Center for the Studyof Traumatic Stress2022

CSTS
The Center for the Study of Traumatic Stress (CSTS) is part of the Department of Psychiatry in
the Uniformed Services University’s (USU) School of Medicine (America’s Medical School). The
Center supports USU, the Military Health System (MHS), and the Department of Defense (DoD).
Since it was established in 1987, the Center has been working to mitigate the impact of trauma
from exposure to war, disasters, terrorism, community violence, public health threats, andhumanitarian operations throughout the nation and across the globe.
The Center’s work encompasses both military and civilian populations, but it focuses on healthissues of special interest to the military, including combat, post-traumatic stress disorder (PTSD),
traumatic brain injury (TBI), suicide and suicide-related behaviors, and the impact of death and loss
on the families of Service members.
CSTS is composed of a multi-disciplinary and collaborative team of scientists, educators,clinicians, and leaders who help inform our Nation’s policies and responses to the impact of
exposure to trauma from disasters, both human-made and natural. The Center is well-positioned
to rapidly respond to DoD mission-relevant activities. CSTS sustains national readiness, enhances
national security, and serves an essential role for the DoD and the nation.

USU
School ofMedicine
Dept ofPsychiatry

CSTS

War in Ukraine Support Highlights in 2022
The war in Ukraine has resulted in countless casualties, displaced millions, and led towidespread exposure to extreme and traumatic events. In 2022, CSTS was sought out
by global colleagues and stakeholders within Ukraine and around the world to provide
consultation, support educational seminars, and disseminate actionable just-in-time
resources that included mental health education fact sheets providing guidance for Service
members, families, military and community leaders, as well as healthcare providers andother global responders. CSTS remains actively involved in numerous consultations in
support of Ukraine with DoD and other federal agencies, NATO partners, the United Nations,
the World Health Organization, and the Five Eyes international collaboration.
SERVING OUR NATION SINCE 1987

CSTS M ss on
The Center provides leadership, education, training, research, scholarship, service, outreach,consultation, and global health engagement. CSTS informs and educates community, regional, state,national, and global stakeholders in government, industry, healthcare, public health, and academia.
The Center’s work includes innovative and ground-breaking research that ranges from the microlevel in laboratories to the macro level in communities, the Nation, and all across the world. CSTS
As an integral part of USU, CSTS activities
humanitarian operations. CSTS has been involved
helps to foster
community and national resilience, andimprove trauma-related care by preparing
support the USU Strategic Framework andin nearly every major disaster our nation has
treatmentthe
providerstheimpact of
mission of tothe address
DoD. CSTS
is committed
to trauma.experienced in the past 30 years. The Center helps

Our Mission

trauma-informed
to ensure that behavioral health is addressed in theThe workadvancingof the Center
also: care. We are dedicatedto furthering the nation’s understanding of theface of public health threats, disaster planning and• Uniquely
combines
integrates
militaryand disaster
psychiatry.
impactof traumaandon individuals,families
anddisaster recovery.
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positioned to rapidly respond to DoD missionstate, national and global stakeholders in government,• Helps ensure
behavioral health is addressed in theindustry,
face ofhealthcare,public healththreats,relevant thatactivities.
public health,and disasterworkrecovery.
includesacademia. CSTS contributes toplanning, The
andCenter’s
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exposures: combat,terrorism, naturaland human-madedisasters,
public healththreats,andadvancing trauma-informedcare by providing
leadership in research,education,training,consultation,global
health, andservice.

2017 ANNUAL REPORT | 3

The Center consists of more than 100 people. In 2022, CSTS directed approximately$30 million in funding through a core grant and 12 external grants.
For more information, visit the CSTS website at: www.CSTSonline.org
CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

ResearchCSTS research encompasses a broad spectrum both in the laboratory and in the field. All theCenter research is designed to support the Military Health System (MHS) in its efforts toprovide a medically-ready force to Combatant Commands in both peacetime and wartime,
and to deliver integrated, affordable, and high-quality health services.
The four core areas of CSTS research are:
• Research on Service members.
• Research on the children and family
members of Service members.
• Research in neuroscience andneurobiology.
• Research on disasters andterrorism.
Examples of specific research
topics include the causes ofsuicide in Service members,
psychological responses totrauma and disasters, andclinical investigations of
the symptomatology andtreatment of PTSD.

