Center for the Studyof Traumatic Stress2018 Annual Report

CONTENTS
From the Director.................................................................................................1
Our Mission.........................................................................................................2
Research...............................................................................................................3
Education and Training.......................................................................................15
Consultation......................................................................................................20
The USS Naifeh .................................................................................................24
Publications.......................................................................................................25
Presentations, Briefings, Interviews and Awards................................................29
Directors, Scientists, Science Collaborative Members and Staff.........................34
Funded Grants ..................................................................................................39
Partnerships.......................................................................................................40“CSTS fulfills its mission through leadership,
education, teaching, training, research, scholarship,
service, outreach, collaboration, consultation andglobal health engagement.” — Dr. Robert J. Ursano

From the Director
Dear Center Colleagues and Friends,
The Center for the Study ofTraumatic Stress (CSTS) is acore part of the Departmentof Psychiatry in the F. Edward
Hébert School of Medicine(America’s Medical School) of
the Uniformed Services University (USU). Since CSTS wasestablished in 1987, we havebeen successfully and proudly fulfilling our mission
to mitigate the impact of trauma from exposure towar, disasters, terrorism, community violence andpublic health threats. The Center actively supports
the Strategic Framework and mission of USU, as wellas the Military Health System, and the broader mission of the Department of Defense (DoD). Throughour broad range of activities, we sustain national
readiness, enhance national security, and serve an
essential role for the DoD and the nation.
CSTS fulfills its mission through leadership,
education, teaching, training, research, scholarship, service, outreach, collaboration, consultationand global health engagement. The Center uses amulti-disciplinary and collaborative team of scientists, educators, clinicians and leaders to carry-out
these activities to advance our mission and goals
and to enhance national preparedness.
The Center focuses on health issues of special
interest to the military including post-traumaticstress disorder (PTSD), traumatic brain injury(TBI), suicide and suicide-related behavior. CSTS
helps inform our nation’s policies and responses
to the impacts of exposure to trauma from disasters, both human-made and natural.
The work of the Center ranges from the microlevel in our laboratories to the macro level in ourcommunities, our nation and across the globe.
We move science from the gene, to the cell, tothe organism, to the person, to the community,
to the world. We move from knowledge to action
by providing rapid consultation, education andknowledge support to personnel who respondto the health needs of Service members and theirfamilies, and personnel who respond to disasters,
public health threats, and other crises aroundthe globe. CSTS combines and integrates the two
fields of military psychiatry and disaster psychiatry
which makes CSTS unique.
The Center uses innovative approaches to neuroscience, and conducts ground-breaking researchon timely topics such as suicidal behavior in theArmy, and the impact of death and loss on family
members of Soldiers. One recent example of an innovative approach is our involvement in “big data”
and precision medicine. Our innovative analytic
activities involve advanced techniques including
machine learning, complex algorithms, and predictive analytics. We use data mining techniquesand state-of-the-art statistical methods to analyze
previously untapped data sources independently
and jointly with other data to gain new insights
resulting in better and faster decision-making, andimproving health.
In the pages of this Annual Report, you can readsummaries of our work in both military and civilian populations to enhance psychological health,speed the recovery from, and help prevent thenegative consequences of trauma on individuals,
families, communities and nations. The goal of ourwork is to improve trauma-related care by preparing treatment providers to address the impact of
trauma and its far-reaching effects, thereby building a more trauma-informed environment acrossthe continuum of our military and civilian healthcare systems.
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
2018 ANNUAL REPORT | 1

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 understanding of the impact of trauma on individuals, families and communities. The
Center is part of our nation’s federal medical school(America’s Medical School) at USU and the Center’s
mission is aligned with the needs of the DoD and thenation, and is well-positioned to rapidly respond to
DoD mission-relevant activities.
The Center’s work includes a broad rangeof trauma exposures: combat,
terrorism, natural and human-made disasters,
public health threats,and humanitarian

2 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

operations. CSTS has been involved in nearly every
major disaster our nation has experienced in thepast 30 years. The Center helps to ensure that behavioral health is addressed in the face of public healththreats, disaster planning and disaster recovery.
Mitigating the effects of disaster and trauma in
military and civilian populations is part of the effort
to foster community and national resilience. The Center informs and educates community, regional, state,national and global stakeholders in government, industry, healthcare, public health, and academia. CSTS
contributes to advancing trauma-informed careby 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 Army Study to Assess Risk and Resiliencein Servicemembers (Army STARRS)
The six-year Army STARRS project was conducted from 2009 to 2015. STARRS-LS, the continuation

project, began in 2015 and will proceed through at
least 2020. Both research projects were designed andconducted 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 of Michigan.
Army STARRS, funded by the Army, included
several separate but integrated studies designed tocomprehensively examine the mental health andresilience of active duty Soldiers including RegularArmy, Army National Guard and activated Army
Reserve. The project involved large representative

samples of Soldiers, making it the largest research
effort of mental health risk and resilience ever conducted among military personnel. The largest of thestudies was an historical cohort study of all Soldiers(more than 1.6 million) on active duty from 2004 to
2009. Army STARRS also included cross-sectional
studies, a longitudinal study, and two case-control
studies that involved collecting data directly froma combined total of more than 100,000 active duty
Soldiers throughout the U.S. and overseas. The
studies included administering questionnaires andneurocognitive tests, collecting blood samples, andperforming state-of-the-art data analyses and biomarker assays. The project produced large, rich andrepresentative datasets to serve the goals 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 six years of Army/DoD administrative data (20102015) for the 2004-2009 historical cohort establishedunder Army STARRS. In addition, STARRS-LS
includes administering two waves of follow-up surveys through 2020 for a longitudinal study involving
a sample of more than 50,000 Soldiers who participated in Army STARRS.
Throughout 2018, 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 the historicalcohort. Once this database is complete, it will allow
analyses of more than 3 million active duty Soldiers
over a 12-year period (2004-2015). The researchteam also completed the first wave of follow-up survey data collection for the STARRS-LS cohort andlaunched the second wave. This longitudinal study isextending the time-frame of Army STARRS to collect and analyze further outcome information from2018 ANNUAL REPORT | 3

