Center for the Studyof Traumatic Stress
Three decades and growing strong

2017 Annual Report

2017

1987

CONTENTS
From the Director.................................................................................................1
Our Mission.........................................................................................................3
Research...............................................................................................................4
Education and Training.......................................................................................16
Consultation......................................................................................................23
Interview with a CSTS Scientist .........................................................................27
Publications.......................................................................................................29
Presentations, Briefings, Interviews and Awards................................................34
Directors, Scientists, Science Collaborative Members and Staff.........................38
Funded Grants ..................................................................................................43
Partnerships.......................................................................................................44

From the Director
Dear Center Colleagues and Friends,
In this our thirtieth year, it is valuable to recall thestructure and role of the Center for the Study ofTraumatic Stress (CSTS). CSTS is a core part of the
Department of Psychiatry in
the F. Edward Hébert Schoolof Medicine (America’s Medical School) of the Uniformed
Services University (USU).
The Center actively supports
the Strategic Framework andmission of USU, as well as theMilitary Health System, andthe broader mission of the
Department of Defense (DoD).
Through leadership, education and training, research and scholarship, service and outreach, global
health engagement, and enhancing preparedness,
CSTS strives to mitigate the impact of trauma fromexposure to war, disasters, terrorism, community
violence and public health threats. In accomplishing
our mission, we sustain national readiness, enhancenational security, and serve an essential role for the
Department of Defense and the nation.
The Center’s focus is on health issues of special
interest to the military including posttraumaticstress disorder (PTSD), mild traumatic brain injury(mTBI), suicide and suicide-related behavior. CSTS
helps inform our nation’s policies and responses tothe impacts of exposure to trauma from disasters,
both human-made and natural. We are comprisedof a multi-disciplinary and collaborative team ofscientists, educators, clinicians and leaders who
provide the research, teaching, outreach, consultation and leadership to advance our mission and ourgoals.
In support of the USU and DoD mission, CSTS
collaborates, educates, investigates, communicatesand innovates. We move science from the gene, tothe cell, to the organism, to the person, to the community, and from knowledge to action. Our work

ranges from the micro level in our laboratories to themacro level in our communities, our nation and all
across the globe.
CSTS is unique in many ways. Importantly, we
combine and integrate military and disaster psychiatry. As described in the pages of this report, theCenter uses innovative approaches to neuroscience,and conducts ground-breaking research on timely
topics such as suicidal behavior in the Army, andthe impact of death and loss on family members of
Soldiers.
Another way we innovate is through our involvement in “big data” and precision medicine. This
involves data capture, curation, management, processing and analysis of large, complex, and diverse
datasets from different sources. Our big data analytic activities involve advanced analytic techniques
including machine learning and predictive analytics.
We use data mining and state-of-the-art statisticalmethods to analyze previously untapped data sources independently and jointly with other data to gain
new insights resulting in better and faster decisions,and improving health.
One example is part of our STARRS-LS researchin which we combine Army and DoD administrative
data from a broad spectrum of military records thatspan a period of 12 years. The many types of records
include demographic, medical, behavioral health, de-In support of the USU and DoD mission,
CSTS collaborates, educates, investigates,
communicates and innovates. We movescience from the gene, to the cell, to theorganism, to the person, to the community,and from knowledge to action. Our work
ranges from the micro level in our laboratories
to the macro level in our communities, ournation and all across the globe.
2017 ANNUAL REPORT | 1

ployment, training, fitness, neurocognitive, casualty, death, and legal. These records involve millionsof active duty Soldiers and billions of variables
which we combine and analyze to produce actionable findings for the Army and DoD.
Another example is our harnessing genomics,
supercomputers, and bioinformatics through ourcollaboration with the Collaborative Health Initiative Research Project (CHIRP). CHIRP is a precision medicine-based initiative based at USU incollaboration with the National Institutes of Health(NIH) and the DoD. We are working with the
CHIRP team to perform whole genome sequencing of DNA from tens of thousands of Soldiers
who participated in the STARRS research project.
This has the potential to transform patient careby producing actionable personalized medicine togenerate novel personalized therapeutic options
that impact both civilian and military lives.
The Center continues to provide rapid consultation, education and knowledge support to personnel who respond to the health needs of Service
members and their families, and for crises aroundthe globe. In 2017, these events included the mass
shooting at Fort Lauderdale-Hollywood International Airport, the Las Vegas concert mass shooting, the concert bombing in Manchester, U.K.,
earthquakes in Mexico, and a series of devastating
hurricanes in Texas, Florida, Puerto Rico and the
U.S. Virgin Islands.
CSTS reaches beyond our nation’s borders to
conduct international outreach and consultation
including our work with the USU Center for Global Health Engagement (CGHE) and the USU U.S.
Forces Korea (USFK) task force. In 2017, the Center sent a scientist to Iraq to support the DoD on a
Defense Institute for Medical Operations (DIMO)
mission, and sent a scientist to Canada as a member of the NATO Human Factors and Medicine

Panel on Leveraging Technology in Military Mental
Health. CSTS worked with the Syrian American
Medical Society, and hosted a delegation of Iraqi
mental health practitioners, educators and service
providers as part of an International Visitor Leadership Program (IVLP) sponsored by the U.S. State
Department. The Center also hosted scientists fromSingapore, Japan, and Australia. The Center sent ascientist to Spain to present research findings, andI traveled to Latvia for a NATO-sponsored militarysuicide prevention meeting and Australia to provide
consultation to the Australian military.
This Annual Report includes a summary of ourwork in both military and civilian populations toenhance psychological health, speed the recovery
from, and help prevent the negative consequencesof trauma on individuals, families, communities andnations. Our work helps to improve trauma-related
care by preparing treatment providers to address theimpact of trauma and its far-reaching implications,
thereby building a more trauma-informed environment across the continuum of our military andcivilian health care systems.
CSTS was established in 1987, making 2017 the30th year we have been successfully and proudly fulfilling our mission. Also in 2017, it was my pleasure
to return to the Center on a full-time basis.
On behalf of everyone at CSTS, I would like toextend our appreciation to all our colleagues andfriends who have collaborated with us and supported
our work throughout this past year, and throughout
the three decades we have been supporting the Military Health System, the DoD and our nation.
Robert J. Ursano, MD
Professor of Psychiatry and Neuroscience
Department of Psychiatry
Director, Center for the Study of Traumatic Stress
Uniformed Services University

Serving our nation for 30 years
2 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Our Mission
As an integral part of USU, CSTS activities
support the USU Strategic Framework andthe mission of the DoD. CSTS is committed toadvancing trauma-informed care. We are dedicatedto furthering the nation’s understanding of the
impact of trauma on individuals, families andcommunities. The Center is part of our nation’sfederal medical school (America’s Medical School)
at USU and the Center’s mission is aligned with
the needs of the DoD and the nation, and is wellpositioned to rapidly respond to DoD missionrelevant activities.
The Center’s work includes
a broad range of trauma
exposures: combat,
terrorism, naturaland human-madedisasters,
public healththreats,
andhumanitarian operations. CSTS has been involvedin nearly every major disaster our nation has
experienced in the past 30 years. The Center helps
to ensure that behavioral health is addressed in theface of public health threats, disaster planning anddisaster recovery.
Mitigating the effects of disaster and trauma in
military and civilian populations is part of the effort
to foster community and national resilience. The
Center informs and educates community, regional,
state, national and global stakeholders in government,
industry, healthcare, public health, andacademia. CSTS contributes toadvancing trauma-informedcare by providing
leadership in research,education,
training,
consultation,
globalhealth, andservice.

2017 ANNUAL REPORT | 3

Research
CSTS research supports the Military Health System (MHS) in its efforts to provide a medically-readyforce to Combatant Commands in both peacetime
and wartime, and to deliver integrated, affordable,
and high quality health services. Specifically, research into the causes of suicide in Service members,
psychological responses to trauma and disasters,
and clinical investigations of the symptomatology
and treatment of PTSD will improve both readinessand quality of care. For example, Army STARRS andSTARRS-LS studies, designed to elucidate potential
targets for acute intervention in Soldiers at risk forsuicide, have the potential to deliver meaningfulinterventions in the next five years. The Daily Diary
Study, with its ecological momentary assessment
approach, will contribute to better understandingof the time course of symptoms in PTSD patientsand may identify symptoms for targeted treatmentthat have the greatest impact on patient’s daily lives.
Finally, clinical trials in medication and psychotherapy for PTSD offer the potential for improved treatments which will contribute to a more ready force
and better quality care for MHS beneficiaries.

RESEARCH ON SERVICE MEMBERS
Study to Assess Risk and Resilience inServicemembers — Longitudinal Study(STARRS-LS)[formerly Army Study to Assess Risk andResilience in Servicemembers (Army STARRS)]
The original Army STARRS project (2009-2015)
and the continuation project STARRS-LS (20142019) were both designed and conducted under thescientific direction and management oversight of
CSTS through a collaborative effort involving USU,
the University of California San Diego (UCSD), Harvard University and the University of Michigan.
Army STARRS included several separate but
integrated studies designed to comprehensively
examine the mental health and resilience of Soldiers
including Regular Army, Army National Guard
4 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

and activated Army Reserve. It involved large andrepresentative samples of Soldiers, making it thelargest research study of mental health risk andresilience ever conducted among military personnel.
One of the studies was an historical cohort studyof the more than 1.6 million Soldiers on active duty
from 2004 to 2009. Army STARRS also included
cross-sectional studies, a longitudinal study, andcase-control studies that involved collecting data
directly from more than 100,000 active duty Soldiers
throughout the U.S. and overseas. The research
included questionnaires, neurocognitive tests, bloodcollection, state-of-the-art genetic and other biomarker assays, and linking these data to extensive,
existing Army/DoD administrative records. These
efforts produced large and rich datasets to serve
the goals of Army STARRS, but can also be used toserve broader goals involving many other outcomes
besides mental health.
The Center is furthering the Army STARRS
research through a five-year DoD-funded projectcalled STARRS-LS. The major research activities of
STARRS-LS are: 1) continue using the STARRS platforms, systems and data to conduct further analyses,
derive further findings, and extract additional value
from Army STARRS; and 2) extend, expand andenhance the STARRS data by obtaining additional
Army/DoD administrative data for 2010 to 2015, anddesigning and conducting a longitudinal follow-up
study of a subset of more than 50,000 Army STARRS
participants.
Throughout 2017, the research team continued
to obtain and process additional existing Army/DoD
administrative records. Once this database is complete, it will allow analyses of an historical cohort ofmillions of active duty Soldiers over a twelve-year
period from 2004 to 2015. The research team also
continued the first wave of follow-up data collection

for the STARRS-LS cohort and planned the second
wave of data collection. This follow-up study is extending the time-frame of Army STARRS to collectand analyze further outcome information throughout the Soldiers’ Army careers, and to follow those
Soldiers who transition out of the Army throughtheir adjustment to civilian life.
STARRS continues to be a large, long-term,
multi-faceted and innovative research project. A major innovation in 2017 was the initiation of a partnership with the Collaborative Health Initiative Research
Project (CHIRP) to perform whole genome sequencing on DNA from tens of thousands of STARRS
participants. CHIRP is a precision medicine-based
initiative based at USU in collaboration with the National Institutes of Health (NIH) and the DoD.
In 2017, the research team conducted many
briefings of the research progress and findings.
These included three in-person briefings to the
STARRS Government Steering Committee, one
meeting with the STARRS Scientific Advisory Board,and an in-person briefing at the Pentagon to senior

Army leadership including the newly-appointed Secretary of the Army, Army Surgeon General, Deputy
Under Secretary of the Army, G-1 and many othersenior Army leaders.
Throughout 2017, the research team continued tobe highly-productive at analyzing data and writing
papers at a rate of generating one paper per week on
average. At the end of 2017, the research team had
published 63 STARRS papers in peer-reviewed scientific journals, had one paper accepted for publication

A Message from the new Chair of the USU Department of Psychiatry
David M. Benedek, MD
For thirty years, CSTS has served as the primary research arm of the Uniformed Services
University’s Department of Psychiatry. Until
June of last year, Dr. Robert Ursano
served as both the Department
Chair and the Director of CSTS.
Under his leadership, the Centerand the Department of Psychiatry grew in breadth of activities
and national reputation.
As the new Chair, I feel extremely fortunate to continue tobe able to count on Dr. Ursano as amentor and role model. While he has
stepped down as Department Chair to focus hisenergy on CSTS, I am certain that the connection between the Department and Center willremain as strong as ever.

In the years ahead, CSTS will continue tolead the Department of Psychiatry’s efforts togenerate and disseminate knowledge related
to understanding and mitigating theeffects of traumatic stress at theneuro-molecular, the individual,
and the population levels.
As the Center continues
to grow, I look forward not
only to continued cutting edge
research, high quality scientificconferences, and consultation tocommunity and national leaders,
but also to expanded opportunities forour medical students to participate in Center
activities and our Center Scientists to enhance
medical student education across the university.

2017 ANNUAL REPORT | 5but not yet published (in press), had submitted eight
papers that were awaiting a decision for publication
by journals, and had many additional papers in various stages of progress. This extraordinary, groundbreaking and complex research project has continued to produce benefits for the Army, the DoD, andthe nation as a whole.

Psychological Stress and Resilience in
Mortuary Affairs (MA) Soldiers: Longitudinal
Study
U.S. Army mortuary affairs (MA) Soldiers workwith the remains of the dead and are exposed to
one of the highest stressors of war, combat death.
CSTS has conducted research on the stresses of MA
work since 2005. MA detachments that deployed to
the Middle East completed pre- and post-deployment surveys assessing factors such as: PTSD andpost-traumatic stress symptoms, depression, somatization, anger, hostility, and health risk behaviors(e.g., increases in alcohol tobacco and drug use). In
addition, this study examines Soldier resilience, psychological well-being, instrumental and emotional
support, identification with the dead and mutilation
fear (responses to blood, injury and mutilation). To
date, we have collected more than 2,900 surveys.
While the majority of Soldiers who have participated in the study have completed one or two surveys,
some Soldiers have completed as many as 8 surveys,
providing the unique opportunity to examine stressand resilience in Soldiers over time. New in 2017,
we began collecting saliva samples along with survey
data. The genetic DNA and RNA material in saliva
will be analyzed for potential biological markers of
PTSD, stress and resilience. Importantly, we willcompare the objective measures of DNA and RNA
biomarkers to the subjective survey measures ofstress and resilience. This study has implications forearly intervention, training, education, leadershipand health surveillance.

Troop Education for Army Morale (TEAM)TEAM is an early intervention for mortuary
affairs (MA) Soldiers to improve post-deployment
readjustment. The intervention is designed to help
Soldiers cope with daily challenges after returning
6 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

from deployment, including re-integration into family
and garrison life. TEAM, based on the evidence-informed principles of Psychological First Aid, involves
a randomized group of MA Soldiers and a comparison group (usual care). A total of 125 MA Soldiersin 10 cohorts participated in the study. While theintervention did not reduce rates of PTSD, fewer
posttraumatic symptoms were associated with number of workshops attended. In addition, skills taught
during TEAM were reported to be helpful and had
no negative effects. Additional analyses of the TEAM
data are being planned.

Reserve Component of the U.S. Armed Forces
The Citizen Soldiers of the Reserve Component(RC) of the U.S. Armed Forces experience uniquestressors, substantially different from those experienced by the Active Component (AC), when thenation is at war and when the RC is called upon for
emergency service, such as disaster relief. The Centeris strongly committed to supporting the RC through abroad range of activities that are oriented to the RC.
CSTS is conducting a nation-wide longitudinal research study on the physical and mental health of National Guard and Reserve Service members in collaboration with Dr. Sandro Galea at Boston University.
This research is unique in that it uses a representative
national cohort and specifically addresses the experiences of the Guard and Reserve, as distinct from theexperiences of the AC. The study addresses the epidemiology and trajectory of posttraumatic stress, deployment stress, health risk behaviors and health careutilization in the National Guard and in the Reservesof the Army, Navy, Air Force and Marine Corps. Fourwaves of data collection have been conducted to date,
and the team developed a protocol to add a fifth waveof data collection to extend the data on trajectories ofhealth in this important population. CSTS is actively
analyzing the rich dataset.
The Army STARRS New Soldier Study included
survey data collection from approximately 23,000 RC
Soldiers, and blood sample collection from a subset,
during their first week of basic training. This data collection at the very beginning of Soldiers’ military service provides an opportunity to follow them throughthe course of their military careers and beyond in or-der to identify risk factors for health outcomes, aswell as factors that promote resilience. The blood
samples are being used for the examination of biomarkers. Army STARRS research also included RC
members in the All Army Study, which included
a sample of the entire Army, and in the in-theater
study which included a sample of Soldiers serving
in Afghanistan. Both of these studies provided datathat can be used in long-term research while also
providing a snapshot of current health and mental
health. These studies create the opportunity forassessment of concentrations of risk in order to develop future interventions to promote and sustain
health among RC members.
The STARRS-LS research involves the continuation of data collection from Army STARRS
participants and allows further in-depth analysis
of risk and resilience factors among members of
the RC. The Center conducted biomarker researchstudies in National Guard units before and after
deployment for combat tours in Afghanistan. RC
members and their families are included in research designed to address the needs of children
and families affected by trauma that is conductedin the CSTS Child and Family Program.
In addition to research that focuses on the RC,
CSTS provides consultation to RC units. Throughthis consultation, the Center provides the RC
leadership with information products specifically
geared to their needs. CSTS has also enhanced
civilian understanding of the special nature of theRC’s mission, structure, and unique stressors by devoting a chapter to the RC in the recently published
CSTS volume, U.S. Army Culture: An Introduction
for Behavioral Health Researchers.

RESEARCH IN THE CHILD AND
FAMILY PROGRAM
The Center’s Child and Family Program (CFP)
is a national leader in advancing scientific andclinical knowledge, and providing educational
resources addressing the needs of children andfamilies affected by trauma, with particular focus
on our nation’s military families. Military children
and families demonstrate unique strengths andvulnerabilities as they are affected by combat-related
illness and injury, bereavement, child maltreatment
and family violence. CFP’s pioneering research
addressing these complex issues has been translated
into scholarly publications, as well as actionable andeducational materials for military and government
stakeholders, clinicians, and community leaders.
CFP also provides consultation to DoD leadership,national media outlets and engages in academic andprofessional projects that more broadly support
children within the U.S. and world-wide.

