Center for the Studyof Traumatic Stress2019 Annual Report

CONTENTS
From the Director................................................................................ 1
Our Mission......................................................................................... 2
Research.............................................................................................. 3
Education and Training...................................................................... 15
Consultation...................................................................................... 20
Publications....................................................................................... 26
Presentations, Briefings, Interviews, and Awards................................ 30
Directors, Scientists, Science Collaborative Members, and Staff......... 35
Funded Grants................................................................................... 39
Partnerships....................................................................................... 40“…the Center’s attention is presently
targeted to the COVID-19 pandemic aswell as our ongoing work on post-traumaticstress disorder (PTSD), traumatic brain injury(TBI), suicide and suicide-related behavior,and disaster response and preparedness.”— Dr. Robert J. Ursano

From the Director
Dear Center Colleagues and Friends,
As we think of this year, let me
first frame our Center and its
work. The Center for the Studyof Traumatic Stress (CSTS)
is an integral part of the Department of Psychiatry andthe F. Edward Hébert Schoolof Medicine (America’s Medical School) of the Uniformed
Services University (USU). As many of you know,
established in 1987, the Center has been proudly fulfilling our mission to mitigate the impact of
trauma from exposure to war, disasters, terrorism,
community violence, and public health threats. The
Center is fully engaged in activities that support theStrategic Framework and mission of USU, as well as
the Military Health System, and the broader missionof the Department of Defense (DoD). Through our
broad range of activities, we sustain national readiness, enhance national security, and serve an essential role for the DoD and the nation.
The Center’s mission is accomplished throughleadership, research, training, education, service,outreach, collaboration, consultation, and global
health engagement. CSTS continues to have an
outstanding multi-disciplinary and collaborative
team of scientists, educators, clinicians, and leaders
to carry out these activities and advance our mission
and goals and to enhance national preparedness.
Focused on health issues of special interest to
the military and the nation, the Center’s attention ispresently targeted to the Coronavirus Disease 2019
(COVID-19) pandemic as well as our ongoing workon post-traumatic stress disorder (PTSD), traumaticbrain injury (TBI), suicide and suicide-related behavior, and disaster response and preparedness. CSTS
helps inform our nation’s policies and responses tothe impacts of exposure to trauma from natural andhuman-made disasters and, especially at this time,
the health emergency response to the pandemic.
The Center’s work starts in our laboratories andextends to our communities, nation, and across theglobe. We bridge science from the gene, to the person,
to the world. We translate knowledge to action by providing rapid consultation, education, and knowledge
support to personnel who respond to the health needsof Service members and their families, and personnel
who respond to disasters, public health threats, andother crises around the globe. CSTS is uniquely situated to bridge the two fields of military psychiatry anddisaster psychiatry.
The Center uses groundbreaking approaches toneuroscience, and conducts innovative research on
relevant and timely topics such as suicidal behavior in
the Army, and the impact of death and bereavementon military family members. One example of an innovative approach is our involvement in “big data” andprecision medicine. Our advanced analytic activities
involve using innovative techniques such as machinelearning, complex algorithms, and predictive analytics. We use data mining techniques and state-of-theart statistical methods to analyze previously untapped
data sources independently and jointly with otherdata to gain new insights, resulting in better and faster
decision-making, and improving health.
In this Annual Report, you can read summaries
of our contributions to enhance psychological healthand resiliency, and mitigate and prevent the negative consequences of trauma on individuals, families,
communities, and the nation. Our goal is to improve
trauma-related care by preparing treatment providers
to address the impact of trauma and its far-reachingeffects, thereby building a more trauma-informed
environment across the continuum of our military andcivilian health care systems.
As we create this annual report, in early 2020,
CSTS is integrally involved with the DoD’s initial andcontinuing COVID-19 pandemic response throughconsultation, education, research and collaboration
with federal, state, and local governments and leaders on the psychological and traumatic effects of thepandemic. CSTS is providing just-in-time educational
resources and surveillance assessments for DoD and
our nation’s health care. We have engaged with ourpartner and stakeholder organizations to collaborate
Continued on page 2
2019 ANNUAL REPORT | 1

From the Director, continued from page 1

and provide resources and assistance in responding
to COVID-19. In addition, Center personnel haveactivated their professional contacts and networks
and disseminated resources, as well as provided
consultation when needed. I encourage our readers
to visit the Center’s website (www.cstsonline.org) forthe latest in our COVID-19 response. Most of thiswork will appear in next year’s Annual Report, but
it is going on now and will continue throughout thisand next year.

On behalf of everyone at CSTS, I would like toextend our appreciation to all our colleagues andfriends who have collaborated with us and assisted
us throughout this past year to help us support 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

Our Mission
As an integral part of USU, CSTS’s activities support the USU Strategic Framework and the missionof the DoD. CSTS is committed to advancing trauma-informed care. We are dedicated to furthering the nation’s understandingof the impact of trauma on
individuals, families,
and communities.
The Center is partof our nation’sfederal medical
school (America’s Medical
School) at
USU, andthe Center’s
mission isaligned with
the needs ofthe DoD andthe nation, andis well-positioned to rapidly
respond to DoD
mission-relevant
activities.
The Center’s work includes a broad range of trauma
exposures: combat, terrorism, natural and
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human-made disasters, public health threats, andhumanitarian operations. CSTS has been involvedin nearly every major disaster our nation has experienced in the past 30 years. The Center helps toensure that behavioral health is addressedin the face of public health threats,disaster planning, and disasterrecovery.
Mitigating the effects
of disaster and trauma
in military and civilian
populations is part ofthe effort to foster
community andnational resilience.
The Center informs
and educates community, regional,
state, national, andglobal stakeholders in government,
industry, healthcare,public health, andacademia. CSTS contributes to advancing trauma-informed care by providing
leadership in research, education,
training, consultation, global health, andservice.

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

RESEARCH ON SERVICE MEMBERS
Study to Assess Risk and Resilience inServicemembers — Longitudinal Study(STARRS-LS)
Formerly the Army Study to Assess Risk andResilience in Servicemembers (Army STARRS)
STARRS-LS is the continuation of a research
project that began more than ten years ago toaddress the increasing and persistent problem of suicide among Army personnel. The original research
project, Army STARRS, was conducted from 2009
to 2015. STARRS-LS began in 2015 and will proceed
through 2020 when a STARRS-LS continuation
award will begin for at least an additional five years,
through 2025. The Army STARRS and STARRS-LS
projects were both designed and conducted under
the scientific direction and project management
oversight of CSTS through a collaborative effort involving USU, the University of California, San Diego(UCSD), Harvard University, and the University ofMichigan.

Army STARRS, funded by the Army, included
a series of several distinct but integrated studies
designed to comprehensively examine the mental
health and resilience of active duty Soldiers, including Regular Army, Army National Guard, andactivated Army Reserve. The project involved large
representative samples of Soldiers, making it thelargest research effort of mental health risk andresilience ever conducted among military personnel.
The largest of the studies was an historical cohort
study of all Soldiers (more than 1.6 million) on active
duty in 2004-2009. Army STARRS also included
cross-sectional studies, a longitudinal study, andtwo case-control studies that involved collecting
data directly from a combined total of more than
100,000 active duty Soldiers throughout the U.S.
and overseas. The studies included administering
questionnaires and neurocognitive tests, collecting
blood samples, and performing state-of-the-art data
analyses and biomarker assays. The project produced
large, rich, and representative datasets to serve thegoals of Army STARRS.
The Center is currently expanding and enhancing the Army STARRS research through a five-year
DoD-funded project called STARRS-LS. Under
STARRS-LS, CSTS is continuing to use the STARRS
platforms, systems, and data to conduct further
analyses and to extend the data by obtaining an additional seven years of Army/DoD administrative data(2010-2016) for the 2004-2009 historical cohort established under Army STARRS. Under STARRS-LS,
the research team is also following up on a cohort ofmore than 72,000 Soldiers who participated in oneof the three largest Army STARRS survey studies
and who provided consent for researchers to link
their Army/DoD data to their STARRS survey data.
In addition, a subsample of this cohort was selectedby the research team, based on previously identified
risk factors and Soldier subgroups of interest to the
Army/DoD. The research team re-contacted members of the subsample and administered two waves
of follow-up surveys for a more in-depth longitudi2019 ANNUAL REPORT | 3

nal study. Approximately 15,000 Soldiers participated in this phase of STARRS-LS.
Throughout 2019, the research team continued
working closely with the Office of the Deputy Under Secretary of the Army (ODUSA) and the Army
Analytics Group (AAG) to obtain and process additional Army/DoD administrative records for thehistorical cohort. Once this database is complete,
it will allow for analyses of data from more than 3
million active duty Soldiers over a 13-year period(2004-2016). The research team also completed thetwo waves of follow-up survey data collection for
the STARRS-LS subsample. This longitudinal study
is extending the time-frame of Army STARRS tocollect and analyze further outcome informationfrom participants throughout their Army careers,and from those who transition out of the Army,through their adjustment to civilian life.
In 2019, the research team conducted many
briefings of the research progress and findings.
These included in-person briefings to the STARRS
Government Steering Committee, meeting with
the STARRS Scientific Advisory Board, and in-person briefings at the Pentagon to senior DoD andArmy leadership, including the Assistant Secretaryof Defense for Health Affairs, the Deputy Under
Secretary of the Army, the Army Surgeon General,
the G-1, and many other senior DoD and Armyleaders. In addition, the research team presented
findings at many military and civilian scientificmeetings and conferences.
STARRS-LS continued the partnership established 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 being conducted at USU incollaboration with the National Institutes of Health(NIH) and the DoD.
Due to the abundance of actionable findings
produced by the STARRS research, the Army established a workgroup called the STARRS Research
Advisory Team (SRAT). The SRAT is comprisedof Army and DoD personnel tasked to review
STARRS findings and recommend actions that the

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Army and/or DoD can take based on those findings.
The STARRS PIs met on a regular basis with the
SRAT throughout 2019 to discuss how to best translate STARRS research findings into actions.
The STARRS research team continued to behighly productive at analyzing vast amounts of data,
writing-up the results, and submitting manuscripts
to scientific journals for publication. At the endof 2019, the team had written and submitted 100
papers for publication in peer-reviewed scientificjournals. Of those, 92 papers have been published,
one paper was accepted for publication but not yet
published (in press), and seven papers were awaitinga decision by the journals. Many additional papers
were drafted and were in various stages of progress.
The extraordinary, ground-breaking, and complex
research conducted by the STARRS research teamhas continued to benefit the Army, the DoD, andthe nation. STARRS data (survey, neurocognitive,
and genetic) have been shared with the public to theextent allowed by the Army and by federal regulations for the protection of human research subjects.
The public data sets have allowed other researchers
outside the STARRS team to analyze the data andproduce additional benefits.

Psychological Stress and Resilience in
Mortuary Affairs (MA) Soldiers: Longitudinal
Study
U.S. Army mortuary affairs (MA) Soldiers
recover, identify, and evacuate the remains of thedeceased from the theater of war. They are a uniquepopulation of Soldiers who are exposed to combat
death and deployment-related stress, and work in acombat environment. This longitudinal research examines the individual, unit, and family stressors, risk
factors, and resiliency of MA Soldiers who deploy to
the Middle East. Questionnaires are group-administered to MA detachments approximately one week
before and after deployment. Empirical and descriptive data are collected on factors such as PTSD,
depression, distress (e.g., anger, hostility, somatization), substance use, and instrumental and emotional support. Soldiers also have the option to donate
saliva samples, which will be analyzed for potential
DNA- and RNA-related biomarkers of stress andresiliency.
In 2019, Reserve MA Soldiers from the 962nd
Quartermaster Mortuary Affairs Company (QM
CO MA) (from locations in the Pacific Rim), 311th
QM CO MA (from Puerto Rico), and 1019th QM
CO MA (from New York) participated in the study.
The CSTS data collection team met with MA Soldiers at Fort Hood, TX while they were there formobilization/demobilization activities prior to andafter deployment. In total, 241 questionnaires werecollected and most Soldiers (71%) donated saliva
samples for genetic analysis (171 DNA and 172 RNA
saliva samples were collected). Since the study began

in 2005, the CSTS data collection team has met
with MA Soldiers 68 times and collected more than
3,300 questionnaires. Data analyses in 2019 included
an examination of the relationship between items
assessing sensitivity to blood, injury, and mutilationand post-traumatic stress symptoms. Findings fromthis study will target resiliency, preparation, training,and education of Soldiers for the stressors of deployment and work with the deceased.
Additionally, two CSTS Scientists participatedin a multi-service workgroup meeting at the Joint
Mortuary Affairs Center (JMAC) in Fort Lee, VA.
Attendees included personnel from the Army,
Air Force, Navy, Marines, Armed Forces Medical
Examiner, Army Chaplain Center and School, and
JMAC. The purpose of the meeting was to conduct
a thorough review of the material for an upcoming
publication, titled “Multi-Service Tactics, Techniques,
and Procedures for Mortuary Affairs in Theaters of
Operations MTTP 4-46.” CSTS contributed an invited section, titled “Stress, Resiliency, and Behavioral
Health Support in Mortuary Affairs Operations.”

Troop Education for Army Morale (TEAM)TEAM is a novel stress management and resilience building early intervention program designed
to improve post-deployment re-adjustment in U.S.
Army MA Soldiers — a group at high risk for psychological problems. The intervention is based on
the five evidence-informed principles of Psychological First Aid (safety, calming, connectedness, self-efficacy, and hope/optimism) and delivered throughfour group workshops, informational handouts, a
dedicated website, and phone and email support
services. A total of 125 MA Soldiers participated in
the study. Baseline questionnaires indicated that MA
Soldiers had a high number of traumatic exposuresand rates of PTSD and depression similar to combat
troops. The intervention did not specifically reduce
rates of PTSD. However, the TEAM intervention
was well-accepted by the Soldiers and the majorityof Soldiers (89%) reported that TEAM was helpful
for them. Calming (relaxation training) and problem
solving were two of the skills reported to be mosthelpful. Findings from TEAM has informed future2019 ANNUAL REPORT | 5

interventions with military and civilian populations
that handle the remains of the dead.

Ecological Momentary Assessment of Posttraumatic Stress Symptoms in U.S. MilitaryService Members (Daily Diary Study)
The Daily Diary Study uses a novel ecologicalmomentary assessment methodology to assess inreal time the post-traumatic stress symptoms of U.S.
Service members. The study is designed to examine
the relationship between variability in post-traumatic stress symptoms and psychiatric disorders,sleep, health risk behaviors (e.g., alcohol and tobaccouse), pain, and other areas of health and functioning. Participants complete daily assessments ofpost-traumatic stress symptoms four times dailyfor 15 consecutive days on electronic tablets, using
a sophisticated software application developed incollaboration with DHA Connected Health, formerly known as the National Center for Telehealth andTechnology (T2) specifically for use in this study.
Psychiatric disorders (e.g., PTSD, depression) are
assessed at baseline and in one and three monthfollow-up assessments. Participants have the option
to donate saliva and/or blood samples for genetic

analysis to identify potential genetic biomarkers
and gene-environment interactions that may distinguish and/or mediate traumatic stress responses
and resilience to stress-related disorders. Participants also have the option to wear a wrist actigraphduring the 15-day daily diary assessment period. The
actigraph provides an objective measure of sleep thatwill complement participants’ self-reports of sleep.
In 2019, 33 Service members enrolled in the study.
Collectively, they provided 1,456 daily post-traumaticstress symptom assessments, 57 saliva and 58 blood
samples for genetic analysis, and 30 participants
wore an actigraph to assess sleep. Data analyses in2019 included an examination of the relationshipbetween sleep disturbances (i.e., short sleep duration,
poor sleep quality, trouble falling asleep, and difficulty staying asleep) and variation in post-traumaticstress symptoms the following day. The findings were
published in the peer-reviewed journal, BMC Psychiatry. In addition, study findings have been presented
in poster sessions at local, national, and international
scientific conferences. The Daily Diary Study represents the cutting-edge in psychological assessment
methodology, measures, equipment, technology, andresearch designed to better understand and improve
the well-being of Service members.