participants throughout their Army careers, and for
those who transition out of the Army, through theiradjustment to civilian life.
In 2018, the research team conducted many
briefings of the research progress and findings.
These included three in-person briefings to the
STARRS Government Steering Committee, one
meeting with the STARRS Scientific Advisory Board,and an in-person briefing at the Pentagon to senior
DoD and Army leadership including the Assistant
Secretary of Defense for Health Affairs, the Deputy
Under Secretary of the Army, the Army Surgeon
General, G-1 and many other senior Army leaders.
In addition, the research team presented findings at
many military and civilian scientific meetings andconferences.
STARRS continued the partnership establishedwith 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 in collaboration
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 comprised ofArmy and DoD personnel tasked to review STARRS
findings and recommend actions the Army and/or
DoD can take based on those findings. The STARRS
PIs met on a monthly basis with SRAT throughout
2018 to discuss how best to translate STARRS research findings into actions.
The STARRS research team continued to be
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highly-productive throughout 2018 at analyzing vast
amounts of data, writing-up the results, and submitting manuscripts to scientific journals for publication. At the end of 2018, the team had published 75
STARRS papers in peer-reviewed scientific journals,
had one paper accepted for publication but not yet
published (in press), had submitted 10 papers thatwere awaiting a decision for publication by journals,
and had many additional papers in various stages ofprogress. This extraordinary, ground-breaking andcomplex research project has continued to produce
benefits for the Army, the DoD, and the nation.

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 thedead from the theater of war. They are exposed to
one of the highest stressors of war, combat death, aswell as deployment-related stress and work in the
combat environment. This longitudinal researchstudy examines the individual, unit, and familystressors, risk factors, and resiliency of MA Soldiers
who deploy to the Middle East. Questionnaires aregroup-administered to MA detachments before andafter the 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 for DNA and RNA, which will be analyzed
for potential biomarkers of stress and resiliency.
In 2018, Reserve MA Soldiers from the 246th and311th QM CO MA (Companies from Puerto Rico)and the 962nd QM CO MA (from Pacific Rim locations) were deployed to the Middle East. The CSTS
data collection team met with the deploying detachments at Fort Hood, TX while they were there formobilization/demobilization activities just prior toand after deployment. In total, 218 questionnaires
were collected and most Soldiers (82%) donatedsaliva samples for DNA and RNA genetic analysis(358 saliva samples collected). Since the study began
in 2005, the CSTS data collection team has met with
MA Soldiers more than 60 times and collected morethan 3,100 questionnaires. Data analyses in 2018 included a factor analysis of items assessing sensitivity
to blood, injury, and mutilation and a manuscript
was produced. Findings from this study will target
resiliency, preparation, training, and education of
Soldiers for the stressors of deployment and workwith the dead.

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 mortuary affairs (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 through four group workshops,
informational handouts, a dedicated website, andphone and email support services. A total of 125 MA
Soldiers participated in the study. Baseline questionnaires indicated that MA soldiers had a high numberof traumatic exposures and 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 majority of Soldiers (89%) reported
that TEAM was helpful for them. Calming (relaxation training) and problem solving were two of theskills reported to be most helpful. Findings fromTEAM will inform future interventions with militaryand 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 an ecological momentary assessment methodology to monitor in realtime post-traumatic stress symptoms of U.S. Service
members. This study examines the relationship ofvariability in stress symptoms, collected four times
daily over a 15-day period, to psychiatric disorders,sleep, health risk behaviors (e.g., alcohol and tobaccouse), pain, and other areas of health and functioning.
Participants complete daily assessments on electronic tablets using a sophisticated software application
developed in collaboration with the National Center
for Telehealth and Technology (T2) specifically foruse in this study. Psychiatric disorders (e.g., PTSD,
depression) are assessed at baseline and in one andthree month follow-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 thatmay distinguish and/or mediate traumatic stressresponses and resilience to stress-related disorders.
New in 2018, study participants have the option towear a wrist actigraph during the 15-day daily diaryassessment period. The actigraph provides an objective measure of sleep that will complement participants’ self-reports. To date, 144 Service members
have enrolled in the study. Among those, 33 enrolled

Dr. Biggs presenting Daily Diary Study findings.

2018 ANNUAL REPORT | 5

in 2018 and together they completed almost 1,600
daily diary assessments. Most participants provided
biological samples for genetic analysis; 88 saliva and129 blood samples were collected. Inclusion of actigraphy was introduced late in 2018 and six Service
members wore an actigraph. Data analyses include
examination of the relationship between measures of
sleep (e.g., hours slept, sleep quality) and variation in
post-traumatic stress symptoms the following day. In
2018, study findings were presented in seven poster
sessions at local, national, and international scientific conferences and a manuscript was prepared for
publication. The Daily Diary Study represents the
cutting-edge in psychological assessment methodology, measures, equipment, technology, and research
designed to better understand and improve thewell-being of Service members.

Reserve Component of the U.S. Armed
ForcesThe Citizen Soldiers of the Reserve Component(RC) of the U.S. Armed Forces experience uniquestressors, substantially different from those experienced by the Active Component (AC), when thenation is at war and when the RC is called uponfor emergency service, such as disaster relief. The
Center is strongly committed to supporting the RC
through a broad range of activities that are oriented to the RC. RC members and their families areincluded in research conducted by the CSTS Childand Family Program addressing the needs of children and families affected by trauma. In addition
to research that focuses on the RC, CSTS provided
consultation to RC units. Through this consultation,
the Center provided the RC leadership with information products specifically geared to their needs.
The Center also enhanced civilian understandingof the special nature of the RC’s mission, structure,and unique stressors by devoting a chapter to the
RC in the recently published CSTS volume, U.S.
Army Culture: An Introduction for Behavioral HealthResearchers.
CSTS continues our nationwide longitudinal
research study on the National Guard and Reserve
Service members, in collaboration with Dr. Sandro
Galea at Boston University. Using a representative
6 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