Family Bereavement
The National Military Family Bereavement
Study (NMFBS)
NMFBS is the first scientific study to examine
the impact of a U.S. military service death on surviving family members. The goal of the study is tobuild upon the robust civilian research literature
on bereavement and its impact on survivors — how
psychological, physical and/or behavioral outcomesof the grieving process are influenced by family
members’ pre-existing psychological and physicalhealth, social and grief support, and military-specificfactors in the population of Service members who
have died since 9/11. The longitudinal portion of thestudy, which consisted of annual interviews over athree-year period, was completed in 2017. Approx2017 ANNUAL REPORT | 7

imately 850 adults and 120 children completed thelongitudinal portion of the study, and 981 participants provided saliva samples for analysis of genetic
biomarkers associated with bereavement-related
outcomes.
Findings from the study have informed ongoing
discussion to define appropriate diagnostic criteria for a condition of impairing grief. As a resultof this groundbreaking work, CSTS has partneredwith colleagues at Columbia University, New York
University, University of Pittsburgh, and the University of California San Diego in developing a proposal
for alternate and more clinically-relevant criteria ofa persistent grief disorder to be included in future
editions of the DSM.
In 2017, CSTS Scientists published two scientific manuscripts and gave several presentations
regarding findings from NMFBS at national conferences. In addition, the San Antonio Express-News
published an article based on a paper published in
Military Medicine.

Stepping Forward in Grief (SFG)
NMFBS found that a sizeable portion of surviving military family members suffer from highlevels of grief and distress, putting them at risk forharmful changes in mental and physical health.
Based on these results, CFP formed a partnershipwith the Center for ComplicatedGrief at Columbia University
to adapt Complicated Grief
Therapy (CGT) into a digitalintervention (GriefSteps) thatis designed to assist with grief
integration, and decrease risk
for long-term problems. CGT
helps to resolve grief complications
and promote wellness and has been shown
to be helpful in civilian populations. The goal of thestudy is to learn how to best assist military family
survivors with their grief and reduce the long-term
problems that can occur after a loss.
The SFG study is a randomized controlled trial(RCT). Participants will be assigned to one of twogroups: either an intervention group to receive

8 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

GriefSteps (informed by CGT) or a control groupto receive WellnessSteps that is focused on building
resilience through more general wellness strategies.
The study will compare overall improvement in grief
severity and adaptation to loss among participantsin the GriefSteps intervention group, as compared tothose in the WellnessSteps control group. GriefStepsand WellnessSteps will be available virtually, either
in a mobile app or on the Internet. Each participant
will also be assigned a “guide” who is a member ofthe study team who can help answer questions about
the study and support use of the assigned program.
Virtual apps may be an extremely helpful resource for current and future bereaved militaryfamily members as they would be easily accessible
and provide comfort to military Service members byknowing that this resource exists. During 2017, thetraining phase of the study was launched, providing opportunities for all research team members to
become facile with procedures and responsibilities
in preparation for the RCT. The training phase also
allowed the study team to determine which study
procedures or program materials needed to be updated prior to the next phase of the study. The RCT
phase will launch in 2018.

Study of Long-Term Outcomes of TerrorismRelated Grief
CFP partnered with Voices of September 11th
(VOICES), a not-for-profit organization that provides services for 9/11 families, and the CanadianResource Centre for Victims of Crime (CRC), an
organization that is engaged with, and supportive of, family members who were bereaved by the
Air India Flight 182 bombing. The study partners
are investigating long-term positive and negative
bereavement outcomes that follow a terrorism-related death, including grief, traumatic symptoms,
resilience characteristics and post-traumatic growth.
More than 400 participants who are family members
bereaved by the bombing of Air India Flight 182 on
June 23, 1985 or by the events of September 11, 2001
completed an online questionnaire about their experiences related to the aftermath of these events andthe death of their family member(s). The study will

determine predictors of bereavement outcomes anduse findings to develop preliminary working models
for understanding risk and protective factors for bereaved family members of terrorism-related deaths.
This study will build a basis for ongoing research to
inform training and counsel for disaster and terrorism victims and their families. Findings from thisstudy were presented to the research community at
professional meetings, and manuscripts are currently in review for scientific publication.

Child Maltreatment in U.S. MilitaryCommunities and Families
Several ongoing CFP projects focus on identifying risk factors for child maltreatment to informthe development of prevention and intervention
strategies that promote military family health andresilience. Our initial work focused exclusively onchild neglect, the child maltreatment type mostcommonly reported in the U.S and most frequently
associated with child fatality. The aim was to identify factors that contribute to elevated risk of childneglect by investigating characteristics of substantiated child neglect cases in U.S. Army families. Data
were collected from records of 400 substantiatedchild neglect cases from Army installations acrossthe country. In 2015, we published the first reportexamining characteristics of substantiated childneglect in U.S. Army families in Military Medicine,including demographic correlates of child victims
and offenders by neglect type and subtype. In 2017,a second manuscript about military-specific risk
factors for child neglect, including deployment-related risk and its association with different types ofchild neglect, was published in Child Maltreatment.
A third manuscript focused on family risk factors
associated with distinct types of neglect is forthcoming.
A second CFP project, supported by funding
awarded from the DoD in 2016, builds on this lineof research to advance understanding of risk andprotective factors for child maltreatment in military families from all Service branches. Data from asample of military families with substantiated casesof child maltreatment and a comparison sample ofmilitary families without maltreatment histories will

be used to identify child, family, and military-specific risk and protective factors for various typeof child abuse (i.e., sexual abuse, physical abuse,emotional abuse) and neglect. Efforts to date havefocused on examining differences in the prevalenceof child abuse and neglect types in relation to child,family, and military factors. Future work will include
a population-based investigation of all active duty
Service members with one or more children between
the years of 2004 and 2014 to examine longitudinal
trends in child maltreatment in military families. Results from this project will inform our understandingof changes in risk and protective factors across themilitary life course.

Combat Injured Families
CSTS Scientists have conducted a set of threestudies over the past several years to examine theshort- and long-term impacts of severe combat injury on military families, aiming to better understandand address the needs of combat injured militaryfamilies.
The first study involved interviews with militaryfamilies assessing the unique and complex challenges related to combat injury and associated family
functioning. Forty families were interviewed at
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), anddata analysis continues.
The second study investigates the impact of
combat injury on military families over time. Participating families at Walter Reed National Military
Medical Center (WRNMMC) and San Antonio
Military Medical Center provided valuable information about their experiences with combat injury
over time, which will be used to inform intervention
strategies for spouses and children of combat injured
Service members. Data collection was completed in2015 and data analyses and manuscript preparation
continue.
The final study, Families OverComing Under
Stress-Combat Injury (FOCUS-CI) consists ofa pilot for a novel intervention for children andfamilies of combat injured Service members in2017 ANNUAL REPORT | 9

order to establish its feasibility and efficacy. Using arandomized controlled trial approach, the intervention is family-centered, strength-based, and evidence-informed to assist families coping with severe
combat injuries by providing instrumental support
and teaching emotion regulation, problem solving,communication, andgoal-setting skills. Data
JOINING FORCES
was collected from famJoining Families
ilies in Washington, DC,
Chapel Hill, NC and San
Antonio, TX and data
analyses comparing theeffectiveness of the FOCUS-CI intervention on
family functioning to theexisting standard of careare ongoing. In addition, data collected fromthis project have provided novel insight into issuesof intimacy within marital relationships between
combat injured Service members and their spouses,suggesting that this is negatively impacted by spouse
post-traumatic stress related to the Service member’s combat injury. A manuscript describing thesefindings is currently in progress. Along with findings
regarding FOCUS-CI intervention effectiveness andthose from the other two projects, these data will
help us better understand the experience of combat
injury, its impact on Service members and their families, and to inform programmatic intervention thatcan better address the needs of military families.
Volume 17, Issue 2 • Winter 2017

R E A L W O R L D R E S E A R C H F O R F A M I LY A D V O C A C Y P R O G R A M S

F E AT U R E D I N T E R V I E W

Stalking and Intimate Partner Violence: Unwanted,
Repeated, Fear-Inducing
An interview with TK Logan, PhD
TK Logan, PhD

Dr. Logan is Professor, University of Kentucky School of Medicine, Department of
Behavioral Science and the Center on Drug
and Alcohol Research. She is an internationallyrecognized expert on partner violence and stalking. She serves on the editorial board of Violence and Victims, the Journal of Interpersonal
Violence, and Sexualization, Media, & Society.
She is a member of many national organizations

In This Issue
This issue of Joining Forces Joining Families (JFJF) features aninterview with TK Logan, PhD, on stalking victimization and perpetration in
the context of intimate partner violence (IPV). We provide a brief overview
of stalking research, a relatively new topic of investigation in IPV. In our
regular research methods article, we describe differences in qualitativeand quantitative research methods using one of Dr. Logan’s articles as an
example. Another article describes threats in IPV as a form of coercive
control. Websites of interest contains a wide variety of online resourcesthat can be used to educate about stalking as well as provide information
for social service providers, victims, advocates, and criminal justiceprofessionals.
CONTENTS
Stalking and Intimate Partner Violence: Unwanted, Repeated,
Fear-Inducing ……………………………………………………… 1
Building Bridges to Research: Qualitative and Quantitative Research:
What are the Differences? ………………………………………… 4
What is Stalking in the Context of Intimate Partner Violence? ……… 5
Threats of Intimate Partner Violence are Forms of Coercive Control… 9
Websites of Interest ………………………………………………… 12

such as the National Domestic Violence Hotline
Research Council, the Violence Against Women
Act Firearms Subcommittee, and is a consultant
to the Kentucky Coalition Against Domestic
Violence. Dr. Logan’s recent research has focusedon coercive control, stalking, protective ordereffectiveness, sexual assault, intimate partner
homicide, and health disparities of rural womenwith partner violence experiences.

Dr. McCarroll: Stalking is considered a type of
intimate partner violence (IPV) and criminal
conduct. It is largely a gendered phenomenon
in which 16% of women and 5% of men
report at least one incident of stalking in their
lifetime and 4% of women and 1.5% of men in
the past 12 months (Black et al., 2011). Thesefigures translate to approximately one in six
women and 1 in 19 men that will be stalked intheir lifetime. How did you become interested
in stalking?
Dr. Logan: One of the themes that drives
my work is what I call silent suffering. [Editor’snote: For example, see her article on silenced
suffering in partner sexual violence (Logan,
Walker, & Cole, 2015).] When I started there
was not much out there about stalking. I noticed that women were leaving, or attempting
to leave, abusive relationships, but the abuse
was not ending with that separation. Yet, theongoing abuse, harassment, and stalking was
not being discussed or addressed. One of thethings that I as a researcher can do is give voice
Continued on page 2

Family Violence
In 2017, the Center continued to support the
Army Family Advocacy Program (FAP) througha variety of functions for the Family Violence andTrauma Project (FVTP). CSTS Scientists conductedanalyses of maltreatment data from the Army Central
Registry (ACR) for all Army installations that reportfamily maltreatment incidents to the ACR. The Center distributed more than 500 copies of the analyses
to the Army Installation Management Command(IMCOM), reporting installations, others in the DoD
and Army, and civilian researchers.
CSTS published and distributed two newsletters
10 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

on family violence research: Joining Forces Joining
Families (JFJF) and the Research Review (RR). JFJF
consists of an interview with a subject matter expert,
the background of that person’s research, and otherfeatures related to family violence research. RR includes brief summaries of scientific research applicable to the Army FAP insuch a way to make it
useful to the Army.
RESEARCH REVIEWThe Center supported the Army’s
Family Advocacy Research Subcommittee
by reviewing research
protocols and coordinating research results
on family violence by avariety of civilian andmilitary research organizations. Center Scientists produced two publishedarticles related to stress and family violence.
CSTS responded to questions from the Army
IMCOM and the Office of the Army Assistant Chiefof Staff for Installation Management (OACSIM) andwrote summaries and analyses of family violenceissues related to recent research involving scientific and medical aspects of child abuse and intimate
partner violence. Center Scientists wrote the reportfor the annual Army Fatality Review Board. This
report analyzes family maltreatment fatalities inorder to assist the Army in developing prevention
and intervention programs for families at high risk
fatal violence.
CSTS conducted daily reviews of publishedresearch related to family violence from PubMed
and the National Center for Biomedical Information,collected articles for the CSTS database, and distributed articles of high interest to the Army.
FamilyAdvocacy
Research
Digests

CURRENT RESEARCH FOR FAMILY ADVOCACY PROGRAMS • Volume 2, Issue 2 • Summer 2017
In This Issue
We present the fourth edition of Research Review (RR), a publication of the Joining Forces Joining Families group. RR consists of summaries of research of interest to family advocacy, medical, andsocial service providers. These summaries consist of topics that provide tips for providers, issues notcommonly encountered in family maltreatment, and innovations for research and practice. Amongthe child maltreatment articles are resilience in abused young children, three on child physical abuse,current information on infant colic, and educational neglect in children. Summaries on intimate
partner violence (IPV) include relationships between animal abuse and IPV, conflicts in relationships
and some strategies to de-escalate conflict, mortality and medical problems in abused women, andthe complex needs of dysfunctional families.
C H I L D M A LT R E AT M E N T

Guidelines for Assessment of Suspected Physical Abuse of a Child

The physical abuse of children can be difficult for casereview committees and child protective services (CPS) to
substantiate. Thorough assessment is essential for the welfareof the child. If an injury exists, they will attempt to determine
whether the injuries were intentional (such as a result ofharsh discipline) or unintentional (such as from an accident).
If abuse is suspected, they will try to determine its severity
and frequency.
An interdisciplinary approach is essential to collecting
information bearing on the events of the case. The following
are steps that will help assure a good assessment of suspected
physical abuse of a child: (1) history of alleged circumstancesof the injury; (2) examination of the child fully unclothed;(3) diagnostic workup and need for medical intervention;

CONTENTS

Guidelines for Assessment of Suspected Physical Abuse of a Child ........ 1
Resilience and Competency in Children from High-Risk
Environments ......................................................................................... 2
Many Factors are Associated with Fatal and Near-Fatal Child PhysicalAbuse........................................................................................................ 3
Supporting Parents Contending with Prolonged Crying in Infants: What
to Do About Colic? ................................................................................. 4
What is Educational Neglect? Differences for Children andAdolescents.............................................................................................. 5
Complex Needs of Families Related to Intimate Partner Violence, Mental
Health, and Substance Abuse ................................................................ 5(4) manage acute medical problems; (5) notify CPS and law
enforcement as mandated by the state; (6) hospitalize thechild if needed; (7) have social work perform an extensivesocial evaluation; and (8) consider forensic workup or referto organization that specializes in child abuse cases.
These guidelines are intended for evaluation by medical
staff when they are unsure of how to evaluate an injured or
child that presents with vague symptoms. The guidelines may
also assist social service personnel about how to evaluate an
injured child or one with vague symptoms.

Reference

Berkowitz, C.D. (2017). Physical abuse of children. New England Journal of Medicine; 376 (17): 1659–1666.

Reasons for the End of an Intimate Relationship....................................... 6
Five Strategies to De-escalate Conflict......................................................... 6
Are there Effective Interventions for Adult Survivors of Adverse
Childhood Experiences?........................................................................ 7
Abuse in Childhood Results in Higher Adult Mortality Rates for
Women than for Men............................................................................. 7
Adverse Health Effects of Intimate Partner Violence Victimization ....... 8
Animal Abuse is Often Linked to Intimate Partner Violence ................... 8RESEARCH IN NEUROSCIENCE AND
NEUROBIOLOGYThe Center is actively seeking effective interventions for trauma and stressor-related disorders aswell as for other sequelae of trauma. CSTS laboratory and clinical research efforts use cutting edge tech-niques in pursuit of new and novel mechanisms totreat the suffering associated with traumatic experiences. These pursuits seek to address military-related health issues including PTSD, mTBI, and suicide.

Laboratory Research in Neuroscience and
Neurobiology

Genetics and Biomarkers
CSTS laboratory research expanded biomarker
research in 2017 by moving our biomarker identification study towards the understanding of theunderlying mechanism. CSTS Scientists use a combined approach of in vivo and in vitro methods tostudy the association of FKBP5 SNPs with PTSD in a
homogenous high-risk military population (n=3,890)
and to determine the mechanism by which FKBP5 isinvolved in PTSD. Findings indicate that traumaticstress responses are mediated by FKBP5, a glucocorticoid-regulated immunophilin. Four single-nucleotide polymorphisms (rs3800373, rs9296158,
rs1360780, rs9470080) covering the FKBP5 gene areassociated with lifetime PTSD in Soldiers. Up-regulated FKBP5 and significantly increased cortisol
levels were observed in the Soldiers with PTSD.
Using an in vitro simulated traumatic situation,
CSTS Scientists found that exposure to a stresshormone results in a redistribution of FKBP5 tomitochondria and concomitant increases of mitochondrial membrane potential and ROS productionin the human cell line. The FKBP5 inhibitor FK506
pharmacologically attenuates the effects of the stresshormone, indicating that FKBP5 regulation of mitochondrial function is necessary. Further data showsthat more FKBP5 co-localizes with the mitochondria
in leukocytes of PTSD subjects compared to controls
without PTSD. Additional findings indicate significant down-regulation of mitochondrial complexes I,
II and III in PTSD subjects compared to non-PTSD
controls, supporting concerns for mitochondrial
dysfunction in the disorder. CSTS current research
provides evidence showing that FKBP5 is associatedwith PTSD and that dysfunction of mitochondria
might play a role in the pathology of PTSD and be a
promising drug target for PTSD.

Drug Development for the Treatment of PTSD
The Center, in collaboration with the Universityof California, Irvine (UCI), has recently establisheda new effort to examine novel compounds for thetreatment of PTSD using a non-mammalian rapid
throughput model. The zebrafish, or Danio rerio,
has been established as a new species at USU andwill be used as a rapid throughput model for early screening. This rapid throughput model will be
used to identify candidate compounds for testing in
additional pre-clinical models of stress with the goalof creating therapeutic agents for the treatment of
PTSD. The zebrafish lab is currently creating standardized profiles of known compounds and coordinating with collaborators regarding future directions
for compound screening. The first novel compounds
to be tested include fatty acid amide hydro-lase(FAAH) inhibitors, with activity in the endocannabinoid system. Successful compounds will then be
evaluated in an established rodent model at UCI.

