wright,
A. G. C. (2022). The hierarchical taxonomy ofpsychopathology (HiTOP) in psychiatric practiceand research. Psychological Medicine, 52(9), 1666–
1678. https://doi.org/10.1017/S0033291722001301
Mash, H.B.H., Fullerton, C.S., Morganstein, J.C.,
Liu, A.G., Vance, M.C., Wang, L., MullinsHussain, B., & Ursano, R.J. (2022). Responding
to repeated disasters: Time to recovery in publichealth workers. Disaster Medicine & Public
Health Preparedness, 1-7.
32 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Morganstein, J.C. (2022). Climate-Related Disasters:
Understanding Causes, Consequences, andInterventions to Protect Community Mental
Health. National Association of State Mental
Health Program Directors Technical AssistanceCenter.
Morganstein, J.C., Bromet, E.J., Shigemura, J. (2022).
The neuropsychiatric aftermath of exposure to
weapons of mass destruction: Applying historicallessons to protect health during the war in
Ukraine. Psychological Medicine. 1-3.
Morganstein, J.C., Ursano, R.J., Benedek, D.M.,
Kurosawa, M., & Shigemura, J. (2022). Preparing
for the mental health consequences of a nuclear
event in Ukraine: The time is now. Psychiatry
and Clinical Neurosciences. Advance online
publication. https://doi.org/10.1111/pcn.13363
Naifeh, J.A., Capaldi, V.F., Chu, C., King, A.J., Koh,
K.A., Marx, B.P., Montgomery, A.E., O’Brien,
R.W., Sampson, N.A., Stanley, I.H., Tsai, J., Vogt,
D., Ursano, R.J., Stein, M.B., & Kessler, R.C.
(2022). Prospective associations of militarydischarge characterization with post-active duty
suicide attempts and homelessness: Resultsfrom the Study to Assess Risk and Resilience inServicemembers-Longitudinal Study (STARRSLS). Military Medicine, usac232. Advance online
publication.
Naifeh, J.A., Ursano, R.J., Stein, M.B., Mash, H.H.,
Aliaga, P.A., Fullerton, C.S., Dinh, H.M., Kao,
T.C., Sampson, N.A., & Kessler, R.C. (2022).
Association of premilitary mental health withsuicide attempts during US Army service. JAMA
Network Open, 5(6), e2214771
Naifeh, J.A., Ursano, R.J., Stein, M.B., Mash, H.H.,
Aliaga, P.A., Fullerton, C.S., Dinh, H.M., Kao,
T.C., Sampson, N.A., & Kessler, R.C. (2022).
Prospective associations of emotion reactivity andrisk behaviors with suicide attempts in US Armysoldiers. Psychological Medicine, 1–8. Advanceonline publication.
Nevo, O.N., Ogle, C.M., Fisher, J.E., Zuleta, R.F.,
Klein, D.A., & Cozza, S.J. (2022). 1.54 Intersecting
stressors among sexual and gender minority
youth and military-connected youth. Journal of
the American Academy of Child & Adolescent
Psychiatry, 61(10), S158. doi: 10.1016/j.
jaac.2022.09.070

North, C.S., Surís, A.M., Clarke, D., Palka, J.M.,
Yousif, L., & Regier, D.A. (2022). A Crosswalk
study of DSM-IV and DSM-5 criteria for PTSD
from the DSM-5 field trials. Psychiatry, 85(3),228–245. https://doi.org/10.1080/00332747.2022.
2034107
Ogle, C.M., Liu, A.G., Fisher, J.E., Ali, B.,
Rasmussen, A., & Cozza, S.J. (2022).
Development of the Bereavement andInterpersonal Domains codebook. Death Studies,46, 949-957.
Ogle, C.M., Miller, T.L., Fisher, J.E., Zhou, J., &Cozza, S.J. (2022). Latent classes of child neglecttypes and associated characteristics. Child Abuse& Neglect, 134, 105909.
Phelps, A.J., Adler, A.B., Belanger, S.A.H., Bennett,
C., Cramm, H., Dell, L., Fikretoglu, D., Forbes,
D., Heber, A., Hosseiny, F., Morganstein, J.C.,
Murphy, D., Nazarov, A., Pedlar, D., Richardson,
J.D., Sadler, N., Williamson, V., Greenberg, N., &Jetly, R. (2022). Addressing moral injury in the
military. BMJ Military Health, e002128.
Radford, K.D., Berman, R.Y., Jaiswal, S., Kim, S.Y.,
Zhang, M., Spencer, H.F., & Choi, K.H. (2022).
Enhanced fear memories and altered brain
glucose metabolism (18F-FDG-PET) following
subanesthetic intravenous ketamine infusion
in female Sprague–Dawley rats. International
Journal of Molecular Sciences, 23(3), 1922.
Raut, S.B., Canales, J.J., Ravindran, M., Eri, R.,
Benedek, D.M., Ursano, R.J., & Johnson, L.R.
(2022). Effects of propranolol on the modificationof trauma memory reconsolidation in PTSD
patients: A systematic review and meta-analysis.
Journal of Psychiatric Research, 150, 246–256.
Advance online publication. https://doi.
org/10.1016/j.jpsychires.2022.03.045
Raut, S.B., Marathe, P.A., van Eijk, L., Eri, R.,
Ravindran, M., Benedek, D.M., Ursano,R.J., Canales, J.J., & Johnson, L.R. (2022).
Diverse therapeutic developments for posttraumatic stress disorder (PTSD) indicate
common mechanisms of memory modulation.
Pharmacology & Therapeutics, 239, 108195.
https://doi.org/10.1016/j.pharmthera.2022.108195
Rowen, A., Grabowski, M., & Russell, D.W. (2022).
The impact of work demands and operational
tempo on safety culture, motivation and perceived
performance in safety critical systems. Safety
Science, 155, 105861.