national cohort, this study specifically addresses thehealth and resilience factors and experiences of theGuard and Reserve, as distinct from the experiencesof Active Duty Service members. CSTS is actively
analyzing this comprehensive dataset to address the
epidemiology and trajectory of post-traumatic stress,
deployment stress, health risk behaviors and healthcare utilization in the National Guard and Reserves
Service members of the Army, Navy, Air Force andMarine Corps. For example, four distinct and heterogeneous post-deployment PTSD trajectories havebeen identified, i.e., resilience, recovery, late onset,
and chronic. The trajectories are associated withvarious levels of suicide risk, which supports theimportance of follow-up assessment of suicide risk.
Four waves of data collection have been conducted
and we are planning a fifth wave of data collection
to extend the data on trajectories of health in thisimportant population.
The Army STARRS project and its follow-on
research, STARRS-LS, provided a wealth of data
about RC soldiers. The Army STARRS New Soldier
Study included survey data collection from approximately 23,000 RC Soldiers, and blood sample collection from a subset, during their first week of basic
training. This data collection at the very beginningof Soldiers’ military service provided an opportunity
to follow them through the course of their military
careers and beyond in order to identify risk factors
for health outcomes, as well as factors that promoteresilience. The blood samples have been used for theexamination of biomarkers. Army STARRS researchalso included RC members in the All Army Study,
which included a sample of the entire Army, and in
the in-theater study which included a sample of Soldiers serving in Afghanistan. Both of these studies
provided data that can be used in long-term research
while also providing a snapshot of current health andmental health. These studies created the opportunity
for assessment of concentrations of risk in order todevelop future interventions to promote and sustain
health among RC members.
The STARRS-LS research involves the continuation of data collection from Army STARRS participants and allows further in-depth analysis of risk
and resilience factors among members of the RC.

The Center conducted biomarker research studies in
National Guard units before and after deployment
for combat tours in Afghanistan.

PTSD and Sleep Study
The PTSD and Sleep Study research is designed
to use existing datasets and state-of-the art analytic methods to better understand the relationshipbetween PTSD and sleep disorders in the military.
Sleep disorders are a frequent problem among
Service members and even more so among those
suffering with PTSD. This research, being done incollaboration with Harvard Medical School, seeks tounderstand the relationship between these entities
and to optimize treatment selection for military
healthcare system clinicians seeing patients withthese conditions. The study will use heterogeneity oftreatment effects (HTE) analyses to identify predictors of variation in sleep disturbance treatment
response and develop predictive analytic models
to improve treatment selection for individuals with
PTSD-related and other sleep disturbances.

RESEARCH IN THE CHILD AND FAMILYPROGRAMThe Center’s Child and Family Program (CFP) isa national leader in advancing scientific and clinicalknowledge, and providing educational resources
addressing the needs of children and families affected by trauma, with particular focus on our nation’s
military families. Military children and families
demonstrate unique strengths and vulnerabilities

as they are affected by combat-related illness andinjury, bereavement, child maltreatment and family
violence. CFP’s pioneering research addressing thesecomplex issues has been translated into scholarly
publications, as well as actionable and educational
materials for military and government stakeholders,clinicians, and community leaders. CFP also provides consultation to DoD leadership, national media outlets and engages in academic and professional
projects that more broadly support children within
the U.S. and throughout the world.

Family Bereavement

The National Military Family Bereavement
Study (NMFBS)
NMFBS is the first scientific study to examine the impact of a U.S. military service death on
surviving family members. The goal of the study
is to build upon the civilian research literature on
bereavement and its impact on survivors and determine how psychological, physical and/or behavioral
outcomes of the grieving process are influenced
by family members’ pre-existing psychological andphysical health, social and grief support, and military-specific factors. The longitudinal portion of thestudy, which consisted of annual interviews over athree-year period, was completed in 2017. Approximately 850 adults and 120 children completed thelongitudinal portion of the study, and 981 participants provided saliva samples for analysis of genetic
biomarkers associated with bereavement-related
outcomes. Findings from the study have informed
ongoing discussion to define appropriate diagnostic
criteria for a condition of impairing grief. As a resultof this groundbreaking work, CSTS has partneredwith colleagues at Columbia University, New York
University, University of Pittsburgh, and the University of California San Diego in developing a proposal
for alternate and more clinically-relevant criteriaof a persistent grief disorder to be included in future
editions of the DSM. A manuscript discussing theseissues has been accepted for publication in Psychological Medicine. In 2018, CSTS Scientists also
gave several presentations regarding findings fromNMFBS at national conferences.
2018 ANNUAL REPORT | 7

Stepping Forward in Grief (SFG)
NMFBS found that a sizeable portion of surviving military family members suffer from high levelsof grief and distress, putting them at risk for harmfulchanges in mental and physicalhealth. Based on these results,
CFP formed a partnershipwith the Center for Complicated Grief at Columbia
University to adapt Complicated Grief Therapy (CGT),
shown to be helpful in civilian
populations, into a digital intervention (GriefSteps)that is designed to assist with grief integration, anddecrease risk for long-term problems. The goal of
SFG, a randomized controlled trial, is to learn how
to best assist military family survivors with theirgrief and reduce the long-term problems that canoccur after a loss. Virtual apps may be an extremely
helpful resource for current and future bereaved
military family members. In 2018, 1,038 SFG participants were screened for eligibility, 464 participants
consented to participate, and 249 participants wererandomized to one of the two conditions.

Study of Long-Term Outcomes of TerrorismRelated Grief
CFP partnered with Voices of September 11th
(VOICES), a not-for-profit organization that provides services for 9/11 families, and the CanadianResource Centre for Victims of Crime (CRC), an
organization that is engaged with, and supportive of, family members who were bereaved by the
Air India Flight 182 bombing. The study partners
investigated long-term bereavement outcomes following a terrorism-related death, including grief,traumatic symptoms, resilience and post-traumatic growth. More than 400 family members
bereaved by the bombing of Air India Flight 182
or by the events of September 11th completed
online questionnaires about their experiences.
The study used findings to develop preliminary
working models for understanding risk and protective factors for bereaved family members ofterrorism-related deaths. Findings from this study
were presented to the research community at pro8 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

fessional meetings and a manuscript was acceptedfor publication.