Reserve Components of the U.S. Armed Forces
The Citizen Soldiers of the Reserve Components(RC) of the U. S. Armed Forces play an importantrole in national defense. Compared to the Active
Component (AC), the RC personnel experience
unique stressors when the nation is at war and when
the RC is called upon for emergency service, suchas disaster relief. CSTS is strongly committed tosupporting the RC through a broad range of activities. The Child and Family Program studied RC
members and their families to address the needs ofchildren and families affected by trauma. In addition
to research, CSTS also provided consultation to RC
units. Through this consultation, the RC leadership
was provided with information products specifically
geared to their needs.
In collaboration with Dr. Sandro Galea at Boston
University, CSTS continued the nationwide longi-

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tudinal research study on the RC personnel. Usinga representative national cohort of 2,003 National
Guard and Reserve Service members, this study specifically addresses the epidemiology and trajectory ofmental health problems, deployment stress, healthrisk behaviors, and health care utilization. CSTS is
actively analyzing this comprehensive dataset to address the health and resilience factors and experiences of the RC personnel. Recently, the association of
separating from military service with risk of mental
health problems at three time points was examined.
Compared to RC Soldiers who stayed in the military, those who left the military had higher risks ofmental health diagnoses, including major depressive
disorder (MDD), suicidal ideation at one year after
leaving military service, and a higher risk of mental
health diagnosis at 1.6 years after leaving military
service. These results provide important informationon the risk pattern of mental health problems, and inparticular, of increased suicide risk by length of timesince leaving the military among the RC personnel in
the United States.
The Army STARRS project and the follow-on
STARRS-Longitudinal Study have also provided a
wealth of data about RC Soldiers. The team continues to study the long-term health of RC Soldiers,
using administrative data sets as well as data collected as part of STARRS research. Future STARRSLS surveys will continue to study RC Soldiers as apopulation of special interest.

PTSD and Sleep Study
Sleep disturbances and PTSD are prevalentand often co-occur among Service members with
combat experience. There is wide variability in the
response to treatments for sleep disturbances, andlittle is known about how various factors, including co-occurring PTSD, combine to predict treatment response, hampering efforts to select effective
treatments for individuals. The CSTS is leading aneffort to identify factors that predict variation insleep disorder treatment response, with the goal ofdeveloping predictive analytic models. The effort,in collaboration with Harvard Medical School, will
utilize data from the Army STARRS, as well as datafrom the Sleep Disorders Center at the Walter Reed
National Military Medical Center (WRNMMC).
Heterogeneity of treatment effects analyses will
be used to identify predictors of variation in sleep
disturbance treatment response. This work will form
the basis for future efforts to develop clinical tools forpractitioners, which will improve treatment selection
for individuals with PTSD-related and other sleep
disturbances.

RESEARCH IN THE CHILD AND FAMILYPROGRAMThe Child and Family Program (CFP) conducts
research to better understand the needs of children
and families affected by traumatic events, with special emphasis on the needs of military families. CFP
informs scientists, clinicians, and the general public
about the impact of stress and trauma on children
and families through scientific publications, national and international presentations, and hardcopy/
web-based resources. Military children and families
possess unique strengths, but can also be affectedby combat-related illness and injury, bereavement,child maltreatment, and family violence that resultin vulnerabilities. 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.

2019 ANNUAL REPORT | 7

CFP also consults with military and government
leadership, informs national media outlets, andconducts projects that promote understanding ofchildren in the U.S., and more broadly throughout
the world.

Bereavement
The National Military Family Bereavement
Study (NMFBS)
The NMFBS was the first large, systematic study
examining the impact of a U.S. military Service
member’s death on their surviving family members.
The goal of the study was to build
upon the civilian research
literature on bereavement andits impact on survivors, anddetermine how psychological,
physical, and/or behavioral outcomes of the grieving
process are influenced by family
members’ pre-existing psychological and physicalhealth, social and grief support, and military-specificfactors. Approximately 850 adults and 120 children
completed the study, and 981 participants provided
saliva samples for analysis of genetic biomarkers
associated with bereavement-related outcomes. Data
from the NMFBS will be used to examine coping
strategies in order to identify actionable targets forintervention programs. As part of this groundbreaking work, CSTS partnered with colleagues at Columbia University, New York University, University ofPittsburgh, and UCSD to develop criteria for a persistent grief disorder to be included in future editionsof the Diagnostic and Statistical Manual of Mental
Disorders (DSM). In 2019, CSTS published a manuscript in Psychological Medicine and CSTS Scientists
gave several presentations regarding findings fromNMFBS at national conferences.

Stepping Forward in Grief (SFG) Study
The NMFBS found that a sizable proportion ofsurviving military family members suffer from highlevels of grief and distress, putting them at risk formental and physical health difficulties. As a re-

8 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

sult, CFP formed a partnership with the Center for
Complicated Grief at Columbia University to adapt
principles from Complicated Grief Therapy (CGT),
shown to be helpful in civilian populations, for a digital intervention to assist with grief integration anddecrease risk for long-term problems. This randomized controlled trial compared the effectiveness of
two digital programs (GriefSteps and WellnessSteps)
in helping those bereaved by military service-related death in managing and adapting to grief. During
2019, 556 participants completed baseline and two
follow-up assessments. CSTS scientists are currently conducting analyses to determine the impact ofGriefSteps and WellnessSteps on grief adaptation.

Study of Long-Term Outcomes ofTerrorism-Related Grief
CFP partnered with Voices of September 11th
(VOICES), a nonprofit organization that aids
9/11-affected families, and the Canadian Resource
Centre for Victims of Crime (CRC), an organization
supporting family members who were bereavedby the Air India Flight 182 bombing, to investigate
long-term bereavement outcomes in family members following terrorism-related death. More than
400 bereaved family members participated in the
study. In 2019, CSTS published a manuscript in the
Journal of Traumatic Stress that identified patternsof depression, anxiety, and grief in bereaved family
members. A second CSTS paper that is currently
under peer review described the effect of being notified multiple times of human remains on grief andposttraumatic stress.

Child Maltreatment in U.S. MilitaryCommunities and Families
CFP examines risk factors for child maltreatment in military families to inform prevention andintervention. Initial work investigated 400 substantiated child neglect cases from four high operational tempo Army installations. CFP has publishedmanuscripts on risk factors for child neglect inMilitary Medicine and Child Maltreatment. Undera study funded by DoD, CFP examines risk andprotective factors for child maltreatment in militaryfamilies from all Service branches. Phase I involveda case-control comparison study of military families with dependent children in FY 2014 to identify
the family, Service member, and military characteristics associated with heightened and diminishedrisk of substantiated child maltreatment incidents.
Phase II builds on these findings to develop a life
course model of military family child maltreatment. Using data from active duty Service member
families with one or more dependent children in FY
2009 through FY 2018, CFP will conduct survival
analyses to investigate predictors of substantiatedchild maltreatment. Results from this congressionally-mandated research will inform DoD’s policy
and practice approaches related to child maltreatment prevention and respond to House Report114-577, which calls for studies to examine andunderstand the causes of the increase in child abuse
and neglect in military families.

Combat Injured Families
CFP scientists conducted three studies over the
past few years to examine the impact of combat injury on military families, to better understand andaddress the needs of these families. The first study
involved interviews with military families to assesschallenges related to combat injury and associatedfamily functioning at Operation Purple Healing
Adventures (OPHA), sponsored by the National
Military Family Association (NMFA). CFP continues to perform data analysis on this study. The second study investigated the impact of combat injury
on military families over time at WRNMMC andSan Antonio Military Medical Center, to inform
intervention strategies for spouses and children of
combat injured Service members. The final study,
Families OverComing Under Stress-Combat Injury(FOCUS-CI), consisted of a pilot for a novel intervention for children and families of combat injured
Service members using a randomized controlled
trial approach to assist families coping with severe
combat injuries. Data CFP collected from thisproject have provided insight into issues of intimacy within marital relationships between combat injured Service members and their spouses,suggesting that intimacy is negatively impacted by
spousal post-traumatic stress related to the Service
member’s combat injury. Findings will inform interventions that more effectively address the needsof these families.

Family Violence
The purpose of the CSTS Family Violence andTrauma Project is to help raise the scientific knowledge of family advocacy, medical, and social service
providers affiliated with the Army Family Advocacy
Program (FAP). Core products to help achieve thispurpose include two newsletters—Research Review(RR) and Joining Forces, Joining Families (JFJF)—
which provide workforce education on family violence-related prevention and intervention research.
Highlights of CSTS knowledge products for 2019
included:■ Two JFJF newsletters featuring in-depth coverage of child exposure to intimate partner violence and evidence-based screening for abusive
head trauma.
■ Two RR newsletters briefly summarizing a broad
range of current family violence research.
■ Army family violence fatality review board
report.
■ Development of an installation-level PowerPoint

2019 ANNUAL REPORT | 9■briefing template to help installation FAP managers present report findings in ways that helps
installation leaders visualize longitudinal family
violence trends.
Two book chapters (Paternal Filicide and Child
Maltreatment in Military Communities) that will
be published in SAGE Handbook of Domestic
Violence in 2020.

RESEARCH IN NEUROSCIENCE AND
NEUROBIOLOGYLaboratory Research in Neuroscience and
Neurobiology
Genetics and Biomarkers
CSTS laboratory research continued to searchfor potential biomarkers for PTSD. Since the Iraq
and Afghanistan wars, the rate of PTSD has signiﬁcantly increased in the combat veteran population.
Cytokines, including chemokines, interferons (INF),
interleukins (IL), and tumor necrosis factors (TNF),
have been associated with PTSD. However, few
cytokine biomarkers for PTSD have been identified.
Cytokines, including chemokines, are small secreted
proteins which speciﬁcally affect the interactions
and communications between cells. Pro-inﬂammatory cytokines are produced predominantly

by activated macrophages and are involved in the
upregulation of inﬂammatory reactions. CSTS usedboth before-and-after and case–control studies tosearch for potential chemokine biomarkers associated with PTSD onset, risk, and resilience, as well as
stress responses in U.S. Service members deployedto Iraq and Afghanistan. CSTS obtained blood samples and scores on the PTSD Checklist (PCL) from
Soldiers pre- and post-deployment (pre, post). Forty
chemokines were measured by CSTS scientists using
the Bio-Plex Pro Human Chemokine Panel Assays.
The before-and-after analysis showed potential
markers (CCL2, CCL15, CCL22, CCL25, CXCL2,
and CXCL12) are associated with PTSD onset, andCCL3, CXCL11, and CXCL16 are related to stressresponse. The case–control study demonstrated that
CCL13, CCL20, and CXCL6 were possible PTSD
risk markers, and CX3CL1 might be a resiliencemarker. In addition, CCL11, CCL13, CCL20, andCCL25 were correlated with PTSD symptom severity. CSTS data, for the ﬁrst time, suggest that thesedysregulated chemokines may serve as biomarkers
for PTSD onset, risk, and resilience as well as stressresponses, and may prove beneficial in developing
approaches for PTSD diagnosis and treatment.
CSTS findings were published in Translational
Psychiatry.

Drug Development for the Treatment of PTSD
The Center, in collaboration with the Universityof California, Irvine (UCI), established a multi-species methodology for evaluating potential new compounds to treat PTSD. This effort uses a non-mammalian model (zebrafish) for high-throughput
screening in conjunction with a long-establishedrodent model. The zebrafish colony will provide
an abundance of potential research opportunities
in drug development and beyond. The zebrafish
lab recently began testing large chemical libraries
to both create standard drug profiles within thezebrafish system, and to find promising candidates
for drug repurposing. In addition to high throughput embryo testing, the CSTS lab has begun ramping up efforts to perform testing in adult zebrafish
which have more than 100 testable characterized
behaviors. Once fully established, the lab will begin

10 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

CSTS staff conducting laboratory experiments.
high throughput testing of novel compounds andcoordinate with its collaborators regarding future
directions for screening. Currently, several novelcompounds are pending testing, and successful
compounds will be evaluated in the establishedrodent model at UCI.

Chronobiology, Light, and Sleep Research
The overarching goal of the Chronobiology,
Light, and Sleep lab research program is to further
understand sleep, circadian rhythms, and light inorder to maximize human health and well-being. To
that end, CSTS takes two major research approaches. From a basic science perspective, the Center
focuses on the neural mechanisms underlying themodulation of photic sensitivity for the biologicaleffects of light in both humans and animal model
systems. From a clinical/translational perspective,
CSTS examines how the basic science of this primitive sensory system can guide the rational development of clinical therapies and architectural lighting
strategies. One key aspect of a successful transition

to application includes a carefully developed, tailored, and tested educational component, which
has become an emerging priority for this group.
Since methods for examining circadian rhythms
in humans under more naturalistic conditions arequite limited and controlled laboratory studies are
impractical for many populations of interest, parallelwork includes the validation of novel strategies forassessing sleep and circadian health in the homeenvironment.
Current ongoing CSTS studies include bothlaboratory and applied work. For the former, CSTS is
conducting rigorous characterizations of the biological effects of light, including examination of the effects of light exposure parameters such as spectrum,
intensity, directionality, and photic history on phaseshifting, acute alerting, mood, pupillary response,
and light-induced suppression of melatonin. In
the field, CSTS scientists assess sleep and circadian health in students, hospital night shift workers,
active duty Service members, and clinical populations. In parallel, CSTS has developed and begun
testing sleep and circadian educational programs
that are tailored to specific populations of interest, in order to provide the target populations withevidence-based information and optimize uptakeof novel interventions. In combining this work, theCenter aims to create comprehensive, multi-component interventions that ultimately serve to enhance
the health and performance of those most in need.

Clinical Research in Neuroscience and
Neurobiology
Riluzole Augmentation Treatment forComplicated Combat-Related PTSD
CSTS completed recruitment of a multi-siteclinical trial at WRNMMC and the Syracuse Veterans Affairs Medical Center. This study, funded by
the U.S. Army Military and Operational Medical
Readiness Program, enrolled participants between
2014 and 2017, testing the efficacy of riluzole fortreatment of combat-related PTSD in veterans who
did not fully respond to standard medication treatment for PTSD. Riluzole alters activity of glutamate,
the primary excitatory neurotransmitter in the2019 ANNUAL REPORT | 11

brain. Preclinical research suggests that riluzole
may protect neurons from damage due to an excess
of glutamate in affected brain regions. This trial
compared the addition of riluzole to placebo in arandomized, double-blind trial over eight weeks.
The primary outcome was improvement in PTSD
symptoms as measured by the Clinician-Administered PTSD Scale (CAPS). In addition to psychometric data, investigators collected magnetic resonancespectroscopy concentrations in the amygdala andanterior cingulate cortex before and after treatment
as a potential biomarker of illness and treatment
response. Analysis to date suggests that riluzole
offers superior efficacy to placebo in the treatment ofhyperarousal symptoms of PTSD (manuscript submitted for publication), but does not show superior
efficacy in overall PTSD symptoms. Riluzole did notdemonstrate significant adverse side effects. Further
analysis will determine if spectroscopy changes in
the amygdala, anterior cingulate cortex, and hippocampus correlate with improvement due to riluzole
treatment. Imaging data are still under analysis.