Clinical Research in Neuroscience and
Neurobiology

Riluzole Augmentation Treatment forComplicated Combat-Related PTSD
CSTS completed enrollment of 70 participantsin a multi-site clinical trial at WRNMMC and the
Syracuse Veterans Affairs Medical Center. This
study tested efficacy of riluzole for treatment of
combat-related PTSD in veterans whose symptoms
2017 ANNUAL REPORT | 11

persist in spite of current evidence-based treatments. Current recommended medications forcombat-related PTSD include selective serotonin
reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). While thesedrugs have some beneficial effect through increasing
serotonin concentrations in the brain, they do notadequately relieve symptoms for many patients. This
study addresses an urgent need to investigate othermedications and other mechanisms that may be
more effective. Riluzole is a modulator of glutamate,a highly prevalent neurotransmitter in the brain.
Preclinical research suggests riluzole has a neuroprotective effect and may help reverse damage to theamygdala, anterior cingulate cortex and hippocampus, where excitotoxicity due to an excess of glutamate is believed to contribute to PTSD symptoms.
This randomized, controlled, double-blind trial compared the effect of riluzole against placebo over eightweeks and measured symptoms of PTSD, depression, anxiety, and quality of life. This study also seeks
to identify magnetic resonance spectroscopy concentrations of neurotransmitters and related chemicals in specific brain regions associated with PTSD
before and after treatment as a potential biomarker
of illness and treatment response. We hypothesizethat treatment with riluzole outperforms placebo ingreater PTSD symptom improvement, improvement
in depression and anxiety symptoms, and reduced
disability compared to placebo. We also hypothesizethat spectroscopy changes in the amygdala, anterior cingulate cortex and hippocampus will correlatewith improvement due to riluzole treatment. We are
currently analyzing data collected in the trial with
anticipated publication of results in 2018.

Enhancing Fear Extinction via Angiotensin
Type 1 Receptor Inhibition: A Randomized
Controlled Trial in Posttraumatic Stress
Disorder
CSTS has partnered with the University of California, San Diego to investigate the efficacy of the
medication losartan for treatment of PTSD. Losartan
is an angiotensin receptor blocker currently in common use as a blood pressure medication. Preclinicalinvestigations suggest losartan enhances fear extinc12 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

tion in animal models through as yet uncharacterized modifications to the angiotensin system in thecentral nervous system. Retrospective data in a large
cross-sectional study revealed lower rates of PTSD
in trauma patients treated with angiotensin receptor blockers. CSTS is currently recruiting participants at WRNMMC for this multi-site study. Other
study sites include Massachusetts General Hospital,
McLean Hospital, New York University, and George
Washington University. This randomized, controlled, double-blinded trial will compare the effectof losartan against placebo on PTSD symptoms
over ten weeks of treatment. We will evaluate PTSD
and depression symptoms, as well as side effects ofmedication every two weeks. This study will alsoseek to identify a potential biomarker, examining thecontribution of variations in the angiotensin converting enzyme (ACE) gene to treatment response.
We hypothesize that treatment with losartan will
result in greater reduction of PTSD symptoms thanplacebo, and that patients with a particular variant of
the ACE gene will respond more favorably to treatment with losartan. This clinical trial is currently
recruiting participants through 2018.

Pilot Trial of Nightmare Deconstruction andReprocessing (NDR) for Treatment of PTSDrelated Nightmares
CSTS is leading a multisite pilot trial of a novel
exposure-based psychotherapy for PTSD-relatednightmares: Nightmare Deconstruction and Reprocessing (NDR). CSTS is partnering with Naval
Hospital, Camp Pendleton, to conduct this pilot
study. NDR has been adapted for treating trauma-related nightmares from Clara Hill’s 3-stage cognitive-experiential dream model. Study objectives areto evaluate the feasibility and tolerability of NDR fortreating PTSD nightmares and insomnia in military Service members and veterans; test changes insymptoms, genetic and inflammatory markers, andphysiologic data; and determine the research utilityof a wristband device used to collect physiologic
data. Specifically, we will evaluate nightmare andinsomnia severity, suicidality, PTSD and depression
symptoms, and genetic and inflammatory biomarkers, as well as heart rate, electrodermal activity, andmotion via the wristband device. This study will also
examine variation in PTSD, depression, and anxiety
symptoms and daytime functioning throughout theday using ecological momentary assessment. Thispilot trial will begin recruiting participants in 2018.

The VA National PTSD Brain BankThe VA National PTSD Brain Bank opened in2015 with a vision of improving the lives of veteranswith PTSD through greater understanding of theneuro-anatomy and molecular biology of the disorder. The National PTSD Brain Bank is the first brain
tissue repository dedicated to researching the impactof trauma and stress on brain tissue and function.
Research conducted by, or facilitated through Brain
Bank scientists, will identify biomarkers of susceptibility and resilience to trauma and help target
new treatments at the cellular level. Through these
efforts, the Brain Bank will pave the way for new
approaches to both diagnostic assessment and treatment of PTSD.
The Brain Bank enrolls potential donors throughout the nation and these donors receive comprehensive longitudinal assessment via clinical interview and periodic surveillance from the time ofenrollment until the time of their deaths, when theirbrain tissue is donated to the Brain Bank. The Brain
Bank has also developed a protocol for comprehensive post-mortem diagnostic assessment of donors(through medical record review and third party interview) in instances where ante-mortem assessmentof PTSD was not possible.
The Brain Bank has collected tissue from morethan 150 donors to date. Nearly half of the donors
were diagnosed with PTSD, while tissue from otherpersons without PTSD will be used as controls inongoing and planned studies. More than 50 living
persons have enrolled in the longitudinal follow-up
registry as future donors.
CSTS Scientists direct the Brain Bank’s Assessment Core and serve on the Brain Bank’s Scientific
Advisory Board. The Brain Bank is now accepting
applications from outside investigators in addition to
conducting intramural research and has distributed
tissue for several extramural projects.
The VA National PTSD Brain Bank, through

CSTS, iscoordinating with the
Collaborative Health
Initiative
Research
Program(CHIRP)
to perform
whole
genome sequencing and methylation studies, in collaboration with Yale, for the Brain Bank’s first core
study. CHIRP is a precision medicine-based collaborative effort between NIH and the DoD. CHIRP isbased at the USU on the campus shared with
WRNMMC.
This year, the Brain Bank added new collection
and assessment sites in Miami and North Carolina.
CSTS welcomed a new scientist to its VA National
PTSD Brain Bank team who is working to enhance
recruitment and longitudinal assessment of consenting donors in the National Capital Area.

The Brain Indices Study
The goal of the Brain Indices Study is to develop
reliable and valid predictors of negative outcomes toinform targeted treatments that can be implemented
early, and thereby improve the lives of our wounded
warriors and their families. The study, funded by the
DoD Congressionally Directed Medical Research
Programs (CDMRP) and the Center for Neuroscience and Regenerative Medicine (CNRM), wasconducted in the Brain Assessment Research Laboratories at WRNMMC and Fort Belvoir Community
Hospital. This longitudinal study was designed to
identify measures of brain structure and functionthat predict PTSD and other deleterious outcomes in
Service members with mTBI.
The assessment battery of the Brain Indicesstudy, which comprised neuroimaging (structural
MRI/DTI), electrophysiological, neurocognitive, andneurological assessments, was administered soonafter injury, and 3 and 6 months later. The outcome
measures included interviews for PTSD, depression,and headache, as well as post-concussive symptoms
2017 ANNUAL REPORT | 13

and overall mental and physical health status.
Since the completion of data collection, CSTS
efforts have been directed to quality assurance, dataprocessing and analysis, and preparation of manuscripts.

The Chronic Effects of Neurotrauma
Consortium Study 1: Observational Studyon Late Neurologic Effects of OEF/OIF/OND
CombatThis is a longitudinal, multisite consortium
investigation, funded by the DoD CDMRP, aimed atevaluation of the chronic sequelae and comorbidities
associated with TBI. An extensive battery of physiological, psychological, neurocognitive, occupational,
and social functioning measures is administered toService members and veterans who sustained TBI
in OEF/OIF/OND. Participants undergo periodic
in-person and telephone reassessments to monitor
their overall status. CSTS directs the electrophysiological (event-related brain potentials and EEG)
component of this study, aimed at assessing sensory
and cognitive function.
This longitudinal cohort will permit an evaluation of the post-TBI prevalence, natural history, andresponse to interventions of chronic symptoms andassociated comorbidities. Cross-sectional data willallow for analysis of the effect of time post-injury on
chronic symptoms, associated comorbidities, andevidence of neurodegeneration or recovery. Data
collection is ongoing.

Application of Somatosensory Evoked
Potentials to the Diagnosis of Traumatic Brain
Injury (TBI): A Translational Approach
CSTS directs this FDA-funded study that aims
to: (a) determine the utility of specific EEG biomarkers as diagnostic tools in Service memberswith blast-induced TBI based on translational workin animal (mouse) models; (b) use components ofthe somatosensory evoked potential (SEP) to assess
neurosensory effects of brain injury; and (c) evaluate
correlations between the magnitude of EEG changes
and the severity of brain injury. This work is aimed at
exploring the use of SEPs as an EEG biomarker for afield-deployable diagnostic for TBI. Data collection
14 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

at WRNMMC is expected to commence in early
2018.

Ecological Momentary Assessment of
Posttraumatic Stress Symptoms in U.S.
Military Service Members (Daily Diary Study)
This study uses a cutting-edge methodology,
ecological momentary assessment, to collect datafrom U.S. military Service members throughout
the day on PTSD and post-traumatic stress symptoms (PTSS), depression, somatization, sleep, pain,
substance use, psychosocial interactions and otherareas of health and functioning. This “daily diary” methodology allows for detailed assessmentof variability of symptom patterns as they occur
throughout the Service member’s daily routine,
providing important insights into the interaction
between symptoms and environment, psychosocial relatedness and brain processes. Participants
use electronic tablets to complete assessments fourtimes per day over 15 continuous days. Data is recorded and stored using a sophisticated application
developed in collaboration with the National Center
for Telehealth and Technology (T2) specifically foruse in this study. This technology allows for moreaccurate data collection and real time evaluation. At
baseline and at one and three month follow-ups, wecollect a wide range of behavioral and psychologicalassessments including: disorders (e.g., PTSD, depression), distress (e.g., PTSS, sleep difficulties), healthrisk behaviors (alcohol, drug and tobacco use), andhealth care utilization. In addition, participants havethe option to donate blood and/or saliva samples
for genetic analysis to identify potential biomarkers
and gene-environment interactions that may distinguish and/or mediate traumatic stress responses
and resilience to stress-related disorders. To date,
115 Service members have participated in the study.
Data analyses in 2017 included examining daily
variation in PTSS across days of the week and therelationship between hours of sleep and PTSS variation. We also are examining PTSD, depression, anddaily caffeine and alcohol consumption. In March,
we presented our findings of daily variation in PTSSat the American Psychosomatic Society’s 75th Annual Scientific Meeting in Seville, Spain. In April,we presented a methodological poster exploring theerror covariance structure in mixed model analyses
at the Anxiety and Depression Association of America’s annual conference in San Francisco, CA. This
innovative study has implications for interventions
and program development through awareness of
post-traumatic symptom variability. This methodology informs future use of technology in psychiatricassessment, treatment, and research.

RESEARCH ON DISASTERS ANDTERRORISM
Florida Department of Health Response toMultiple Hurricanes
To address the significant impact of disaster
exposure, such as the recent devastation from Hurricanes Maria and Irma in Puerto Rico and the U.S.
Virgin Islands, CSTS continues to examine the risk
and protective factors for post-traumatic disorders,
distress, and health risk behaviors in civilian andmilitary populations following traumatic events.
Center Scientists are examining the psychologicaland behavioral responses to the multiple hurricanesthat occurred during the 2004 and 2005 hurricane
seasons among Florida Department of Healthworkers, who were both first responders as well as
personally affected by the storms. This included injury to self and family, and damage to homes, which insome cases required relocation. Our current focus
is on the influence of individual collective efficacy
following the four hurricanes and one tropical storm
in 2004 on residents’ self-reports of daily mental
health 21 months later, as measured by the CDC
Health-Related Quality of Life Healthy Days assessment. Findings indicated that decreased collective
efficacy was associated with increased risk of PTSD
and frequent mental distress (reported as 14 or morementally unhealthy days within the last 30 days).
This research suggests the importance of community
factors to disaster recovery in residents, and provides actionable recommendations for community
leaders and clinicians to address longer-term mental
health issues in individuals and communities following natural disaster exposure.

Washington, DC Area Sniper Study
Due to the increase in terrorist attacks worldwide, the Center remains focused on the psychological and behavioral effects of terrorist events. We
collected data from Washington, DC area residents
at the time of the 2002 DC area sniper attacks. Our
research in this area adds to the limited empirical findings, and makes a unique contribution to
the literature on terrorist events. Currently we are
examining the relationship of perceived safety andTV viewing during the attacks to post-traumaticstress and depressive symptoms. In our study of
1,238 Washington, DC area residents, we found thathigh amounts of event-related television viewing (atleast 2 hours per day) and decreased perceived safety
were related to post-traumatic stress and depressive
symptoms. Specifically, higher levels of TV viewing
were associated with post-traumatic stress symptoms in individuals who reported both low and highlevels of perceived safety, whereas high TV viewing
was related to depressive symptoms particularly inthose who reported low safety. We continue to explore the inter-relationships of these characteristics
and others in order to better prepare for terrorist
events and inform interventions with individuals andcommunities.

Washington Navy Yard Shooting Study
In an ongoing collaboration with the Universityof California, Los Angeles (UCLA) and the National Institute of Justice, the Center is serving as partof a multi-site study to better understand risk andprotective factors associated with response efforts
following community mass violence. For the study,
the Center is collaborating with leadership from the
Washington Navy Yard because of the 2013 workplace mass shooting incident. This collaboration
furthers an existing partnership between the Centerand the Naval Sea Systems Command (NAVSEA)
to provide ongoing assessment and interventions
in support of NAVSEA personnel who have experienced social and occupational difficulties after the
Washington Navy Yard mass shooting event. The
Center and UCLA began the next phase of community engagement to further understand the impact ofthe 2013 event.
2017 ANNUAL REPORT | 15

Education and Training
A core component of the Center’s mission is
education and training. Center Scientists educate andtrain USU medical students committed to service in
our nation’s Army, Air Force, Navy and Public HealthService. The Center provides education to interagency and private sectors leaders and other personnel.
The Center advances the field of military and disaster psychiatry through presentations, outreach andtraining, as well as through participation in conferences, collaborations and workshops across the U.S.
and internationally. In addition, the Center sponsors
conferences, seminars and symposia that have educational and training objectives. The Center also educates and expands knowledge through public healthefforts and interventions during and after disasters.
An important and long-standing vehicle for theCenter’s education is through the dissemination of
educational materials to inform stakeholders including: healthcare providers, community leaders, families, first responders, teaching professionals and policy makers. For more than two decades, the Centerhas created customized, easy-to-read, just-in-timeeducational fact sheets to assist Center stakeholders
to effectively manage the adverse effects of traumaticstress through enhanced preparation and response
to disaster events.
In 2017, the Center provided educational resources to interagency partners, including DoD
and other federal partners as well as state and local
agencies, professional associations, and others.

16 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

The Center also responded to many disaster events,
including the mass shooting incident at Fort Lauderdale-Hollywood International Airport, the concert
bombing in Manchester, U.K., the Las Vegas concert
shootings, earthquakes in Mexico, and hurricanes in
Texas, Florida, and Puerto Rico.

DISASTER RESPONSE AND PUBLICEDUCATION
Since its inception in 1987, the Center has been
providing disaster preparedness and response consultation and education in many situations utilizing
numerous formats. Center personnel have provided
on-the-ground education and consultation to extreme national and global disasters, as well as immediate and long-term video and telephonic support tosupport response and recovery efforts to a range ofdisaster events.
The Center Director serves as Chair of the Disaster Committee for the American Psychiatric Association, the largest professional organizing body ofpsychiatrists in the world. Current and former Center
personnel have been called upon to provide expert
guidance on disaster preparation and response activities as a result of the experience and subject matter
expertise obtained while working at the Center.
The following are examples of Center disaster
response and education activities in 2017:■■ CSTS partnered with the National Center for
Disaster Medicine and Public Health (NCDMPH) on a “Crisis Leadership” symposium. A
Senior Center Scientist was a key presenter andpanel discussant on psychological and behavioral
aspects of disasters, with an emphasis on issues
relevant to those leading disaster management
efforts. The symposium was attended by an international audience of disaster planners, leaders,and educators.
■■ In preparation for and response to the catastrophic hurricanes in Texas, Florida and Puerto
Rico, CSTS developed and disseminated dedicat-

ed website education pages that provided actionable guidance to assist responders and emergency workers, families, healthcare personnel
and community leaders in providing support toindividuals and communities which reduce distress and enhance well-being. Center Scientists
also provided extensive ongoing consultation
to national organizations, such as the National
Association of State Mental Health Program
Directors, the American Psychiatric Association,
the Assistant Secretary for Preparedness andResponse, and the Substance Abuse and Mental
Health Services Administration to support theirdisaster preparedness and response efforts.
■■ In an effort to support Spanish speaking communities which were heavily impacted by thehurricanes in Texas, Florida and Puerto Rico,as well as the earthquakes in Mexico, the Center had professional translations made of manyof the commonly accessed fact sheets, which
provide actionable guidance regarding earlyinterventions following mass trauma, managing
the psychological effects of exposure to humanremains, supporting the well-being of children
following disasters, and resources on grief, stressmanagement and communication designed toaid leaders in supporting their communities.
These fact sheets were disseminated to numerous national health and community organizations which advocate for Spanish speaking
citizens and communities.
■■ The Center continues its collaboration with the
U.S. Air Force 480th Intelligence, Surveillance
and Reconnaissance Wing at Langley Air Force
Base to identify and mitigate stress in the intelligence operators managing information fromremotely piloted drone aircraft. The collaboration has expanded to include the 711th Human
Performance Wing, collectively establishing the
Human Performance and Health Data Analytics
Work Group (HPH-DAWG)■■ The Center partnered with the Drug Enforcement Administration (DEA) as the lead presentation for a three-day reintegration event
for DEA agents (and spouses) returning fromhigh-threat overseas posts as well as OEF andOIF conflicts in the Middle East. Center Scientists provided training that included informationon understanding stress, identifying adverse signsof stress, the benefits of seeking help and how to
overcome barriers, such as stigma. Agents andtheir family members spent time with Center Scientists following the formal presentation to shareand discuss personal experiences and challenges.
■■ CSTS provided two educational seminars toseventeen tri-service healthcare professionals
enrolled in the Master in Public Health programat USU. The content addressed mental healthissues relevant in domestic, as well as international, disaster response. The information andresources provided within the seminar serve as
the core mental and behavioral health education
within the curriculum, serving to ensure thesestudent leaders are equipped to address the broad
range of national and global health security issues
relevant to disaster events.
■■ For the fourth consecutive year, a Center Scientist
presented a one-day seminar to the senior psychiatry residents at the University of Maryland andSheppard Pratt combined Psychiatry Residency
Program, providing the only education in disaster psychiatry for these junior psychiatrists. As aresult of that relationship, a Center Scientist was
invited to give a presentation on climate-related
disasters and mental heath at Grand Rounds for
the Residency Program.
■■ A Center Associate Director gave the opening
keynote address and conducted a workshop on
Integrating Emergency Management and DisasterBehavioral Health at SUNY New Paltz, Instituteof Disaster Mental Health, for their 14th Annual
Conference on Psychosocial Response to Pandemic Disasters, Infectious Diseases, and Bioterrorism.