Child Maltreatment in U.S. Military Communities
and Families
Several ongoing CFP projects focus on identifying risk factors for child maltreatment to inform thedevelopment of prevention and intervention strategies that promote military family health and resilience. CSTS initial work focused exclusively on childneglect, the child maltreatment type most commonly reported in the U.S. and most frequently associated with child fatality. The aim was to identify factorsthat contribute to elevated risk of child neglect by investigating characteristics of substantiated child neglect cases in U.S. Army families. Data were collected from records of 400 substantiated child neglect
cases from Army installations across the country. A
second CFP project, supported by funding awarded
from the DoD in 2016, builds on this line of research
to advance understanding of risk and protective
factors for child maltreatment in military families
from all Service branches. CSTS efforts to date havefocused on examining differences in the prevalenceof child abuse and neglect types in relation to child,family, and Service member characteristics. Future
work will include a population-based investigationof all active duty Service members with one or morechildren between the years 2004 and 2014 to examine longitudinal trends in child maltreatment in military families. Results from this project will informthe understanding of changes in risk and protective
factors for child maltreatment across the military life
course.

Combat Injured Families
CSTS Scientists have conducted a set of threestudies over the past several years to examine theshort- and long-term impacts of severe combat injury on military families, aiming to better understandand address the needs of combat injured militaryfamilies. The first study involved interviews withmilitary families assessing the unique and complex
challenges related to combat injury and associatedfamily functioning. Forty families were interviewed
at Operation Purple Healing Adventures (OPHA), anannual summer camp program for combat injured
Service members and their families sponsored by the
National Military Family Association (NMFA), anddata analysis continues. The second study investigates the impact of combat injury on military families over time. Participating families at Walter Reed
National Military Medical Center (WRNMMC)
and San Antonio Military Medical Center provided
valuable information about their experiences with
combat injury over time, which will be used to inform intervention strategies for spouses and childrenof combat injured Service members. Data collection
was completed in 2015 and data analyses and manuscript preparation continue. The final study, Families
OverComing Under Stress-Combat Injury (FOCUS-CI) consists of a pilot for a novel intervention
for children and families of combat injured Service
members in order to establish its feasibility and efficacy. Using a randomized controlled trial approach,the intervention is family-centered, strength-based,and evidence-informed to assist families coping withsevere combat injuries by providing instrumental
support and teaching emotion regulation, problem
solving, communication, and goal-setting skills. Data
were collected from families in Washington, DC,
Chapel Hill, NC and San Antonio, TX and data analyses comparing the effectiveness of the FOCUS-CI
intervention on family functioning to the existing
standard of care are ongoing. In addition, data collected from this project have provided novel insight
into issues of intimacy within marital relationships
between combat injured Service members and theirspouses, suggesting that this is negatively impacted
by spouse post-traumatic stress related to the Service member’s combat injury. A manuscript is currently in progress. Findings from these studies will
help us better understand the experience of combat
injury, its impact on Service members and their families, and inform programmatic intervention that canbetter address the needs of military families.

Family Violence
Since 1995, the Center’s Family Violence andTrauma Project has helped the Army Family Advocacy Program (FAP) meet its research and educationneeds. Staple products of this decades-old relation-

ship include the publication and distribution of two
newsletters — Research Review (RR) and Joining
Forces, Joining Families (JFJF). RR provides briefsummaries of current family violence research of interest to family advocacy, medical, and social service
providers. Under the motto “Real World Research
for Family Advocacy Programs,” JFJF consists of indepth coverage of research topics and methods. For
example, the Summer 2018 edition of JFJF featured
an interview with Dr. David Finkelhor, Director of
the Crimes Against Children Research Center, on
the limitations of screening for Adverse Childhood
Experiences in clinical settings.
CSTS research products produced for the Army
FAP in 2018 include bi-annual briefing books containing statistics on child and spouse maltreatment
for all Army installations that report family violence
as well as theater-level books for Europe, Japan, Korea, and the Army. Data presented include the type,
frequency and severity of substantiated incidents
of maltreatment as well as the demographics forvictims and offenders. Center Scientists also participated in the annual Army Fatality Review Board(FRB), wrote the initial report, and enhanced themethodological rigor of the annual reports. CSTS
also supported the Army Family Violence Research
Subcommittee in reviewing, coordinating, and disseminating family violence research conducted with
Army Central Registry data and other Army family
violence data sources.
Throughout any given year, Army FAP leadership is tasked with responding to a variety of urgent
topics, and Center Scientists assist their efforts by
2018 ANNUAL REPORT | 9

providing relevant research findings and associatedrecommendations where such literature exists. Center Scientists also assisted other Army agencies, suchas the Office of the Assistant Secretary of the Army
(Manpower and Reserve Affairs), the Office of theAssistant Chief of Staff for Installation Management,
the Installation Management Command, the Medical Command, the Army Military Police School,
and the Criminal Investigation Division. The Center
provided recent publications on subjects of interest
such as abusive head trauma, infanticide, assistancewith children who are exposed to family violence,
firearms and intimate partner homicide, child sexual
abuse, youth who sexually offend, strangulation as
well as other topics.

RESEARCH IN NEUROSCIENCEAND NEUROBIOLOGYLaboratory Research in Neuroscience and
Neurobiology

Genetics and Biomarkers
CSTS laboratory research continued to search
for the potential biomarkers for suicidal risk. Suicide is one of the 10 leading causes of death in the
U.S. and the suicide rate in the military population
has increased since the Iraq and Afghanistan wars.
However, few biomarkers for suicidal risk, particularly current suicidal ideation (CSI), have been
identified. CSTS has examined the association offour candidate genes with CSI in active duty U.S.
Army Special Operations Command and National
Guard units (n= 3,889) in Iraq and Afghanistan between November 2009 and July 2014. Current PTSD
symptoms, CSI, and traumatic events were assessedusing the PTSD Checklist (PCL) and PHQ-9, and theLife Events Checklist (LEC) that meet the DSM-IV
PTSD definition of a traumatic stressor, respectively. All genotypes of saliva DNA were discriminatedusing the TaqMan 5’-exonuclease assay. The associations between CSI and brain-derived neurotrophic
factor (BDNF), FK506 binding protein (FKBP5),
catechol-O-methyltransferase (COMT), or S100A10(p11) were examined. The research found CSI was
associated with BDNF, but not FKBP5, COMT, and
10 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

p11. Female Soldiers reported CSI more often thanmales, although gender did not affect CSI severity. In
addition, CSI was associated with depression, PTSD,
and BDNF, but not traumatic events. The BDNF Val66Met contributed to the severity of CSI even after
adjusting for PTSD, depression and LEC. The associations of BDNF with CSI and its severity suggest that
BDNF may be a predictor of suicidal risk, allowing
scientists to develop laboratory tools for medical
practice in suicide prevention and treatment.