Enhancing Fear Extinction via Angiotensin
Type 1 Receptor Inhibition: A Randomized
Controlled Trial in Post-traumatic Stress
Disorder
CSTS continued its collaboration with the UCSD
as part of a multisite clinical trial testing the efficacyof the blood pressure medication losartan for treatment of PTSD. Losartan is an angiotensin receptor
blocker, currently FDA-approved for treatment ofhigh blood pressure. Leveraging preclinical evidenceof the role of the renin-angiotensin system in thecentral nervous system in fear memory reconsolidation, angiotensin receptor blockers like losartan appear to enhance fear extinction. This trial compares
treatment with losartan to placebo as mono-therapy
for treatment of PTSD over 10 weeks of treatment.
The primary outcome of this study will be improvement in PTSD symptoms as measured by the CAPS
at the beginning and end of treatment. This study
will also examine the influence of a specific angiotensin converting enzyme (ACE) gene as a potential
biomarker of treatment response. CSTS recently

12 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

completed recruitment of participants at WRNMMC
for this multi-site study. Other study sites included
Massachusetts General Hospital, McLean Hospital,
and New York University.

Nightmare Deconstruction and Reprocessing(NDR) for Treatment of PTSD-related
Nightmares
Nightmares and insomnia are signature symptoms of PTSD and among the most resistant to evidence-based treatment. CSTS is conducting a clinicalpilot trial of Nightmare Deconstruction and Reprocessing (NDR), an exposure-based psychotherapy for
PTSD-related nightmares and insomnia. NDR is anadaptation of the Hill cognitive-experiential model forworking with dreams in psychotherapy. It specificallytargets participants’ most distressing nightmare images and their understanding of their distress related tothese images in order to facilitate reconsolidation of
trauma-related memories. In working toward the goalof conducting a full-scale clinical trial of NDR, CSTS
is partnering with WRNMMC, Naval Medical Hospital San Diego, and the NIH to test a range of potential
psychometric, physiologic, and biochemical markers
of NDR’s tolerability and feasibility as a treatment inmilitary Service members and veterans. In addition toassessing nightmare and insomnia severity, suicidality,
and PTSD symptoms, the study is performing assays ofgenetic and inflammatory biomarkers at various points
in treatment as potential indicators of treatment response, as well as continuously monitoring physiologic
indicators of stress, such as heart rate variability andskin conductance. The study began enrolling participants in December 2019 and is ongoing.

The VA National PTSD Brain BankThe VA National PTSD Brain Bank is a humantissue repository that collects, processes, stores, anddistributes research specimens for future scientificstudies. It is the first brain tissue repository dedicatedto examining the impact of trauma and stress on brain
tissue and function, with the objectives of identifying
biomarkers of susceptibility and resilience to trauma,
and assisting in targeting new treatments at the cellular level.

inform AFRH residents of opportunities to participate in PTSD research, including the Brain Bank
project. Recruitment and assessment procedures for
the Brain Bank’s AFRH enrollment site were finalized
in 2019 and full research engagement is expected tocommence in 2020.

RESEARCH ON DISASTERS ANDTERRORISM

The Brain Bank enrolls potential donors acrossthe nation. Donors receive comprehensive longitudinal assessment via clinical interview and periodic
surveillance from the time of enrollment until thetime of their death, when their brain 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) for instances in which ante-mortem assessment of PTSD is notpossible. The Brain Bank began collecting tissue in2015 and has now obtained tissue from 267 donors,
101 of whom received a primary diagnosis of PTSD.
In addition, 114 living persons have enrolled in thelongitudinal follow-up registry to serve as future
donors.
CSTS Scientists direct the Brain Bank’s Assessment Core and serve on the Brain Bank’s Scientific
Advisory Board. The Assessment Core developed a
new standardized record review form ensuring that
all collection sites render post-mortem diagnosis of
PTSD (and comorbid conditions) in a harmonizedmanner. The form will also facilitate export of relevant diagnostic data in conjunction with ongoing genomic analyses. Through CSTS, the Brain Bank has
also collaborated with the Lieber Institute for Brain
Development and the USU Collaborative Health
Initiative Research Program (CHIRP) to perform
whole genome sequencing and methylation studies
in collaboration with Yale University, for the Brain
Bank’s first core study.
In 2019, CSTS Scientists continued their workwith the Armed Forces Retirement Home (AFRH)
in Washington, DC to allow researchers to regularly

Florida Department of Health Response toMultiple Hurricanes
CSTS Scientists continued to identify risk factors
for adverse responses following natural disasters
in civilian and military populations, including
post-traumatic disorders, psychological distress, andhealth risk behaviors. Further, during the past year,
the Center has specifically focused on protective
factors that can help to promote resilience following
exposure, including collective efficacy and hurricane
preparedness behaviors. This work is particularly
important in light of the multiple disasters that haveoccurred within the past year, including the devastating California wildfires and Australian bushfires,
Hurricane Dorian, and extreme weather events.
These include typhoons, heatwaves, and droughts,
which resulted in significant destruction to property, as well as severe injury and death to community
residents. During 2019, Center Scientists identified
factors that may play a role in recovery from multiple hurricane exposure by examining the behavioral

2019 ANNUAL REPORT | 13

Washington, DC Area Sniper Study
Recognizing the increased incidence of terrorist
attacks worldwide, the Center continued to focus on
the psychological and behavioral impact associatedwith these traumatic events. The aim of this researchis to identify mechanisms that may affect responses, and through these findings, develop actionable
recommendations for health care providers andcommunity leadership. This research makes a uniquecontribution to the understanding of terrorist eventsand their sequelae by examining data collectedfrom 1,238 community residents during the 2002
Washington, DC area sniper attacks. Recent work
has examined the role of confidence in local law
enforcement and government, and perceived safety
on changes in behavior related to routine activities during the sniper attacks. Findings indicatedthat those who were younger, female, and reported
lower levels of confidence in local law enforcement/
government, and lower perceived safety, were more
likely to change their routine behaviors in response

14 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

to the sniper attacks. A better understanding of
the interrelationships of cognitive and behavioral
mechanisms have implications for targeted recommendations to help reduce psychological distressand functional impairment in community residents
exposed to terrorist events.

Washington Navy Yard Shooting Study
The Center completed data collection at the
Washington Navy Yard as part of multi-site study
in collaboration with the University of California,
Los Angeles (UCLA) and funded by the National
Institute of Justice, which was designed to better
understand risk and protective factors associatedwith response efforts following community mass
violence. The first phase of the study involved
performing assessments at the sites of five school
mass shootings. The second phase focused on six
community violence events, including the Washington Navy Yard workplace mass shooting in
2013, to examine the impact of this mass shooting
incident. This collaboration leveraged a long-standing relationship with Naval Sea Systems Command(NAVSEA) to provide a better understanding of thesocial and occupational difficulties still impacting
personnel following the event. The Center is collaborating with UCLA in the process of data analysis
and development of a final report. The results will
inform public policy on future interventions following mass violence events.

© Copyright Getty Images

responses in Florida Department of Health workers
who were both first responders to, and were personally affected by, a series of hurricanes that occurredin 2004 and 2005. In particular, CSTS examined theinfluence of individual perceived collective efficacy prior to the 2005 hurricanes on community
residents’ self-reports of hurricane preparedness.
Findings indicated that higher perceived collective efficacy was associated with greater hurricane
preparedness nine months after the hurricanes, evenafter adjusting for individual and community socio-demographic characteristics, individual injury/
damage, community storm damage, and hurricane
preparedness prior to the hurricanes. This researchsuggests the importance of neighborhood cohesionin promoting resilience, and the usefulness of developing strategies that increase community collective
efficacy. This can be accomplished through community-level interventions, which are cost-effective,
practical, and may reach individuals who may notseek or have available interventions after a disaster.

Education and Training
An essential element of the Center’s work is
training and education. Center Scientists provide
education and training to USU medical students
committed to service in the nation’s Public HealthService, Army, Air Force, and Navy. CSTS educates
health care providers and community leaders infederal, state, private sector, and global settings.
CSTS also sponsors conferences, forums, symposia,
and seminars with focused educational and training
objectives. CSTS helps advance the field of militaryand disaster psychiatry through presentations, training, and outreach, and participation in conferences,collaborations, and workshops throughout the U.S.
and global community. CSTS also educates and expands knowledge through public health efforts andinterventions before, during, and after a broad rangeof disaster events.
One of the Center’s instrumental public healtheducation tools is development and disseminationof educational materials to inform stakeholders, including: healthcare personnel, families, communityand organizational leaders, first responders, publichealth emergency workers, teaching professionals,
and policy makers. For more than two decades,
CSTS has created customized, easy-to-read, highly
actionable, and just-in-time educational fact sheets
to assist Center stakeholders in managing the ad-

CSTS staff at conference exhibit booth.

verse effects of disaster events through enhanced
preparedness, response, and recovery efforts.
In 2019, the Center provided educational resources to partners throughout the DoD, other Federal agencies, state and local agencies, professional
associations, and international partners. CSTS also
responded to many disaster events, including themass shooting incidents at the Virginia Municipal
Center, VA; Gilroy Garlic Festival, CA; Henry Prattworkplace, IL; El Paso, TX and Dayton, OH malls;
Pearl Harbor, HI and Pensacola Naval Air Station,
FL; coordinated shootings at multiple New Zealandmosques; floods in Ontario, Canada; wildfires in
California; and Hurricane Dorian, which impacted
the Bahamas, southeastern United States and Atlantic regions of Canada.

DISASTER RESPONSE AND PUBLICEDUCATION
Since its inception in 1987, the Center has been
providing disaster preparedness and response education and consultation in a variety of forms andin many situations. CSTS personnel have provided on-the-ground education and consultation in
response to extreme national and global disasters, aswell as immediate and long-term online, video, andtelephonic support to assist response and recovery
efforts following a wide range of disaster events,
which have impacted various organizations andcommunities.
The Center’s Assistant Director serves as Chairof the Disaster Committee for the American Psychiatric Association, the world’s largest professionalorganizing body of psychiatrists. Current and former
CSTS personnel have been sought out to provide
guidance on disaster preparedness, response, andrecovery efforts as a result of the experience andsubject-matter expertise obtained while working at
the Center.
The following are examples of Center disaster
response and education activities in 2019:2019 ANNUAL REPORT | 15

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Center scientists collaborated with Navy Medicine leadership to support their response andrecovery efforts following the collisions of the
U.S.S. McCain and U.S.S. Fitzgerald, as well as aseries of suicides on Naval installations, by helping to refine and implement a data collection
instrument to support the well-being of Sailors
and enhance understanding of the impact ofthese events on Sailor and family readiness.
In response to a catastrophic hurricane in Florida, Georgia, Virginia, and the Carolinas, CSTS
developed and disseminated dedicated website
education pages to provide actionable guidance
for responders and emergency workers, families,
healthcare personnel, and community leaders to
reduce distress and enhance well-being.
To support members and leaders in Spanish-speaking communities impacted by hurricanes in the Southeastern United States andwildfires in Canada, the Center translated anddisseminated Spanish versions of the disastereducation fact sheets to provide actionableguidance on early interventions following masstrauma, supporting the well-being of children
following disasters, managing the psychologicaleffects of exposure to human remains, and resources on leadership grief, stress management,
and communication.
The Center provided consultation and collaboration with the Army Public Health Command
to develop resources and analyze data in the assessment of a series of suicide clusters on Army
installations.
Center Scientists provided educational support
to the USU Masters in Public Health Program bydelivering educational seminars on domestic andinternational disaster behavioral health.
CSTS partnered with the National Center for Disaster Medicine and Public Health (NCDMPH)
to hold a conference titled, “Crisis Leadership
Symposium: Promoting Emotional and Mental
Well-Being.”
For the fifth consecutive year, a Center Scientist was invited to provide disaster psychiatry
training for the fourth-year psychiatry residents
at the University of Maryland/Sheppard Pratt

16 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU■■

Psychiatry Residency Program.
Center Scientists were invited to present at theannual “Hidden Heroes Journey Home” symposium, sponsored by the John P. Mayhugh Foundation. The symposium, attended by membersof Congress and congressional staffers, enhances
the understanding of government officials regarding the challenges faced by military Service
members and others following traumatic events
such as war and other disasters.
The Center continued ongoing collaborations
with the NCDMPH by initiating a revision of
the 2014 “Curriculum Recommendations for
Disaster Behavioral Health Professionals.” This
document is the only disaster behavioral healthcurriculum of its kind, and has been disseminated to numerous countries; a full update is
anticipated for release in 2020.

NEUROSCIENCE MODULE FOR PRECLERKSHIP USU MEDICAL STUDENTS
The Neuroscience & Behavior Module is amultidisciplinary eight week course. The module
teaches medical students the principles of neuroscience through integrated content across a range of
disciplines. From this foundation, students learn torecognize, describe, and diagnose common neuroscience-related medical conditions with a focus
on effective management of a wide variety of neurologic and psychiatric conditions. Effective, safe,and patient-centered clinical skills, including theperformance of neurologic and mental status examinations, were developed through simulated patient
experiences. Topics related to military medicine,
medical history, and health systems science areintegrated throughout the module with the goal of
fostering a robust and well-rounded education for
future military medical officers.

CSTS GRADUATE STUDENTFELLOWSHIPThe Center’s commitment to advancing research
into the neuropsychiatric consequences of trauma
and its effects on neural function and overall brainhealth includes a Graduate Student Fellowship
program to support outstanding USU graduate students in pursuit of their doctoral degrees. The CSTS
Graduate Student Fellowship program provides two
years of salary and travel support. In 2019, due to thenumber of outstanding candidates, CSTS awarded
two winners from a highly competitive pool of applicants: Ms. Maegan Paxton and Mr. Michael Shaughness. Ms. Paxton is a fourth-year student in theClinical Psychology program, and is completing her
dissertation work with Dr. David Riggs, Professor
and Chair of the Department of Medical and ClinicalPsychology. Mr. Shaughness is a fourth-year student
in the Neuroscience Program working with Dr. Kimberly Byrnes, Associate Professor in the Departmentof Anatomy, Physiology & Genetics and Director of
the USU Graduate Program in Neuroscience. Ms.
Paxton was a Research Assistant at CSTS prior toentering the graduate program at USU. CSTS is very
proud to see a former employee advancing in her
career.

EDUCATION AND TRAINING IN
COMBAT AND OPERATIONAL STRESSCONTROL: OPERATION BUSHMASTER
CSTS Scientists offer training in Combat andOperational Stress Control (COSC) as a corecomponent in military medical education. In linewith USU’s mission to prepare uniformed healthprofessionals to support the readiness of the U.S.
Armed Forces, CSTS Scientists engaged in curriculum preparation, faculty development, and directteaching as part of the annual medical field training
exercise, OPERATION BUSHMASTER. This training exercise challenged senior medical and graduate
nursing students to operate in forward medical units
in a complex battlefield simulation over four days.
Students evaluated and treated a continuous streamof battlefield casualties and non-battle injuries, andconducted public health and health outreach activities while on a simulated combat deployment.
Evaluation and treatment of combat and operational
stress reactions were core skills taught and evaluatedas part of the exercise. CSTS faculty collaborate withthe psychiatry residency programs of the National

Capital Consortium and the San Antonio Uniformed
Services Health Education Consortium to provide an
opportunity for resident physicians to develop theirteaching skills and understanding of COSC as part oftheir core military-unique curriculum.

EDUCATIONAL CONFERENCES
The Center sponsored two educational conferences in 2019: the 14th Annual Amygdala, Stress, and
PTSD Conference and the Symposium on Reimagining Reintegration.