Russell, D., Russell, C., & Lei, Z. (2022). Development
and testing of a tool to measure the organizationalsafety climate Aboard US Navy Ships. Journal of
Safety Research, 80, 293-301.
Schmied, E.A., Harrison, E.M., Easterling, A.P.,
Hurtado, S.L., & Glickman, G.L. (2022).
Circadian, light, and sleep skills program: Efficacy
of a brief educational intervention for improving
sleep and psychological health at sea. Sleep
Health, 8(5), 542–550. https://doi.org/10.1016/j.
sleh.2022.05.010
Soumoff, A.A., Driscoll, M.Y., Kim, S., Benedek,
D.M., & Choi, K.H. (2022). Hospitalization for
physical injury may contribute to recovery ofinvisible war wounds: Response to Peterson’s(2021) commentary on Soumoff, et al. (2021).
Journal of Traumatic Stress, 35(1), 341–342.
https://doi.org/10.1002/jts.22765
Spencer, H.F., Berman, R.Y., Boese, M., Zhang,M., Kim, S.Y., Radford, K.D., & Choi, K.H.
(2022). Effects of an intravenous ketamine
infusion on inflammatory cytokine levels inmale and female Sprague-Dawley rats. Journalof Neuroinflammation, 19(1), 75. https://doi.
org/10.1186/s12974-022-02434-w
Stanley, I.H., Chu, C., Gildea, S.M., Hwang, I.H.,
King, A.J., Kennedy, C.J., Luedtke, A., Marx, B.P.,
O’Brien, R., Petukhova, M.V., Sampson, N.A.,
Vogt, D., Stein, M.B., Ursano, R.J., & Kessler,
R.C. (2022). Predicting suicide attempts among
U.S. Army soldiers after leaving active duty
using information available before leaving active
duty: Results from the Study to Assess Risk andResilience in Servicemembers-Longitudinal Study(STARRS-LS). Molecular Psychiatry.
Taylor, C.T., Campbell-Sills, L., Kessler, R.C., Sun, X.,
Nock, M.K., Ursano, R.J., Jain, S., & Stein, M.B.
(2022). Social network size and personality traits
independently and prospectively predict distressdisorders and suicidal behavior in U.S. Armysoldiers. Psychological Medicine, 1–10. Advanceonline publication.
Ursano, R.J., & Stein, M.B. (2022). From soldier’s
heart to shared genetic risk: PTSD andcardiovascular disease. The American Journalof Psychiatry, 179(11), 785–787. https://doi.
org/10.1176/appi.ajp.20220778
Viboch, T., Amescua, M., Jones, D., Nardulli,P., Sessoms, P., Markwald, R., Russell, D., &2022 ANNUAL REPORT | 33

Cialdella-Kam, L. (2022). Pre-deployment vitamin
D and nutritional status in US Navy sailors.
Medicine & Science in Sports & Exercise, 54, 307.
Wang, J., Naifeh, J.A., Herberman Mash, H.B.,
Morganstein, J.C., Fullerton, C.S., Cozza, S.J.,
Stein, M.B., & Ursano, R.J. (2022). Attachment
style and risk of suicide attempt among new
soldiers in the U.S. Army. Psychiatry, 1–12.
Advance online publication.
Wang, J., Naifeh, J.A., Mash, H.B.H., Morganstein,J.C., Fullerton, C.S., Cozza, S.J., Stein, M.B., &Ursano, R.J. (2022). Parental suicide attempt andsubsequent risk of pre-enlistment suicide attemptamong male and female new soldiers in the U.S.
Army. Suicide & Life-Threatening behavior, 52(1),59–68. https://doi.org/10.1111/sltb.12772
Wang, J., Ursano, R.J., Gifford, R.K., Dinh, H.,
Weinberg, A., Cohen, G.H., Sampson, L., Galea,
S., & Fullerton, C.S. (2022). Suicide ideation andsocial support trajectories in National Guard andReserve servicemembers. Psychiatry, 1–13.
West, J.C., Walsh, A.K., & Morganstein, J.C. (2022).
Just-in-time adaptive interventions for suicide:The right idea at the right time. Psychiatry. 85(4),347-353.
West, J.C., Morganstein, J.C., & Benedek, D.M.
(2021). Fourteen years later: Hobfoll andcolleagues five principles of psychological firstaid through the lens of the COVID-19 global
pandemic. Psychiatry, 84(4), 373-377.

34 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

BOOKThe Textbook of Disaster Psychiatry 2nd Edition,edited by Dr. Robert J. Ursano, Dr. Carol S.
Fullerton, Dr. Lars
Weisaeth and Dr.
Beverley Raphael, wastranslated into Japanese
by Dr. Jun Shigemura.
Dr. Shigemura wasa former CSTS
International Fellow(2003–2005) and is
now a Professor for
the Faculty of Health
Sciences at Mejiro
University in Saitama,
Japan. The translated
edition is now available in print.
Link to Japanese version: https://www.
seishinshobo.co.jp/book/b594884.html
Citation for original/English Version: Ursano, R.,
Fullerton, C., Weisaeth, L., & Raphael, B. (Eds.).
(2017). Textbook of Disaster Psychiatry (2nded.). Cambridge: Cambridge University Press.
doi:10.1017/9781316481424.

BOOK CHAPTER
Regier, D.A. Classification of Mood Disorders,in Nemeroff CB, Rasgon N, Schatzberg AF,
Strakowski SM (eds). The American Psychiatric
Association Publishing Textbook of Mood
Disorders, 2nd Edition, APA Publishing,Washington, DC (2022) pp 15-30.

Presentations, Interviews and Briefings,
Awards and Appointments
PRESENTATIONS(Names in bold text are CSTS personnel)
Angkaw, A.C., Cozza, S.J., Detlefsen, E.G., Mehaffey,
E.P., & Reynolds III, C.F. (2022, May). Literature
in madness. Virtual forum presentation for the
University of California, San Diego.
Biggs, Q.M. (2022, April). Depression in U.S. Army
Mortuary Affairs Soldiers. Oral presentation at theMortuary Affairs Connect semi-annual worldwide
mortuary affairs community meeting, virtual.
Biggs, Q.M., Morganstein, J.C., Mullins-Hussain,
B., Petrini, J.M., McCarroll, J.E., Fullerton,
C.S., Ursano, R.J. (2022, September). Leadership
tools to foster resilience and readiness in service
members working with human remains during
COVID-19 and other disasters: Turning evidence
into action with the MA-STAR Pocket Card.
Poster presentation at the Military Health System
Research Symposium, Kissimmee, FL.
Biggs, Q.M., Mullins-Hussain, B., Petrini, J.M.,
Thomas, A., Steward, A.E., Wang, L., Fullerton,
C.S., & Ursano, R.J. (2022, April). Potentiallytraumatic exposures in Middle East deployed
and non-deployed U.S. Army Mortuary Affairs
Specialist Soldiers. Poster presentation (virtual)
at the 16th Annual Amygdala, Stress, and PTSD
Conference: Cells, Circuits, Sensors, and Stress,
USU, Bethesda, MD.
Biggs, Q.M., Wang, J., Petrini, J.M., Jefferies, J.,
Thomas, A., Blumhorst, A., Weingrad, A.,
Fullerton, C.S., Amin, R., & Ursano, R.J. (2022,
April). Perceived barriers to seeking mental healthcare in military Service members with and without
post-traumatic stress disorder. Poster presentation(virtual) at the 16th Annual Amygdala, Stress, and
PTSD Conference: Cells, Circuits, Sensors, andStress, USU, Bethesda, MD.
Brenner, G., West, J.C., Naturale, A., & Koyfman,
S. (2022, June). The chronic disaster model.
Presentation at Bridging the Gap: A symposium on
Disaster Behavioral Health Access for All, virtual.