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. The effort uses a non-mammalian model (zebrafish) for high-throughput rapid
screening in conjunction with a long establishedrodent model. The zebrafish colony, a new species
for the USU community, will provide an abundanceof potential research opportunities in drug development and beyond. The zebrafish lab has recently
begun initial tests of various chemical panels forstandardization of profiles within the zebrafish model. In addition to high-throughput embryo testing,the lab has begun ramping-up efforts to performtesting in adult zebrafish which have more than 100
testable characterized behaviors. Once fully established, the lab will begin high-throughput testing
and coordinate with its collaborators regarding

future directions for compound screening. Several
novel compounds are currently pending testing andsuccessful compounds will then be evaluated in theestablished rodent model at UCI.

Clinical Research in Neuroscience and
Neurobiology

Riluzole Augmentation Treatment forComplicated Combat-Related PTSD
CSTS continues analysis of data collected from
73 participants enrolled in a multi-site clinical 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.
The study tested efficacy of riluzole for treatmentof combat-related PTSD in veterans who continued
to have PTSD symptoms despite ongoing treatment
with evidence-based medications. Riluzole modulates the activity of glutamate, a highly prevalentneurotransmitter in the brain. Preclinical researchsuggests neuroprotective effects of riluzole as wellas downregulation of glutamate activity make it apromising addition to current evidence-based medications. This trial compared the addition of riluzole or placebo in a randomized, double-blind trial
over eight weeks. Participants reported symptomsof PTSD, depression, anxiety, and quality of life. In
addition to psychometric data, investigators collected magnetic resonance spectroscopy concentrationsin the amygdala and anterior cingulate cortex before
and after treatment as a potential biomarker ofillness and treatment response. Preliminary analysis
suggests that riluzole offers superior efficacy to placebo in the treatment of hyperarousal symptoms of
PTSD (unpublished data), but that is does not showsuperior efficacy in overall PTSD symptoms. Riluzole was well-tolerated in all study participants, withnone having to discontinue the trial due to medication side effects. CSTS Scientists further hypothesizethat spectroscopy changes in the amygdala, anterior
cingulate cortex and hippocampus will correlatewith 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 University of California, San Diego as part of a multisite
clinical trial testing the efficacy of the blood pressure
medication losartan for treatment of PTSD. Losartan is an angiotensin receptor blocker currently
FDA approved for treatment of high blood pressure.
Growing preclinical evidence points to the role of
the renin-angiotensin system in the central nervous
system as playing a role in fear memory reconsolidation and suggests that angiotensin receptor
blockers like losartan enhance fear extinction inrodent models. CSTS is currently recruiting participants at WRNMMC for this multi-site study. Other
study sites include Massachusetts General Hospital,
McLean Hospital, and New York University. This
trial compares treatment with losartan to placebo as
mono-therapy for treatment of PTSD over 10 weeks
of treatment. Participants report symptoms of PTSD
and depression, as well as side effects of medication,
every two weeks. Participants also undergo genetic
analysis of the angiotensin converting enzyme (ACE)gene as a potential biomarker of treatment response.
This clinical trial is currently recruiting participants
through 2019.

Nightmare Deconstruction and Reprocessing(NDR) for Treatment of PTSD-related
Nightmares
CSTS is conducting a clinical pilot trial of anovel exposure-based psychotherapy for PTSD-related nightmares, Nightmare Deconstruction andReprocessing (NDR). NDR is an adaptation of Dr.
Clara Hill’s three-stage cognitive-experiential dreammodel that specifically targets participants’ appraisal of dream content and meaning. The goal of thispilot study is to develop measures and proceduresfor development of a full-scale clinical trial. We will
test a range of potential psychometric, physiologic,
and biochemical markers and assess their tolerability and feasibility as well as that of the therapy. This
study will measure nightmare and insomnia severity, suicidality, PTSD and depression symptoms as2018 ANNUAL REPORT | 11

psychometric outcomes. It will measure genetic andinflammatory biomarkers at various points in treatment as potential biomarkers of treatment response.
Finally, we will collect continuous data on heart rate,electrodermal activity, and motion using the Empatica E4 wristband device. Included in this continuous
data collection will be ecological momentary assessment to measure variation in PTSD, depression, andanxiety symptoms and daytime functioning throughout the day. This pilot trial will begin recruiting
participants in 2019 at WRNMMC with participant
recruitment at Naval Hospital Camp Pendleton laterin 2019.

The VA National PTSD Brain BankThe VA National PTSD Brain Bank, which began
in 2015, is the first brain tissue repository dedicatedto researching the impact of trauma and stress on
brain tissue and function. CSTS Scientists direct
the Brain Bank’s Assessment Core and serve on the
Brain Bank’s Scientific Advisory Board. This research
is designed to identify biomarkers of susceptibility
and resilience to trauma and help target new treatments at the cellular level. The Brain Bank enrolls
potential donors throughout the nation. The donors
receive comprehensive longitudinal assessment via
clinical interview and periodic surveillance fromthe time of enrollment until the time of their death,when their brain tissue is donated to the Brain Bank.
The Brain Bank has also developed a protocol forcomprehensive post-mortem diagnostic assessmentof donors (through medical record review and third
party interview) in instances where ante-mortem
assessment of PTSD is not possible.
12 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

This year the Brain Bank obtained tissue from26 donors diagnosed with PTSD and 41 persons
with no history of PTSD. The Brain Bank includes
tissue from nearly 200 donors, half of whom werediagnosed with PTSD. In addition, nearly 80 living
persons have enrolled in the longitudinal follow-up
registry to serve as future donors. Through CSTS,
the Brain Bank continued collaborating with the
Lieber Institute for Brain Development and the USU
Collaborative Health Initiative Research Program(CHIRP) to perform whole genome sequencing andmethylation studies in collaboration with Yale, for
the Brain Bank’s first core study.
The Brain Bank continues to explore expansion
sites. The Assessment Core developed a new standardized record review form insuring that all collection sites render post-mortem diagnosis of PTSD
(and comorbid conditions) in a harmonized manner.
The form will also facilitate export of relevant diagnostic data in conjunction with ongoing genomic
analyses. This year, CSTS Scientists formalized anagreement with the Armed Forces Retirement Home
(AFRH) in Washington, DC to allow investigators toregularly inform AFRH residents of opportunities
to participate in PTSD research including the VA
National PTSD Brain Bank project.