ServiceMembers

Disasters

CoreResearch
Areas

Children&Families

Neuroscience& Neurobiology

Research Highlights in 2022
• COVID-19 Pandemic - CSTS continues to work with the National Guard Bureau (NGB) to provide
the New York National Guard with interpretation of the public health surveillance assessment toinform NGB leadership and provide recommendations.
• Study to Assess Risk and Resilience in Servicemembers (STARRS) - CSTS continues itsrole leading STARRS studies -- the largest ever conducted on military suicide. Results andrecommendations actively shape DoD and civilian mental healthcare for suicide and related riskfactors. There have been 119 published articles and more than 100 recommendations.
• Suicide Prevention Program (SPP) - Informed by STARRS studies, CSTS launched the SPP todevelop action-oriented and evidence-based products and programs to address suicide andrisk-related behaviors. Twelve SPP projects focus on a range of risk factors through interagency
and private sector partnerships.
• Brain Bank - CSTS continues to work with the Veteran’s Administration (VA) National Centerfor PTSD on Brain Bank project that we co-founded with them. The Brain Bank’s objective is
to identify biomarkers of susceptibility and resilience to trauma and assist in targeting newtreatments.
SERVING OUR NATION SINCE 1987

Educat on and Tra n ng
The Center provides educational resources to interagency organizations (including DoD and otherfederal entities) as well as state and local agencies, professional associations, and others.
Center Scientists educate and train USU medical students committed to service in our Nation’sArmy, Air Force, Navy, and Public Health Service. The Center provides education to interagency
and private sector leaders and other personnel.
The Center advances the field of military and disaster psychiatry through publications,presentations, outreach, and training. CSTS sponsors and participates in conferences, seminars,symposia, workshops, and collaborations with educational and training objectives across the U.S.
and internationally. The Center also educates and expands knowledge through public healthefforts and interventions during and after disasters.
CSTS disseminates educational materials to stakeholders, including healthcare providers,
community leaders, families, first responders, teaching professionals, and policy makers. TheCenter creates and disseminates customized, easy-to-read, just-in-time educational fact sheets
to assist stakeholders in effectively managing the adverse effects of traumatic stress throughenhanced preparation and response to disaster events.

Conferences

SymposiaForums

GraduatePrograms

Education and Training Highlights in 2022
• Adapted and trained Combat and Operational Stress Control principles to numerous
healthcare systems, professional associations, and other organizations, in order to enhancewell-being and functioning in work environments in the face of stress and trauma.
• Supported response efforts following a range of climate-related disasters, including Hurricane
Ian, Hurricane Fiona, and the massive floods across the Central states, which particularly
devastated the state of Kentucky.
• Provided community mental health support resources to multiple local and national organizationsin the wake of three mass violence events over a period of five weeks: shootings at a supermarket
in Buffalo, New York, a parade in Highland Park, Illinois, and Robb Elementary School in Uvalde, Texas.
• Refined an eight-week Neuroscience and Behavioral Module to be conducted in distance andhybrid learning as well as in-person classes and simulations.
• Virtually conducted the 16th Annual Amygdala Conference: Stress and the Mind, sponsoredby CSTS in collaboration with the USU Department of Psychiatry, USU Neuroscience Program,
USU Department of Family Medicine, and the Walter Reed National Military Medical Center
Department of Psychiatry.
CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Consultat on
The Center develops relationships with, and provides consultation to, many agencies andorganizations throughout the DoD and other federal agencies, as well as with state, local,and national agencies, professional associations, and international organizations.
Since its inception, establishing and maintaining consultative relationships have been
cornerstones of CSTS’s work, and include a wide variety of organizations both inside and outside
government, and internationally. These collaborations build bridges that provide opportunities tocontribute Center resources and expertise in the service of others and to monitor real-time needsof other organizations.