Amygdala, Stress, and PTSD Conference
In 2019, the Center presented the “14th Annual Amygdala, Stress, and PTSD Conference: Risk,
Resilience, and Recovery.” This annual international
conference was sponsored by CSTS in collaboration with the USU Department of Psychiatry, USU
Neuroscience Program, USU Department of Family Medicine, and the WRNMMC Department of
Psychiatry. With more than 300 registrants, thisconference brought together scientists, clinicians,and policymakers for a day of working towards
solving the biological basis of stress, fear, and PTSD.
Nationally renowned speakers came from leading
institutions across the U.S., including the Universityof Pittsburgh, the Icahn School of Medicine at Mt.
Sinai, the National Institutes of Health, and George
Washington University. The speakers presented anddiscussed topics such as resilience, gene activity
related to chronic PTSD symptoms, mobilizing hopein brief clinical encounters, preclinical developmentof ketamine for depression, and the role of sleep inresilience and readiness.
In addition, a recorded session from the 2019
Amygdala Conference was added by the American
Psychiatric Association (APA) as a continuing medical education (CME) course entitled, “Resilience: The
Science of Mastering Life’s Greatest Challenges.” This
course outlines training methods to increase resilience and the ability to ‘bounce back’ after trauma.
Specific factors were discussed through the experiences of survivors who described real-life methods
to develop resilience.

2019 ANNUAL REPORT | 17

Symposium on Reimagining Reintegration
In 2019, CSTS co-sponsored the symposium“Reimagining Reintegration: The Challenge for Deployed Doctors.” The symposium assembled a groupof interdisciplinary experts in healthcare and the humanities to discuss the unique problems of healthcare workers returning from combat deployment.
Incorporating perspectives from anthropology,
history, psychology, and the performing arts, panelists discussed the complicated issues of returning
to life as usual after an extended period of providing
casualty care, and considered a range of potential
approaches to facilitating healthy reintegration.

TRAINING TO SUPPORT RESEARCH
The Center trains and educates its own staff,
including research support staff such as Research
Assistants (RAs). RAs play an important role insupporting research at CSTS, and are provided with
opportunities to learn by working closely with CSTS
Scientists and other staff. The RAs contribute toCenter research in many ways, including conducting

literature searches, data collection, data entry andquality control, producing tables and graphic representations of study findings, and writing summary reports of meetings. The RAs acquire valuable
research skills at CSTS, including developing slides
and posters for research presentations, and presenting research findings to professionals as well as thegeneral public. In addition, RAs are offered professional development opportunities, including attending, presenting posters, and representing CSTS at
professional conferences, and assisting with manuscript preparation for publication in peer-reviewed
scientific journals. Many RAs move on to further
their education by pursuing advanced degrees.
Others advance to careers in research and related
fields. CSTS RAs have furthered their education at
institutions including Yale, Notre Dame, Johns Hopkins, Duke, Columbia, Georgetown, London Schoolof Hygiene and Tropical Medicine, University of
Maryland, George Washington University, Catholic
University, and USU. Opportunities that RAs havepursued following their experience at CSTS haveincluded:■ Ph.D. programs in psychology and related fields■ Medical school■ Law school■ Master’s degree programs in psychology, counseling, public health, and social work
■ Training positions at the NIMH and other institutes at the NIH■ Careers with the FBI

DISSEMINATION AND
IMPLEMENTATION OF HEALTH AND
RESEARCH KNOWLEDGE
Fact Sheets and Infographics

Dr. West presenting at the Symposium on Reimagining
Reintegration.
18 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Fact sheets are a highly regarded and long-standing communication tool of CSTS. They are easy tounderstand, topic-focused, and actionable education resources developed using expert knowledge
to communicate essential behavioral health content
on difficult and/or crisis-related issues. Fact sheets
and infographics address the needs of a broad rangeof partners and stakeholders, including health careproviders, first responders and emergency workers,

family members, community leaders, and policy
makers. CSTS fact sheets, which are developed,
updated, and maintained in an online repository,
address a wide range of issues pertaining to preparedness and response for disasters, such as mass
violence, natural disasters, and pandemics; risk andcrisis communication; elements of crisis leadership;
family health behaviors; and health risk education.
CSTS fact sheets and infographics provide readerswith resources tailored to the unique aspects of eachdisaster event and disaster community. The Center
develops and rapidly disseminates fact sheets in realtime following major disasters and traumatic events,
such as community violence, terrorism and bioterrorism, and public health threats.

Visual Abstracts
CSTS posts visual abstracts of research publications on the Center’s Facebook and Twitter accounts.
Used to enhance the visibility of published research,visual abstracts communicate scientific findings as
graphic representations to professional as well as lay
audiences. In 2019, CSTS produced visual abstracts
for a number of studies including: STARRS, Child andFamily, Daily Diary and Florida Hurricane publications.

ference reports, and a searchable repository of CSTS
disaster mental health education fact sheets. The website includes a “What’s New” section to highlight recent disaster education materials, research initiatives,
publications, conference summaries, and announcements of upcoming events. In 2019, the CSTS website
was used by an average of 1,785 persons per month fora total of 21,422 users over the calendar year. Mobile
users comprised 22% of those who viewed the website.
Most of the website visitors in 2019 (83%) were fromthe U.S., but people from a total of 133 countries visited the website. Aside from the U.S., the countries withthe most users were Australia (420), Canada (411),
China (269), and the United Kingdom (264).

Social Media

WebsiteA primary tool the Center uses to further thegoal of disseminating relevant and timely information to a wide range of stakeholders is the CSTS
website (www.CSTSonline.org). Throughout theyear, CSTS personnel continually added content andmade content more accessible. Material available on
the website includes summaries of current research
activities, publication citations, newsletters, con-

In 2019, the Center continued to grow its online
presence through the use of social media. These social
media resources allow for the timely disseminationof relevant content to CSTS partners and the public.
New in 2019 was the use of visual abstracts to communicate published research findings. CSTS Twitter
followers increased by 24% and CSTS Facebook followers increased by 26% in the past year. The Centerencourages people to visit and follow CSTS postings
via Twitter and Facebook to stay up-to-date on new
CSTS activities and publications. “Like” CSTS on
Facebook at Center for the Study of Traumatic Stressand follow CSTS on Twitter @CSTS_USU.
2019 ANNUAL REPORT | 19

Consultation
Consultation has always been and remains a corefunction of the Center. It is a primary mechanism
through which CSTS staff share research findings
and apply the deep and broad experience of CSTS
staff and leadership. The fact that consultations aresought from CSTS, rather than sought by CSTS, isa testament to the respect that the Center receives
from around the world. In addition, consultation isa valuable mechanism to ensure that CSTS staff areaware of, and responsive to, those who face challenges and opportunities related to trauma of many
types. The Center has developed partnerships 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. The Center has established many
longstanding organizational relationships, and iscontinuously increasing its consultative activities
with new partners. The following are examples andupdates of some long-standing CSTS consultations
as well as some new activities.

WHITE HOUSE OFFICE

tion, Center scientists were asked to author several
chapters in the TSNRP-driven “Battlefield Nursing
Handbook” on topics such as Combat and Operational Stress Control, Crisis Leadership, and Health
Personnel Self-Care.
CSTS assisted the Navy Bureau of Medicine andSurgery in efforts to enhance their ORION database,which provides ongoing assessment and follow-up for
Sailors involved in disaster events, such as collision ofnaval vessels, as well as suicide events within units.

FEDERAL BUREAU OF INVESTIGATION(FBI)CSTS began consultations with the leadership of
the FBI’s Victims Services Division around the impact
of death notification on victims’ families following
criminal events and mass casualties, as well as thepaucity of standardized death notification training
across the nation. CSTS Scientists shared professional
education materials developed for health care providers about death notification with members of the FBI’s
Victims Services Division. It is anticipated that consultation will continue in the coming year to deepen

In 2019, the Director was invited by the WhiteHouse to serve as the Risk Identification Section
Lead on the Research Line of Effort (LOE) for Executive Order (EO) 13861 “National Roadmap to
Empower Veterans and End Suicide.”

DEPARTMENT OF DEFENSE
Center Scientists consulted with a Tri-Service
Nursing Research Program (TSNRP) workgroup to
discuss clinical practice guidelines for transport ofbehavioral health casualties and distressed medical/
surgical casualties within and out of theater. They offered perspectives on current practice and presented
Psychological First Aid principles as a frameworkaround which to organize their guidelines. In addi20 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

CSTS scientists and staff at the Canadian Embassyin Washington, DC for the NATO meeting on
Personalized Medicine in Mental Health andPerformance.

the collaboration regarding death notification, and to
expand consultation to other related topics.

DRUG ENFORCEMENTADMINISTRATION (DEA)
CSTS continued its long-standing relationshipwith the DEA, and a Center Scientist was asked
again to serve as the lead speaker for their annual
Reintegration Seminar. This event brings agentsfrom around the country who recently returned
from high-threat overseas assignments (as well as
their spouses) to participate in a four-day seminarthat provides knowledge and experiential activities
to assist agents in the process of identifying andovercoming reintegration challenges. The presentation to 30 agents and 11 spouses addressed understanding and managing the impact of stress andtrauma in their roles as agents, spouses, parents, employees, and supervisors. This activity continues anongoing partnership with the Department of Justice.

U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES (DHHS)
DHHS disaster and trauma responsibilities
overlap considerably with the activities of CSTS.
The primary partners of the Center at DHHS are theAssistant Secretary for Preparedness and Response(ASPR) and the Substance Abuse and Mental HealthServices Administration (SAMHSA).
In 2019, CSTS provided additional DHHS consultations, including the contribution of behavioral
health subject-matter expertise and technical input
for the “Tick-Borne Disease Working Group 2018
Report to Congress.” This document was designed
to guide U.S. Government policy regarding thisincreasing public health threat, which is associatedwith significant adverse neuropsychiatric sequelae.

Assistant Secretary for Preparedness andResponse (ASPR)
CSTS continues to work in close collaboration
with ASPR staff and leadership on a regular basis.
This long-standing relationship allows the Center to

Dr. Wynn presenting at the NATO meeting on
Personalized Medicine in Mental Health andPerformance.
enhance awareness of existing and emerging federal
issues and initiatives and to provide evidence-based
consultation and information sharing around issues
related to disasters and emergencies.

Substance Abuse and Mental Health Services
Administration (SAMHSA)SAMHSA has been one of the Center’s partners
since SAMHSA’s founding more than 25 years ago.
SAMHSA is the lead federal agency responsible forsupporting and improving national mental health services. CSTS provides emerging evidence-based articles and materials to assist SAMHSA in their national
leadership role. In 2019, a Center Associate Director
continued to serve on the Disaster Distress Helpline(DDH) Steering Committee. In addition, CSTS leadership provided guidance on the needs of people withexisting mental illness in disasters and wrote an article
for their publication, “The Dialogue,” for SAMHSA’s
Disaster Technical Assistance Center (DTAC). CSTS
leaders were sought out by SAMHSA to serve as subject matter experts in reviewing their DTAC materials
related to disasters and substance use.

THE NATIONAL CENTER FOR DISASTER
MEDICINE AND PUBLIC HEALTH(NCDMPH)
CSTS maintained a strong and growing partner-

2019 ANNUAL REPORT | 21

ship with NCDMPH. In 2019, CSTS and NCDMPH
continued their collaboration by significantly updating and restructuring the 2014 cooperative publication entitled, Curriculum Recommendations for
Disaster Health Professionals: Disaster Behavioral
Health. In a continuation of a several year collaboration, two CSTS leaders presented a seminar entitled,“Critical Concepts in Disaster Behavioral Health” tointerdisciplinary MPH students. As in prior years,
two members of the Center’s leadership team served
as Associate Editors for the journal Disaster Medicine and Public Health Preparedness, a publication
affiliated with NCDMPH.

PROFESSIONAL ORGANIZATIONSNATIONAL ASSOCIATION OF
STATE MENTAL HEALTH PROGRAMDIRECTORS (NASMHPD)The Center’s nearly two-decade-long relationshipwith NASMHPD continues to thrive. NASMHPD
is a membership organization representing state
mental health authorities (Commissioners) responsible for preparedness, response, and recovery fromlarge- and small-scale disasters. CSTS assists theCommissioners in addressing the many challenges
inherent in those systems, including issues faced bymilitary families and veterans who are served by thestate public mental health systems. In 2019, NASMHPD facilitated CSTS consultation to specific states
and localities following disasters and community
violence events. CSTS and NASMHPD leadershipwere in frequent contact throughout the year to
identify and address information on disaster response. NASMHPD remains a key distribution andutilization vehicle for the Center’s targeted public
information products.

NATIONAL CHILD TRAUMATIC STRESSNETWORK (NCTSN)The Center continued to work with NCTSN in
partnering with the Network’s Military and Veteran22 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Families Program in their efforts to develop and implement trauma-informed, evidenced-based interventions and approaches for military children andfamilies. CSTS also served as a NCTSN Treatment
and Services Adaptation Center (Category II site)
by providing expertise on specific types of traumatic
events experienced by military families, as well as
serving as a resource for programs and providers
that specialize in treatment and services for militarycommunities.

MILITARY CHILD EDUCATIONCOALITION (MCEC)MCEC’s mission is to support the educational, developmental, and social-emotional needs ofmilitary-connected children worldwide. In 2019,
CSTS co-sponsored a pre-conference workshop with
NCTSN at MCEC’s annual meeting in Washington,
DC. This event brought together expert researchersand practitioners to discuss approaches to challenges
faced by military and veteran children and families,
as well as positive youth development strategies.

NATIONAL ACADEMIES OF SCIENCES,
ENGINEERING, AND MEDICINE(NASEM)A CSTS Scientist participated on the National
Academies of Sciences, Engineering, and Medicine
Committee on Military Family Well-being. Committee participation resulted in the NASEM publication,
Strengthening the Military Family Readiness System
for a Changing American Society, a report commissioned by the DoD’s Military Community and Family
Policy (MC&FP) office to describe the challenges
and opportunities facing military families and ways
to protect them.
Additionally, a senior CSTS Scientist moderated
the discussion panel titled “Policy Leaders Driving
Mental Health Legislature and its Impact on HealthProfessional Education.” This panel was part of aworkshop sponsored by NASEM’s Global Forum on
Innovation in Health Professional Education.

THE AMERICAN PSYCHIATRICASSOCIATION (APA)
CSTS personnel helped initiate the APA’s efforts
in disaster psychiatry by establishing its Committee
on Disaster Psychiatry in 1992, and has remained
actively involved ever since. CSTS works with the
APA and other national medical associations to educate and train health professionals in disaster mental
health. In 2019, CSTS Scientists provided formal
and informal disaster consultation and education
resources to APA District Branches in response to awide range of disaster events, including climate-related disasters, such as hurricanes and wildfires aswell as mass violence and terrorist events in the U.S.
and Canada. CSTS also provided education and consultation support to the government of New Zealandto support their response to the largest mass shooting in their country’s history. Further, CSTS Scientists served as consultants and contributed resourceson enhancing preparedness, response, and recovery
following disasters. CSTS education fact sheets were
important resources for members, District Branches,and partner organizations, assisting them in rapidly
disseminating critical, time-sensitive, and actionable
information to optimize the well-being of patientsand other community members.
At the APA Annual Meeting, CSTS Scientists
presented at a sold-out half-day course on disaster mental health, which addressed fundamental
issues such as psychological and behavioral responses to disasters, vulnerable populations, andevidence-based early interventions to reduce distressand enhance well-being. Topical areas included
modules on climate-related disasters, mass violence,and pandemics. The audience of 48 psychiatrists andother mental health professionals from around theworld took part in the course, which offered a blendof didactic learning, interactive polling, and casebased small group exercises to reinforce content.
In addition, a Center Senior Scientist collaborated with colleagues from the WRNMMC, Yale University, and the Veterans Health Administration topresent two workshops at the APA Annual Meeting.
The workshops presented communication strategies for physicians to better understand risk deci-sion-making by their patients concerning firearms
ownership and storage practices, and to help movetheir patients toward safer alternatives.
The Center Assistant Director served as Chairof APA’s Disaster Committee. In this role, he oversaw the work of a newly formed Caucus on Climate
Change and Mental Health. The Caucus delivered
presentations and engaged healthcare organization
partners to enhance public health education about
the adverse effects and mitigation strategies withrespect to climate-related disasters. The Caucus
also initiated development of toolkits on mitigating
adverse impacts of extreme heat and other consequences of a changing global climate.
Additional 2019 APA highlights:■ A CSTS Scientist hosted the annual Society of
Uniformed Services Psychiatrists (SUSP) meeting, the military branch of the APA. The meeting provided content ranging from disaster andglobal mental health to monitoring outcomes in
active duty patients.
■ A CSTS Scientist chaired an APA panel session
titled, “Serving the Underserved through theMedical Review of Systems and the PhysicalExam.” This panel was selected for publication asa textbook.
■ A CSTS Scientist advised the APA’s Council on
Advocacy and Government Relations on future
mental health advocacy priorities.
■ A senior CSTS Scientist served on an APA panelsession on ethical issues in supervising psychiatric residents conducting psychotherapy.