The Brain Indices Study
The goal of this research is to develop reliable
and valid predictors of negative outcomes after mild
traumatic brain injury (mTBI). Potential predictors
include measures of brain structure and function.
The research will inform targeted treatments thatcan be implemented early, and thereby enhance thelives of our wounded warriors and their families.
The study was funded by the DoD CongressionallyDirected Medical Research Programs (CDMRP)
and the Center for Neuroscience and Regenerative
Medicine (CNRM). Data were collected in the Brain
Assessment Research Laboratory at WRNMMC and
Fort Belvoir Community Hospital. This longitudinal study was designed to identify brain measuresthat predict PTSD and other deleterious outcomesin Service members with mTBI. The assessment
battery includes clinical, neuroimaging (structural
MRI/DTI), electrophysiological, neurocognitive, andneurological assessments. The assessments, conducted soon after injury, and three and six months
later, included interviews for PTSD, depression, andheadache, as well as post-concussive symptoms andoverall mental and physical health status. Activities
in 2018 included data processing and analysis, andmanuscript preparation.

The Chronic Effects of Neurotrauma
Consortium Study 1: Observational Studyon Late Neurologic Effects of OEF/OIF/OND
CombatThis investigation is funded by the DoD CDMRP
as part of the multisite TBI Consortium. The goal isthe evaluation of the chronic effects and comorbidities of TBI. A battery of physiological, psychological,
neurocognitive, occupational, and social functioning
tests was given to current and past Service members
who sustained TBI in OEF/OIF/OND. They underwent repeated in-person and telephone assessments
to track their overall status. CSTS directed theelectrophysiological (event-related brain potentials
and EEG) component of this study, related to assessment of sensory and cognitive abilities. This cohort
will allow an evaluation of the post-TBI prevalence,natural history, and intervention response to chronic
symptoms and related comorbidities. The data willallow for analysis of the effect of post-injury time
on chronic symptoms, comorbidities, and signs ofneurodegeneration or recovery.

Application of Somatosensory Evoked
Potentials to the Diagnosis of Traumatic
Brain Injury (TBI): A Translational ApproachRESEARCH ON DISASTERS 		
AND TERRORISM
Florida Department of Health Response to Multiple
Hurricanes
CSTS Scientists continue to examine the risk
and protective factors for post-traumatic disorders,
psychological distress, and health risk behaviors
in civilian and military populations that have been
exposed to natural disasters. This work is particularly important in light of the multiple disasters thathave occurred within this past year, including thedevastating California wildfires and mudslides, andHurricanes Michael and Florence, each resulting insignificant destruction to property, as well as severe
injury and death to community residents. During
2018, Center Scientists identified factors that may
play a role in recovery from multiple hurricane exposure by examining the psychological and behavioral
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
on community residents’ self-reports of daily distress following the hurricanes, as measured by the
CDC Health-Related Quality of Life Healthy Days
assessment. Findings indicated that lower perceived
collective efficacy was associated with increased
risk of PTSD and frequent mental distress (reported as 14 or more mentally unhealthy days within
the last 30 days), even after adjusting for individual

The goals of this FDA-funded research are to: (a)determine the diagnostic utility of specific EEG biomarkers in Service members with blast-induced TBI
based on translational work in mouse models; (b)employ components of the somatosensory evoked
potential (SEP) to assess TBI neurosensory effects;and (c) assess correlations between the magnitudeof EEG changes and the severity of TBI. The research was designed to shed light on the question ofwhether SEPs can function as an EEG field-deployable biomarker diagnostic of TBI. Data collection at
WRNMMC is expected to commence in early 2019.
2018 ANNUAL REPORT | 13

and community socio-demographic characteristics,
individual injury/damage, and community storm
damage. This research suggests the importance ofdeveloping strategies that increase neighborhood cohesion and promote resilience. This can be achieved
through community-level interventions, which arecost-effective, practical, and may reach individuals
who may not seek or have available interventions
after a disaster.

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 relationships of sniper-related
television viewing, identification with the victimsof the attacks, and peri-traumatic dissociation
on post-traumatic stress symptoms. The findings
indicated that higher levels of TV viewing (at least
two hours per day) may influence identification andis associated with increased post-traumatic stresssymptoms. In addition, CSTS research has foundthat high amounts of event-related television viewing and decreased perceived safety were related topost-traumatic stress and depressive symptoms. Specifically, higher levels of TV viewing were associatedwith post-traumatic stress symptoms in individuals
who reported both low and high levels of perceived
safety, whereas high TV viewing was related to depressive symptoms particularly in those who reported low safety. CSTS is currently examining the roleof confidence in law enforcement and perceived safety on changes in behavior during the sniper attacks.
Findings indicated that those who were younger, female, and reported lower levels of confidence in law
enforcement and lower perceived safety were more

14 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

likely to change their routine behaviors in responseto the sniper attacks. A better understanding of theinterrelationships of these 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 is part of a multi-site study designed
to better understand risk and protective factors associated with response efforts following community
mass violence. The first phase of the study involved
assessment 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 theimpact of this mass shooting incident. This collaboration leverages an ongoing relationship with Naval
Sea Systems Command (NAVSEA) to provide a
better understanding of the social and occupationaldifficulties still impacting personnel following theevent. The next steps involve data collection andanalysis with a representative sample of personnel
and family members impacted by the event. The
results will inform public policy on future interventions following mass violence events.