NEUROSCIENCE MODULE FOR PRECLERKSHIP USU MEDICAL STUDENTS
The neuroscience module develops pre-clerkship
medical students’ understanding of the principles ofneuroscience through integrated clinically relevant
content in head and neck anatomy, neurology, psy2017 ANNUAL REPORT | 17are seamlessly integrated into the simulation and
CSTS Scientists use these scenarios to assess student
performance in basic combat and operational stresscontrol skills. In 2017, CSTS Scientists published anarticle in Academic Psychiatry entitled Real Stress
Reactions in Simulation: Vignettes from Extended
Mass-Casualty Simulations based on experiences in
the field exercise.

chiatry, neurobiology, and behavior. This foundation
allows students to recognize, describe, and diagnose
common neuroscience related medical conditions
with an eye towards effective management of a wide
variety of neurologic and psychiatric conditions.
Co-directed by the Department of Psychiatry,
including CSTS Scientists, and the USU Departmentof Anatomy, Physiology, and Genetics, the module
covers topics related to the head, neck, and nervous
system integrated across the disciplines of grossanatomy, neuroanatomy, radiology, physiology, histology, embryology, biochemistry/metabolism, pharmacology, microbiology, pathology, medical psychology and psychiatry. Instructional methods include
large group lecture, small group case discussions,laboratory sessions, self-study units, and supervised
clinical experiences that foster the development ofclinical skills and professional attitudes. Effective,
safe and patient-centered clinical skills, including
the performance of neurologic and mental status
examinations, are also developed through simulated
patient experiences.
Topics related to military medicine, medical history, human context and health service support are
integrated throughout the module to further foster
the student’s professional identity as an officer andphysician committed to fulfill a promise of duty andexpertise through personal values, knowledge, skills
and a desire to master the basic and clinical scienceneeded to help one’s patient and one’s unit.

The Center developed the Personal Firearm
Safety Education Project in partnership with the
Yellow Ribbon Reintegration Program (YRRP) andthe Defense Suicide Prevention Office (DSPO). The
project delivered multimodal educational materials
on personal firearm safety to support DoD suicide
prevention efforts by educating Service memberson the importance of personal firearm safety within their homes. As a final element of this project,
the Center gathered a collection of subject matter
experts and stakeholders from the DoD and VA for a
day-long forum on health and national security entitled, “Family Safety and Military Service members:
Understanding Risk and Intervention Strategies.”
The forum examined themes of epidemiology of
firearm death and injury among active duty families,
risk communication and decision-making aroundrisk, and considered strategies to minimize the riskof personal firearms to families.

EDUCATION AND TRAINING IN
COMBAT AND OPERATIONAL STRESSCONTROL: OPERATION BUSHMASTERTEXTBOOKON U.S. ARMYCULTURE

Combat and Operational Stress Control (COSC)
is a core component in military medical education.
CSTS Scientists are an integral part of COSC education at USU as teaching faculty during the annual
medical field training exercise, Operation Bushmaster. During Operation Bushmaster, students learn ina four-day, large-scale medical simulation in which
they must practice medicine in a realistic combat environment. Evaluation and treatment of combat andoperational stress reactions are among many skills
USU students must demonstrate. COSC scenarios

The Center published a book titled
U.S. Army Culture:
An Introduction for
Behavioral HealthResearchers. The
book was edited by
two Center Scientists and the Center
Director (Drs. Meyer, McCarroll, and

18 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

FAMILY SAFETY EDUCATIONUrsano) and includes contributions from 19 national
experts on Army Culture. At 89 pages, the book covers the basics of cultural competence and conducting
research in the Army, followed by a review of Army
culture and sub-cultures, structure, training, andtransitions. It then highlights special aspects of the
National Guard and Reserves followed by an overview of how technology and war can impact Army
cultural identity. The book is highly referenced andhas been incorporated as a resource for applicants
applying for MRMC/CDMRP grants.

INNOVATIVE BOOK PUBLICATION
Dr. Flynn, CSTS Associate Director for Health
Systems, co-edited and contributed chapters to abook entitled, Integrating Emergency Management
and Disaster Behavioral Health: One Picture throughTwo Lenses. His co-editor and fellow chapter contributor, Mr. Ron Sherman, was a former Federal
Emergency Management Agency (FEMA) senior
executive. The book is unique in both its content andformat, and the only book ever published on this
topic.
The approach follows the Center’s long standing efforts to integrate our interests, expertise, andpriorities with those of stakeholders in different
professions, occupations, and responsibilities. The
goal is always to share what we know and learn fromothers in service of enhanced outcomes for individuals, organizations, and systems. This book, solicitedby Elsevier, combines the many years of work in
disaster preparedness and response shared by theco-editors and their consistent experience that when
integration of these two professions and professional
cultures occur, outcomes are consistently enhanced.
In preparation for this book, both emergency managers and disaster behavioral health experts weresurveyed to determine the topical areas most criticalfor such a book. The topics addressed reflect thosepriorities.
The format of the book is also unique. In orderto model the desired integration, each chapter/topic has two authors: one an experienced emergency
manager and one an experienced disaster behavioral health expert. Both comment on a shared topic

Amygdala Conference presentation.
from their unique perspective and experience. Eachchapter then concludes with practical advice on how
to achieve and sustain integration on the topic. The
book has enjoyed wide recognition and acceptancein both professions and appears to have stimulated
integration efforts across the nation.

UPCOMING TEXTBOOK ON PTSD
Center Scientist LTC Wynn and Center Associate Director COL Benedek are currently completing
work as editors and authors on the American Psychiatric Association’s textbook on PTSD. Working
with the American Psychiatric Press, Drs. Wynn
and Benedek have engaged experts in the field of
PTSD to put together a full professional textbook on
the topic. The textbook will cover a wide spectrumof topics from the basics of diagnosis and neurobiology to working with special populations and cultural considerations. The book is slated for publicationin the fall of 2018.

EDUCATIONAL CONFERENCES
The Center sponsored two educational conferences in 2017: the 12th Annual Amygdala, Stressand PTSD Conference, and the Forum on Healthand National Security.

Amygdala, Stress and PTSD Conference:
Understanding Stress
Since 2004, CSTS has sponsored the Amygdala,Stress and PTSD Conference in collaboration with
the USU Department of Psychiatry, USU Neurosci2017 ANNUAL REPORT | 19

Amygdala Conference presentation.
ence Program, USU
Department of Family Medicine, and the
WRNMMC Department of Psychiatry.
In 2017, the Center
presented the “12thAnnual Amygdala,Stress and PTSD
Conference: Understanding Stress.”
This conference,with more than 400
registrants annually, aims to bring together scientists, clinicians andpolicy makers for a day of working towards solving
the biological basis of stress, fear and PTSD. The
nationally renowned speakers came from leading
institutions across the U.S. including Yale University,
Duke University, University of Missouri, and Boston
University. The speakers presented and discussed
topics such as the cellular and genetic studies of
PTSD, the role of glial cells in PTSD, and trauma
as a population health concern. In addition to theconference, the Center partnered with the Journal of
Neuroscience Research to put together a special issue
based on the conference.

Forum on Health and National Security
As part of continued efforts to better understandthe importance of family safety and how best to
20 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

train our health care providers who strive to decrease
PTSD and suicide risk, CSTS hosted a Forum on
Health and National Security in January 2017, gathering experts from across the country to meet withscholars from the military health system to consider
the issues. This forum examined firearm deaths inmilitary members, how military members assess
safety risks and make safety decisions in their homes,
and considered strategies to reduce this risk. Notable themes identified in the forum include the needfor better data on personal firearms and risk among
military members, strategies to better identify at-risk
populations, and public health interventions that may
reduce risk.

TRAINING TO SUPPORT RESEARCH
CSTS activities include not only educating andtraining others, but also educating and training ourown staff, including research support staff. Our research support staff include Program Managers, Program Coordinators and Research Assistants (RAs).
RAs play an important role in supporting researchat CSTS, and are provided with many opportunities
to learn. CSTS Scientists provide the RAs with training and oversight for many research-related tasks.
At CSTS, RAs learn by doing. They work closelywith CSTS Scientists as members of the teams thatdesign and conduct research. The RAs contribute toCenter research in many ways including conducting

CSTS Research Assistants making a presentation
about science communication.

literature searches, data collection, data entry, data
editing, writing meeting minutes, and writing summary reports of meetings.
CSTS Scientists train the RAs in not only how
to design and implement research, but they also
educate RAs in how to write-up and present thefindings of research. Skills the RAs develop at CSTS
include how to create slides and posters for researchpresentations, how to communicate research findings to a professional audience of scientists, and how
to present complicated findings in an easily understandable way to the general public. In addition, RAs
are offered many professional development opportunities including attending and presenting posters at
professional conferences, and assisting in preparing
manuscripts for publication in peer-reviewed scientific journals.
The training and experience RAs receive at CSTS
prepare them for the future. Many RAs move on
to further their education by pursuing advanced
degrees. Others move on to careers in research andrelated fields. CSTS RAs have furthered their education at institutions including Yale, Notre Dame,
Johns Hopkins, Duke, Columbia, London Schoolof Hygiene and Tropical Medicine, and USU. Opportunities our Research Assistants have pursued
following their training and experience at CSTS haveincluded:■■ PhD programs in psychology and related fields■■ Medical school■■ Law school■■ Master degree programs in psychology, counseling, public health and social work■■ Careers with the FBI

DISSEMINATION AND
IMPLEMENTATION OF HEALTHAND RESEARCH KNOWLEDGE
Fact Sheets
Fact sheets are a long-standing tool of CSTS toprovide disaster mental health education for enhancing preparedness, response and recovery efforts.
The Center develops, updates and rapidly disseminates fact sheets, in real time, following majordisasters and traumatic events such as community

violence, terrorism and bioterrorism, and publichealth threats. CSTS fact sheets provide readerswith resources tailored to the unique aspects of eachdisaster event. Fact sheets are easy to understand,topic-focused tools that CSTS develops using expert
knowledge to communicate the basics surrounding
an often difficult and/or crisis related issue. CSTS
fact sheets address the needs of different partners
and stakeholders, including health care providers,
community leaders, family members, safety andemergency workers, and policy makers. CSTS maintains a growing repository of fact sheets on disaster
preparedness and response, risk and crisis communication, and health risk education, which are readily
available to all visitors of the CSTS website.
Recently developed fact sheets include “Leaders
Guide to Risk Communication in the Face of Emerging Threats,” “Assessment Instruments for First
Responders and Public Health Emergency Workers,”and “Assessment Instruments for Special Operators;”
the latter two can be particularly useful to better
understand survey instruments that can be useful instudying the effects of a broad range of operational
2017 ANNUAL REPORT | 21

创伤应激研究中心
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org
创伤应激研究中心（CSTS）是美国国防医科大学精神病学系的一部分

心理急救：您如何为灾难受害者提供身心健康支持人们经常对灾难产生强烈和不愉
快的情感和身体反应。这些反应可能
包括困惑、恐惧、绝望、无助、失眠、身体疼痛、焦虑、悲痛、震惊、
攻击性、多疑、自责、羞耻感、对宗
教信仰产生怀疑和对自我或他人失去信心。多种有帮助的干预方法可协助个人和社区复原。

灾难发生后，政府和救济组织在减轻受害者和更大范围社区成员的悲痛方面
起到重要的作用。

灾难发生后，政府和救济组织在减轻受害者和更大范围社区成员的悲痛方面起到重要的作用。确保资源
的公平分配（例如食品、衣物和住宅）和及时获得健
康护理可增强信任感和改善结果。在提供干预和救济
服务时坚持道德原则可增强社区的福祉。
在与受灾难事件影响的个人交往时，国际灾难应对
专家和研究人员一致认为，心理急救（PFA）有助于减
轻痛苦的情感，并降低灾难最初反应造成的进一步伤害。您的行动和与他人的交往有助于向处于困境的人
提供心理急救，方法是创造和保持 (1) 安全感、(2) 平和、(3) 与他人紧密联系、(4) 自我效能和 (5) 充满希望的环境。请考虑以下建议：应当：帮助人们满足对食品和住宅的基本需求，并获取紧
急医疗护理。提供有关如何获取这些物品和服务的重复、简单、准确的信息（安全感）。

倾听愿意分享自己的经历和情感的人说话；请记住
感觉不存在错误或正确之分（平和）。

即使人们表现得很固执，也要表现友善和富有同情
心（平和）。



提供有关灾难或创伤和救济工作的准确信息。这将
帮助人们理解现状（平和）。

帮助人们与朋友或亲人取得联系（紧密联系）。



尽可能让家人在一起；让孩
子与父母或其他近亲在一起（紧密联系）。

 提出切实可行的建议，鼓励人们
自助和满足自身的需求（自我效能）。


指导人们前往可提供政府和非政府服务的地点（充
满希望）。



如果您得知很快会获得更多的帮助和服务，请在人们表现出恐惧或担忧时告诉他们（充满希望）。

不应当：强迫人们与您分享自己的经历，尤其是极为私密的细节（可能会减弱平和感）。

说出简单的安慰话，例如“一切都会好起来的”或“至少你是幸存者”（经常会消除平和感）。

告诉人们你认为他们现在应当有何种感受、怎样思维
或行事，或他们本应怎样行动（降低自我效能）。

告诉人们你为什么认为他们会感到痛苦，并列举造成他们的个人行为或信念的原因（也会降低自我效
能）。



作出可能不会兑现的承诺（降低希望）。



在需要接受服务的人面前批评现有服务或救济活动（降低希望和平和感）。

Psychological First Aid (SCH) (11-2017)

stressors in those who work in a variety of high-tempo, high-threat career fields.
This year, the Center translated several of ourmost frequently accessed fact sheets into Spanishand Mandarin, to support Spanish and Mandarin-speaking communities within the United States
and abroad. The Spanish fact sheets were widely disseminated and utilized following the Mexico earthquakes and series of devastating hurricanes in Texas,
Florida, Puerto Rico and the Virgin Islands.

WebsiteThe Center website (www.CSTSonline.org) is
another tool used to further our goal of disseminating relevant and timely information to a wide rangeof stakeholders. This year, we conducted a significant
overhaul to the website to continue adding content
and making content more accessible. Material available on the website includes summaries of current
research activities, publication citations, newsletters,
conference reports, and a searchable repository of

22 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

our disaster mental health education fact sheets.
A “What’s New” section of the website highlights
recent disaster education materials, research initiatives, publications, conference summaries andannouncements of upcoming events. In 2017, theCSTS website was visited by 14,788 people. Mostof those people (77%) were between the ages of 18
and 44 years, and most (78%) were from the UnitedStates. The 11,595 people from the U.S. who visited
our website in 2017 represented all 50 states and theDistrict of Columbia. The people from outside theU.S. who visited our website in 2017 were from 122
different countries.

Social MediaIn 2017, the Center continued to grow its online
presence through the use of social media. Thesesocial media resources allow for the timely dissemination of relevant content to our partners. CSTS
Twitter followers increased by 55% and CSTS Facebook followers increased by 32% in the past year.
The Center encourages people to visit and follow
CSTS postings via Twitter and Facebook to stay
up-to-date on new CSTS activities and publications.
“Like” CSTS on Facebook at Center for the Study ofTraumatic Stress and follow CSTS on Twitter at@CSTS_USU.

Consultation
The Center has developed partnerships with, andprovides consultation to, many agencies and organizations throughout the DoD and other Federal
agencies, as well as with state, local and national
agencies, professional associations, and internationalorganizations.

CONSULTATIVE PARTNERSHIPS
Since its inception, consultative relationships
have been a cornerstone of CSTS’s mission, including a wide variety of partner organizations both
inside and outside government, and internationally.
Such collaborations build bridges that provide opportunities to contribute our resources and expertisein the service of others and to monitor real timeneeds of partners and stakeholders. The following
are examples of some of our long-standing consultations as well as some new consultations in 2017.

National Association of State Mental Health
Program Directors (NASMHPD)
For more than a decade, CSTS has had along-standing relationship with NASMHPD, amembership organization representing state mental health authorities (Commissioners). The Commissioners are responsible for directing the public
mental health system in their states. The state public
mental health systems are largely responsible forpreparedness, response, and recovery from manylarge and small scale disasters. CSTS assists theCommissioners in addressing the many challenges
inherent in those systems. Many military families
and veterans are served by the state public mental
health systems. CSTS and NASMHPD leadership
are in frequent contact to share experience and meetmutual needs.
Following the leadership change at NASMHPD
with the appointment of a new Executive Director,
the two organizations have continued to be in regular contact and sustain a close partnership. It is common following disasters for the Center to provide

unsolicited general and targeted public information
to NASMHPD for distribution to impacted states.
In addition, it is common for NASMHPD to request
help and specialized information and consultation
regarding individual events.

Substance Abuse and Mental Health Services
Administration (SAMHSA)SAMHSA is one of the oldest and most important federal partners for CSTS. This relationshipgoes back to SAMHSA’s founding in 1992. Located within the Department of Health and Human
Services, SAMHSA is the lead federal entity responsible for supporting and improving mental healthservices in the nation. A Center Associate Director
continues to serve on the Disaster Distress Helpline(DDH) Steering Committee to provide guidance
and feedback to this SAMHSA-funded resourcethat assists those needing help in their recovery
from disasters.
2017 saw continued work between the twoorganizations including review of documents andprograms, in light of changing SAMHSA staffing,
and meetings with CSTS leadership to update ongoing collaborative activities and explore additional
opportunities.

The National Center for Disaster Medicine
and Public Health (NCDMPH)
In addition to partnering with NCDMPH on
the global “Crisis Leadership” symposium, a Center
Scientist was the featured presenter for the first 2017
NCDMPH Webinar series, presenting on “DisasterBehavioral Health: Education Fact Sheets to Enhance
Preparedness and Response.” This presentation drew
greater participation than any previous NCDMPH
webinar with 250+ attendees from over 80 different federal agencies and private entities working indisaster management and public health.
At the request of our partners at the NCDMPH
who oversee disaster training for the USU MPH program, two CSTS staff presented an afternoon seminar2017 ANNUAL REPORT | 23

“Critical Concepts in Disaster Behavioral Health” toten Joint Service, interdisciplinary MPH students.
Two members of the Center’s leadership teamserve as Associate Editors for the journal Disaster
Medicine and Public Health, a publication based in
NCDMPH.
This partnership within USU continues to develop into an extremely productive one for both entities. Our missions and goals are complimentary andthe combined experience and expertise of leaders inboth organizations is creating much creative planning. Ongoing partnerships are in development for2018 and beyond.