ADDITIONAL CONSULTATIONS
A senior CSTS leader served as an adviser toHarvard University’s Schwartz Center for Compassionate Care, which provides training on enhancing
healthcare personnel well-being after adverse events
to more than 1,000 medical centers globally. The
Schwartz Center requested that a Center Scientist
serve as a subject-matter expert and consultant tohelp guide their development of a toolkit aimed
at addressing distress and other adverse reactions
experienced by healthcare providers following mass
violence events.
2019 ANNUAL REPORT | 23

The CSTS Director and the Psychiatry Department Chair provided consultation to the CEO of
RallyPoint, to explore ways to improve suicide
prevention and better support veterans and Service
members. RallyPoint is an online platform with 1.6
million registered users, of which approximately 90%
are Service members or veterans.
CSTS Associate Directors were contacted by theCommissioner of the Virginia Department of Behavioral Health & Developmental Services (VADBHDS)
regarding the mass shooting in Virginia Beach that
had occurred two days prior. Consultation was requested and provided regarding what to anticipate in
the aftermath of the event. CSTS provided follow-up
consultation to the Director of Emergency Management at the VADBHDS.

INTERNATIONAL OUTREACH
The reach of CSTS consultation activities extends
beyond the nation’s borders to the international
community. The following are examples of CSTS
international activities in 2019.

International Ministerial 5-Eyes Alliance
CSTS collaborated with a mental health-focusedtask group of the International Ministerial 5-Eyes
Alliance, comprised of military- and veteran-related

centers from Australia, the United Kingdom, New
Zealand, Canada, and the United States. This is acore group of centers and departments that joined
together to work on defense and veteran mental
health. CSTS worked closely with the individuals,
centers, and departments in this group. Several
Center leaders participated in a meeting of the International 5-Eyes Mental Health Research Innovation Collaborative on “Military and Veteran Mental
Health.” This meeting brought together 30 seniorresearchers and clinicians from the five countries
listed previously who advise their respective governments. The focus of the meeting was to discusscurrent issues and future directions for military andveteran mental health and well-being. The results ofthis meeting will inform recommendations made to
5-Eyes Ministers. In addition, based on this collaboration, an article was published in the International
Review of Psychiatry, entitled “Treatment of Military-Related Post-Traumatic Stress Disorder: Challenges, Innovations, and the Way Forward.”
In addition, the Center Director participated in
the International Ministerial (5-Eyes) Centres of
Excellence Conference on Veterans’ Issues in Sydney,
Australia. The conference involved the AustralianGovernment Minister for Veterans’ Affairs and delegations from all member countries, and discussed
veterans mental health issues and transition frommilitary and civilian life. The CSTS Director alsopresented the work CSTS has been doing during the“Innovative Research Consortium,” an international
working group on military and veteran health.

North Atlantic Treaty Organization (NATO)A Center Scientist hosted the NATO Personalized Medicine in Mental Health and Performance Research Task Group two-day meeting on the
topic of Precision Medicine in Human Performanceat the Canadian Embassy in Washington, DC. This
international meeting, sponsored in part by CSTS,
focused on identification of cutting-edge precision
medicine techniques that will lead to improvements
in how NATO member nations optimize performance, improve prevention, and expedite diagnoses and treatment as well as maximize cognitive
performance (e.g., focused concentration, mental
24 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

endurance) related to military-relevant mission
performance. International representation included
Canada, the Netherlands, and the United Kingdom,along with a number of U.S. partner institutions.
A senior CSTS Scientist coordinated and hosted
an international NATO meeting held at the University of Southern California in Los Angeles, CA. The
meeting, titled “Leveraging Technology in Military
Mental Health: Virtual Reality, Neuromodulation,
and Telehealth” included participants from the United States, Canada, the Netherlands, and Australia.
In addition, this senior CSTS Scientist co-chaired
a panel meeting of the NATO Research Task Groupon Personalized Medicine in Mental Health andPerformance. The meeting, which was held at King’s
College London, focused on personalized mental
health for military Service members and included
speakers and panel members from the United States,
the United Kingdom, the Republic of Ireland, theNetherlands, and Australia.

Defense Institute for Medical Operations(DIMO)
CSTS supported the Defense Institute for
Medical Operations (DIMO) by providing a CSTS
Scientist as the team lead and subject matter expert to deliver a five-day course in Nigeria. The
U.S. five member team, comprised of active duty
mental health providers, trained 26 students in thetenets of military psychiatry with a focus on combat stress and post-traumatic stress disorder. The
Nigerian learners were comprised of highly skilled
psychiatrists, clinical psychologists, social workers, and psychiatric nurses with extensive combat
experience, as well as emergency responders fromthe National Fire Service and the Nigeria Security
and Civil Defense Corps. The course helped initiate
Nigeria’s tri-service, multi-disciplinary collaboration,
to include increased awareness of capabilities andoperational approaches with the intent of ongoingproject planning and support. The instruction also
sparked interest in training Service members andemergency responders in Psychological First Aid.

Dr. Morganstein presenting at the NATO meetingon Personalized Medicine in Mental Health andPerformance.
Culturally-specific tool development, including
screening questionnaires and treatment protocols,
was a high-interest item and several learners developed plans to incorporate these questionnaires andprotocols into their clinical interviews.

Phoenix Australia, Centre for Posttraumatic
Mental HealthA senior CSTS Scientist hosted two leaders from
Phoenix Australia, Centre for Posttraumatic Mental
Health, for a two-day visit to meet with CSTS leadership and various CSTS study teams to learn about
current research and other activities at CSTS. The
visit included discussion of topics of mutual interest
with a focus on harnessing and encouraging newcollaborations, and a presentation titled, “Phoenix
Australia: Update on Research and Translation Work
with Australian Military and High Risk Organisations.”

New Zealand Surgeon General’s Office
The Center was contacted by the New Zealand
Surgeon General’s Office to support their response,
recovery, and outreach efforts following the deadly
mass shootings at two mosques in Christchurch, NZ.

2019 ANNUAL REPORT | 25

Publications(Names in bold text are CSTS personnel)
JOURNAL ARTICLES
Adams, R. S., Campbell-Sills, L., Stein, M. B., Sun,
X., Larson, M. J., Kessler, R. C., Ursano, R. J.,
Jain, S., & Corrigan, J. D. (2019). The associationof lifetime and deployment-acquired traumaticbrain injury with postdeployment binge andheavy drinking. J Head Trauma Rehab, 35(1), 2736. doi: 10.1097/HTR.0000000000000508
Agtarap, S., Campbell-Sills, L., Thomas, M. L.,
Kessler, R. C., Ursano, R. J., & Stein, M. B.
(2019). Postconcussive, posttraumatic stressand depressive symptoms in recently deployed
U.S. Army soldiers with traumatic brain injury.
Psychol Assess, 31(11), 1340-1356. doi: 10.1037/
pas0000756
Anderson, L., Campbell-Sills, L., Ursano, R. J.,
Kessler, R. C., Sun, X., Heeringa, S. G., Nock,
M. K., Bliese, P. D., Gonzalez, O. I., Wynn, G.
H., Jain, S., & Stein, M. B. (2019). Prospective
associations of perceived unit cohesion withpostdeployment mental health outcomes.
Depress Anxiety. 36(6), 511-521. doi: 10.1002/
da.22884
Biggs, Q. M., Ursano, R. J., Wang, J., Krantz, D.
S., Carr, R. C., Wynn, G. H., Probe Adams,D., Dacuyan, N. M., & Fullerton, C. S. (2019).
Daily variation in post traumatic stress symptoms
in individuals with and without probable posttraumatic stress disorder. BMC Psychiatry, 19(1),56. doi: 10.1186/s12888-019-2041-7
Campbell-Sills, L., Kessler, R. C., Ursano, R. J., Sun,
X., Heeringa, S. G., Nock, M. K., Jain, S., & Stein,
M. B. (2019). Nicotine dependence and preenlistment suicidal behavior among U.S. Army
Soldiers. Am J Prev Med, 56(3), 420-428. doi:
10.1016/j.amepre.2018.09.016
Campbell-Sills, L., Stein, M. B., Liu, H., Agtarap,
S., Heeringa, S. G., Nock, M. K., Heeringa, S.
G., Nock, M. K., Ursano, R. J., & Kessler, R. C.
(2019). Associations of lifetime traumatic brain
26 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

injury characteristics with prospective suicide
attempt among deployed US Army Soldiers. J
Head Trauma Rehabil. 35(1), 14-26. doi: 10.1097/
HTR.0000000000000516
Choi, K. W., Chen, C. Y., Ursano, R. J., Sun, X.,
Jain, S., Kessler, R. C., Koenen, K. C., Wang, M.
J., Wynn, G. H., Major Depressive Disorder
Working Group of the Psychiatric Genomics
Consortium, Campbell-Sills, L., Stein, M. B.,& Smoller, J. W. (2019). Prospective study ofpolygenic risk, protective factors, and incident
depression following combat deployment in US
Army soldiers. Psychol Med, 15, 1-9. doi: 10.1017/
S0033291719000527.
Cozza, S., Shear, M., Reynolds, C., Fisher, J.,
Zhou, J., Maercker, A., Simon, S., Mauro, C.,
Skritskaya, N., Zisook, S., Lebowitz, B., Bloom,
C. G., Fullerton, C. S., & Ursano, R. J. (2019).
Optimizing the clinical utility of four proposed
criteria for a persistent and impairing griefdisorder by emphasizing core, rather thanassociated symptoms. Psychol Med, 50(3), 438445. doi: 10.1017/S003329171900025
Cozza, S. J., Fisher, J. E., Fetchet, M. A., Chen, S.,
Zhou, J., Fullerton, C. S., & Ursano, R. J. (2019).
Patterns of comorbidity among bereaved family
members 14 years after the September 11th, 2001
terrorist attacks. J Trauma Stress, 32(4), 526-535.
doi: 10.1002/jts.2240
Cozza, S. J., Hefner, K. R., Fisher, J. E., Zhou, J.,
Fullerton, C. S., Ursano, R. J., & Shear, M. K.
(2019). Mental health conditions in bereaved
military service widows: A prospective, casecontrolled, and longitudinal study. Depress
Anxiety, 37(1), 45-53. doi: 10.1002/da.22971
Dempsey, C. L., Benedek, D. M., Zuromski,
K. L., Riggs-Donovan, C., Ng, T. H. H.,
Nock, M. K., Ressler, R. C., & Ursano, R. J.
(2019). Association of firearm ownership,use, accessibility, and storage practices withsuicide risk among US Army soldiers. JAMA

Network Open, 2(6), e195383. doi: 10.1001/
jamanetworkopen.2019.538
Dornbach-Bender, A., Ruggero, C. J., Schuler,
K., Contractor, A. A., Waszczuk, M., Kleva,
C. S., Bromet, E., Luft, B., & Kotov, R. (2019).
Positive and negative affect in the daily life ofWorld Trade Center responders with PTSD: An
ecological, momentary assessment study. Psychol
Trauma, 12(1), 75-83. doi: 10.1037/tra0000429
Fisher, J. E., Guha, A., Heller, W., & Miller, G. A.
(2019). Extreme-groups designs in studies ofdimensional phenomena: Advantages, caveats
and recommendations. J Abnorm Psychol, 129(1),14-20. doi: 10.1037/abn0000480.
Flynn, B. W. (2019). My Father’s Wake: How theIrish Teach Us to Live, Love, and Die. Psychiatry,82(2), 183-186. doi:10.1080/00332747.2019.1600
996
Forbes, D., Pedlar, D., Adler, A. B., Bennett, C.,
Bryant, R., Busuttil, W., Cooper, J., Creamer, M.
C., Fear, N. T., Greenberg, N., Heber, A., Hinton,
M., Hopwood, M., Jetly, R., Lawrence-Wood,E., McFarlane, A., Metcalf, O., O’Donnell, M.,
Phelps, A., Richardson, J. D., Sadler, N., Schnurr,
P. P., Sharp, M.-L., Thompson, J. M., Ursano, R.
J., Van Hooff, M., Wade, D., & Wessely, S. (2019).
Treatment of military-related post-traumaticstress disorder: Challenges, innovations, and theway forward. Int Rev Psychiatry, 31(1), 95-110.
doi: 10.1080/09540261.2019.1595545
Fullerton, C. S., Mash, H. B. Herberman, Wang,
L., Morganstein, J. C., & Ursano, R. J. (2019).
Posttraumatic stress disorder and mental distressfollowing the 2004 and 2005 Florida hurricanes.
Disaster Med Public Health Prep, 13(1), 44-52.
doi: 10.1017/dmp.2018.153
Gonzalez, O. I., Naifeh, J. A., Biggs, Q. M., Ng, T.
H. H., Fullerton, C. S., & Ursano, R. J. (2019).
Internal consistency and factor structure of abrief scale assessing sensitivity to blood, injury,
and mutilation. BMC Res Notes, 12(1), 167. doi:
10.1186/s13104-019-4200-9
Hefner, K. & Rosenheck, R. (2019). Multimorbidity
among veterans diagnosed with PTSD in the
Veterans’ Health Administration nationally.
Psychiatr Q. 90(2), 275-291. doi: 10.1007/s11126-019-09632-5
Hettema, J. M., Verhulst, B., Chatzinakos, C.,
Bacanu, S. A., Chen, C. Y., Ursano, R. J.,
Kessler, R. C., Gelernter, J., Smoller, J. W., He,
F., Jain, S., & Stein, M. B. (2019). Genome-wide
association study of shared liability to anxiety
disorders in Army STARRS. Am J Med Genet B:
Neuropsychiatr Genet. 10.1002/ajmg.b.32776
Karlsson Linner, R., Biroli, P., Kong, E., Meddens, S.
F. W., Wedow, R., Fontana, M. A., … Ursano, R.
J., … & Beauchamp, J. P. (2019). Genome-wide
association analyses of risk tolerance and risky
behaviors in over 1 million individuals identify
hundreds of loci and shared genetic influences.
Nature Genetics, 51(2), 245-257. doi: 10.1038/
s41588-018-0309-3
Levey, D. F., Polimanti, R., Cheng, Z., Zhou, H.,
Nunez, Y. Z., Jain, S., He, F., Sun, X., Ursano,R. J., Kessler, R. C., Smoller, J. W., Stein, M. B.,
Kranzler, H. R., & Gelernter, J. (2019). Genetic
associations with suicide attempt severity andgenetic overlap with major depression. Transl
Psychiatry, 9(1), 22. doi: 10.1038/s41398-0180340-2
Meyer, E. G., Chen, H. C., Uijtdehaage, S.,
Durning, S. J., & Maggio, L. A. (2019).
Scoping review of entrustable professional
activities in undergraduate medical education.
Acad Med. 94(7), 1040-1049 doi: 10.1097/
ACM.0000000000002735
Morganstein, J. C. (2019). Caring for people withmental illness in disasters. The Dialogue, 15(3-4),
8-11.
Naifeh, J. A., Ursano, R. J., Kessler, R. C.,
Gonzalez, O. I., Fullerton, C. S., Herberman
Mash, H. B., Riggs-Donovan, C. A., Ng, T.
H. H., Wynn, G. H., Dinh, H. M., Kao, T.C.,
Sampson, N. A., & Stein, M. B. (2019). Suicide
attempts among activated soldiers in the U.S.
Army reserve components. BMC Psychiatry,
19(1), 31. doi: 10.1186/s12888-018-1978-2
Naifeh, J. A., Ursano, R. J., Kessler, R. C., Aliaga,
P. A., Mash, H. B. H., Fullerton, C. S., Ng, T.
H. H., Dinh, H. M., Gonzalez, O. I., Stokes, C.
M., Wynn, G. H., Kao, T. C., Sampson, N. A., &Stein, M. B. (2019). Early first deployment and2019 ANNUAL REPORT | 27