National &InternationalActivities
Multilateral
Agreements
EpidemiologicConsults
Global Health
Initiatives
Consultation Highlights in 2022
• Provided numerous consultations in support of COVID-19 and the war in Ukraine. Expanded
on CSTS’s existing consultative relationships with international organizations, DoD and otherfederal agencies, state and local level agencies, and professional organizations.
• Worked with U.S. Coast Guard psychiatric leadership in preparing Coast Guard members tomanage unique exposures during activation and how to support them and their families.
• Supported resiliency leadership at Immigration and Customs Enforcement (ICE) in reviewing andresearching the effectiveness of their current programs and practices designed to protect themental health of agents, analysts, and other personnel exposed to child exploitation material in
the process of their investigations.
• In its ongoing collaboration with the Five Eyes Alliance Advisory Group on Mental Health, CSTS
coauthored multiple publications on Service member and family well-being, including research
priorities on moral injury and optimizing pathways to mental health care across the military
career life cycles.
SERVING OUR NATION SINCE 1987

Knowledge D ssem nat on
CSTS disseminates knowledge through a variety of means, including:• Publishing research findings in peer-reviewed
scientific journals.

Health Education
Campaigns• Publishing books, volumes, and newsletters.
• Making presentations at scientific meetings andconferences, and other events.

Publications• Giving briefings and interviews.

Online Presence• Developing and disseminating fact sheets.
• Conducting educational campaigns.
• Posting information and other resources toCSTS social media platforms.

Newsletters• Developing pocket cards to address leader support
for Service member activations during mortuary
affairs and pandemics.

Disaster Education
Fact Sheets
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■ Pepper spray
Firearms are an essential tool for“Firearm Leadership” involves knowing themany service members in military■ Stun guns and tasers
operations and also a part of sports andrisks and taking actions to prevent firearm■ Pocket and tactical knives
hunting for many. The safe handlinginjuries,
bothduring
routinedaily
operations■ Guard dogs
and storage of firearms is critical to thesafety of service members and theirand acute situations when you are concernedPromote
Family Safety
families. Leaders influence service
about a service member’s safety.
❏ Inform service
members not only on the battlefield but
members that while
also in their personal lives. “Firearma loaded and unlocked firearm at home might makeLeadership” involves knowing the risks
them feel safer, it greatly increases risk of accidental
and taking actions to prevent firearm injuries, both during
injury or impulsive shooting deathroutine daily operations and acute situations when you are❏ Recommend keeping firearms out of the reachconcerned about a service member’s safety.
of children❏ Remind personnel to teach children thatDo You Know?
firearms are not toys and should only be handled when
■ Almost all firearm deaths in garrison are self-inflictedsupervised by a trained adult■ Suicide death by firearms often occurs without warning■ It’s difficult to know who or when a person will
Steps to Take When You Are Concerned
attempt suicide
A leader may feel concerned when a service member is “not■ Not everyone who dies by suicide looks sad, angry,
acting like themselves.” When going through a tough time,
anxious, or talks about wanting to end their life
having access to a firearm increases the risk of impulsive selfharm. How a leader responds can save a life:■ Military children die of accidental firearm incidents■ Be compassionate and genuine in your approach
Firearm Leadership Actions■ Tell the person you are there to help
Actions to promote Firearm Leadership include■
When time permits, seek advice from behavioral healtheducating service members and role modeling personaland chaplain teams
firearm practices that reduce risk:■ Escort the person to emergency care
■ Discuss Personal Firearms Storage■ If firearms are present, offer to store them away from home
❏ Talk about personal firearm safety with all personnel
until the situation improves❏ Encourage storing personally owned firearms
unloaded and locked in a case or gun safe when
■ Protect the service member’s personal information andnot in use
quickly address rumors❏ Promote storing and locking ammunition in a
separate location
Resources■ Discourage Alcohol Use When Using Firearms
Suicide & Crisis Lifeline❏ Practice zero tolerance mixing alcohol withCall or text 988
handling weapons

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❏ Communicate clearly: “Don’t mix alcohol withyour firearms”

Military OneSource
1-800-342-9647

Alternatives to Firearms for Protection

The Firearm Industry Trade Association
https://www.nssf.org/articles/securely-storing-firearms-in-the-home/■ Alarm systems

Defense Suicide Prevention Office Lethal
Means Safety Guide
https://www.dspo.mil/Tools/Resource-Library/lethalmeanssafety/

Remind personnel of options for personal and homesafety that are safer than unlocked weapons. These include:

Center for the Study of Tr
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others and extend

www.CSTSonline.org

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

Knowledge Dissemination Highlights in 2022
• 49 publications• 65 presentations at scientific or professional meetings, conferences, and symposia• 15 fact sheets and 2 pocket cards addressing mental health aspects of the war in Ukraine
CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

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