Centers for Disease Control and Prevention(CDC)
Two members of the Center’s leadership teamparticipated in an exploratory consultation to fivemembers of the Deployment Risk Mitigation Unit
in CDC’s Office of Preparedness and Response. The
goal was to learn about that Unit’s mission and needs
and to explore the possibility of an ongoing partnership with CSTS. This is a relatively new Unit, formed
during the Ebola response, with the primary missionof enhancing the health, safety, and well-being of deployed CDC staff and their loved ones. A wide variety of areas of potential collaboration were explored
including research, knowledge consolidation andsharing and organizational and systems consultationfrom CSTS. Follow-up activities are planned.

The American Psychiatric Association (APA)
CSTS has extended its knowledge and reach byworking with national medical associations, such as
the APA, through education and training on disaster mental health. CSTS helped establish the APA’s
Committee on Disaster Psychiatry in 1992, and theCenter Director continued this year in his role as
Chair of the committee. This year, CSTS Scientists
provided formal and informal disaster consultationand education resources to APA District Branches
in response to a wide range of disaster events, including the severe hurricanes in Florida, Texas, andPuerto Rico; recurrent wildfires in California; andmass shootings at the First Baptist Church in Texas
and the Route 81 concert in Las Vegas. Consultation
24 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

services include guidance and resources on enhancing preparedness, response and recovery following
disasters. Education fact sheets serve as an important resource for District Branches to assist themin rapidly disseminating critical, time-sensitive,
actionable information to reduce distress, optimize
well-being, and improve functioning of patients andother community members.
At the APA Annual Meeting, CSTS Scientists
presented a workshop on climate-related disasters
and mental health, addressing issues such as psychological and behavioral responses, populations mostvulnerable to the impacts of climate-related disasters, and evidence-based early interventions to reduce distress and enhance well-being. The audienceof 67 psychiatrists from across the globe participatedin a series of interactive case-based learning sessions
to apply and reinforce content.
At the Annual Conference for the Institute of
Psychiatric Services, which was organized by the
APA, a Center Scientist presented to an audience of
58 international psychiatrists on the mental healthaspects and climate-related disasters. The presentation served as a springboard for discussions about
how to become more engaged in disaster mental
health care and efforts to address mental healtheffects of climate-related disasters through effective
preparedness and response.

National Child Traumatic Stress Network(NCTSN)The Center worked with NCTSN in partneringwith the Network’s Military and Veteran Families
Program in their efforts to develop and implement
trauma-informed, evidenced-based interventions
and approaches to military children and families.
CSTS also serves as a NCTSN Treatment and Services Adaptation Center (Category II site), which
involves providing expertise on specific types oftraumatic events experienced by military families,
as well as programs and providers that specialize intreatment and services for military communities.

Military Child Education Coalition (MCEC)
The MCEC seeks to identify and address issues
specific to children with military connections. A

Center Scientist presented at MCEC’s 2017 annual
meeting to discuss military children’s access to mental health services.

China (e.g., the Southeast Asian Tsunami). Thistranslation project will ultimately result in 10 disaster education fact sheets translated into Mandarin
and Spanish to expand the reach of our disaster
preparedness and response education resources.

International Outreach

GLOBAL HEALTH
Global Health Engagement
The Global Health Engagement focus at USU
has continued to evolve and solidify during 2017. As
context, the Center Director participated in the USU
School of Medicine Strategic Planning meeting todiscuss the mission of the School of Medicine as it
relates to the DoD’s initiatives in addressing national
security, global health and global health engagement. The result was USU’s decision to consolidate
its activities into the USU Center for Global HealthEngagement (CGHE). During 2017 CSTS hosted
representatives of the CGHE as part of a series ofongoing meetings intended to increase CGHE’s
understanding of the roles of CSTS and the Department of Psychiatry. In addition, the Center regularly
participates in briefings by CGHE for all relevant
USU stakeholders.
In related activities, the Center Scientists provided consultation to the Harvard Program in Refugee
Trauma in support of their work with the Syrian
American Medical Society and their efforts to remotely supervise Syrian civilian healthcare providers
delivering care to combat casualties. The consultation explored issues related to trauma exposure,moral injury, training and supervision in the context
of delivering remote healthcare consultation andsupervision.
CSTS translated the first two in a series of CSTS
disaster education fact sheets into Mandarin. This is
to support colleagues, friends, the Chinese-American population, and others following disasters in

The Center sent a scientist to Baghdad, Iraq to
support the DoD on a Defense Institute for Medical Operations (DIMO) mission. DIMO facilitates
healthcare education and training to international
partners by utilizing subject matter experts (SMEs)
from the DoD to develop curriculum and teachcourses around the world. On this mission, CSTS
provided global mental health education and training by sharing the fundamentals of Disaster Psychiatry with the Iraqi Special Forces and the principles ofsetting up a Military Behavioral Health Care System
to military medical leadership. At the same time,
the team coordinated efforts with the U.S. assets,
helping prioritize future efforts. The 28 participants
included seasoned combat medics, new recruits,senior medical officers from the Iraqi Ministry of
Defense, and faculty from the Iraqi Military Medical
School.
CSTS hosted a delegation of Iraqi mental healthpractitioners, educators and service providers aspart of an International Visitor Leadership Program(IVLP) sponsored by the U.S. State Department. The
delegation consulted with Center Scientists on how
to support post-war recovery of Iraq, with particularfocus on the psycho-social rehabilitation of traumatized children and youth. The participants discussed
a variety of complex psycho-social challenges that
Iraqi children face, including traumatic exposures,sectarian aggression and violence, as well as inadequate infrastructure to meet their needs. CSTS
encouraged programmatic public health approaches
to address the problems (e.g., preventive health strategies, school based interventions), discussed trauma-informed evidence based clinical practices andrecommended making connections with other large
U.S. organizations that address child trauma, suchas the federally funded and SAMHSA administered
National Child Traumatic Stress Network (NCTSN).
The Center was selected to support the USU
2017 ANNUAL REPORT | 25

U.S. Forces Korea (USFK) task force. The task force
provides needs assessment to the military line andmedical commands in South Korea to optimize theirtraining and education of medical concerns related
to radiologic and nuclear threats. Center Scientists
assist with reviewing policy and procedure for enhancement recommendations, as well as providing
education and training to personnel to assist USFKin optimizing their preparedness and response
efforts in the face of real or threatened radiologic or
nuclear events.
Other examples of CSTS international outreachin 2017 included:■■ The Center Director met with scientists in Latvia
at a NATO-sponsored military suicide prevention meeting and presented on suicide andsuicidality.
■■ The Center Director travelled to Australia toprovide consultation to the Australian Armyand to make a presentation on PTSD, suicide,
TBI and other trauma-related disorders to theAustralian Trauma Society.
■■ A Center Scientist travelled to Canada to serve
as a panel member for the NATO Human Factors and Medicine (HFM) Panel meeting on Leveraging Technology in Military Mental Health.
■■ A Center Scientist travelled to Spain to present
findings of the research “Ecological Momentary
Assessment of Daily Variation in Post-TraumaticStress Symptoms” at a meeting of the American
Psychosomatic Society in Seville.
■■ Dr. Jun Shigemura of the National Defense Med-26 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

■■

■■

■■

■■

ical College of Japan visited the Center, presented research findings to CSTS Scientists on theaftermath of the Fukushima Nuclear disaster,and met with the Center Director.
The Head of the Department of Psychological
Medicine of the National University of Singapore, Dr. John Wong, visited the Center, discussed the National University and Mind Centerwith CSTS Scientists, and met with the Center
Director.
Dr. Alexander McFarlane, Director of the Centre
for Traumatic Stress Studies in Australia, visited
CSTS, presented research findings on the prolonged and unanticipated impact of traumaticstress, and met with the Center Director.
The Assistant Director of Health and Safety Division of the Western Australia Police Force, Ms.
Fiona Donaldson, visited the Center and met
with CSTS Scientists who provided consultation
on resilience programs in emergency responder
and military agencies.
The CSTS website was visited by persons from122 different countries outside the U.S.

Extreme Weather-Related Disasters andMental HealthCenter Scientists served as SMEs in the review
of national and global documents in the field ofextreme weather-related disasters, including the 4th
National Climate Assessment, developed by the U.S.
Global Change Research Program, a confederationof the research arms of thirteen different federal
agencies. Center Scientists served as SMEs and provided consultation in the development of the American Psychological Association’s 2017 document,“Mental Health and Our Changing Climate: Impacts,
Implications, and Guidance” as well as the American
Psychiatric Association’s family education resource
pages on extreme weather change and mental health.
A Center Scientist delivered Grand Rounds on
the topic of extreme weather-related disasters andmental health to behavioral health faculty at the joint
program of the University of Maryland, Sheppard
Pratt, and Veterans Administration, as well as at
WRNMMC.

Interview with a CSTS Scientist
Gary H. Wynn, MD
Lieutenant Colonel, Medical Corps, U.S. Army
Dr. Wynn is an Associate Professor andAssistant Chair in the Department of Psychiatryat USU and a Scientist at CSTS. After
graduating from West Point in 1996,
Dr. Wynn received his medical degreein 2000 from USU and completed a
combined residency in Psychiatry andInternal Medicine at Walter Reed Army
Medical Center. After completing his
residency, he spent a year as the Division Psychiatrist for the 2nd Infantry
Division at Camp Casey, Korea. Dr.
Wynn spent the next three years as theAssistant Chief of Inpatient Psychiatryat Walter Reed Army Medical Center where heworked with Service members returning fromthe conflicts in Iraq and Afghanistan. From 2009
through 2013, Dr. Wynn worked as a research
psychiatrist in the Military Psychiatry Branchof the Center for Military Psychiatry and Neuroscience at the Walter Reed Army Institute of
Research in Silver Spring, MD. In July, 2013, Dr.
Wynn joined the USU Department of Psychiatry.
Dr. Wynn has been a leader at CSTS in new
and innovative approaches to neuroscience inrelation to recently emerging themes in DoD.
We interviewed Dr. Wynn about his work in thisarea.
What is on the horizon for the use of newtechnologies in DoD and the military mental
health system?
The future of the use of technology in military mental health is pretty amazing. Right
now we are seeing a great deal of innovationin the use of a variety of technologies that will
be integrated into clinical care in the coming
years. The big areas of advancement are in theuse of computer-aided therapies, neurostimulation,
smart phones apps, and virtual realities. In someways, this will really change the way we provide care.
The ability for individuals to undergo therapy withthe aid of an app without ever interacting with thehealthcare system represents a largechange in how we think about and how
we deliver care. There are apps andcomputer programs that can provide
cognitive behavioral therapy, narrative
expression therapy, supportive therapy, and suicide prevention with more
becoming available all the time. The
big questions about these programs are
how well do they work, how do we getthem in the hands of those who needthem, and how do we deal with what
happens when someone does not get better from using these technologies. In addition, advances in areas
like neurostimulation provide yet another avenue forclinicians to care for those suffering from a variety ofmental health issues.
What are you currently working on regarding new
drug development?
Over the past two years, with the support of
CSTS, I and my co-investigator Dr. David Mears,
have set-up a zebrafish lab and a collaboration with
Dr. Daniele Piomelli and the University of California,
Irvine. This zebrafish lab is intended to be a rapid
screening tool for drug discovery with our partneredrodent model at UCI. The reason for this effort isthat drug discovery for PTSD has been underperforming over the past couple decades. Only two
drugs have been FDA-approved for PTSD and thelast one was closing in on twenty years ago. Our
hope is to screen candidate compounds in order todecrease the risk of the early investigational phase of
drug discovery and then partner with biotech firms
when we discover promising compounds. Putting
more promising compounds in the hands of drug2017 ANNUAL REPORT | 27

developers will hopefully stimulate the private sector
drug development pipeline so that new and effective
treatments for PTSD end up in the hands of clinicians working tirelessly to treat those suffering fromthis disabling disorder.
What do you see as the future of complementary
and alternative medicine for military mental
health?
That is a complicated question. Complementary
and alternative medicine for the treatment of military mental health issues is a burgeoning topic witha lot of potential. Dr. Benedek and I just recently
published an entire textbook on the topic — Complementary and Alternative Medicine for PTSD —that is an excellent resource for those interested infurther reading on the issue. It is a good look at the
topic but it is not an exhaustive review given theincredibly broad nature of CAM. From acupuncture
to yoga to animal-assisted therapies to alternative
pharmacology, the topic spans such a broad arena,
but there are signs that many of these approaches
are worth further exploration. The current limitation is that while many of these modalities are being
used in the community and even supported by somehealthcare organizations, especially given the low
risk, there is very little rigorous research to support
the majority of these approaches. Additionally, there
is concern that the use of these approaches is only
helpful while the individual continues to participate. A recent study of yoga for PTSD showed thatthe most important factor in who responded to

28 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

treatment with yoga was long-term continued yoga
practice. Such issues need to be fully understood sothat clinicians can be informed as to the best practices for CAM.
Can you tell us about your role as the U.S.
Representative to the NATO Research Task Groupon Leveraging Technology in Military Mental
Health?
For the past two years, I have been the U.S.
Representative to the NATO Research Task Group(RTG) on Leveraging Technology in Military Mental
Health. This effort was undertaken given the rapid
advancement in technology that has been occurring
over the past 10 years. Our group of NATO reps
proposed this RTG to NATO and were approved
for a three-year study of how to better utilize technology to address military mental health issues forNATO member states. We have representatives froma number of NATO countries including Canada, The
Netherlands and Germany. We are holding meetings
every 6 months for three years to review areas oftechnology that are ready to be integrated into clinical care or show substantial promise in impacting
clinical care in the near future. Our two most recent
meetings involved a thorough review of biomarkers
including neuroimaging which occurred in Toronto,
Canada, and a review of virtual reality and serious
gaming which occurred in Amsterdam, Netherlands.
After the entire series of meetings, we will create atechnical report on the topic that will be shared with
NATO member states.

Publications(Names in bold text are CSTS personnel)

JOURNAL ARTICLESBandoli, G., Campbell-Sills, L., Kessler, R. C., Heeringa,
S. G., Nock, M. K., Rosellini, A. J., Sampson,
N. A., Schoenbaum, M., Ursano, R. J., & Stein,
M. B. (2017). Childhood adversity, adult stress,
and the risk of major depression or generalized
anxiety disorder in US soldiers: A test of the stresssensitization hypothesis. Psychol Med, 47(13),2379-2392. doi: 10.1017/s0033291717001064
Campbell-Sills, L., Kessler, R. C., Ursano, R. J.,
Rosellini, A. J., Afifi, T. O., Colpe, L. J., Heeringa,
S. G., Nock, M. K., Sampson, N. A., Sareen, J.,
Schoenbaum, M., Sun, X., Jain, S., & Stein, M.
B. (2017). Associations of childhood bullying
victimization with lifetime suicidal behaviors
among new U.S. Army soldiers. Depress Anxiety,34(8), 701-710. doi: 10.1002/da.22621
Campbell-Sills, L., Kessler, R. C., Ursano, R. J., Sun,X., Taylor, C. T., Heeringa, S. G., Nock, M. K.,
Sampson, N. A., Jain, S., & Stein, M. B. (2017).
Predictive validity and correlates of self-assessed
resilience among U.S. Army soldiers. Depress
Anxiety, 35(2), 122-131. doi: 10.1002/da.22694
Campbell-Sills, L., Ursano, R. J., Kessler, R. C., Sun,
X., Heeringa, S. G., Nock, M. K., Sampson, N.
A., Jain, S., & Stein, M. B. (2017). Prospective
risk factors for post-deployment heavy drinking
and alcohol or substance use disorder among US
Army soldiers. Psychol Med, 1-12. doi: 10.1017/
s0033291717003105
Cozza, S. J., Fisher, J. E., Zhou, J., HarringtonLaMorie, J., La Flair, L., Fullerton, C. S., &Ursano, R. J. (2017). Bereaved military dependent
spouses and children: Those left behind in a decadeof war (2001—2011). Military Medicine, 182(3),e1684-91. doi: 10.7205/MILMED-D-16-0010
Cozza, S. J., Whaley, G. L., Fisher, J. E., Zhou,
J., Ortiz, C. D., McCarroll, J. E., Fullerton,
C. S., & Ursano, R. J. (2017). Deployment
status and child neglect types in the U.S.
Army. Child Maltreatment, 23(1):25-33. doi:
10.1177/1077559517717638
Dalgard, C., Eidelman, O., Jozwik, C., Olsen, C. H.,
Srivastava, M., Biswas, R., Eudy, Y., Rothwell
S. W., Mueller, G. P., Yuan, P., Drevets, W. C.,

Manji, H. K., Vythlingam, M., Charney, D. S.,
Neumeister, A., Ursano, R. J., Jacobowitz, D. M.,
Pollard, H. B., & Bonne, O. (2017). The MCP-4/
MCP-1 ratio in plasma is a candidate circadianbiomarker for chronic post-traumatic stressdisorder. Translational Psychiatry, 7(2), e1025. doi:
10.1038/tp.2016.285
Duncan, L. E., Ratanatharathorn, A., Aiello, A. E.,
Almli, L. M., Amstadter, A. B., Ashley-Koch, A. E.,
Baker, D. G., Beckham, J. C., Bierut, L. J, Bisson,
J., Bradley, B., Chen C. Y., Dalvie, S., Farrer, L. A.,
Galea, S., Garrett, M. E., Gelernter, J. E., Guffanti,G., Hauser, M. A., Johnson, E. O., Kessler, R. C.,
Kimbrel N. A., King, A., Koen, N., Kranzler, H.
R., Logue, M. W., Maihofer, A. X., Martin, A. R.,
Miller, M. W., Morey, R. A., Nugent, N. R., Rice, J.
P., Ripke, S., Roberts, A. L., Saccone, N. L., Smoller,
J. W., Stein, D. J., Stein, M. B., Sumner, J. A.,
Uddin, M., Ursano, R. J., Wildman, D. E., Yehuda,
R. Zhao, H., Daly, M. J., Liberzon, I., Ressler, K.
J., Nievergelt, C. M., & Hauser, M. A. (2017).
Largest GWAS of PTSD (N=20,070) yields genetic
overlap with schizophrenia and sex differences inheritability. Mol Psychiatry, 23(3), 666-673. doi:
10.1038/mp.2017.77
Fisher, J. E., Mauro, C., Cozza, S. J., Wall, M., Simon,
N. M., Ortiz, C. D., Harrington-Lamorie, J.,
Wang, Y., Fullerton, C. S., Ursano, R. J., & Shear,
M. K. (2017). Examination of factor structure of theinventory of complicated grief (ICG) in a sample of
bereaved military family members with persistentand elevated grief. Int J Methods Psychiatr Res,
26(3). doi: 10.1002/mpr.1571
Friedman, M. J., Huber, B. R., Brady, C. B., Ursano,R. J., Benedek, D. M., Kowall, N. W., & McKee,
A. C. (2017). VA’s National PTSD Brain Bank: A
national resource for research. Curr Psychiatry
Rep, 19(10), 73. doi: 10.1007/s11920-017-0822-6
Kotov, R., Krueger, R. F., Watson, D., Achenbach,T. M., Althoff, R. R., Bagby, R. M., Brown, T. A.,
Carpenter, W. T., Caspi, A., Clark, L. A., Eaton,
N. R., Forbes, M. K., Forbush, K. T., Goldberg, D.,
Hasin, D., Hyman, S. E., Ivanova, M. Y., Lynam,
D. R., Markon, K., Miller, J. D., Moffitt, T. E.,
Morey, L. C., Mullins-Sweatt, S. N., Ormel, J.,
Patrick, C. J., Regier, D. A., Rescorla, L., Ruggero,2017 ANNUAL REPORT | 29