risk of suicide attempt among first-term enlisted
soldiers in the U.S. Army. Suicide Life Threat
Behav, 50(2), 345-358. doi: 10.1111/sltb.12592.
Nievergelt, C. M., Maihofer, A. X., Klengel,... Ursano, R. J., … Koenen, K. C. (2019).
International meta-analysis of PTSD genomewide association studies identifies sex- andancestry-specific genetic risk loci. Nat Commun,
10(1), 4558. doi: 10.1038/s41467-019-12576-w
Radford, K. D., Spencer, H. F., Zhang, M., Berman,
R. Y., Girasek, Q. L., & Choi, K. H. (2019).
Association between intravenous ketamineinduced stress hormone levels and long-term
fear memory renewal in Sprague-Dawley rats.
Behav Brain Res, 378, 112259. doi: 10.1016/j.
bbr.2019.11225
Regier, D. A. (2019). The DSM-5 Alternative Modelof Personality Disorders: Integrating Multiple
Paradigms of Personality Assessment. Psychiatry,
82(4), 375-378. doi:10.1080/00332747.2019.1683
422
Ruggero, C. J., Kotov, R., Hopwood, C. J., First, M.,
Clark, L. A., Skodol, A. E.,,… Regier, D. A,…&
Docherty, A. (2019). Integrating the HierarchicalTaxonomy of Psychopathology (HiTOP) into
clinical practice. J Consult Clin Psychol, 87(12),1069 -1084. doi: 10.1037/ccp0000452
Russell, C. A., Hamby, A. M., Grube, J. W., &Russell, D. W. (2019). When do public healthepilogues correct the influence of alcoholstorylines on youth? The interplay of narrativetransportation and persuasion knowledge.
Journal of Public Policy & Marketing, 38(3), 316331, doi: 10.1177/0743915618818567
Russell, D. W., Kazman, J., & Russell, C. A.
(2019). Body composition and physical fitness
tests among US Army soldiers: A comparisonof the active and reserve components.
Public Health Rep, 134(5), 502-513. doi:
10.1177/0033354919867069
Settle, J. R., Clawson, D. M., Sebrechts, M. M.,
French, L. M., Massey Watts, A. T., & Duncan,
C. C. (2019). Prospective memory in service
members with mild traumatic brain injury. Mil
Med, 184(11-12), 723-730. doi: 10.1093/milmed/
usz06228 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Stein, M. B., Choi, K. W., Jain, S., Campbell-Sills,
L., Chen, C. Y., Gelernter, J., He, F., Heeringa, S.
G., Maihofer, A. X., Nievergelt, C., Nock, M. K.,
Ripke, S., Sun, X., Kessler, R. C., Smoller, J. W.,& Ursano, R. J. (2019). Genome-wide analysesof psychological resilience in U.S. Army soldiers.
Am J Medical Genet B: Neuropsychiatr Genet,
180(5), 310-319. doi: 10.1002/ajmg.b.32730
Stein, M. B., Kessler, R. C., & Ursano, R. J. (2019).
Reframing the suicide prevention message formilitary personnel. JAMA Psychiatry, 76(5), 466468. doi: 10.1001/jamapsychiatry.2018.3943
Stokes, C. M., Alonso, J., Andrade, L. H., Atwoli,
L., Cardoso, G., Chiu, W. T, Dinolova, R. V.,
Gureje, O., Karam, A. N., Kessler, R. C., Chatterji,S., King, A., Lee, S., Mneimneh, Z., Oladeji, B.
D., Petukhova, M., Rapsey, C., Sampson, N. A.,
Scott, K., Street, A., Viana, M. C., Williams,
M. A., Bossarte, R. M., & WHO World Mental
Health Survey Collaborators. (2019). Pre-marital
predictors of marital violence in the WHO World
Mental Health (WMH) Surveys. Soc Psychiatry
Psychiatr Epidemiol, 55(3), 393-405. doi: 10.1007/
s00127-019-01703-z
Stokes, C. M., Naifeh, J. A., Kessler, R. C.,
Stein, M. B., Fullerton, C. S., Mash, H. B.
H., Riggs-Donovan, C. A., Ng, T. H. H.,
Aliaga, P.A., Wynn, G. H., Dinh, H. M.,
Kao, T. C. Gonzalez, O. I., Sampson, N. A., &Ursano, R. J. (2019). Risk factors and timingof suicide attempts among US Army Reserve
Component soldiers during deployment to
the Afghanistan and Iraq Wars: Results from
Army Study to Assess Risk and Resilience inServicemembers. Psychiatry, 82(3), 240-255. doi:
10.1080/00332747.2019.1653056
Ursano, R. J. (2019). Culture, borders and
Dr. Carl Bell. Psychiatry, 82(3), 191. doi:
10.1080/00332747.2019.1654351
Vance, M. C. (2019). Recognizing trauma in thehealer. Health Affairs, 38(5), 868-871. doi:
10.1377/hlthaff.2018.05061
Vance, M. C., Caverly, T. J., & Hayward, R. A. (2019).
Underappreciated bias created by measurement
error in risk factor assessment - A case studyof no safe level of alcohol consumption. JAMA

Intern Med 10.1001/jamainternmed.2019.6116
Wang, H. E., Campbell-Sills, L., Kessler, R. C., Sun,
X., Heeringa, S. G., Nock, M. K., Ursano, R. J.,
Jain, S., & Stein, M. B. (2019). Pre-deployment
Insomnia is associated with post-deployment
PTSD and suicidal ideation in US Army Soldiers.
Sleep, 42(2). doi: 10.1093/sleep/zsy229
Wang, Y., Karstoft, K. I., Nievergelt, C. M., Maihofer,
A. X., Stein, M. B., Ursano, R. J., BybjergGrauholm, J., Baekvad-Hansen, M., Hugaard, D.
M., Andreassen, O. A., Werge, T., Thompson,
W. K., & Andersen, S. B. (2019). Post-traumaticstress following military deployment: Genetic
associations and cross-disorder genetic
correlations. J Affect Disord, 252, 350-357. doi:
10.1016/j.jad.2019.04.070
Zachar, P., Regier, D. A., & Kendler, K. S. (2019). The
aspirations for a paradigm shift in DSM-5: An
oral history. J Nerv and Ment Dis, 207(9), 778784. doi: 10.1097/NMD.0000000000001063
Zhang, L., Hu, X. Z., Benedek, D. M., Fullerton,
C. S., Forsten, R. D., Naifeh, J. A., Li, X. &Biomarker Study Group (Wynn, G., Russell,D., & Ursano R. J.). (2019). Genetic predictor
of current suicidal ideation in US service
members deployed to Iraq and Afghanistan.
J Psychiatri Res, 113, 65-71. doi: 10.1016/j.
jpsychires.2019.03.007
Zhang, M., Radford, K. D., Driscoll, M., Purnomo,
S., Kim, J., & Choi, K. H. (2019). Effects ofsubanesthetic intravenous ketamine infusion
on neuroplasticity-related proteins in theprefrontal cortex, amygdala, and hippocampus ofSprague-Dawley rats. IBRO Reports, 6, 87-94. doi:
10.1016/j.ibror.2019.01.006
Zuromski, K. L., Bernecker, S. L., Gutierrez, P.
M., Joiner, T. E., King, A. J., Liu, H., Naifeh, J.
A., Nock, M. K., Sampson, N. A., Zaslvasky,
A. M., Stein, M. B., Ursano, R. J., & Kessler,
R. C. (2019). Assessment of a risk index for
suicide attempts among US Army Soldierswith suicide ideation: Analysis of data fromthe Army Study to Assess Risk and Resiliencein Servicemembers (Army STARRS). JAMA

Netw Open, 2(3), e190766. doi: 10.1001/
jamanetworkopen.2019.0766
Zuromski, K. L., Dempsey, C. L., Ng, T. H. H.,
Riggs-Donovan, C. A., Brent, D. A., Heeringa,
S. G., Kessler, R. C., Stein, M. B., Ursano, R.
J., Benedek, D. M., & Nock, M. K. (2019).
Utilization of and barriers to treatment among
suicide decedents: Results from the Army
Study to Assess Risk and Resilience Among
Servicemembers (Army STARRS). J Consult Clin
Psychol. 87(8), 671-683. doi: 10.1037/ccp0000400
Zuromski, K. L., Ustun, B., Hwang, I., Keane, T. M.,
Marx, B. P., Stein, M. B., Ursano, R. J., & Kessler,
R. C. (2019). Developing an optimal short-formof the PTSD Checklist for DSM-5 (PCL-5).
Depress Anxiety, 36(9), 790-800. doi: 10.1002/
da.22942
BOOK CHAPTERS
Cozza, S. J., Harrington-LaMorie, J., & Fisher,
J. E. (2019). U.S. Military Service Deaths:
Bereavement in Surviving Families. In E. L.
Weiss, C. A. Castro (Eds.), American MilitaryLife in the 21st Century: Social, Cultural, andEconomic Issues and Trends. Santa Barbara, CA:
ABC-CLIO.
Morganstein, J. C., West, J. C., & Ursano, R. J.
(2019). Work Associated Trauma. In M. B. Riba,
S. Parikh, J. Greden (Eds.), Mental Health in
the Workplace: Strategies and Tools to Optimize
Outcomes. Cham, Switzerland: Springer Nature
Publishing Company.
Morganstein, J. C., Yang, S., Wynn, G. H.,
Benedek, D. M., & Ursano, R. J. (2019). AcuteStress Disorder. In B. O. Olatunji (Ed.), Handbookof Anxiety and Related Disorders (pp. 685-722).
Cambridge, UK: Cambridge University Press.
Zhang, L., Hu, X. Z., Li, H., Li, X., Yu, T., Dohl, J.,& Ursano, R. J. (2019). Updates in PTSD animalmodels characterization. In F. H. Kobeissy(Ed.), Psychiatric disorders: Methods in molecularbiology (pp. 331-344). New York, NY: Humana.

2019 ANNUAL REPORT | 29

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

PRESENTATIONS
Understanding and addressing the needs of bereaved
military families. Cozza, S. J., & Shear, M. K.
Presented as a webinar at the TAPS Institute for
Hope and Healing, Washington, DC, January 2019.
Disaster behavioral health: Critical concepts. Flynn,
B. W., & Morganstein, J. C. Presentation to MPH
students at the Uniformed Services University,
Bethesda, MD, January 2019.
Considerations on resilience: Building, fostering,sustaining resilience from the perspective of trauma,
terrorism and disaster. Ursano, R. J. Plenary
lecture at the 5th National University of Singapore
International Academic Psychiatry Conference 2019:
Resilience Across the Age Continuum, Singapore,
January 2019.
Resilience in adversity: Trauma, disaster and recovery.
Ursano, R. J. Plenary lecture at the 5th National
University of Singapore International Academic
Psychiatry Conference 2019: Resilience Across the
Age Continuum, Singapore, January 2019.
PTSD, suicide, TBI... DSM and other trauma
disorders. Ursano, R. J. Presented at the Departmentof Psychiatry Grand Rounds at MedStar Georgetown
University Hospital, Washington, DC, February 2019.
Trends in substantiated U.S. Army child maltreatment
reports. McCarroll, J. E. Presented at the 34th
Annual International Conference on Child andFamily Maltreatment, San Diego, CA, February 2019.
Documented family violence and risk of suicide attemptamong U.S. Army Soldiers. Whalen, R. J. Presented
at the 34th Annual International Conference onChild and Family Maltreatment, San Diego, CA,
February 2019.
Types, subtypes and severity of substantiated childneglect in U.S. Army communities. Cozza, S.
J. Presented at the 34th Annual International
Conference on Child and Family Maltreatment, San
Diego, CA, February 2019.
Impact of the previous night’s sleep disturbances on
post-traumatic stress symptoms among individuals
with and without post-traumatic stress disorder.
Biggs, Q. M., Ursano, R. J., Wang, J., Wynn, G. H.,
30 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Krantz, D. S., Carr, R. B., Dacuyan, N, M., Pokorny,
K., Gover-Chamlou, A., Martinez, S., & Fullerton,
C. S. Poster presentation at the 40th Annual Meetingof the Society of Behavioral Medicine, Washington,
DC, March 2019.
Influence of number of awakenings during the previous
1-3 nights on post-traumatic stress symptoms
among individuals with PTSD. Wang, J., Ursano,R. J., Biggs, Q. M., Krantz, D. S., Wynn, G. H.,
Carr, R. B., Gover-Chamlou, A., Martinez, S.,
Pokorny, K., Stephens, T. B., & Fullerton, C. S.
Poster presentation at the 40th Annual Meeting of
the Society of Behavioral Medicine, Washington, DC,
March 2019.
Nightmare deconstruction and reprocessing: Proofof concept of a novel treatment for PTSD-relatednightmares and insomnia. Spangler, P., West, J.,
Benedek, D., Dempsey, C., Schuler, K., Paxton,
M., Asabre, E., Phares, A., & Canales, J. Poster
presentation at the 40th Annual Meeting of theSociety of Behavioral Medicine, Washington, DC,
March 2019.
Relationship of perceived safety to behavioral change
following active shooter events. Herberman Mash,
H. B., Fullerton, C. S., & Ursano, R. J. Poster
presentation at the 40th Annual Meeting of theSociety of Behavioral Medicine, Washington, DC,
March 2019.
Mental health and nuclear and radiologic emergencies:
What to expect, surveillance, triage and coordinatingcare. Ursano, R. J. Presented at the Workshop on
Challenges in Initiating and Conducting Long-Term
Health Monitoring of Populations Following Nuclear
and Radiological Emergencies in the United States at
the National Academies of Sciences, Engineering andMedicine, Washington, DC, March 2019.
Helping people after disasters: Impacts, interventions,and future directions. Morganstein, J. C. Presented
at the 2nd Annual Hero’s Journey Home Symposium,
John P. Mayhugh Foundation, U.S. Capitol,
Washington, DC, March 2019.
Pathways of risk and recovery in military families.
Cozza, S. J. Presented at the 2nd Annual Hero’s
Journey Home Symposium, John P. MayhughFoundation, U.S. Capitol, Washington, DC, March
2019.
Understanding and addressing the needs of bereaved
military family members. Cozza, S. J. Presented at
The Cohen Veterans Network, Silver Spring, MD,
April 2019.
Mental health and nuclear emergencies: What to expect,surveillance, triage and coordinating care. Ursano, R.
J. Webinar presentation at The 4th WHO REMPAN
Webinar- Mental Health Impact of Nuclear
Emergencies, Geneva, Switzerland, April 2019.
Mental health and psychosocial challenges forvictims and responders during international
disasters. Morganstein, J. C. Presentation to MPH
students at the Uniformed Services University,
Bethesda, MD, April 2019.
An introduction to disaster psychiatry. Morganstein, J.
C. Presentation to Psychiatry residents at the NCC
Psychiatry Residency Training Program, Bethesda,
MD, April 2019.
Effect of prior hurricane experiences on preparedness inFlorida Department of Health workers. Herberman
Mash, H. B., Morganstein, J. C., Fullerton, C. S.,
Wang, L., Liu, A. G., Farooq, S., & Ursano, R. J.
Poster presentation at the 14th Annual Amygdala,Stress and PTSD Conference, Center for the Studyof Traumatic Stress, Department of Psychiatry,
Uniformed Services University, Bethesda, MD, April
2019.
Impact of the previous night’s sleep disturbanceson post-traumatic stress symptoms amongindividuals with and without post-traumatic stressdisorder. Biggs, Q. M., Ursano, R. J., Wang, J.,
Wynn, G. H., Krantz, D. S., Carr, R. B., Dacuyan,
N, M., Pokorny, K., Gover-Chamlou, A., Martinez,
S., & Fullerton, C. S. Poster presentation at the 14th
Annual Amygdala, Stress, and PTSD Conference:
Risk, Resilience, and Recovery, Uniformed Services
University, Bethesda, MD, April 2019.
Influence of number of awakenings during the previous
1-3 nights on post-traumatic stress symptoms
among individuals with PTSD. Wang, J., Ursano,R. J., Biggs, Q. M., Krantz, D. S., Wynn, G. H.,
Carr, R. B., Gover-Chamlou, A., Martinez, S.,
Pokorny, K., Stephens, T. B., & Fullerton, C. S.
Poster presentation at the 14th Annual Amygdala,Stress, and PTSD Conference: Risk, Resilience, andRecovery, Uniformed Services University, Bethesda,
MD, April 2019.
Longitudinal changes in children’s mental healthconditions and physical injury rates following
father death. Ogle, C. M., Fisher, J. E., Zhou,