Cozza, S.J. (2022, September). Grief and substance userelated deaths. Presentation at the National Capital
Region Pain Initiative’s Annual Substance Use
Disorder Symposium.
Cozza, S.J. (2022, July). Military family safety andsafety promotion. Presented at the Military Child
Education Coalition’s Global Summit, National Child
Traumatic Stress Network.
Cozza, S.J. (2022, April). Minefields in the vast
emptiness. Presentation at the Lincoln Ideas Forum:
Grief and Loss.
Cozza, S.J. (2022, January). Risk and resilience:
Military connected children and families. Virtualpresentation as part of the symposium entitledChild Maltreatment in Military Families:
Research, Training and Building Partnerships fora Coordinated Community Response at the 37th
Annual San Diego International Conference onChild and Family Maltreatment.
Cozza, S.J., Leskin, G.A., & Ogle, C.M. (2022, January).
Child maltreatment in military families: Research,training, and building partnerships for a coordinatedcommunity response. Symposium presentation at the37th Annual San Diego International Conference onChild and Family Maltreatment.
Cozza, S.J. & Walsh, T.R. (2022, June) Helping
children manage stress in the midst of a crisis /Talking to children about war. Virtual presentation
to Ukrainian providers and parents from refugee
camps.
CrossBear, S., Higgins, L., & Cozza, S.J. (2022,
October). My child is suicidal and I don’t know how
to help. Panelist presentation for the Arizona State
University and Mental Health America “I Don’t
Know How” Series.
Dempsey, C.L., Benedek, D.M., West, J.C., Nock,
M.K., Zuromski, K.L., Georg, M.W., Ao, J.,
Weinberg, A., Mullins-Hussain, B., Bossarte,
R.M., & Ursano, R. (2022, March). Principal reasonsfor gun ownership and suicide risk in U.S. Armysoldiers and veterans. Poster presentation at theAnxiety and Depression Association of America
Conference, Denver, CO.
2022 ANNUAL REPORT | 35

Dempsey, C.L., Benedek, D.M., West, J.C., Nock,
M.K., Zuromski, K. L., Ao, J., Georg, M. W.,
Probe, D., Blumhorst, A., Bossarte, R.M., &Ursano, R.J. (2022, August). Firearm behavioral
practices and suicide attempt and ideation in U.S.
Army soldiers and veterans. Poster presentation
at the American Psychological Association
Convention, Minneapolis, MN.
Dempsey, C.L., Benedek, D.M., West, J.C., Nock,
M.K., Zuromski, K.L., Georg, M.W., Ao, J.,
Probe, D., Blumhorst, A., Dhanraj, N., Bossarte,
R.M., & Ursano, R.J. (2022, September). Weapon
storage practices, reasons for gun ownership andsuicide risk in U.S. Army soldiers and veterans.
Poster presentation at the Military Health System
Research Symposium, Kissimmee, FL.
Dempsey, C.L., Benedek, D.M., West, J.C.,
Nock, M.K., Zuromski, K., Georg, M.W., Ao,
J., Bossarte, R.M., & Ursano, R.J. (2022, Nov.)
Reasons for gun ownership and suicide risk
in Servicemembers: An actionable target forintervention. Presented at the Association for
Behavioral and Cognitive Therapies Convention.
New York, NY.
Dempsey, C.L., Benedek, D.M., West, J.C., Nock,
M.K., Zuromski, K.L., Bossarte, R.M., Probe,
D.M., Georg, M.W., Ao, J., Blumhorst, A.,
Dhanraj, N. & Ursano, R.J. (2022, November).
Gun ownership, storage practices and suicide
risk in U.S. Army active-duty Service members.
Presented at the National Research Conference on
Firearm Injury Prevention, Omni Shoreham Hotel,
Washington, D.C.
Fisher, J.E., Blumhorst, A.L., Zhou, J., Ogle, C.M.,
Zuleta, R.F., Fullerton, C.S., Ursano, R.J., &Cozza, S.J. (2022, April). Predictive validity of item
9 of the Patient Health Questionnaire in a bereaved
sample: Comparison to the Beck Scale for Suicide
Ideation. Virtual poster presentation at the 16th
Annual Amygdala, Stress, and PTSD Conference:Stress and the Mind.
Fisher, J.E., Ogle,C. M., Zhou, J., Zuleta, R.F., &Cozza, S.J. (2022, November). Mechanisms ofsuicidal ideation in a military-bereaved sample.
International Society for Traumatic Stress Studies
38th Annual Meeting, Atlanta, GA.
Fisher, J.E., Walsh, T.R., Ogle, C.M., Zuleta, R.F.,
Morganstein, J., & Cozza, S.J. (2022, May).
Enhancing effective coping as a suicide prevention
36 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

strategy: A virtual program for bereaved family
members. Presented at the annual conference of the
Association for Psychological Science, Chicago, IL.
Gabbay, F.H., Kessler, R.C., Sampson, N.A., Collen,
J.F., Williams, S.G., Robertson, B.D., Ao, J.,
Georg, M.W., & Capaldi, V.F. (2022, September).
Variation in individual responses to insomnia
treatments: Building a longitudinal dataset to
identify predictors in improving sleep in the DoD:
Investigations in operational, therapeutic, andbiomarker strategies. Poster presented at the 2022
Military Health System Research Symposium,
Kissimmee, FL.
Hisle-Gorman, E., Cozza, S.J. (2022, April). The
partnership for military child health research
symposium. Symposium presentation for theMonth of the Military Child, Department ofPediatrics, Uniformed Services University.
Hu, X.Z., Ursano, R.J., Benedek, D.M., Li, X.X.,& Zhang, L. (2022, December). The associationof p11 with the depressive severity in Service
Members. Poster presentation at the USUHSNeuroscience Program Thirty-Second WinterSymposium &amp; Poster Show, Bethesda, MD.
Kim, S.Y., Soumoff, A.A., Raiciulescu S., Kemezis,
P.A., Spinks, E.A., Ursano, R.J., Benedek, D.M.,& Choi, K.H. (2022, December). Association of
Mild Traumatic Brain Injury and NeuropsychiatricSymptoms in Wounded Military Service Members[Poster presentation]. USUHS Neuroscience
Program Thirty-Second Winter Symposium &amp;
Poster Show, Bethesda, MD.
Kumer, K., & Cleaves, E.S. (2022, June). Lessons
from the Front: Teaching Psychological First Aidand Disaster Preparedness in Medical Schools.
Presented at the Association of Directorsof Medical Student Education in Psychiatry
Conference.
Mash, H.B.H., Fullerton, C.S., Morganstein,J.C., Dinh, H.M., & Ursano, R.J. (2022, April).
Responding to the COVID-19 pandemic: Workproductivity and psychological responses in
activated New York National Guard service
members. Poster presented at the virtual 16th
Annual Amygdala, Stress, and PTSD Conference:
Cells, Circuits, Sensors, and Stress, USU, Bethesda,
MD.
Morganstein, J.C., Farley, H., Dyrbye, L. Ripp, J.
(2022, January). Reconsidering priorities andpractical strategies for addressing clinician wellbeing in Omicron’s wake. STEPS Forward webinar,
American Medical Association, Virtual.
Morganstein, J.C., Meyer, E.G., Capaldi, V.,
Millegan, J. (2022, Mar). Careers in military
psychiatry: Paths less taken. Panel presentation
to Society for Uniformed Services Psychiatrists
District Branch, American Psychiatric Association.
Morganstein, J.C. (2022, April). Finding structurein chaos: Fostering resilience and operationalsustainment in the healthcare workforce throughcrisis leadership in COVID-19 & beyond. Presented
at the 2022 Physician Business Leadership
Certification Program, Iowa Hospital Association.
Morganstein, J.C. (2022, April). Healing ourworkforce & creating the workplace of the future.
Fireside Chat at the Annual Board of Directors
Retreat, Christiana Care, Wilmington, DE.
Morganstein, J.C. (2022, November). Preparing forthe next pandemic & other disasters to protect
mental health, foster resilience, and enhancesustainment: What have we learned fromCOVID-19. Virtual presentation at the Education
Series, Saint Luke Institute.
Morganstein, J.C. (2022, December). Protecting
community mental health and fostering resiliencein climate-related disasters and beyond. Virtualpresentation at the Annual Meeting, American
Geophysical Union.
Morganstein, J.C. (2022, May). Protecting mental
health: COVID-19 and beyond. Webinar at STEPS
Forward, American Medical Association.
Morganstein, J.C. (2022, May). What does history
teach us about the mental health impacts ofdisasters. Keynote at Center for Workplace
Mental Health, American Psychiatric Association
Foundation, New Orleans, LA.
Morganstein, J.C. (2022, June). Applying principles
of disaster mental health to foster well-resilience insurvivors and workers during the war in Ukraine
and beyond. Presented to the International
Psycho-Oncology Society.
Morganstein, J.C. (2022, June). Protecting mental
health in COVID-19, war, and beyond. Webinar
presented at the “Psychiatric Dimensions ofDisaster” annual conference, Disaster Psychiatry
Canada, Ontario Medical Association, &University of Toronto.
Morganstein, J.C. (2022, June). Principles of crisis