C. J., Samuel, D. B., Sellbom, M., Simms, L. J.,
Skodol, A. E., Slade, T., South, S. C., Tackett, J.
L., Waldman, I. D., Waszczuk, M. A., Widiger, T.
A., Wright, A. G. C., & Zimmerman, M. (2017).
The Hierarchical Taxonomy of Psychopathology(HiTOP): A dimensional alternative to traditional
nosologies. Journal of Abnormal Psychology,
126(4), 454-477. doi: 10.1037/abn0000258
Lewandowski-Romps, L., Schroeder, H. M., Berglund,P. A., Colpe, L. J., Cox, K., Hauret, K., Hay, J. D.,
Jones, B., Little, R. J. A., Mitchell, C., Schoenbaum,
M., Schultz, P., Stein, M. B., Ursano, R. J., &Heeringa, S. G. (2017). Medical-encounter
mental health diagnoses, non-fatal injury andpolypharmacy indicators of risk for accident deathin the US Army enlisted soldiers, 2004-2009. Prev
Med, S0091-7435(17), 30457-7. doi: 10.1016/j.
ypmed.2017.11.016
Mash, H. B. H., Fullerton, C. S., Cozza, S. J., &Howe, E. G. (2017). Nine lessons from Ashley andher parents. The Journal of Clinical Ethics, 28(3),177-188
Mash, H. B. H., Fullerton, C. S., Cozza, S. J.,
McCarroll, J. E., & Ursano, R. J. (2017).
Association of on-post and off-post resources withperception of residential neighborhood quality in
U.S. Army families. Journal of Military Behavioral
Health doi: 10.1080/21635781.2017.1333068
Mash, H. B. H., Fullerton, C. S., Benevides, K. N., &Ursano, R. J. (2017). Identification with terrorist
attack victims: Association with television viewing
and prior life threat. Disaster Med Public HealthPrep, 1-8. doi: 10.1017/dmp.2017.72
McCarroll, J. E., Fisher, J. E., Cozza, S. J., Robichaux,
R. J., & Fullerton, C. S. (2017). Characteristics,
classification, and prevention of child maltreatment
fatalities. Military Medicine, 182(1), e1551-e1557
Millner, A. J., Ursano, R. J., Hwang, I., A, J. K., Naifeh,
J. A., Sampson, N. A., Zaslavsky, A. M., Stein,
M. B., Kessler, R. C., & Nock, M. K. (2017). Prior
mental disorders and lifetime suicidal behaviors
among US Army soldiers in the Army Study toAssess Risk and Resilience in Servicemembers(Army STARRS). Suicide Life Threat Behav. doi:
10.1111/sltb.12394
Millner, A. J., Ursano, R. J., Hwang, I., King, A.
J., Naifeh, J. A., Sampson, N. A., Zaslavsky, A.
M., Stein, M. B., Kessler, R. C., & Nock, M. K.
(2017). Lifetime suicidal behaviors and career
characteristics among U.S. Army soldiers: Resultsfrom the Army Study to Assess Risk and Resilience
30 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

in Servicemembers (Army STARRS). Suicide Life
Threat Behav. doi: 10.1111/sltb.12363
Moore, T. M., Gur, R. C., Thomas, M. L., Brown,
G. G., Nock, M. K., Savitt, A. P., Keilp, J. G.,
Heeringa, S., Ursano, R. J., & Stein, M. B.
(2017). Development, administration, andstructural validity of a brief, computerizedneurocognitive battery. Assessment, doi:
10.1177/1073191116689820
Naifeh, J. A., Ursano, R. J., Benfer, N., Wu, H.,
Herman, M., Benedek, D. M., Russell, D. W.,
Benevides, K. N., Kao, T. C., Ng, T. H., Aliaga,
P. A., Wynn, G. H., Zhang, L., Forsten, R. D., &Fullerton, C. S. (2017). PTSD symptom severity
and sensitivity to blood, injury, and mutilation in
U.S. Army special operations soldiers. Psychiatry
Research, 250, 78-83. doi: 10.1016/j.
psychres.2017.01.058
Nock, M. K., Dempsey, C. L., Aliaga, P. A., Brent,
D. A., Heeringa, S. G., Kessler, R. C., Stein,
M. B., Ursano, R. J., & Benedek, D. (2017).
Psychological autopsy study comparing suicide
decedents, suicide ideators, and propensity scorematched controls: Results from the Study toAssess Risk and Resilience in Servicemembers(Army STARRS). Psychol Med, 1-12. doi: 10.1017/
s0033291717001179
Pitts, B. L., Safer, M. A., Castro-Chapman, P. L., &Russell, D. W. (2017). Retrospective appraisalsof threat and benefit mediate the effects of
combat experiences on mental health outcomesin army medics. Military Behavioral Health. doi:
10.1080/21635781.2017.1401967
Pitts, B., Safer, M., Chapman, P., & Russell, D.
(2017). Utilization of behavioral health services
by United States Army medics. Military
Behavioral Health, 5(3), 208-217. doi:
10.1080/21635781.2016.1272024
Polimanti, R., Kaufman, J., Zhao, H., Kranzler, H.
R., Ursano, R. J., Kessler, R. C., Stein, M. B., &Gelernter, J. (2017). Trauma exposure interacts
with the genetic risk of bipolar disorder in alcohol
misuse of US soldiers. Acta Psychiatr Scand,
137(2), 148-156. doi:10.1111/acps.12843
Polimanti, R., Kaufman, J., Zhao, H., Kranzler, H.
R., Ursano, R. J., Kessler, R. C., Gelernter, J., &Stein, M. B. (2017). A genome-wide gene-bytrauma interaction study of alcohol misuse in two
independent cohorts identifies PRKG1 as a risk
locus. Mol Psychiatry, 23(1), 154-160. doi: 10.1038/
mp.2017.24

Radford, K. D., Park, T. Y., Lee, B. H., Moran, S.,
Osborne, L. A. & Choi, K. H. (2017). Doseresponse characteristics of intravenous ketamine
on locomotion, dissociative stereotypy,
sensorimotor gating, and antinociception inSprague-Dawley rats. Pharmacology, Biochemistry
and Behavior, 153, 130-140. doi: 10.1016/j.
pbb.2016.12.014
Reynolds, C. F., Cozza, S. J. & Shear, M. K. (2017).
Clinically relevant diagnostic criteria for a
persistent impairing grief disorder: Putting patientsfirst. JAMA Psychiatry, 74(5), 433-434. doi:
10.1001/jamapsychiatry.2017.0290
Ribeiro, J. D., Gutierrez, P. M., Joiner, T. E., Kessler,
R. C., Petukhova, M. V., Sampson, N. A., Stein, M.
B., Ursano, R. J., & Nock, M. K. (2017). Healthcare contact and suicide risk documentation prior
to suicide death: Results from the Army Study toAssess Risk and Resilience in Servicemembers(Army STARRS). J Consult Clin Psychol, 85(4), 403408. doi: 10.1037/ccp0000178
Rosellini, A. J., Monahan, J., Street, A. E., Petukhova,
M. V., Sampson, N. A., Benedek, D. M., Bliese,
P. B., Stein, M. B., Ursano, R. J., & Kessler, R. C.
(2017). Predicting sexual assault perpetration in
the U.S. Army using administrative data. American
Journal of Preventive Medicine, 53(5), 661-669. doi:
10.1016/j.amepre.2017.06.022
Rosellini, A. J., Stein, M. B., Benedek, D. M., Bliese, P.
D., Chiu, W. T., Hwang, I., Monahan, J., Nock, M.
K., Petukhova, M. V., Sampson, N. A., Street, A.
E., Zaslavsky, A. M., Ursano, R. J., & Kessler, R. C.
(2017). Using self-report surveys at the beginningof service to develop multi-outcome risk models for
new soldiers in the U.S. Army. Psychol Med, 47(13),2275-2287. doi: 10.1017/s003329171700071x
Rosellini, A. J., Street, A. E., Ursano, R. J., Chiu,
W. T., Heeringa, S. G., Monahan, J., Naifeh, J.
A., Petukhova, M. V., Reis, B. Y., Sampson, N.
A., Bliese, P. D., Stein, M. B., Zaslavsky, A. M., &Kessler, R. C. (2017). Sexual assault victimizationand mental health treatment, suicide attempts,
and career outcomes among women in the US
Army. Am J Public Health, 107(5), 732-739. doi:
10.2105/ajph.2017.303693
Russell, C. A., Gibbons, S. W., Abraham, P. A.,
Howe, E. R., Deuster, P., & Russell, D. W. (2017).
Narrative approach in understanding the drivers
for resilience of military combat medics. Journalof the Royal Army Medical Corps. doi: 10.1136/
jramc-2017-000877

Russell, C., Russell, D., Lehu, J., & Morales, A.
(2017). Hedonic contamination: Exposure toadvertising taints subsequent entertainment
experiences. Journal of Advertising Research, 57(1),38-52. doi: 10.2501/JAR-2017-012
Russell, C., Swasy, J., Engels, L., & Russell, D.
(2017). Eye tracking evidence that happy
faces impair comprehension of the verbal
message: The case of health warnings indirect-to-consumer pharmaceutical televisioncommercials. International Journal of Advertising,36(1), 82-106. doi: 10.1080/02650487.2016.1196030
Russell, D. W., Kazman, J. B., Benedek, D. M.,
Ursano, R. J., & Russell, C. A. (2017). Domestic
civil support missions can aggravate negative
mental health outcomes among National
Guardsmen: The moderating role of economic
difficulties. J Trauma Stress, 30(2), 195-199. doi:
10.1002/jts.22164
Stein, M. B., Campbell-Sills, L., Ursano, R. J., Rosellini,
A. J., Colpe, L. J., He, F., Heeringa, S. G., Nock, M.
K., Sampson, N. A., Schoenbaum, M., Sun, X., Jain,
S., & Kessler, R. C. (2017). Childhood maltreatment
and lifetime suicidal behaviors among new soldiersin the US Army: Results from the Army Study toAssess Risk and Resilience in Servicemembers(Army STARRS). J Clin Psychiatry. doi: 10.4088/
JCP.16m10900
Stein, M. B., Ware, E. B., Mitchell, C., Chen, C. Y.,
Borja, S., Cai, T., Dempsey, C. L., Fullerton, C.
S., Gelernter, J., Heeringa, S. G., Jain, S., Kessler, R.
C., Naifeh, J. A., Nock, M. K., Ripke, S., Sun, X.,
Beckham, J. C., Kimbrel, N. A., VA Mid-Atlantic
Mental Illness Research, Education, and ClinicalCenter (MIRECC) Workgroup, Ursano, R. J. &Smoller, J. W. (2017). Genomewide association
studies of suicide attempts in US soldiers. Am J
Med Genet B Neuropsychiatr Genet, 174(8), 786797. doi: 10.1002/ajmg.b.32594
Stein, M. B., Chen, C. Y., Jain, S., Jensen, K. P., He, F.,
Heeringa, S. G., Kessler, R. C., Maihofer, A., Nock,
M. K., Ripke, S., Sun, X., Thomas, M. L., Ursano,R. J., Smoller, J. W., & Gelernter, J. (2017). Genetic
risk variants for social anxiety. Am J Med GenetB Neuropsychiatr Genet, 174(2), 120-131. doi:
10.1002/ajmg.b.32520
Ursano, R. J., Kessler, R. C., Naifeh, J. A., Mash, H.
B. H., Fullerton, C. S., Bliese, P. D., Zaslavsky,
A. M., Ng, T. H. H., Aliaga, P. A., Wynn, G. H.,
Dinh, H. M., McCarroll, J. E., Sampson, N. A.,
Kao, T. C., Schoenbaum, M., Heeringa, S. G., &2017 ANNUAL REPORT | 31

Stein, M. B. (2017). Risk of suicide attempt amongsoldiers in army units with a history of suicide
attempts. JAMA Psychiatry, 74(9), 924-931. doi:
10.1001/jamapsychiatry.2017.1925
Ursano, R. J., Kessler, R. C., Naifeh, J. A., Mash, H.
B. H., Fullerton, C. S., Bliese, P. D., Wynn, G.
W., Aliaga, P. A., Wryter, C., Sampson, N. A.,
Kao, T., Colpe, L. J., Schoenmbaum, M., Cox,
K. L., Heeringa, S. G., & Stein, M. B. Frequency
of Improvised Explosive Devices and Suicide
Attempts in the U.S. Army. (2017). Military
Medicine, 182(3), e1697-e1703. doi: 10.7205/
milmed-d-16-00270
Ursano, R. J., Kessler, R. C., Naifeh, J. A., Mash,
H. B. H., Fullerton, C. S., Ng, T. H. H., Aliaga,
P. A., Wynn, G. H., Dinh, H. M., McCarroll, J.
E., Sampson, N. A., Kao, T. C., Schoenbaum M.,
Heeringa, S. G., & Stein, M. B. (2017). Suicide
attempts in U.S. Army combat arms, Special Forces
and combat medics. BMC Psychiatry, 17(1), 194.
doi: 10.1186/s12888-017-1350-y
Ursano, R. J., Stein, M. B., Mash, H.B.H., Naifeh,
J. A., Fullerton, C. S., Zaslavsky, A. M., Ng, T.
H. H., Aliaga, P. A., Wynn, G. H., Dinh, H.
M., McCarroll, J. E., Sampson, N. A., Kao, T.
C., Schoenbaum, M., Heeringa, S. G., & Kessler,
R. C. (2017). Documented family violence
and risk of suicide attempt among U.S. Army
Soldiers. Psychiatry Research. doi: 10.1016/j.
psychres.2017.09.046
Ursano, R. J., Wang, J., Fullerton, C. S., Ramsawh,
H., Gifford, R. K., Russell, D., Cohen, G. H.,
Sampson, L., & Galea, S. (2017). Post-deployment
mental health in Reserve and National Guard
Service members: Deploying with or without
one’s unit and deployment preparedness. Military
Medicine, 183(1-2), e51-e58. doi:10.1093/milmed/
usx002
West, J. C., Morganstein, J. C., Meyer, E. G., &Wynn, G. H. (2017). Real stress reactions insimulation: Vignettes from extended mass-casualty
simulations. Acad Psychiatry, 42(1), 164-167. doi:
10.1007/s40596-017-0774-5
Worthen, M., Rathod, S. D., Cohen, G., Sampson, L.,
Ursano, R., Gifford, R., Fullerton, C., Galea, S.,& Ahern, J. (2017). Risk and protective factors fordifficulty controlling violent behavior in National
Guard and Reserve Service Members. J Interpers
Violence. doi: 10.1177/0886260517737552
Wynn, G. H. & Ursano, R. J. (2017).
Posttraumatic Stress Disorder. In Reference
32 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Module in Neuroscience and Biobehavioral
Psychology, Elsevier. doi: 10.1016/B978-0-12809324-5.05378-5

BOOK CHAPTERS
Ashwood, A., Moskowitz, S., Flynn, B. W., &Sherman, R. (2017). Why Is Integrating DisasterBehavior Health Essential to Emergency
Management? Challenges and Opportunities.
In B. W. Flynn, & R. Sherman (Eds.), Integrating
Emergency Management and Disaster Behavioral
Health: One Picture through Two Lenses (pp. 3970). Cambridge, MA: Elsevier.
Benedek, D. M., Morganstein, J. C., Holloway, H.
C., & Ursano, R. J. (2017). Disaster Psychiatry:
Disasters, Terrorism, and War. In B. J. Sadock, V.
A. Sadock, & P. Ruiz (Eds.), Kaplan & Sadock’s
Comprehensive Textbook of Psychiatry, (pp. 25642576). Baltimore, MD: Lippincott Williams &Wilkins.
Benedek, D. M. & Wynn, G. H. (2017). Acute stressdisorder and posttraumatic stress disorder. In
R. J. Ursano, C. S. Fullerton, L. Weisaeth, & B.
Raphael (Eds.), Textbook of Disaster Psychiatry(2nd ed., pp. 101–123). Cambridge, UK: Cambridge
University Press.
Brown, J. J., Freeman, C. A., Flynn, B. W., & Sherman,
R. (2017). Integration in the Emergency Operations
Center (EOC)/Emergency Communications
Center (ECC). In B. W. Flynn, & R. Sherman(Eds.), Integrating Emergency Management andDisaster Behavioral Health: One Picture throughTwo Lenses (pp. 255-276). Cambridge, MA:
Elsevier.
Cozza, S. J., Rauch, P., & Keller, M. (2017). Family andcommunity support. In A. Kellerman, E. Elster& Borden Institute (Eds.), Out of the Crucible:
How the US Military Transformed Combat
Casualty Care in Iraq and Afghanistan (pp. 317325). Washington, DC: Department of the Army.
Flynn B. W., Bushnell, P. & Lurie, N. (2017).
Leadership in disasters. In R. J. Ursano, C.S.
Fullerton, L. Weisaeth, & B. Raphael (Eds.),
Textbook of Disaster Psychiatry (2nd ed., pp. 285–
297). Cambridge, UK: Cambridge University Press.
Flynn, B. W., & Philbin, J. P. (2017). Risk and Crisis
Communications. In B.W. Flynn, & R. Sherman(Eds.), Integrating Emergency Management andDisaster Behavioral Health: One Picture throughTwo Lenses (pp. 277-296). Cambridge, MA:
Elsevier.