J., Gover-Chamlou, A. N., & Cozza, S. J. Poster
presentation at the 14th Annual Amygdala, Stress,
and PTSD Conference: Risk, Resilience, and Recovery,
Uniformed Services University, Bethesda, MD, April
2019.
Prevalence of health conditions and healthcare
utilization in treatment-seeking, bereaved military
widows: A prospective, case-controlled, longitudinal
study. Hefner, K., Fisher, J. E., Zhou, J., Burris,A., & Cozza, S. J. Poster presentation at the 14th
Annual Amygdala, Stress, and PTSD Conference:
Risk, Resilience, and Recovery, Uniformed Services
University, Bethesda, MD, April 2019.
Risk and resilience of lifetime stressful experiences among
US Army soldiers at risk for suicide: Results from the
Army Study to Assess Risk and Resilience Among
Servicemembers (Army STARRS). Dempsey, C.
L., Benedek, D. M., Zuromski, K. L., Nock, M. K.,
Ng, T. H. H., Riggs-Donovan, C. A., Broshek, C.,
Martinez, S., & Ursano, R. J. Poster presentation
at the 14th Annual Amygdala, Stress, and PTSD
Conference: Risk, Resilience, and Recovery,
Uniformed Services University, Bethesda, MD, April
2019.
Safety and confidence in law enforcement during
terrorist-related events: Association with daily life
activities. Herberman Mash, H. B., Fullerton, C.
S., Morganstein, J. C., Flynn, B. W., & Ursano, R.
J. Poster presentation at the 14th Annual Amygdala,Stress and PTSD Conference, Center for the Studyof Traumatic Stress, Department of Psychiatry,
Uniformed Services University, Bethesda, MD, April
2019.
Understanding and addressing the needs of bereaved
military family members. Cozza, S. J. Presented
as a webinar at Columbia University’s Center for
Complicated Grief, New York, NY, April 2019.
Effect of gender, perceived workplace training, and mental
health care use on psychological distress following
the 2004 Florida hurricanes. Liu, A. G., Farooq,
S., Herberman Mash, H. B., Fullerton, C. S., &Ursano, R. J. Poster presentation at the 31st Annual
Convention of the Association for Psychological
Science, Washington, DC, May 2019.
Risk and resilience of lifetime stressful experiences among
US Army soldiers at risk for suicide. Dempsey, C. L.,
Benedek, D. M., Zuromski, K., Nock, M. K., Ng, T.
H., Riggs-Donovan, C. A., Broshek, C., Martinez,
S., Exley, S., & Ursano, R. J. Poster presentation at
the 31st Annual Convention of the Association for
Psychological Science, Washington, DC, May 2019.
Testing the utility of mobile applications to support grief2019 ANNUAL REPORT | 31

adaptation in military survivors. Fisher, J. E., Liu,
A. G., Skritskaya, N., Farooq, S., Gorscak, B. J.,
Hefner, K., Ogle, C., Gribbin Bloom, C., Bottex, G.,
Cozza, S. J., & Shear, M. K. Poster presentation at
the 31st Annual Convention of the Association for
Psychological Science, Washington, DC, May 2019.
Disaster psychiatry review and updates: Mass violence,
Ebola, and climate change. Morganstein, J. C., West,
J. C., Napoli, J., Stoddard, F., & Ursano, R. J. Course
presented at the Annual Meeting of the American
Psychiatric Association, San Francisco, CA, May
2019.
Outside the system: Risk factors for suicide attemptamong U.S. Army soldiers with no history of mental
health diagnosis. Naifeh, J. A., Herberman Mash,
H. B., Stokes, C. M., Fullerton, C. S., Aliaga, P. A.,
Riggs-Donovan, C. A., Ng, T. H. H., Stein, M. B.,
Kessler, R. C., & Ursano, R. J. Poster presentation at
the 31st Annual Convention of the Association for
Psychological Science, Washington, DC, May 2019.
Military healthcare systems throughout NATO. Wynn,
G. H., Berendsen, B. J., & Jetly, R. Presented at the
Tri-Service Conference of the Society of Uniformed
Services Psychiatrists, San Francisco, CA, May 2019.
Nightmare deconstruction and reprocessing: Feasibilityof a novel treatment for PTSD-related nightmares
and insomnia. Spangler, P., West, J. C., Benedek, D.
M., Dempsey, C., Schuler, K., Paxton, M., Asabre,
E., Phares, A., & Canales, J. Poster presentation at
the 31st Annual Convention of the Association for
Psychological Science, Washington, DC, May 2019.
Fear of death biases reporting on mental healthassessments. Russell, D. W. & Russell, C. Poster
presentation at the 31st Annual Convention of the
Association for Psychological Science, Washington,
DC, May 2019.
Deployment and suicide: Is there an association? Wynn,
G. H. Presented at the Congress of the International
Society of Travel Medicine meeting, Washington,
DC, May 2019.
Combat operational stress and mental health issues inmilitary deployment. Benedek, D. M. Presented at
the 16th Congress of the International Society ofTravel Medicine, Washington, DC, May 2019.
Update from Army STARRS. Ursano, R. J. Presented
at the 2019 Artiss Symposium, Bethesda, MD, June
2019.
Disaster psychiatry: Finding structure in chaos. Ursano,R. J. Presented as a keynote at the Psychiatry
Dimensions of Disaster: Training Course II, Toronto,
Canada, June 2019.
Politics, identity, and therapy in the VA behavioral healthenvironment. Spangler, P. Presented at the Veterans
Affairs Palo Alto Health Care System Psychology
32 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Continuing Education & Social Work Service
Workshop, Providing Clinical Care in a PolarizedAmerica: Politics in Mental Health Practice, Palo Alto,
CA, June 2019.
Feasibility of a novel treatment for PTSD nightmares:
Integrating psychometric physiologic, and genetic
data. Spangler, P., Azad, A., West, J., Benedek,
D., Zhang, L., Gill, J., Dempsey, C., et al. Panelpresentation at the 50th Annual International Meetingof the Society for Psychotherapy Research, Buenos
Aires, Argentina, July 2019.
Science of stress and trauma: Impact and interventions.
Morganstein, J. C. Presented at the Reintegrationfrom High-Threat Posts and Military Deployments
Seminar, Drug Enforcement Administration,
Department of Justice, Quantico, VA, July 2019.
Disasters and mental health: Impact, vulnerability, andearly interventions. Morganstein, J. C. Presented
at the Clinical Communities Speaker Series on
Innovations in Health Care from Centers of Excellenceand Communities of Practice Groups, Defense HealthAgency, Silver Spring, MD, August 2019.
Psychiatric dimensions of disaster and the impact ofclimate change. West, J. C. Presented to the Southern
Psychiatric Association, Louisville, KY, August 2019.
Prevalence of mental health conditions and physicalinjury rates associated with paternal death in militarychildren. Ogle, C. M., Fisher, J. E., Zhou, J, &Cozza, S. C. Presented at the 66th Annual Meetingof the American Academy of Child and Adolescent
Psychiatry, Chicago, IL, October 2019.
Nightmare deconstruction and reprocessing: Integratingcollection of physiologic stress indicators via
wearable technology and genomic analyses inpilot testing a psychotherapy for PTSD-relatednightmares. Spangler, P., Azad, A., West, J., Zhang,L., Gill, J., Benedek, D., Dempsey, C., et al. Poster
presentation at the Technology, Mind, and Society
Conference, American Psychological Association,
Washington, DC, October 2019.
Child neglect types in US Army communities andassociated risk factors. Cozza, S. J., Fisher, J. E.,
Ogle, C. M., & Zhou, J. Presented at the 66th Annual
Meeting of the American Academy of Child andAdolescent Psychiatry, Chicago, IL, October 2019.
Exposure to and management of human remains: Posttraumatic consequences and pathways of recovery.
Cozza, S. J., Flynn, B. W., & Biggs, Q. M. Panelpresentation at the 35th Annual Meeting of theInternational Society for Traumatic Stress Studies,
Boston, MA, November 2019.
Bereavement outcomes after sudden and violent losses:
Suicide-loss survivors compared to survivors ofaccident and combat loss. Fisher, J., E., Zhou, J., &Cozza, S. J. Poster presentation at the 35th Annual
Meeting of the International Society for TraumaticStress Studies, Boston, MA, November 2019.
Combat exposure, PTSD, and other potential risk factors
for the transition from recent suicide ideation tosuicide attempt in U.S. Army Soldiers. Naifeh, J.
A., Dempsey, C. L., Bartolanzo, D., Herberman
Mash, H. B., Fullerton, C. S., & Ursano, R. J. Poster
presentation at the 35th Annual Meeting of theInternational Society for Traumatic Stress Studies,
Boston, MA, November 2019.
Posttraumatic stress disorder: Updates on assessmentand management. Morganstein, J. C. Presented aspart of the Saint Luke Institute Continuing Education
Series, Silver Spring, MD, November 2019.
Relationship of hurricane-related concerns to hurricane
preparedness and subsequent mental distress. Liu,
A. G., Mash, H. B. H., Fullerton, C. S., MullinsHussain, B., & Ursano, R. J. Poster presentation at
the 35th Annual Meeting of the International Society
for Traumatic Stress Studies, Boston, MA, November
2019.
Influence of number of awakenings during the previous
1-3 nights on post traumatic stress symptoms amongindividuals with PTSD. Wang, J., Ursano, R. J.,
Biggs, Q. M., Krantz, D. S., Wynn, G. H., Carr, R.
B., Gover-Chamlou, A., Martinez, S., Pokorny,
K., Stephens, T. B., & Fullerton, C. S. Poster
presentation at the Neuroscience 29th Annual OpenHouse, Uniformed Services University, Bethesda,
MD, December 2019.
Impact of the previous night’s sleep disturbances on posttraumatic stress symptoms among individuals withand without post traumatic stress disorder. Biggs, Q.
M., Ursano, R. J., Wang, J., Wynn, G. H., Krantz,
D. S., Carr, R. B., Dacuyan, N. M., Pokorny, K.,
Gover-Chamlou, A., Martinez, S., & Fullerton,
C. S. Poster presentation at the Neuroscience 29th
Annual Open House, Uniformed Services University,
Bethesda, MD, December 2019.

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BRIEFINGS/INTERVIEWS■■■

Dr. Ursano and Dr. Benedek gave an overview
presentation about CSTS and provided consultation
to the Virginia Department of Veterans Services
Interagency Executive Strategy Committee (IESC).
The Committee is tasked with considering strategies
aimed at reducing suicide and self-harm as part of
the Governor’s Challenge to Prevent Suicide among
Military Service Members, Veterans and their Families.
Dr. Stephen Cozza participated in a Connecting
Vets radio interview in which he discussed concepts■■of grief and military family bereavement. He also
discussed CSTS’s ongoing study “Stepping Forward in
Grief ”.
Dr. Ursano was interviewed by Dr. Michael Blumenfield of PsychiatryTalk for a podcast. The podcast
covered a variety of topics including suicide, PTSD
and the STARRS research program.
Dr. Whalen provided members of a Defense Health
Board Child Abuse and Neglect Subset Meeting an
overview of CSTS with emphasis on our Child andFamily Program and an overview of Dr. Stephen
Cozza’s ongoing study of child maltreatment in DoD
families.
Dr. Stephen Cozza participated in a podcast with Dr.
Richard Lerner from Tufts University sponsored by
the Military Child Education Coalition on “Building
Convoys of Care for Military Children.”
Dr. Stephen Cozza participated in a podcast withPatricia Barron at the Association of the UnitedStates Army (AUSA) focusing on supporting militarychildren and families and included a discussion of theCenter’s “Stepping Forward in Grief ” study.
Dr. Ursano was interviewed by Fort Meade’s newspaper, Soundoff! on his work on Army STARRS andsuicide prevention.
Dr. Morganstein presented an overview of CSTS
activities to the newly formed Indo-Pacific Research
Alliance for Military Medicine during their visit to
USU. This collaboration included a range of DoD andother interagency partners seeking to share common
interests and develop collaboration in biomedical
research.
Dr. Ogle provided consultation to the American
Association for the Advancement of Science (AAAS)
Center for Scientific Evidence in Public Issues (EPI
Center) regarding how findings from developmental
science can be more effectively accessed and integrated into the decision-making process throughout the
judicial system. The EPI Center is a new AAAS initiative designed to deliver clear, concise, and actionable scientific evidence to policy makers and otherdecision makers.
Dr. Benedek was quoted in articles on CNN, Fox
News, US News and World Reports, among others,
regarding the findings in the publication, “Associationof Firearm Ownership, Use, Accessibility and Storage
Practices With Suicide Risk Among US Army Soldiers.”
Dr. Stephen Cozza was interviewed by a journalist
from Reuters who is writing an article on a Gold Star
widow. The conversation revolved around researchon bereaved military family members’ PTSD andgrieving process.
Dr. Benedek was interviewed by Dr. Carol Bernstein,2019 ANNUAL REPORT | 33

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past President of the American Psychiatric Association, on Sirius XM Doctor Radio regarding the recent publication “Association of Firearm Ownership,
Use, Accessibility and Storage Practices with Suicide
Risk among U.S. Army Soldiers.”
Dr. Stephen Cozza participated in a podcast regarding the recently released National Academies of Sciences, Engineering, and Medicine report “Strengthening the Military Family Readiness System for a
Changing American Society.”
Dr. Wynn was interviewed by Medscape Psychiatry
for their article “Five-Minute Injection May Offer an
Effective Option for PTSD.”
STARRS methods, findings and recommended
actions for risk reduction and resilience-building
to prevent suicide and suicide-related behaviors in
DoD and veterans were presented to the Personnel
Subcommittee of the U.S. Senate Armed Services
Committee as testimony during a hearing on Service
member, family, and veteran suicides and prevention
strategies.
Dr. Choi received an intramural New Opportunity Research award for his proposal, “Interaction
between Intravenous Ketamine and Opioid on Fearand Stress in Rats.”
Dr. Vance’s publication in Circulation: Cardiovascular Quality and Outcomes, and the related news release titled: “Veterans with mental health conditions
have higher risk of heart disease, stroke” generated
5,574,880 media impressions and 89,131 views on
American Heart Association social media channels.
This exceeded the average number of views for thisjournal. Media impressions are mentions of thestudy in consumer and trade media in print publications, online, or broadcast media. It does not include
citations in peer-reviewed scientific journals.