leadership and disaster mental health to foster
resilience and operational sustainment in thehealthcare workforce during Covid-19 & beyond.
Presented at the 2022 Leaders Lecture Series,
Greater New York Hospital Association.
Morganstein, J.C. (2022, July). Climate-Related
disasters and public mental health: Impacts, risks,
and interventions to protect workers and others.
Annual Meeting, National Association of State
Mental Health Program Directors, Arlington, VA.
Morganstein, J.C. (2022, July). Finding structurein chaos: Enhancing well-being and operationalsustainment for healthcare workers in COVID-19
and beyond. Presented at the “Helping the Helpers
and Those Who Serve” webinar series, MED
CHI and the Behavioral Health Administration,
Maryland Department of Health.
Morganstein, J.C. (2022, July). Leadership
actions to protect military and civilians in war
and other disasters. Presented at the virtual
conference “Cognitive Neuroscience and Clinical
Neuropsychology: The Beginning of a New Pathin Ukraine,” Association of Neuropsychologists of
Ukraine.
Morganstein, J.C. (2022, July). Leadership behaviors
in war and disasters for civilian and military
populations to foster action, sustainment, andrecovery. Presented in the series “HOT TOPICS in
Dark Times,” Traumatic Stress Network, European
College of Neuropsychopharmacology.
Morganstein, J.C. (2022, July). What does history
teach us about the impact of disasters. Corporate
Alliance, American Psychiatric Association
Foundation.
Morganstein, J.C. (2022, August). Protecting mental
health & fostering resilience in mass violence andother disasters. Presented to the Department
of Behavioral Health, North Shore Healthcare
System.
Morganstein, J.C., Toukolehoto, O., Meyer, E.G.,& West, J.C. (2022, May). Military Support for
the U.S. Health System During COVID-19: A
framework to enhance workforce well-being andsustainment in future disasters. Committee on
Psychiatric Dimensions of Disasters, APA Annual
Meeting on Demand, New Orleans, LA.
Morganstein, J.C., & West, J.C. (2022, May).
Disasters and mental health: Helping your patientsdeal with adverse effects of climate change,
2022 ANNUAL REPORT | 37

pandemics, and mass violence part 1. Disasters.
Committee on Psychiatric Dimensions ofDisasters, APA Annual Meeting on Demand, New
Orleans, LA.
Morganstein, J.C., West, J.C., & Winakor, J.S. (2022,
May). Disasters and mental health: Helping yourpatients deal with adverse effects of climate change,
pandemics, and mass violence part 2. Disasters.
Committee on Psychiatric Dimensions ofDisasters, APA Annual Meeting on Demand, New
Orleans, LA.
Nevo, O.N., Ogle, C.M., Fisher, J.E., Zuleta, R.F.,
Klein, D.A., & Cozza, S.J. (2022, October).
Intersecting stressors among sexual and genderminority youth and military-connected youth.
American Academy of Child and Adolescent
Psychiatry 69th Annual Meeting, Toronto, Canada.
Ogle, C.M. (2022, October). Child maltreatment inmilitary families. Presentation to the National
Child Traumatic Stress Network Military and
Veteran Families and Children Collaborative
Group.
Ogle, C.M., Fisher, J.E., Walsh, T.R., Zhou, J., &Cozza, S.J. (2022, May). Risk factors for childhood
exposure to domestic violence. Presented at
the annual conference of the Association for
Psychological Science, Chicago, IL.
Ogle, C.M., Weingrad, A.B., Zuleta, R.F., Fisher,
J.E., Walsh, T.R., & Cozza, S.J. (2022, April). A
conceptual model of family safety to inform future
research and prevention efforts. Virtual poster
presentation at the 16th Annual Amygdala, Stress,
and PTSD Conference: Stress and the Mind.
Ogle, C.M., Zhou, J. (2022, April). Risk factors
associated with latent classes of child neglect.
Virtual poster presentation at the 16th Annual
Amygdala, Stress, and PTSD Conference: Stressand the Mind.
Spangler, P.T., Dempsey, C.L., Nissan, D., Phares,
A., West, J., Willing, M., & Winslow, B. (2022,
September). Nightmare deconstruction andreprocessing: final pilot results of a treatment
for trauma-related nightmares and insomnia.
Poster presentation at the Military Health System
Research Symposium, Kissimmee, FL.
Spangler, P., Benedek, D., Bolis, M., Dempsey, C.L.,
Hillman, K., Kwasinski, R., Phares, A., West,J., Winslow, B. (2022, November). Nightmare
deconstruction and reprocessing: Proof of concept
38 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