Flynn, B. W., & Sherman, R. (2017). Conclusion/
Summary. In B.W. Flynn, & R. Sherman(Eds.), Integrating Emergency Management andDisaster Behavioral Health: One Picture throughTwo Lenses (pp. 331-337). Cambridge, MA:
Elsevier.
Flynn, B.W., & Sherman, R. (2017). Sustaining
Integration: A Way Forward. In B.W. Flynn,& R. Sherman (Eds.), Integrating Emergency
Management and Disaster Behavioral Health:
One Picture through Two Lenses (pp. 321-330).
Cambridge, MA: Elsevier.
Fullerton, C. S., Ursano R. J., Weisaeth, L. & Raphael
B. (2017). Public health and disaster mental
health: Preparing, responding and recovering. In
R. J. Ursano, C. S. Fullerton, L. Weisaeth, & B.
Raphael (Eds.), Textbook of Disaster Psychiatry(2nd ed., pp. 325–339). Cambridge, UK: Cambridge
University Press.
Howe, E. G. & Newman, E. (2017). Ethical issues
in disaster psychiatry. In R. J. Ursano, C. S.
Fullerton, L. Weisaeth, & B. Raphael (Eds.),
Textbook of Disaster Psychiatry (2nd ed., pp. 314–
324). Cambridge, UK: Cambridge University Press.
McCarroll, J. E., Biggs, Q. M., Fullerton, C. S., &Ursano R. J. (2017). Disaster workers: Exposure
to mass and traumatic death. In R. J. Ursano, C.
S. Fullerton, L. Weisaeth & B. Raphael (Eds.),
Textbook of Disaster Psychiatry (2nd ed., pp. 231–
260). Cambridge, UK: Cambridge University Press.
Morganstein, J. C., West, J. C., & Ursano, R. J.
(2017). Work Associated Trauma. In K. Brower,& M. B. Riba (Eds.), Physician Mental Health andWell-Being: Research and Practice (pp. 33-60).
Cham, Switzerland: Springer Nature Publishing
Company.
Morganstein, J. C., Ursano, R. J., Fullerton, C. S., &Holloway, H.C. (2017). Pandemics: Health Care
Emergencies. In R. J. Ursano, C. S. Fullerton, L.
Weisaeth, & B. Raphael (Eds.), Textbook of Disaster
Psychiatry, 2nd ed. (pp. 270-283). Cambridge, UK:
Cambridge University Press.
Morganstein, J. C., Ursano, R. J., Fullerton, C. S., &Holloway, H. C. (2017). Terrorism and Weapons ofMass Destruction. In R. J. Ursano, C. S. Fullerton,
L. Weisaeth, & B. Raphael (Eds.), Textbook
of Disaster Psychiatry, 2nd ed. (pp. 193-211).
Cambridge, UK: Cambridge University Press.
Shultz, J. M., Jackson, M. C., Flynn, B. W., & Sherman,
R. (2017). Integration in Disasters of Different
Types, Severity, and Location. In B.W. Flynn,& R. Sherman (Eds.) Integrating Emergency
Management and Disaster Behavioral Health:
One Picture through Two Lenses (pp. 101-128).
Cambridge, MA: Elsevier.
Ursano, R. J., Fullerton, C. S., Weisaeth, L. &Raphael B. (2017). Individual and community
responses to disaster. In R. J. Ursano, C. S.
Fullerton, L. Weisaeth & B. Raphael (Eds.),
Textbook of Disaster Psychiatry (2nd ed., pp. 1–26).
Cambridge, UK: Cambridge University Press.
Whaley G. J., Cohen W. L., & Cozza S. J. (2017)Children and families: responding to disaster andbereavement. Disaster Psychiatry, Cambridge
University Press: New York.
Zensinger, L.W., Jacobs, G.A., Flynn, B.W., Sherman,
R. (2017). Expanding the Tent: How Training and
Education Partnerships with Other Professions
Can Enhance Both EM and BH. In B.W. Flynn,
R. Sherman (Eds.) Integrating Emergency
Management and Disaster Behavioral Health:
One Picture through Two Lenses (pp. 191-220).
Cambridge, MA: Elsevier.

BOOKS/VOLUMES
Flynn, B. W., Sherman, R. (Eds.). (2017). Integrating
Emergency Management and DisasterBehavioral Health: One Picture through Two
Lenses. Cambridge, MA: Elsevier.
Meyer, E. G., McCarroll, J. E., & Ursano, R. J. (Eds.).
(2017). U.S. Army Culture: An Introduction for
Behavioral Health Researchers. Bethesda, MD:
Center for the Study of Traumatic Stress.
Ursano, R. J., Fullerton, C. S., Weisaeth, L., &Raphael, B. (Eds.). (2017). Textbook of Disaster
Psychiatry (2nd Ed.). Cambridge, England:
Cambridge University Press.

2017 ANNUAL REPORT | 33

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

PRESENTATIONSDisaster Behavioral Health: Education Fact Sheets
to Enhance Preparedness and Response.
Morganstein, J. C. Presented at the 2017
NCDMPH webinar series, January 2017.
Psychological Effects of Disasters. Benedek, D.
Presented at the Hospital Management ofChemical, Biological, Radiological, Nuclear andExplosive Incidents (HM-CBRNE) course at the
US Army Medical Research Institute of Chemical
Defense (USAMRICD), Aberdeen Proving
Ground, MD, February 2017.
Ecological Momentary Assessment of Daily
Variation in Post-Traumatic Stress Symptoms.
Biggs, Q. M., Fullerton, C. S., Wang, J., Krantz,
D. S., Wynn, G., Probe, D., Dacuyan, N., Franz,
M., Carr, R. B., & Ursano, R. J. Presented at theannual meeting of the American PsychosomaticSociety, Seville, Spain, March 2017.
Association of General Belief in a Just World andMental Health Outcomes Following the 9/11
Terrorist Attacks. Christopher, E., Fisher,
J. E., Zhou, J., Liu, A. G., Karp, J. N., Chen,
S., Fetchet, M., Fullerton, C. S., Ursano, R.
J., Cozza, S. J. Presented at the 12th Annual
Amygdala, Stress and PTSD Conference,
Bethesda, MD, April 2017.
Community Strength & Disasters: Collective
Efficacy Following the 2004 Florida
Hurricanes. Morganstein, J.C., Herberman
Mash, H.B., Franz, M., Wang, L., Meyer, E.G.,
Santiago, P.N., Fullerton, C.S., Ursano, R.J.
Presented at the 12th Annual Amygdala, Stressand PTSD Conference, Bethesda, MD, April
2017.
Community Strength & Disasters: Collective
Efficacy Following the 2004 Florida
Hurricanes. Morganstein, J. C., Herberman
Mash, H.B., Franz, M., Wang, L., Meyer, E.G.,
34 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Santiago, P.N., Fullerton, C.S., Ursano, R.J.
Presented at the WRNMMC Research Innovations
Symposium, Bethesda, MD, April 2017.
Decomposition of Daily Variation in the
Posttraumatic Stress and Depression Symptoms
in U.S. Military Service Members: Trait, Stateand Error. Wang, J., Biggs, Q. M., Fullerton,
C. S., Wynn, G. H., Probe, D., Dacuyan, N.,
Franz, M., Carr, R. B., & Ursano, R. J. Presented
at the 12th Annual Amygdala, Stress and PTSD
Conference, Bethesda, MD, April 2017.
Decomposition of Daily Variation in the
Posttraumatic Stress and Depression Symptoms
in U.S. Military Service Members: Trait, Stateand Error. Wang, J., Biggs, Q. M., Fullerton,
C. S., Wynn, G. H., Probe, D., Dacuyan, N.,
Franz, M., Carr, R. B., & Ursano, R. J. Presented
at the Anxiety and Depression Conference, San
Francisco, CA, April 2017.
Grief, Anxiety, and Depression Independently
Predict Cognitive Failures in Bereaved Family
Members. Liu, A. G., Fisher, J. E., Zhou, J.,
Christopher, E., Karp, J., Fullerton, C. S.,
Ursano, R. J., & Cozza, S. J. Presented at
the 12th Annual Amygdala, Stress and PTSD
Conference, Bethesda, MD, April 2017.
Just When You Thought It Could Not Get MoreComplicated. Flynn, B. W. Presented the opening
keynote address at SUNY New Paltz, Instituteof Disaster Mental Health, for their 14th Annual
Conference, New Paltz, NY, April 2017.
Multiple Notifications of Human Remains
in Families of September 11th Decedents
Associated with Depression and PosttraumaticStress Disorder. Karp, J., Fisher, J., Chen, S.,
Liu, A., Christopher, E., Zhou J., Fullerton,C., Ursano, R., Cozza, S. Presented at the 12th
Annual Amygdala, Stress and PTSD Conference,
Bethesda, MD, April 2017.
Promoting Family Safety through Personal FirearmSafety Education. Fisher, A. V., Liu, A. G.,
Stephens, T., & West, J. C. Presented at the 12th
Annual Amygdala, Stress and PTSD Conference,
Bethesda, MD, April 2017.
Stepping Forward in Grief: An Online Selective
Intervention for Bereaved Military Families.
Cozza, S. J. Presented at the annual MOMRP
Military Family IPR, Ft. Detrick, MD, April
2017.
The Impact of Service Member Death on Military
Families: A National Study of Bereavement.
Cozza, S. J. Presented at the annual MOMRP
Military Family IPR, Ft. Detrick, MD, April 2017.
The Protective Effect of Social and Support
Networks among US Army Soldiers. Dempsey,
C. L., Benedek, D. M., Nock, M. K., Wang, L.,
Ng, T. H., Riggs, C., Long, W. & Caulfield, N.
Presented at the 12th Annual Amygdala, Stressand PTSD Conference, Bethesda, MD, April
2017.
Use of neuromodulation techniques in the treatmentof post-traumatic stress disorder. Shea, C. J. &Wynn G. H. Presented at 12th Annual Amygdala,Stress and PTSD Conference, Bethesda, MD,
April 2017.
Disaster Psychiatry: Current Needs in Managing
Climate Change. Morganstein, J. C., Cooper,
R., Van Susteren, L., West, J. C. Workshop
presented at the Annual Meeting of theAmerican Psychiatric Association, San Diego,
CA, May 2017.
Grief, Anxiety, and Depression Independently
Predict Cognitive Failures in Bereaved Family
Members. Liu, A. G., Fisher, J. E., Zhou, J.,
Christopher, E., Karp, J., Fullerton, C. S.,
Ursano, R. J., & Cozza, S. J. Presented at the
Association for Psychological Science’s 29th
Annual Convention in Boston, MA, May 2017.
Buying Compliance: Our Best Bet for Better
Antipsychotic Adherence or a Deal with theDevil? Gray K., West J. C., Wynn G. H., HoweE. Presented at the American Psychiatric
Association Annual Conference, San Diego, CA,
June 2017.
CV Workshop. Morganstein, J., Meyer, E, West,
J. C., Wynn, G.H. Presented at the Tri-Service

Conference of the Society of Uniformed Services
Psychiatrists, San Diego, CA, June 2017.
Forensic Aspects of the Treatment of Victimsof Military Sexual Assault. Benedek, D. M.
Presented at the annual Artiss Syposium,
Bethesda, MD, June 2017.
PTSD and Suicide — Army STARRS Genotype,
Phenotype, and Timing in Precision Medicine.
Ursano, R. J. Presented at the 2017 Military
Operational Readiness: Precision Medicine
Conference in Potomac, MD, June 2017.
Towards Beneficence: Ethical Controversies andEvolving Views on the Involuntary Treatmentof Substance Use Disorders. Yang, S., West,
J. C., Wynn, G. H., Howe E. Presented at theAmerican Psychiatric Association Annual
Conference, San Diego, C.A., June 2017.
Personal Firearm Safety: What Every Provider
Should Know on Firearm Safety. West, J. C.
Presented at the Naval Center for Combat
and Operational Stress Control (NCCOSC)
Symposium, Bethesda, MD, August 2017.
Crisis leadership: Behavioral Health Considerations.
Benedek, D. M. Presented as a panelist at the
USU National Center for Disaster Medicine
and Public Health Crisis Leadership in Disaster
Symposium, Bethesda, MD, September 2017.
Assessing Individuals in Crisis with PTSD. Wynn,
G. H. Presented at the Virginia Community
Services Board Annual Conference in Roanoke,
VA, October 2017.
Climate Change and Disaster Psychiatry.
Morganstein, J. C. Presented at Climate Change:
The Ultimate Social Determinant of Health andMental Health, Institute of Psychiatric Services,
New Orleans, LA, October 2017.
Five Critical Concepts Care Providers and Ethics
Consultants Should Know When They Care forTransgender Persons in Clinical Settings. Howe,E. G. Presented at the Annual American Society
for Bioethics and Humanities (ASBH) meeting,Kansas City, KS, October 2017.
Risk and Protective Factors for Military Suicide.
Benedek, D. M. Presented at the fall meetingof the Psychiatric Society of Virginia, Virginia
Beach, VA, October 2017.
2017 ANNUAL REPORT | 35

Senior Career Mentoring. Morganstein, J.
C. Presented at the American Psychiatric
Association Public Psychiatry Fellowship at
the Annual Conference, Institute of PsychiatricServices, New Orleans, LA, October 2017.
BDNF Val66Met polymorphism associated withincreased risk of complicated grief following
bereavement, independent of its effect on
depression. Fisher, J. E., Zhang, L., Zhou, J.,
Hu, X., Fullerton, C. S., Ursano, R.J., & Cozza,
S. J. Presented at the ISTSS Annual Meeting,
Chicago, IL, November 2017.
Longitudinal Effects of Deployment, Recency of
Return, and Hardiness on Behavioral HealthSymptoms in US Army Combat Medics.
Krauss, S., Russell, D., Kazman, J., & Deuster, P.
Presented at the Military Health System Research
Symposium, Kissimmee, FL, November 2017.
PTSD Pharmacology: State of the Science. Wynn,
G. H. Presented at the Marne Behavioral HealthSummit in Ft. Stewart, GA., November 2017.
The Impact of Self-quantification: How Gamificationof Personal Data Motivates Individual throughAffective Response. Honea, H. & Russell, D.
Presented at the 7th Annual Games for HealthEurope Conference, Eindhoven, Netherlands,
November 2017.
The protective effect of social and support networks
among U.S. Army Soldiers at risk for suicide.
Dempsey, C. L., Benedek, D. M., Nock, M. K.,
Wang, L., Ng, T. H., Riggs, C.,​DeStefano, S.,& Caulfield, N. Presented at the ISTSS Annual
Meeting in Chicago, IL, November 2017.
What is Psychopathology: Relationship topathophysiology, epidemiology, health services
research, and mental health policy? Regier, D.
A. Presented at the Walter Reed Department of
Psychiatry, Bethesda, MD, November 2017.
Disaster Mental Health and Climate Change:
Making the Connection. Morganstein, J. C.
Presented at the Grand Rounds for the Universityof Maryland Psychiatry Department, Baltimore,
MD, December 2017.

36 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

BRIEFINGS AND INTERVIEWS
n Dr. Benedek was a panel discussant of the Burns& Novack Vietnam Documentary at the Army
Heritage Center in Carlisle, PA. There was apublication this week from a group at Yale withwhom Dr. Benedek and Dr. Ursano are associated(the Traumatic Stress Brain Studies Group).
n Dr. Cozza was invited by the Military Family
Research Institute to speak at their “Battlemind
to Home Mental Health Summit” held at Purdue
University. Dr. Cozza’s presentation included
research findings from the Bereavement Study.
n Dr. Morganstein conducted a videotape interview
for Airman Magazine as part of a series on“Invisible Wounds” on disasters, combat andtrauma.
n Dr. Morganstein was interviewed by Medscape on
current knowledge regarding the psychologicaland behavioral effects of climate-related
disasters and how healthcare providers can assist
individuals and communities to more effectively
prepare for and respond to these events.
n Dr. Morganstein was interviewed by Medscape,an online health care education, training andknowledge dissemination portal for health careproviders and patients, about the background,importance, and utility of the American
Psychiatric Association’s recently publishedposition statement on “Mental Health andClimate Change.”n Dr. Ursano and Dr. Ron Kessler (Harvard Medical
School) briefed Senior Army Leadership at
the Pentagon on Army STARRS and STARRSLS at the first Interim Progress Report (IPR).
The audience included the new Secretary of
the Army (Hon. Mark Esper), Army Surgeon
General, Deputy under Secretary of the Army,
G-1 and other senior Army leaders. Dr. Wagner(University of Michigan), Mr. Ludtke (ODUSA),
Dr. Cox (USAPHC), Dr. Gifford (CSTS), and Mr.
Hurwitz (CSTS) also attended.
n Dr. Ursano gave a webinar through the Interuniversity Consortium for Political and Social
Research (ICPSR) entitled, “An Introduction to
the Army STARRS Survey Data.”

Dr. Ursano
speaking at the2017 Amygdala,Stress and PTSD
Conference.

n Dr. Ursano briefed the STARRS-LS Government

Steering Committee (GSC) at a meeting at the
Office of the Deputy Undersecretary of the Army.
The briefing described the progress made by the
research team on the STARRS-LS project. Dr.
Gifford (CSTS) and Mr. Hurwitz (CSTS) also
attended.
n Dr. Ursano was interviewed by MD Magazine
regarding an Army STARRS publication in JAMA
Psychiatry entitled, “Risk of Suicide Attemptamong Soldiers in Army Units”.
n Dr. Ursano, as chairman of the American
Psychiatric Association’s Committee on
Psychiatric Dimensions of Disasters, wasinterviewed by CNN after the London Grenfell
fire tragedy for a feature focusing on thepsychological impact of rebuilding after adisaster.
n Drs. West and Morganstein were interviewed
with Mark Moran of APA Psychiatric News
regarding medical education on trauma witha focus on large scale events, responses andinterventions.
n Dr. West participated in a meeting with theHarvard Program in Refugee Trauma (HPRT)
entitled, “Working with Syrian Refugees: Medical
and Psychological Implications for Self Care”
in which he presented alongside the Directorof Telemedicine for HPRT, Eugene Augusterfer,
on distance supervision via telehealth in hostileenvironments. The meeting was convened for the

benefit of the Syrian American Medical Society(SAMS) to advise on their ongoing medical careof Syrian refugees and assistance to physicians in
Syria in areas of active conflict.
n Dr. Wynn served as a panel member for the NATOHFM Panel meeting on Leveraging Technology in
Military Mental Health in Toronto, Canada.
n Dr. Wynn was interviewed by OZY.com and quoted
in their article about drug treatment for PTSD.