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AWARDS AND APPOINTMENTS■

Dr. Ursano was awarded the 2019 Lifetime Achievement Award of the Association of Military Surgeonsof the United States (AMSUS). The AMSUS Lifetime
Achievement Award is for a distinguished career of
excellence in development, invention, and innovation in healthcare that is recognized internationally

34 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU■

and makes significant fundamental contributions oflasting impact to better health outcomes in federal
healthcare. AMSUS was founded by Congress in1903 and is the Society of Federal Health Professionals.
Dr. Morganstein received a Certificate of Appreciation for outstanding service and dedication in
supporting Capital Area Provider Team 3 of the U.S.
Public Health Service for the “Independence Day
Support Mission” deployment. The award was granted by CAPT Chertow, Team Commander, Capital
Area Provider Team 3, U.S. Public Health Service.
Dr. Vance was promoted to a member of the APA
Council on Advocacy and Government Relations(CAGR). In this capacity, she assumed leadership of
CAGR’s mentorship program for APA fellows. She
also became CAGR’s liaison with the Council on
Medical Education and Lifelong Learning.
Dr. Vance was selected for the American Psychoanalytic Association Fellowship, an early-career initiative for future leaders in mental health to learn more
about and receive mentorship in psychoanalysis.
Dr. Ursano was invited by the White House to serveas the Risk Identification Section Lead on the Research Line of Effort (LOE) for Executive Order (EO)
13861 “National Roadmap to Empower Veterans and
End Suicide.”
Dr. Stephen Cozza served as a member on the
National Academies of Sciences, Engineering, andMedicine Committee on the Well-Being of Military
Families.
Dr. Benedek and Dr. Kelly Cozza served as membersof the American Association of Orthopedic Surgeon’s (ASOS) Clinical Practice Guideline workgroup developing the Practice Guideline for Psychosocial Screening of Adult trauma patient
Dr. Morganstein was asked to serve as an adviser toHarvard University’s Schwartz Center to help guidetheir development of a tool kit aimed at addressing
distress and other adverse reactions experienced byhealthcare providers following mass shooting events.
Dr. Vance was appointed to serve as a member of the
APA Workgroup to Evaluate the Editor-in-Chief of
APA Publishing Books.

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, Consultation and
Education
Center for the Study of TraumaticStress
Uniformed Services University
Stephen J. Cozza, MD
Professor
Department of Psychiatry
Associate Director, Child and Family
ProgramCenter for the Study of TraumaticStress
Uniformed Services University

Brian W. Flynn, EdD
Adjunct Professor
Department of Psychiatry
Associate Director, Health Systems
Center for the Study of TraumaticStress
Uniformed Services University
Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
Scientific Director
Center for the Study of TraumaticStress
Uniformed Services University
Robert K. Gifford, PhD
Assistant Professor
Department of Psychiatry
Executive Officer and Associate
Director, Homeland Security Studies
Center for the Study of TraumaticStress
Uniformed Services University

Joshua C. Morganstein, MD
CAPT, USPHSAssociate Professor/Assistant Chair
Department of Psychiatry
Assistant Director
Center for the Study of TraumaticStress
Uniformed Services University
SCIENTISTS
Alvi Azad, DO, MBA
Lt Col, USAF
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
David M. Benedek, MD
COL, MC, USA
Consultant to the U.S. Army
Surgeon General for Forensic
Psychiatry
Chair, Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Quinn M. Biggs, PhD, MPH
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Robert Bossarte, PhD
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
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
Catherine L. Dempsey, PhD,
MPH
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Connie C. Duncan, PhD
Research Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Joscelyn E. Fisher, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
2019 ANNUAL REPORT | 35

Brian W. Flynn, EdD
Adjunct Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Kathryn Hefner, PhD
Research Assistant 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

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

Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Frances Gabbay, PhD
Research Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Robert K. Gifford, PhD
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Gena L. Glickman, PhD
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Oscar I. Gonzalez, PhD
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
Jill Harrington-LaMorie, DSW,LCSW
Senior Field Researcher
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
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
Tzu Cheg Kao, PhD
Professor
Department of Preventive Medicine
and Biometrics
Center for the Study of TraumaticStress
Uniformed Services University
Elie Karam, MD
Professor and Chairman
Department of Psychiatry
American University, Beirut
Beirut, Lebanon
David S. Krantz, PhD
Professor
Department of Medical and ClinicalPsychology
Center for the Study of TraumaticStress
Uniformed Services University
He Li, MD, PhD
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

36 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Xian Liu, PhD
Research Professor
Deployment Health Clinical Center
Walter Reed Army Medical Center
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
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Joshua C. Morganstein, MD
CAPT, USPHSAssociate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
James A. Naifeh, PhD
Research Assistant 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
Darrel A. Regier, MD, MPH
Adjunct Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Dori B. Reissman, MD, MPH
RADM, USPHS
Medical Director
World Trade Center Responder Health
Program
Senior Medical Advisor
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 Dean for Diversity andInclusion
School of Medicine
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Keke L. Schuler, PhD
Clinical Research Psychologist
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Leonard Skipper, PhD
MAJ, MS, USA
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Patricia Spangler, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Cara M. Stokes, PhD, MPH
Postdoctoral Fellow
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 Research Institute

Robert J. Ursano, MD
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Director
Center for the Study of TraumaticStress
Uniformed Services University
Mary C. Vance, MD, MSc
Assistant Professor of Psychiatry
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Jing Wang, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Maree J. Webster, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Director
Laboratory of Brain Research
Stanley Medical Research InstituteLars Weisaeth, MD
Professor
Division of Disaster Psychiatry
University of Oslo
Oslo, Norway
James (Curt) West, MD
CAPT, MC, USN
Deputy Chair
Associate Professor
Clerkship Director
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Ronald Whalen, PhD, LMSW
Senior Research Social Worker
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Kathleen Wright, PhD
Former Director (Ret.)
Force Health Protection Program
USAMRU-E
Walter Reed Army Institute of
Research
Gary H. Wynn, MD
COL, MC, USA

Professor
Department of Psychiatry
Senior Scientist
Center for the Study of TraumaticStress
Uniformed Services University

Lei Zhang, MD
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
SCIENCE COLLABORATIVEMEMBERSJames E. Barrett, PhD
Emeritus Professor and Former
Chairman
Department of Pharmacology andPhysiology
Drexel University
College of Medicine
Paul D. Bliese, PhD
Associate Professor
Department of Management
University of South Carolina
Darla Moore School of Business
Robert Bossarte, PhD
Associate Professor
Department of Behavioral Medicine
and Psychiatry
Director
West Virginia University Injury Control
Research CenterWest Virginia University
David Brody, MD, PhD
Professor
Department of Neurology Director
Center for Neuroscience andRegenerative Medicine
Uniformed Services University
M. Richard Fragala, MD
COL, USAF, MC, FS (Ret.)
Professor
Department of Psychiatry
Uniformed Services University
Matthew J. Friedman, MD, PhD
Professor
Department of Psychiatry
Professor
Department of Pharmacology &Toxicology
Dartmouth University
Geisel School of Medicine
Director
Leahy-Friedman National PTSD Brain
Bank2019 ANNUAL REPORT | 37

Senior Advisor
National Center for Post-traumaticStress Disorder
U.S. Department of Veterans Affairs

Harry C. Holloway, MD
COL, MC, USA (Ret.)
Professor Emeritus
Department of Psychiatry
Uniformed Services University
Ronald C. Kessler, PhD
McNeil Family Professor
Department of Health Care Policy
Harvard Medical School
Craig H. Llewellyn, MD
Professor
Department of Military and Emergency
Medicine
Uniformed Services University
Irwin Lucki, PhD
Professor and Chair
Department of Pharmacology &Molecular Therapeutics
Uniformed Services University
Matthew K. Nock, PhD
Edgar Pierce Professor and Chair
Department of Psychology
Harvard University

Collaborative Health Initiative
Research Program (CHIRP)
Uniformed Services University

Robert M. Post, MD
HeadBipolar Collaborative Network
Former Chief
Biological Psychiatry Branch
National Institute of Mental HealthDavid Riggs, PhD
Professor and Chair
Department of Medical ClinicalPsychology
Executive Director
Center for Deployment Psychology
Uniformed Services University
Arieh Y. Shalev, MD
Professor
Department of Psychiatry
New York University Professor
Department of Psychiatry
Hadassah University School of
Medicine
Jerusalem, Israel

Francis O’Conner, MD, MPH
COL, MC, USA
Professor and Chairman
Department of Military and Emergency
Medicine
Uniformed Services University

Murray B. Stein, MD, MPH
VA San Diego Healthcare
SystemDistinguished Professor
Department of Psychiatry
Distinguished Professor
Department of Family Medicine andPublic Health
University of California, San
Diego

Harvey B. Pollard, MD, PhD
Professor and Chair
Department of Anatomy, Physiology
and Genetics
Director

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

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

STAFF
Deborah Probe Adams
Pablo Aliaga
Eva Asabre
Jared Axelowitz
Danielle Bartolanzo
Sara Bessman
Catherine Broshek
Alexandra Burris
Paula Burris
Jessica Canales
Madeline Crissman
Sarah Cupples
Victoria DeHoyos
Hieu Dinh

Erin Doherty
Maria Dudek
Shannon Exley
Sumr Farooq
Alice Fladung
Benjamin Garcia
Dana Gordon
Matthew Georg
Ametisse Gover-Chamlou
Jordana Gruber
Xianzhang Hu
Paul Hurwitz
Abeer Iqbal
Lydia Lee

38 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Alex Liu
Jacqueline Mai
Samantha Martinez
Diana Monday
Susan Moss
Ami Neiberger-Miller
Britany Mullins-Hussain
Stanley Ng
Julia Petrini
Ashley Phares
Joseph Piemontese
Katherine Pokorny
Charlotte Riggs-Donovan
Michelle Rusk

Trevor Stephens
MSgt Amy Steward
Natara Strother-Ware
Tung Tu
Leming Wang
Anjali Whalen
Holly Wu
Shemsiya Yimam
Michael Zhang
Jing Zhou
Rafael Zuleta

Funded Grants
AWARDS (Jan-Dec 2019)

FUNDING INSTITUTION

Evaluation of the Safety and Pharmacokinetics of the FAAH Inhibitor URB597

USAMRMC

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

DHP

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

DHP

Family Violence and Trauma Project

IMCOM

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

CDMRP

Military-Related Risk for Child Neglect in DoD Families: A Population Study to Inform Future DoD 		
Child Neglect Prevention Efforts
MCFP
Enhancing Fear Extinction via Angiotensin Type 1 Receptor Inhibition: A Randomized Controlled Trial in
Posttraumatic Stress Disorder

UCSD

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
USAMRMCContinuation Pilot Trial of Nightmare Deconstruction and Reprocessing, a Novel Treatment for 		
PTSD-Related Nightmares and Insomnia
USAMRMC
Identifying Predictors of Treatment Response in Service-members with Posttraumatic Stress Disorder
Related Sleep Disturbances: Use of Large Datasets to Improve Treatment Selection over the Military
Lifecycle
USAMRMC
Support for Voices of September 11th — Public Safety Canada

Voices of September 11th

Center for the Study of Traumatic Stress (CSTS) Program

DHP

Coping Strategies Used by Survivors of Suicide Loss

AFSP

Personalized Medicine Approach to Light Treatment for Increasing Alertness 		
and Performance in Operational Settings
ONR Global

2019 ANNUAL REPORT | 39

Partnerships
CSTS would like to acknowledge and thankour partners and collaborators. The Centerhas worked with organizations in the public
and private sector through research partnerships, project collaborations, consultations
and trainings.
5-Eyes Mental Health Research Consortium
Alfred P. Sloan Foundation
Alliance of Hope
American Academy of Child and Adolescent
Psychiatry
American Association of Suicidology
American Gold Star Mothers
American Psychiatric Association
American Psychological Association
Architect of the Capitol
Armed Forces Retirement Home
Army OneSource
Assistant Secretary for Preparedness andResponse
Association for Death Education andCounseling
Broad Institute
California Mental Health Services Authority
The Carter Center
Canadian Embassy, Washington, DC
Canadian Forces Health Services
Captain Scott Corwin Foundation
Catholic University of America
Center for Forensic Behavioral Sciences
Center for Health Disparities Research,
Medical University of South Carolina
Centers for Disease Control and Prevention
Collaborative Health Initiative Research
ProgramColumbia University
Columbia University Center for Complicated
Grief
Connecticut Department of Mental Healthand Addiction Services
Cornell University
Dartmouth University
Defense Centers of Excellence for
Psychological Health and Traumatic
Brain Injury
Defense Health Agency
Department of Mental Health, District ofColumbia
Deployment Health Clinical Center
Dover Air Force Base
Drexel University
Drug Enforcement Administration
Emory University
Fallen Patriots
Federal Bureau of Investigation
Florida Department of Health
Ft. Bragg, North Carolina
Ft. Detrick. Maryland
Ft. Hood, Texas
Ft. Lee, Virginia
Ft. Stewart, Georgia
George C. Marshall Center for European
Security
George Washington University

George Washington University, School of
Medicine and Health SciencesGold Star Wives of America
Hadassah Medical Organization, Jerusalem,
IsraelHarvard University Medical School
Harvard University School of Public HealthHenry M. Jackson Foundation for the
Advancement of Military Medicine
Honor and Remember
Honoring Our Fallen
Institute for Disaster Mental Health, State
University of New York, New Paltz
International Society for Traumatic StressStudiesInter-university Consortium for Political andSocial Research
Italian Embassy, Washington, DC
Joint Base Lewis-McChord, Washington
Joint Mortuary Affairs Center and School,
Fort Lee, Virginia
Knights of Heroes
Las Vegas Psychiatric Association
Maryland Emergency Management Authority
Massachusetts General Hospital
McLean Hospital
Medical Research Command at Ft. Detrick
Michigan Department of Health and Human
Services
Michigan Psychiatric Society
Military Child Education Coalition
Military Families United
Miller School of Medicine of the Universityof Miami
Missouri Department of Mental HealthNational Association for PTSD
National Association of Social Workers
National Association of State Mental Health
Program Directors
National Center for Disaster Medicine andPublic HealthNational 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 Defense Medical College, Japan
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
New Jersey Division of Mental Health andAddiction Services
New York University
North Atlantic Treaty Organization
Psychiatric Genomics Consortium
Psychological Health Center of Excellence
Rockefeller University
Rutgers University Cell & DNA Repository
Rutgers University School of Social Work40 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Sesame Workshop
Sheppard Pratt Health System
Snowball Express
Stanford University
Substance Abuse and Mental Health Services
Administration
Suicide Awareness Voices of Education
Syracuse University
Syracuse VA Medical Center
The Compassionate Friends
Tragedy Assistance Program for Survivors
Travis Manion Foundation
Tulane School of Social Work
Uniformed Services University
Union Pacific Railroad
University of California, Irvine
University of California, Los Angeles
University of California, San Diego
University of Maryland
University of Melbourne, Australia
University of Michigan
University of Minnesota
University of Pennsylvania
University of Pittsburgh
University of South Carolina
University of South Dakota Disaster Mental
Health Institute
University of Virginia
University of Virginia’s Critical Incident
Analysis Group
University of Washington
University Medical Center Utrecht,
Netherlands
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 and MaterielCommand
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. Navy
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Snapshots of CSTS

Dr. Ursano receiving an award from the Association of Military
Surgeons of the United States.

Dr. West at his retirement ceremony.

Drs. West, Benedek, and Ursano.

Dr. Benedek talking to CSTS staff during USU
tour.

CSTS staff visit to the Warrior Canine
Connection.

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