Education and Training
A fundamental aspect of the Center’s work is education and training. Center Scientists educate andtrain USU medical students committed to service
in our nation’s Army, Air Force, Navy and Public
Health Service. The Center educates leaders andhealth care providers in state, federal, private sector
and global settings. In addition, the Center sponsors
conferences, seminars, symposia, and forums thathave educational and training objectives. The Center
advances the field of military and disaster psychiatry
through presentations, outreach and training, as wellas through participation in conferences, collaborations and workshops throughout the U.S. and international community. The Center also educates andexpands knowledge through public health efforts
and interventions during and after disasters.
One of the Center’s important public healtheducation tools is development and dissemination of
educational materials to inform stakeholders including: families, healthcare providers, community andorganizational leaders, first responders and publichealth emergency workers, teaching professionals
and policy makers. For more than two decades, theCenter has created customized, easy-to-read, highlyDrs. Fullerton and Mash at CSTS exhibit booth.

actionable, just-in-time educational fact sheets toassist Center stakeholders in managing the adverse
effects of disaster events through enhanced preparedness, response, and recovery efforts.
In 2018, the Center provided educational resources to partners throughout the DoD, as well as
to other Federal agencies, state and local agencies,
professional associations, and others. The Center
also responded to many disaster events, including
the mass shooting incidents at Stoneman Douglas
and Santa Fe High Schools, the Tree of Life Synagogue, the Borderline Bar, and the Capital Gazette;
Merrimack Valley gas explosions; the 156th Puerto
Rico Air National Guard plane crash; shootingsand car terrorism in Toronto, Canada; wildfires inNorthern and Southern California; and Hurricanes
Florence and Michael, which impacted the Gulf
region and East Coast of the United States.

DISASTER RESPONSE AND PUBLICEDUCATION
Since its inception in 1987, the Center has been
providing disaster preparedness and response consultation and education in many forms and in many
situations. Center personnel have provided on-theground education and consultation to extreme national and global disasters, as well as immediate andlong-term online, video and telephonic support toassist response and recovery efforts following a wide
range of disaster events.
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
Center personnel have been sought out for expert
guidance on optimizing disaster preparedness andresponse 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 2018:2018 ANNUAL REPORT | 15

■■

■■

■■

■■

■■

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As part of his role as a Deputy Commander for
a Disaster Medical Assistance Team (DMAT)of the U.S. National Disaster Medical System(NDMS), a Center Scientist was deployed toFort Walton Beach Medical Center in Florida toassist with medical response operations following Hurricane Michael, and was later deployed
to the U.S. Commonwealth of the Northern
Mariana Islands to assist with response operations following the devastation caused by Super
Typhoon Yutu.
In response to the catastrophic hurricanes in
Florida, Georgia, Virginia, and the Carolinas,
CSTS developed and disseminated dedicatedwebsite education pages to provide actionableguidance for responders and emergency workers, families, healthcare personnel and community leaders to reduce distress and enhancewell-being.
To aid community leaders in Spanish-speaking
communities impacted by the hurricanes in the
Gulf of Mexico, the Center disseminated Spanish
versions of the most commonly accessed disaster education 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 grief, stress management and communication.
The Center worked with the embedded healthcare team at the U.S. Air Force 480th Intelligence, Surveillance and Reconnaissance Wing
at Langley Air Force Base to assess stress andmental health in the intelligence operators managing information from remotely piloted combat
aircraft.
Center Scientists provided educational support
to the USU Masters in Public Health Program bydelivering two educational seminars on domestic
and international 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.”

16 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

The Center partnered with the Drug Enforcement Administration (DEA) to provide the leadpresentation for a three-day reintegration event
for DEA agents (and their spouses) returningfrom high-threat overseas posts, as well as military deployments in the Middle East.
■■ For the fourth 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
Psychiatry Residency Program.
■■

NEUROSCIENCE MODULE FOR PRECLERKSHIP USU MEDICAL STUDENTS
The neuroscience module is led by CSTS Senior
Scientists and the USU Department of Anatomy,
Physiology, and Genetics. The module teaches medical students the principles of neuroscience throughintegrated content across a range of disciplines.
From this foundation, students learn to recognize,
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-centeredclinical skills, including the performance of neurologic and mental status examinations, were developed through simulated patient experiences. Topics
related to military medicine, medical history, humancontext and health service support are integrated
throughout the module with the goal of fostering amore robust and well-rounded education for thesefuture military medical officers.

EDUCATION AND TRAINING IN
COMBAT AND OPERATIONAL STRESSCONTROL: OPERATION BUSHMASTER
In line with USU’s mission to prepare uniformed
health professionals to support the readiness of the
U.S. Armed Forces, CSTS Scientists offer training
in Combat and Operational Stress Control (COSC)
as a core component in military medical education.
CSTS Scientists were engaged in curriculum preparation, faculty development, and direct teaching aspart of the annual USU medical field training exer-

cise, Operation Bushmaster. Operation Bushmasterchallenged senior medical and graduate nursing
students to operate an operational medical unit
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 was a core skill taught and evaluatedas part of the exercise. CSTS faculty collaborate withthe psychiatry residency programs of the National
Capital Consortium, the San Antonio Uniformed
Services Health Education Consortium, and theNaval Medical Center Portsmouth to provide an
opportunity for resident physicians to develop theirteaching skills and understanding of COSC as adjunct faculty.

Center Scientists are finalizing work on theAmerican Psychiatric Association’s textbook on
PTSD. This textbook pulls together experts fromacross the field of PTSD and trauma with the goalof creating an expansive and engaging reference on
this important topic. Slated for publication in late2019, the textbook covers a wide spectrum of topics
from basic diagnostics and neurobiology to more
specialized areas such as cultural considerations andworking with special populations.

Center presented the “13th Annual Amygdala, Stressand PTSD Conference: The Sequelae of Trauma.”With more than 300 registrants, this conference
brought together scientists, clinicians and policy
makers for a day of working towards solving thebiological basis of stress, fear and PTSD. Nationallyrenowned speakers came from leading institutions
in Canada and across the U.S. including the University of Western Ontario, Yale University, Columbia
University, and Cornell University. The speakers
presented and discussed topics such as complicated grief, PTSD and addiction, and understanding
trauma in a cultural context. In addition to theconference, the Center partnered with the Journal of
Neuroscience Research for a special mini-issue basedon the conference presentations.

EDUCATIONAL CONFERENCES

Forum on Health and National Security

UPCOMING TEXTBOOK ON PTSD

The Center sponsored two educational conferences in 2018: the 13th Annual Amygdala, Stress and
PTSD Conference, and the Forum on Health andNational Security.