AWARDSn Dr. Meyer, MAJ, USAF, MC, Assistant Professor,

Department of Psychiatry, Associate Psychiatry
Clinical Clerkship Director was awarded the
USUHS 2017 Innovation in Education award,
by popular vote, for his presentation, “A New
Psychiatry Clerkship Experience: Improved Skills
in a Simulated Clinical Environment.”n The 2016 CSTS Annual Report was among thewinners of the 2017 American Graphic DesignAwards.
n The CSTS poster, “The Protective Effect of Socialand Support Networks among US Army Soldiers,”
won the “2017 Outstanding Poster Presentation
Award” at the 12th Annual Amygdala, Stress and
PTSD Conference held in Bethesda, MD.
n Drs. Flynn and Morganstein accepted
appointments as Associate Editors for the journal,
Disaster Medicine and Public Health. This
invitation was initiated by the National Center
for Disaster Medicine and Public Health, a CSTS
partner Center at USUHS.
n Dr. Gabbay was invited to serve on the Editorial
Board of the journal, Policy Insights from the
Behavioral and Brain Sciences, published by Sage
for a term that begins immediately.
n Dr. Gabbay was invited to serve a threeyear term as Consulting Editor for thejournal, Psychophysiology.
n Dr. Russell was selected for his second Fulbrightscholarship and will be working on a substanceuse project with the European equivalent of the
National Institutes of Health.
n Dr. Russell was selected to serve as a behavioral
health research consultant to the FDA
Commissioner.
2017 ANNUAL REPORT | 37

Directors, Scientists, Science Collaborative
Members and Staff
DIRECTORS
Robert J. Ursano, MD
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Director
Center for the Study of TraumaticStress
Uniformed Services University
David M. Benedek, MD
COL, MC, USA
Chair, Professor
Department of Psychiatry
Associate Director, Consultationand Education
Center for the Study of TraumaticStress
Uniformed Services University
Stephen J. Cozza, MD
Professor
Department of Psychiatry
Associate Director, Child andFamily Program
Center for the Study of TraumaticStress
Uniformed Services University
Brian W. Flynn, EdD
Adjunct Professor
Department of Psychiatry
Associate Director, Health Systems
Center for the Study of TraumaticStress
Uniformed Services University
Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
Scientific Director
Center for the Study of TraumaticStress
Uniformed Services University

Robert K. Gifford, PhD
Assistant Professor
Department of Psychiatry
Executive Officer, and Associate
Director, Homeland Security
Studies
Center for the Study of TraumaticStress
Uniformed Services University
Joshua C. Morganstein, MD
CAPT, USPHSAssociate Professor of Psychiatry
Department of Psychiatry
Assistant Director
Center for the Study of TraumaticStress
Uniformed Services University
John A. Stuart, PhD
Research Assistant Professor
Department of Psychiatry
Director, Resource Management
Center for the Study of TraumaticStress
Uniformed Services University

SCIENTISTSDavid M. Benedek, MD
COL, MC, USA
Chair, Professor
Consultant to the U.S. Army
Surgeon General for Forensic
Psychiatry
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Quinn M. Biggs, PhD, MPH
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress38 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Uniformed Services University
Robert Bossarte, PhD
Adjunct Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Maria Braga, DDS, PhD
Associate Professor
Department of Anatomy,
Physiology and Genetics
Center for the Study of TraumaticStress
Uniformed Services University
Shenglin Chen, PhD
Biostatistician
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Kwang Choi, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Kelly L. Cozza, MD, DFAPA,
FAPM
Associate Professor
Psychiatry Clinical Clerkship
Director
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Stephen J. Cozza, MD
Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Brian Crowley, MD
Adjunct Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Frances Gabbay, PhD
Research Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Catherine L. Dempsey, PhD,
MPH
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Robert K. Gifford, PhD
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Connie C. Duncan, PhD
Research Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Joscelyn E. Fisher, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Brian W. Flynn, EdD
Adjunct Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Michael C. Freed, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Oscar I. Gonzalez, PhD
CPT, USA
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Derrick Hamaoka, MD
Lt Col, USAF, MC, FS
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Marjan G. Holloway, PhD
Associate Professor
Department of Medical & ClinicalPsychology
Center for the Study of TraumaticStress
Uniformed Services University
Tomoko I. Hooper, MD
Professor
Department of Preventive
Medicine & Biostatistics
Center for the Study of TraumaticStress
Uniformed Services University
Edmund G. Howe III, MD, JD
Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Luke Johnson, PhD
Adjunct Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Jill Harrington-LaMorie, DSW,LCSW
Senior Field Researcher
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Tzu Cheg Kao, PhD
Professor
Department of Preventive
Medicine and Biometrics
Center for the Study of TraumaticStress
Uniformed Services University

Kathryn Hefner, PhD
Research Psychologist
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

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

Harry C. Holloway, MD
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

David S. Krantz, PhD
Professor
Department of Medical andClinical Psychology
Center for the Study of TraumaticStress
Uniformed Services University
2017 ANNUAL REPORT | 39

He Li, MD, PhD
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Christin M. Ogle, PhD
Child Research Psychologist
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Xian Liu, PhD
Research Professor
Deployment Health Clinical Center
Walter Reed Army Medical
CenterDarrel A. Regier, MD, MPH
Adjunct Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Holly H. Mash, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
James E. McCarroll, PhD, MPH
Research Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Eric Meyer II, MD
Maj, USAF, MC
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Joshua C. Morganstein, MD
CAPT, USPHSAssociate Professor of Psychiatry
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
James A. Naifeh, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Dori B. Reissman, MD, MPH
CAPT, USPHS
Medical Director, World Trade
Center Responder Health
Program
Senior Medical Advisor, National
Institute of Occupational
Safety and Health
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Dale Russell, PhD
Behavioral Science Researcher
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Patcho N. Santiago, MD, MPH
CDR, MC, USN
Psychiatry Residency Program
Director
Walter Reed National Military
Medical Center
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Keke L. Schuler, PhD
Clinical Research Psychologist
Department of Psychiatry

40 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Center for the Study of TraumaticStress
Uniformed Services University
Patricia Spangler, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
John A. Stuart, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
E. Fuller Torrey, MD
Executive Director
Stanley Medical ResearchInstitute
Robert J. Ursano, MD
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Director
Center for the Study of TraumaticStress
Uniformed Services University
Jing Wang, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Maree J. Webster, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Director, Laboratory of Brain
Research
Stanley Medical ResearchInstituteLars Weisaeth, MD
Professor, Division of Disaster
Psychiatry
University of Oslo
Oslo, Norway
James (Curt) West, MD
CAPT, MC, USN
Deputy Chair
Associate Professor of Psychiatry
Clerkship Director
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Kathleen Wright, PhD
Former Director (Ret.)
Force Health Protection Program
USAMRU-E
Walter Reed Army Institute of
Research
Gary H. Wynn, MD
LTC, MC, USA
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Suzanne Yang, MD, PhD
Research Psychiatrist
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Lei Zhang, MD
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

SCIENCE COLLABORATIVEMEMBERSJames E. Barrett, PhD
Professor and Chairman,
Department of Pharmacology

and Physiology
Drexel University, College ofMedicine
Paul D. Bliese, PhD
Associate Professor, Departmentof Management
University of South Carolina,
Darla Moore School ofBusiness
Robert Bossarte, PhD
Associate Professor, Department
of Behavioral Medicine andPsychiatry
Director, West Virginia University
Injury Control ResearchCenterWest Virginia University
David Brody, MD, PhD
Professor, Department of
Neurology
Director, Center for Neuroscienceand Regenerative Medicine
Uniformed Services University
M. Richard Fragala, MD
COL, USAF, MC, FS (Ret.)
Professor, Department of
Psychiatry
Uniformed Services University
Matthew J. Friedman, MD, PhD
Professor, Department of
Psychiatry
Professor, Department ofPharmacology & Toxicology
Dartmouth University, Geisel
School of Medicine
Director, Leahy-Friedman
National PTSD Brain Bank
Senior Advisor, National Center
for Posttraumatic Stress
DisorderU.S. Department of Veterans
Affairs
Harry C. Holloway, MD
COL, MC, USA (Ret.)
Professor Emeritus, Departmentof Psychiatry
Uniformed Service University
Ronald C. Kessler, PhD
McNeil Family Professor,
Department of Health Care
PolicyHarvard Medical School
David S. Krantz, PhD
Professor, Department of Medical
and Clinical Psychology
Uniformed Services University
Craig H. Llewellyn, MD
Professor, Department of Militaryand Emergency Medicine
Uniformed Services University
Irwin Lucki, PhD
Professor and Chair, Departmentof Pharmacology & Molecular
Therapeutics
Uniformed Services University
Matthew K. Nock, PhD
Professor, Department of
Psychology
Harvard University
Francis O’Conner, MD, MPH
COL, MC, USA
Professor and Chairman,
Department of Military andEmergency Medicine
Uniformed Services University
Harvey B. Pollard, MD, PhD
Professor and Chair, Anatomy,
Physiology and Genetics
Director, Collaborative Health
Initiative Research Program(CHIRP)
Uniformed Services University
Robert M. Post, MD
Head, Bipolar Collaborative
Network
Former Chief, BiologicalPsychiatry Branch
National Institute of Mental
Health2017 ANNUAL REPORT | 41

David Riggs, PhD
Professor and Chair, Departmentof Medical Clinical Psychology
Executive Director, Center for
Deployment Psychology
Uniformed Services University
Arieh Y. Shalev, MD
Professor, Department of
Psychiatry
New York University
Professor, Department of
Psychiatry
Hadassah University School of
Medicine
Jerusalem, Israel
Murray B. Stein, MD, MPH
VA San Diego Healthcare System
Distinguished Professor,
Department of Psychiatry
Distinguished Professor,
Department of Family
Medicine and Public Health
University of California, San
Diego

STAFF
Deborah Probe Adams
Bilal Ali
Pablo Aliaga
Joseph Allely
Suzanne Antoniou
Eva Asabre
TSgt Rondricueas Barlow
Danielle Bartolanzo
K. Nikki Benevides
Alexandra Burris
Nicole Caulfield
Enryka Christopher
Alexa Churan
Nicole Dacuyan
Hieu Dinh
Sydney DeStefano
Kathryn DeWitte

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

DISTINGUISHED FORMERSCIENCE COLLABORATIVEMEMBERS & EMERITUS
FRIENDS OF CSTS
Herbert A. Hauptman, PhD(1917-2011)1985 Nobel Laureate, Chemistry
President, Hauptman-Woodward
Medical Research InstituteResearch Professor, Departmentof Biophysical Sciences
Adjunct Professor, Department ofComputer Science
University of Buffalo

Maria Dudek
Alice Fladung
Elyse Frank
Mackenzie Franz
Andrea Gould
Alissa Gutierrez
TSgt. Jorge Hastings
MSgt. Syrus Henderson
Lizabelle HernandezPaul Hurwitz
Jamon Jex
Mark Jimerson
Daniel Jureller
Jeremy Karp
Gail Kohls
Megan Lindberg
Alex Liu
Sarah Meirama
Diana Monday

42 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Joshua Lederberg, PhD,
ForMenRS (1925-2008)
1958 Nobel Laureate, Physiology
or Medicine
Professor Emeritus, Departmentof Molecular Genetics andInformatics
Rockefeller University
Founder, Department of Medical
Genetics
University of Wisconsin-Madison
David H. Marlowe, PhD(1931-2014)
Senior Lecturer, Department of
Psychiatry
Uniformed Services University
Former Chief, Department ofMilitary Psychiatry
Walter Reed Army Institute of
Research
Fellow, American Anthropological
Association

Susan Moss
Alysa Mullen
Alison Neuwirth
Stanley NgThomas Park
Joseph Piemontese
Anabel Reynolds
Charlotte Riggs-Donovan
Caleb Saguil
Alexis Shahidi
Trevor Stephens
Natara Strother-Ware
Tung Tu
Lydia Umhau
Leming Wang
Sydney West
Holly Wu
Michael Zhang
Jing Zhou

Funded Grants
GRANT

FUNDING INSTITUTION

Development of an Education Curriculum for Personally Owned Firearms Safety Enhancements Initiative

DSPO

Riluzole Augmentation Treatment for Complicated Posttraumatic Stress Disorder

USAMRMC

Traumatic Stress and Biomarkers in a Military Population

USAMRMC

Education of the Safety and Pharmacokinetics of the FAAH Inhibitor URB597

USAMRMC

Brain Bank Project: Consortium for the Translational Neuroscience and Treatment of Stress and PTSD
(VA Biorepository Brain Bank: PTSD Brain Bank Protocol)
Study to Assess Risk and Resilience in Servicemembers — Longitudinal Study (STARRS-LS)

VA
DHP

Family Violence and Trauma Project

IMCOM

The Impact of Service Member Death on Military Families: A National Study of Bereavement

CDMRP

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

CDMRP

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

MCFP

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

UCSD

Examination of the Short and Long-term Impact of School Shootings

UCLA

Pilot Trial of Nightmare Deconstruction and Reprocessing, a Novel Treatment for
PTSD-Related Nightmares and Insomnia
Center for the Study of Traumatic Stress (CSTS) Program

USAMRMCDHP

2017 ANNUAL REPORT | 43

Partnerships
CSTS would like to acknowledge andthank our partners and collaborators.
The Center has worked with organizations in the public and private sector
through research partnerships, project
collaborations, consultations andtrainings.
Alfred P. Sloan Foundation
American Academy of Child andAdolescent Psychiatry
American Gold Star Mothers
American Psychiatric Association
American Psychological Association
Architect of the Capitol
Armed Forces Retirement Home
Broad Institute
California Mental Health Services
Authority
The Carter Center
Catholic University of America
Center for Forensic Behavioral
Sciences
Center for Health Disparities Research,
Medical University of South
Carolina
Centers for Disease Control andPrevention
Columbia University
Cornell University
Dartmouth University
Defense Centers of Excellence
for Psychological Health andTraumatic Brain Injury
Department of Mental Health, Districtof Columbia
Deployment Health Clinical Center
Dover Air Force Base
Drexel University
Drug Enforcement Administration
Emory University
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
George Washington University
Gold Star Wives of America
Hadassah Medical Organization,

Jerusalem, Israel
Harvard University Medical School
Harvard University School of Public
HealthHenry M. Jackson Foundation for the
Advancement of Military Medicine
International Society for TraumaticStress Studies
Inter-university Consortium for
Political and Social Research
Italian Embassy, Washington, DC
Joint Base Lewis-McChord
Joint Mortuary Affairs Center andSchool, Fort Lee, Virginia
Las Vegas Psychiatric Association
Maryland Emergency Management
Authority
Massachusetts General Hospital
Medical Research Command at Ft.
Detrick
Michigan Department of Health andHuman Services
Michigan Psychiatric Society
Military Child Education Coalition
Miller School of Medicine of the
University of Miami
National Association for PTSD
National Association of State Mental
Health Program Directors
National Center for PTSD of the
Department of Veterans Affairs
National Child Traumatic Stress
Network
National Committee for Employer
Support of the Guard and Reserve
National Fallen Firefighters Foundation
National Intrepid Center of Excellence
National Institute for Occupational
Safety and HealthNational Institute of Mental HealthNational Institutes of HealthNational Institute of JusticeNational Military Family Association
Naval Sea Systems Command
North Atlantic Treaty Organization
Psychiatric Genomics Consortium
Rockefeller University
Rutgers University Cell & DNA
Repository
Sesame Workshop
Sheppard Pratt Health System
Stanford University

44 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Substance Abuse and Mental HealthServices Administration
Syracuse University
Syracuse VA Medical Center
Tragedy Assistance Program for
Survivors
Tulane School of Social Work
Uniformed Services University
Union Pacific Railroad
University of California, Los Angeles
University of California, San Diego
University of Maryland
University of Michigan
University of Pennsylvania
University of Pittsburgh
University of Virginia
University of Virginia’s Critical
Incident Analysis Group
University of Washington
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 andMateriel Command
U.S. Department of Agriculture
U.S. Department of Defense
U.S. Department of Energy
U.S. Department of Health and Human
Services
U.S. Department of Homeland Security
U.S. Department of Justice
U.S. Department of State
U.S. Department of Veterans Affairs
U.S. Postal Service
VA Connecticut Healthcare System
Veterans Administration Medical
Center of DC
Virginia Commonwealth University
Voices of September 11th
Walter Reed Army Institute of
Research
Walter Reed National Military Medical
CenterWest Virginia University
Western New York Psychiatric Society
Wright State University
Yale University
Yellow Ribbon Reintegration Program
Zero to Three

CSTS Timeline Highlights
Three Decades of Consultation, Research and Training

1980s–1990s

2000s–2010s

1985		Gander, Newfoundland Army Plane
Crash Consultation

2001

1987		Chemical & Biological Warfare
Consultation & Research2001		9/11: NYC, Pentagon, USNS Comfort Hospital
Ship Consultation & Research

1988		Ramstein Air Show Crash Research

2002

1989		USS Iowa Gun Turret Explosion
Consultation & Research
1989		United Plane Crash, Sioux City
Consultation & Research

ABC Interview with Robert J. Ursano:
Psychological Consequences of 9/11

Mental Health & Mass Violence: Evidence
Based Early Psychological Intervention,
Consensus Conference

2002		DC Sniper Attacks Research
2003

1989		Armenian Earthquake Consultation

Terrorism and Disaster: Individual andCommunity Mental Health Interventions

1990		Operation Desert Storm, USNS
Comfort Hospital Ship Consultation &Research

2004		Florida Hurricanes Consultation & Research

1990		Motor Vehicle Accidents Research2005		Asian Tsunami Consultation

1992		Hurricane Andrew Research
1994		
Individual and Community Responses
to Trauma and Disaster: The Structureof Human Chaos
1996		
Emotional Aftermath of the Persian
Gulf War: Veterans, Families,
Communities, and Nations

Through leadership, education and training, researchand scholarship, service and outreach, global healthengagement, and enhancing preparedness, CSTS
strives to mitigate the impact of trauma from exposure
to war, disasters, terrorism, community violence andpublic health threats.
— Robert J. Ursano, MD, Director, CSTS

2004		Mortuary Affairs Soldiers Intervention (TEAM)
2005		1st Annual Amygdala Conference
2005		Hurricanes Katrina and Rita: U.S. Postal Service
Research
2006

Workplace Preparedness for Terrorism, Sloan
Foundation Report

2006		Sesame Street Bereavement Intervention
2006		National Guard and Reserve Research
2007

Textbook of Disaster Psychiatry

2007		
Five Essential Elements of Immediate and
Mid-Term Mass Trauma Intervention: Empirical
Evidence
2007

First Responders: Mental Health Consequencesof Natural & Human-Made Disasters for Public
Health & Public Safety Workers

2008		Child Neglect and Bereavement in Military
Families Research2009		Families of Injured Soldiers Intervention
2009

Army STARRS Research2010		1st Forum on Health and National Security
2011

Clinical Manual for Management of PTSD

2014		
Clinical Manual for the Care of Military Service
Members, Veterans and their Families
2014

STARRS-LS Research2014		Curriculum for Firearm Safety Enhancement
2017

Textbook of Disaster Psychiatry (2nd edition)

Ongoing Fact Sheets and Just in Time Resources for War,
Disaster and Terrorism

CSTS has historically held a “Trauma Team” meetingof all personnel at the end of every week to share,
inform and teach.

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