of a novel treatment for ptsd-related nightmares
and insomnia. Poster presented at the International
Society for Traumatic Stress Studies, 38th Annual
Meeting, Atlanta, GA.
Ursano, R.J. (2022, January). What PTSD as a disorderteaches us about the brain and psychotherapy
treatment. Presented at the International
Psychotherapy Institute’s (IPI) Master Speaker
Series, Washington, DC.
Ursano, R.J. (2022, June). International roundtable.
Invited moderator at the Psychiatric Dimensionsof Disasters: 5th Annual CME Training Course,
Disaster Psychiatry Canada, virtual.
Ursano, R.J. (2022, August). Disaster psychiatry
and behavioral health: From hurricanes andearthquakes, to war and terrorism...to COVID-19.
Invited (virtual) plenary talk. 2022 Annual Meetingof the American College of Psychiatrists, Naples, FL.
Ursano, R.J. (2022, October). Thinking from the big
data perspective. opportunities, challenges, andlimitations for military mental health care ref suicide
and other [Virtual presentation]. Personalized
Medicine in Mental Health and Performance:
North Atlantic Treaty Organization Human Factors
and Medicine (HFM) Meeting #5, University of
Melbourne, Carlton, Melbourne, Australia.
Ursano, R.J., Benedek, D. M. & Vermetten, E. (2022,
March). Hot topics Q&A. Virtual roundtable
presentation/discussion at the ECNP TraumaticStress Network Meeting.
Walsh, A.K., Weingrad, A.B., Morganstein, J.C.,
Heintz Morrissey, B., Fullerton, C.S., Petrini,
J.M., Ursano, R.J. (2022, April). Translating brain
trauma: A practical approach to suicide prevention[Poster Presentation]. Amygdala, Stress, and
PTSD: Cells, Circuits, Sensors, and Stress, Virtual
Conference.
Weingrad, A.B., Walsh, A.K., Morganstein, J.C.,
Heintz Morrissey, B., Fullerton, C.S., Petrini,
J.M., Ursano, R.J. (2022, May). A public healthapproach to suicide prevention using the Haddon
matrix conceptual framework. Poster Presentation at
USU Research Days, Bethesda, MD.
West, J.C. & Benedek, D.M. (2022, April). Resiliency inmass casualty events: Application of military combat
and operational stress control. Presentation at the
Hardwiring Resiliency Conference, Boston, MA.
West, J.C. (2022, June). Maintaining therapeutic
alliance in treatment resistant depression.

Presentation at WRNMMC Artiss Symposium,
Bethesda, MD.
West, J.C. (2022, September). Tough conversations:Talking to patients about firearms and risk.
Oral presentation at the Southern Psychiatric
Association and Maryland Psychiatric Society
Annual Meeting, Baltimore, MD.
Zuromski, K. L., Dempsey, C.L., (Co-Chairs), Betz,
E., Anestis, M.D., Mattson, S. (Presenters), Bryan,
C. (Discussant; 2022, Nov). Addressing the firearm
suicide epidemic in the U.S. military: Opportunities
for behavioral science to make an impact.
Symposium conducted at the Association for
Behavioral and Cognitive Therapies Convention.
New York, NY.
INTERVIEWS AND BRIEFINGS
Dr. Morganstein was interviewed in his USU capacity
by a reporter with the American Association of
Medical Colleges about the resources developedby CSTS in support of mental health during
the war in Ukraine. The discussion involved anunderstanding of important and evolving issues
related to mental health during a war and armed
conflict, including the need for easy-to-use andactionable resources that are culturally sensitive
and address current and evolving challenges for
affected families, healthcare and aid workers,
military personnel, and leaders.
Dr. Benedek and Dr. Dempsey were interviewed by
the Public Health Reporter from The Trace about
the CDC-funded study: Firearms and Behavioral
Practices and Suicide Risk in U.S. Army Soldiersand Veterans.
Dr. S. Cozza and Dr. Ogle briefed the Office ofMilitary Community & Family Policy (MC&FP) on
their study, Child Maltreatment in DoD Families:
A Population Study to Inform Prevention Efforts.
Dr. S. Cozza and Dr. Ogle briefed Thomas Constable,
the Principal Deputy Assistant Secretary of
Defense for Readiness, on the results of theChild Maltreatment in DoD Families Study.
Representatives from the Office of MilitaryCommunity & Family Policy were also in
attendance. The purpose of the briefing was todetermine whether the research findings shouldbe transmitted to Congress, and if so, the mostappropriate format for submission.

Dr. Morrissey led a briefing at the National Guard
Headquarters to NGB J1 Warrior Resilience &Fitness Director and his team for Project SafeGuard,a National Guard peer-to-peer lethal means
counseling project supported by CSTS Suicide
Prevention Program. The purpose of the brief was toprovide an in-progress review for state participation,
implementation and evaluation recommendations.
The meeting resulted in a request for a Project
SafeGuard executive training for senior NG leaders.
AWARDS AND APPOINTMENTS
Dr. S. Cozza was acknowledged for his contributions inadvancing the science of Prolonged Grief Disorderin a JAMA Psychiatry viewpoint article, “Prolonged
Grief Disorder Diagnostic Criteria—Helping
Those With Maladaptive Grief Responses,” by Dr.
Prigerson, et al.
Dr. S. Cozza and Dr. Fisher received the Notice ofAward from the CDC for their project, Grief andhealth-related quality of life in WTCHR Survivors:
Associations with bereavement, trauma exposures,and mental and physical health conditions.
Dr. S. Cozza was selected to join the Five Eyes Mental
Health Research and Innovation Collaborative(MHRIC). The Five Eyes MHRIC is led by Phoenix
Australia and the Canadian Institute for Military
and Veteran Health Research (CIMVHR) and is acollaboration of 11 centers of expertise in military
and Veteran mental health from the United States,
United Kingdom, New Zealand, Canada andAustralia.
Dr. Thomas was appointed as Research Professor of
Psychiatry at USU.
Dr. A. Walsh was invited to be a journal reviewer for
Military Behavioral Health.
Dr. Mash was invited to serve as an Academic Editor for
PLOS ONE.
CSTS won a 2022 American Graphic Design Awardfor the SP) website. The American Graphic DesignAwards are a national competition with more than
10,000 entries. The immediate benefit is to thefaculty, researchers, and staff working on SPP. It is arecognition of their hard work under tight deadlines.
For funders, it is a validation of the program, its
purpose, and a statement about the strong designof the website that features the messaging “Care,
Connect, Safety, Conversations.” (https://www.
cstsonline.org/suicide-prevention-program/)2022 ANNUAL REPORT | 39

CSTS Personnel
DIRECTORS
Robert J. Ursano, MD
Col, MC, FS, USAF (Ret.)
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Director
CSTS, USUDavid M. Benedek, MD
COL, MC, USA (Ret.)
Chair, Professor
Department of Psychiatry
Associate Director, Consultationand Education
CSTS, USU
Stephen J. Cozza, MD
COL, USA (Ret.)
Professor of Psychiatry and
Pediatrics
Department of Psychiatry
Associate Director, Child andFamily Program
CSTS, USU
Brian W. Flynn, EdD
RADM, USPHS (Ret.)
Adjunct Professor
Department of Psychiatry
Associate Director, Health
Systems
CSTS, USU
Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
Scientific Director
CSTS, USUPaul E. Hurwitz, MPH
Instructor
Department of Psychiatry
Director, Program Operations(STARRS)
CSTS, USU
Holly H. Mash, PhD
Research Associate Professor
Department of Psychiatry
Assistant Scientific Director
CSTS, USU
Joshua C. Morganstein, MD
CAPT, USPHS
Professor/Assistant Chair
Department of Psychiatry
Deputy Director
CSTS, USUJames A. Naifeh, PhD
Research Associate Professor
Department of Psychiatry
Assistant Scientific Director
CSTS, USU
Jeffrey L. Thomas, PhD
COL, USA (Ret.)
Research Professor
Department of Psychiatry
Executive Director - Center/
Program Operations
CSTS, USUSCIENTISTS
Pablo A. Aliaga, MS
Instructor
Department of Psychiatry
CSTS, USU

40 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

David M. Benedek, MD
COL, MC, USA (Ret.)
Consultant to the U.S. Army
Surgeon General for Forensic
Psychiatry
Chair, Professor
Department of Psychiatry
CSTS, USU
Quinn M. Biggs, PhD, MPH
Research Assistant Professor
Department of Psychiatry
CSTS, USU
Robert Bossarte, PhD
Professor
Department of Psychiatry and
Behavioral Neurosciences
University of South Florida
Adjunct Professor
Department of Psychiatry
CSTS, USUMaria Braga, DDS, PhD
Professor
Department of Anatomy,
Physiology and Genetics
CSTS, USU
Allen R. Braun, MD
Senior Scientist
Department of Psychiatry
CSTS, USU
Oscar A. Cabrera, PhD
LTC, MS, USA
Department of Psychiatry
CSTS, USU

Vincent F. Capaldi, II, ScM, MD,
DFAPA, FACP, FAASM
LTC (P), MC, USA
Vice Chair, Department of
Psychiatry (Research)
Professor of Psychiatry, Medicine,and Neuroscience
Senior Scientist, CSTS
Program Director, Combined
Internal Medicine/Psychiatry
Residency, USU
Senior Medical Scientist, WRAIR
Kwang Choi, PhD
Associate Professor
Department of Psychiatry
CSTS, USU
Elle S. Cleaves, MD
Maj, USAF, MC, FS
Assistant Professor
Director, Psychiatry Clerkship
Department of Psychiatry
CSTS, USU

Joscelyn E. Fisher, PhD
Research Associate Professor
Department of Psychiatry
CSTS, USU

Elizabeth A. Greene, MD
Assistant Professor
Department of Psychiatry
CSTS, USU

Brian W. Flynn, EdD
RADM, USPHS (Ret.)
Adjunct Professor
Department of Psychiatry
CSTS, USU

Derrick Hamaoka, MD
Col, USAF, MC, FS (Ret.)
Associate Professor
Department of Psychiatry
CSTS, USU

Michael C. Freed, PhD
Chief
Services Research and Clinical
Epidemiology Branch
National Institute of Mental
HealthDepartment of Psychiatry
CSTS, USU

Brooke A. Heintz Morrissey,
PhD, LCSWLTC, ARNG
Operations Director, Suicide
Prevention Program
Department of Psychiatry
CSTS, USU

Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
CSTS, USU

Kelly L. Cozza, MD, DLFAPA,
FACLP
Professor and Vice Chair(Education)
Director, Departmental Faculty
Appointments, Promotions,and Development
Department of Psychiatry
CSTS, USUFrancie Gabbay, PhD
Research Associate Professor
Department of Psychiatry
CSTS, USU

Stephen J. Cozza, MD
COL, USA (Ret.)
Professor of Psychiatry and
Pediatrics
Department of Psychiatry
CSTS, USU

Gena L. Glickman, PhD
Assistant Professor
Director, Chronobiology, Light,
and Sleep Lab
Department of Psychiatry and
Neuroscience
CSTS, USU

Catherine L. Dempsey, PhD,
MPH
Research Assistant Professor
Department of Psychiatry
CSTS, USU

Robert K. Gifford, PhD
Assistant Professor
Department of Psychiatry
CSTS, USU

Oscar I. Gonzalez, PhD
MAJ, MC, USA
Research Psychologist
Army Resilience Directorate
Headquarters, US Department of
the Army, DCS, G-1
Department of Psychiatry
CSTS, USU

Harry C. Holloway, MD
COL, MC, USA (Ret.)
Professor Emeritus
Department of Psychiatry
CSTS, USU
Marjan G. Holloway, PhD
Professor
Department of Medical & ClinicalPsychology and Psychiatry
CSTS, USU
Edmund G. Howe III, MD, JD
Professor
Department of Psychiatry
CSTS, USU
Xianzhang Hu, MD, PhD
Neuroscientist
Department of Psychiatry
CSTS, USU
Luke Johnson, PhD
Associate Professor
Department of Psychology
University of Tasmania
Tasmania, Australia
Adjunct Assistant Professor
Department of Psychiatry
CSTS, USU
2022 ANNUAL REPORT | 41

Tzu Cheg Kao, PhD
Professor
Department of Preventive
Medicine and Biometrics
CSTS, USUJames E. McCarroll, PhD, MPH
COL, USA (Ret.)
Research Professor
Department of Psychiatry
CSTS, USU

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

Eric Meyer II, MD
Lt Col, USAF, MC, FS
Associate Professor
Department of Psychiatry
CSTS, USUDavid S. Krantz, PhD
Professor
Department of Medical & ClinicalPsychology
CSTS, USU

Joshua C. Morganstein, MD
CAPT, USPHS
Professor
Department of Psychiatry
CSTS, USU

Kimberly D. Kumer, MD
Col, USAF, MC
Assistant Professor
Director of Operational
Curriculum
Department of Psychiatry
CSTS, USUJames A. Naifeh, PhD
Research Associate Professor
Department of Psychiatry
CSTS, USU

Christina La Croix, DO
CDR, USN
Assistant Professor
Department of Physical Medicine& Rehabilitation
CSTS, USU
He Li, MD, PhD
Associate Professor
Department of Psychiatry
CSTS, USU
Xian Liu, PhD
Research Professor
Deployment Health ClinicalCenter
Walter Reed Army Medical Center
Holly H. Mash, PhD
Research Associate Professor
Department of Psychiatry
CSTS, USU

Christin M. Ogle, PhD
Research Assistant Professor
Department of Psychiatry
CSTS, USU
Darrel A. Regier, MD, MPH
RADM, USPHS (Ret.)
Adjunct Professor
Department of Psychiatry
CSTS, USU
Dori B. Reissman, MD, MPH
RADM, USPHS (Ret.)
Associate Administrator
World Trade Center Health
Program
NIOSH, CDC
Department of Psychiatry
CSTS, USU
Dale Russell, PhD
Director of Research/SeniorResearch Psychologist
Commander, Naval Surface Forces
Behavioral Science Researcher
Department of Psychiatry
CSTS, USU

42 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Patcho N. Santiago, MD, MPH
CAPT, MC, USN (Ret.)
Associate Dean for Diversity &Inclusion
School of Medicine
Associate Professor
Department of Psychiatry
CSTS, USU
Rachel Shor, PhD
Research Psychologist
Department of Psychiatry
CSTS, USU
Patricia Spangler, PhD
Research Assistant Professor
Department of Psychiatry
CSTS, USU
Madeline Teisberg, DO
LCDR, MC, USN
Assistant Professor
Department of Psychiatry
CSTS, USU
Faculty, National Capital
Consortium Psychiatry
Residency
WRNMMC
Jeffrey L. Thomas, PhD
COL, USA (Ret.)
Research Professor
Department of Psychiatry
Executive Director – Center/
Program Operations
CSTS, USU
E. Fuller Torrey, MD
Executive Director
Stanley Medical Research Institute
Robert J. Ursano, MD
Col, USAF (Ret.)
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Director
CSTS, USU

Mary C. Vance, MD, MSc
LCDR, USPHS
Director, Behavioral Health,Pacific Area, USCG
Assistant Professor of Psychiatry
Department of Psychiatry
CSTS, USU
Adam Walsh, PhD, LCSW
Adjunct Professor
Department of Psychiatry
CSTS, USU
Tasanee Walsh, PhD, MPH,
MSW
Senior Scientist
Department of Psychiatry
CSTS, USU
Jing Wang, PhD
Research Associate Professor
Department of Psychiatry andMedical & Clinical Psychology
CSTS, USU

Ronald Whalen, PhD, LMSW
Senior Research Social Worker
Department of Psychiatry
CSTS, USU

Glory Owe, MPH
Data Analyst
Department of Psychiatry
CSTS, USU

Kathleen Wright, PhD
Former Director (Ret.)
Force Health Protection Program
USAMRU-E
WRAIR

Jing Zhou, MS
Biostatistician
Department of Psychiatry
CSTS, USU

Gary H. Wynn, MD
COL, MC, USA (Ret.)
Professor
Department of Psychiatry
Senior Scientist
CSTS, USU

Alexandra Blumhorst, BS
Study Coordinator
Department of Psychiatry
CSTS, USU

BIOSTATISTICIANS

Hieu Dinh, BS
CSTS Program Manager
Department of Psychiatry
CSTS, USU

Pablo A. Aliaga, MS
Instructor
Department of Psychiatry
CSTS, USU

Maree J. Webster, PhD
Research Assistant Professor
Department of Psychiatry
CSTS, USU
Director
Laboratory of Brain Research
Stanley Medical Research Institute

Leming Wang, MS
Instructor
Department of Psychiatry
CSTS, USUJames (Curt) West, MD
CAPT, MC, USN (Ret.)
Associate Professor and Deputy
Chair
Department of Psychiatry
CSTS, USU

Sara Bessman, MS
Laboratory Manager
Department of Psychiatry
CSTS, USU

Lei Zhang, MD
Associate Professor
Department of Psychiatry
CSTS, USU

Leming Wang, MS
Instructor
Department of Psychiatry
CSTS, USU

Lars Weisaeth, MD
Professor
Division of Disaster Psychiatry
University of Oslo
Oslo, Norway

PROGRAM
MANAGEMENT

Jingning Ao, MPH
Biostatistician
Department of Psychiatry
CSTS, USU
Matthew Georg, MPH
Data Analyst
Department of Psychiatry
CSTS, USU
Katy Haller, MSPH
Data Analyst
Department of Psychiatry
CSTS, USU

Brooke A. Heintz Morrissey,
PhD, LCSWLTC, ARNG
Operations Director, Suicide
Prevention Program
Department of Psychiatry
CSTS, USU
Miranda Meyer, MPA
Senior Program Coordinator
Department of Psychiatry
CSTS, USU
Julia Petrini, ScB
Project Coordinator
Department of Psychiatry
CSTS, USU
Ashley Phares, BA
Clinical Project Coordinator
Department of Psychiatry
CSTS, USU
2022 ANNUAL REPORT | 43

Joseph Piemontese, BS
Information Technology Specialist
Department of Psychiatry
CSTS, USU
Deborah Probe, MA
Project Coordinator
Department of Psychiatry
CSTS, USU
Aaron Weingrad, BS
Assistant to the Director &Scientific Program Coordinator
Department of Psychiatry
CSTS, USU
Rafael Zuleta, BS
Associate Program Manager
Department of Psychiatry
CSTS, USUFINANCIALMANAGEMENT
Diana Monday
Administrative Assistant II &Presentations Coordinator
Department of Psychiatry
CSTS, USU
Joshua Ruff, BA
Senior Finance Program Manager
Department of Psychiatry
CSTS, USU

CSTS FELLOWSHIP
AWARD RECIPIENTSWilliam Flerlage
Haley Spencer
Matthew Thompson

MILITARY SUPPORTOPERATIONS

STAFFSasha Baghdadi
Rina Berman
Marita Bolis
Natasha Dhanraj
Aliya Hilmi
Joseph Hooke
Jamiere Jefferies
Xiaoxia Li
Madeleine McGuinness
Ami Neiberger-Miller
Britany Mullins-Hussain
Arrey Thomas
Alysse Weinberg

SCIENCECOLLABORATIVEMEMBERSJames E. Barrett, PhD
Emeritus Professor and Former
Chairman
Department of Pharmacology andPhysiology
Drexel University
College of Medicine
Paul D. Bliese, PhD
Associate Professor
Department of Management
University of South Carolina
Darla Moore School of Business
Robert Bossarte, PhD
Professor
Department of Psychiatry and
Behavioral Neurosciences
University of South Florida
Adjunct Professor
Department of Psychiatry
CSTS, USU

TSgt Jessica Moore
MSgt Amy Steward

44 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

David Brody, MD, PhD
Professor
Department of Neurology
Director
Center for Neuroscience andRegenerative Medicine
USU
M. Richard Fragala, MD
COL, USAF, MC, FS (Ret.)
Professor
Department of Psychiatry
USU
Matthew J. Friedman, MD, PhD
Professor
Department of Psychiatry
Professor
Department of Pharmacology &Toxicology
Dartmouth University
Geisel School of Medicine
Director Emeritus
Leahy-Friedman
National PTSD Brain Bank
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
USU
Ronald C. Kessler, PhD
McNeil Family Professor
Department of Health Care Policy
Harvard Medical School
Craig H. Llewellyn, MD
Professor
Department of Military &Emergency Medicine
USU

Irwin Lucki, PhD
Professor and Chair
Department of Pharmacology &Molecular Therapeutics
USU
Matthew K. Nock, PhD
Edgar Pierce Professor and Chair
Department of Psychology
Harvard University
Francis O’Conner, MD, MPH
COL, MC, USA
Professor
Department of Military andEmergency Medicine
Uniformed Services University
Harvey B. Pollard, MD, PhD
Professor
Department of Anatomy,
Physiology, & Genetics
USU
Robert M. Post, MD
HeadBipolar Collaborative Network
Former Chief
Biological Psychiatry Branch
NIMHDavid Riggs, PhD
Professor and Chair
Department of Medical & ClinicalPsychology
Executive Director
Center for Deployment
Psychology
USU

Arieh Y. Shalev, MD
Professor
Department of Psychiatry
New York University Professor
Department of Psychiatry
Hadassah University School of
Medicine
Jerusalem, Israel
M. Katherine Shear, MD
Professor
Department of Psychiatry in Social
Work
Columbia University School ofSocial Work
Columbia University College ofPhysicians and Surgeons
Director, Center for Complicated
Grief
Columbia University
Murray B. Stein, MD, MPH
VA San Diego Healthcare System
Distinguished Professor
Department of Psychiatry andFamily Medicine & Public
HealthUniversity of California, San Diego
Lars Weisaeth, MD
Professor
Division of Disaster Psychiatry
University of Oslo
Oslo, Norway

DISTINGUISHEDFORMERSCIENCECOLLABORATIVEMEMBERS & EMERITUS
FRIENDS OFCSTS
Herbert A. Hauptman, PhD(1917-2011)1985 Nobel Laureate, Chemistry
President
Hauptman-Woodward Medical
Research InstituteResearch Professor
Department of BiophysicalSciences
Adjunct Professor
Department of Computer Science
University of Buffalo
Joshua Lederberg, PhD,
ForMenRS (1925-2008)
1958 Nobel Laureate, Physiology
or Medicine
Professor Emeritus
Department of Molecular
Genetics and Informatics
Rockefeller University
Founder, Department of Medical
Genetics
University of Wisconsin, Madison
David H. Marlowe, PhD(1931-2014)
Senior Lecturer
Department of Psychiatry
USU
Former Chief
Department of Military Psychiatry
WRAIR Fellow
American Anthropological
Association

2022 ANNUAL REPORT | 45

Funded Grants
AWARDSFUNDING INSTITUTION

Evaluation of the Safety and Pharmacokinetics of the FAAH Inhibitor URB597
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)

USAMRMCVA
DHP

Family Violence and Trauma Project

IMCOM

Central Nervous System Correlates Study

MOMRP

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 Servicemembers 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

Grief and Health-Related Quality Of Life In WTCHR Survivors: Associations With Bereavement, 		Trauma Exposures, and Mental and Physical Health Conditions
CDC
Identifying Motivations for Service Members and Veterans Owning Firearms, Storing Themin 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

46 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

NIOSHPartnerships
The Center has worked with organizations in the public and private
sectors through research partnerships, project collaborations,consultations and trainings. CSTS
would like to acknowledge andthank our partners and collaborators listed below:
American Academy of Child andAdolescent Psychiatry
American Association for the
Advancement of Science(AAAS)
American Gold Star Mothers
American Psychiatric Association
American Psychological
Association
Architect of the Capitol
Armed Forces Retirement Home
Broad Institute
The Carter Center
Catholic University of America
Center for Health Care Research
Medical University of South
Carolina
Centers for Disease Control andPrevention
Columbia University
Columbia University Mailman
School of Public HealthCornell University
Dartmouth University
Defense Centers of Excellence
for Psychological Health andTraumatic Brain Injury
Defense Institute of Medical
Operations, Mexico (DIMO)
Department of Mental Health, The
District of Columbia
Deployment Health ClinicalCenter (DHCC)
Disaster Psychiatry Canada

Dover Air Force Base
Drexel University
European College of
Neuropharmacology (ECNP)
Federal Bureau of Investigation
Florida Department of Health
Ft. Bragg, North Carolina
Ft. Hood, Texas
Ft. Lee, Virginia
Ft. Stewart, Georgia
George C. Marshall Center for
European Security
Gold Star Wives of America
Harvard University Medical
SchoolHarvard University School of
Public HealthHenry M. Jackson Foundation for
the Advancement of Military
Medicine
Human Performance Resources by
CHAMP (HPRC)
Immigration and Customs
Enforcement (ICE)International Initiative on Mental
Health Leadership (IIMHL)
International Ministerial Five Eyes
Alliance
International Society forTraumatic Stress Studies
Italian Embassy, Washington, D.C.
Joint Base Lewis-McChord
Joint Mortuary Affairs Center andSchool, Ft. Lee, Virginia
Las Vegas Psychiatric Association
Massachusetts General Hospital
Medical Research Command at Ft.
Detrick
Military Child Education Coalition
Military Mortuary Affairs
Miller School of Medicine of the
University of Miami

National Association of State
Mental Health Program
Directors
National Center for PostTraumatic Stress Disorder ofthe Department of Veterans
Affairs
National Child Traumatic Stress
Network
National Committee for Employer
Support of the Guard andReserve
National Fallen Firefighters
Foundation
National Institute for
Occupational Safety and
Health (NIOSH)
National Institute of Mental
Health (NIMH)
National Institutes of HealthNational Military Family
Association
The National Association for
PTSD
The National Association ofState Mental Health Program
Directors
National Intrepid Center of
Excellence
National Military Family
Association
Norwegian Military
Rockefeller University
Rutgers University Cell & DNA
Repository
Rutgers University School ofSocial Work
Sesame Workshop
Stanford University
State of California
State of Colorado
State of Texas
State of Maryland
2022 ANNUAL REPORT | 47

Substance Abuse and Mental
Health Services Administration(SAMSHA)
Syracuse University and Syracuse
VA Medical Center
The Alfred P. Sloan Foundation
Tragedy Assistance Program for
Survivors
Tulane School of Social Work
Uniformed Services University
Union Pacific Railroad
U.S. Agency for International
Development (USAID)
U.S. Air Force
U.S. Army
U.S. Army Family Advocacy
Program
U.S. Army Family Programs
U.S. Army Installation
Management Command
U.S. Army Medical Research &Development Command

U.S. Coast Guard
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. Postal Service
University of California, Los
Angeles
University of California, San Diego
University of Michigan
University of Pennsylvania
University of Pittsburgh
University of Virginia
University of Virginia’s Critical
Incident Analysis Group(CIAG)

Operation Bushmaster: Mass casualty scenario — medical evacuation.

48 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

University of Washington
Veterans Administration Medical
Center of D.C.
Vibrant Emotional Health
Walter Reed Army Institute of
Research
Walter Reed National Military
Medical Center
World Psychiatric Association(WPA)
Wright State University
Yale University
Yale School of Medicine and VA
Connecticut Healthcare System
Yellow Ribbon Reintegration
ProgramZero to Three

The CSTS team participates in a virtual noon “check-in” meeting every workday for
updates, discussions, presentations and guest speakers.

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org