Amygdala, Stress and PTSD Conference
The Amygdala, Stress and PTSD Conference isan annual international conference sponsored by
the Center based on the collaboration of the USU
Department of Psychiatry, USU Neuroscience Program, USU Department of Family Medicine, and the
WRNMMC Department of Psychiatry. In 2018, theIn 2018, CSTS co-sponsored the “Forum on
Health and National Security: Ethical Use of Big
Data for Healthy Communities and a Strong Nation.”
The forum brought together 20 interdisciplinary
experts in science, engineering, and healthcare from
DoD, the Veterans Administration, the National Science Foundation, private sector entities and a number of universities including the University of North
Carolina, Emory University, Georgia Tech, Meharry
Medical College and Spelman College. The forum
was held to develop informed recommendations forthe ethical implementation of research involving
the collection and analysis of big data as well as the2018 ANNUAL REPORT | 17

development anduse of predictive
algorithms. The
findings andrecommendations will be used
to guide futurestudies anddevelop recommendations
for public andprivate sector
research using
big data.

TRAINING TO SUPPORT RESEARCH
CSTS educates and trains its own staff, including
research support staff such as Research Assistants(RAs). RAs play an important role in supporting
research at CSTS, and are provided with opportunities to learn by working closely with CSTS Scientists. The RAs contribute to Center research inmany ways including conducting literature searches,data collection, data entry, and writing summary
reports of meetings. Skills the RAs develop at CSTS
include developing slides and posters for researchpresentations, and presenting complicated findings
in an understandable way to professionals as wellas the general public. In addition, RAs are offeredprofessional development opportunities including
attending and presenting posters at professional
conferences, and assisting with manuscript preparation for publication in peer-reviewed scientificjournals. Many RAs move on to further their education by pursuing advanced degrees. Others moveon 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 School of Hygiene
and Tropical Medicine, and USU. Opportunities RAs
have pursued following their experience at CSTS
have included:■■ PhD programs in psychology and related fields■■ Medical school■■ Law school
18 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Master degree programs in psychology, counseling, public health and social work■■ Training positions at NIMH■■ Careers with the FBI■■

DISSEMINATION AND
IMPLEMENTATION OF HEALTH AND
RESEARCH KNOWLEDGE
Fact Sheets
Fact sheets are a long-standing communication
tool of CSTS. Fact sheets are easy to understand,topic-focused, actionable, education resources developed using expert
knowledge tocommunicate essential behavioral
health content
on difficult and/or crisis-related
issues. Fact sheets
address the needsof a broad rangeof partners andstakeholders,
including healthcare providers,
first responders and emergency workers, family
members, community leaders, and policy makers.
CSTS fact sheets, which are developed, updated andmaintained in an online repository, address a wide
range of issues pertaining to disaster preparedness
and response, risk and crisis communication, as wellas health risk education. CSTS fact sheets provide
readers with resources tailored to the unique aspectsof each disaster event and disaster community. The
Center develops, updates and rapidly disseminates
fact sheets, in real time, following major disasters
and traumatic events such as community violence,terrorism and bioterrorism, and public healththreats.

WebsiteA central tool the Center uses to further the goalof disseminating relevant and timely information
to a wide range of stakeholders is the CSTS website

CSTS website was used by an average of 1,884 persons per month for a total of 22,613 users over thecalendar year. That represents a 53% increase in use
as compared to last year. More importantly, morethan three-quarters (78%) of the website visitors in2018 were new users. Most of the website visitors(82%) were from the U.S., but people from a total of
136 countries visited the website in 2018 (14 morecountries than in 2017). Aside from the U.S., thecountries with the most users were Canada, Australia, France and India.

Social Media(www.CSTSonline.org). Throughout the year, CSTS
personnel continually added content and madecontent more accessible. Material available on thewebsite includes summaries of current research
activities, publication citations, newsletters, conference reports, and a searchable repository of ourdisaster mental health education fact sheets. The
website includes a “What’s New” section to highlight recent disaster education materials, research
initiatives, publications, conference summaries andannouncements of upcoming events. In 2018, theIn 2018, the Center continued to grow its online
presence through the use of social media. Thesesocial media resources allow for the timely dissemination of relevant content to our partners and the
public. CSTS Twitter followers increased by 59% andCSTS Facebook followers increased by 27% in thepast year. The Center encourages people to visit andfollow CSTS postings via Twitter and Facebook tostay up-to-date on new CSTS activities and publications. “Like” CSTS on Facebook at Center for
the Study of Traumatic Stress and follow CSTS on
Twitter @CSTS_USU.

Amygdala Conference presentation.

CSTS staff supporting Amygdala Conference.

2018 ANNUAL REPORT | 19

Consultation
Consultation has been a central function of CSTS
since its founding and a key mechanism throughwhich CSTS staff share the outcomes of their research and utilize their deep and broad experience.
In addition, consultation is a valuable mechanism
to assure that CSTS staff are aware 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 and organizations throughout the DoD and other Federal agencies, as well aswith state, local and national agencies, professional
associations, and international organizations. Ourconsultative partnerships include a wide variety ofpartner organizations both inside and outside government, and internationally. At times, our interactions are based on longstanding organizational linkages, while other times our consultation is sought by
new partners. The following are examples of some of
our long-standing consultations as well as some newconsultations in 2018.

NATIONAL ASSOCIATION OF
STATE MENTAL HEALTH PROGRAMDIRECTORS (NASMHPD)
For more than a decade, CSTS has had a relationship with NASMHPD, a membership organization
representing state mental health authorities (Commissioners) responsible for preparedness, response,
and recovery from large and small scale disasters.
CSTS assists the Commissioners in addressing themany challenges inherent in those systems including
military families and veterans served by the statepublic mental health systems. CSTS and NASMHPD
leadership were in frequent contact throughout 2018
to address information on disaster response. The
Center provided unsolicited general and targeted
public information to NASMHPD for distribution
to disaster impacted states. In addition, NASMHPD
requested specialized information and consultationfrom CSTS regarding individual events. The Center’s
20 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

relationship with NASMHPD fosters CSTS relationships with individual states. For example, at the invitation of the Missouri Department of Mental Health(MODMH), CSTS leadership facilitated a Disaster
Summit that focused on training disaster responders
following 2018 events including floods, tornadoes,
and civil unrest. Also in 2018, a CSTS Scientist was
asked to serve on the State of Maryland’s Medical
Reserve Corps’ advisory council which provides strategic direction for the state’s Medical Reserve Corps.

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).

Assistant Secretary for Preparedness andResponse (ASPR)
CSTS communicated with ASPR staff and leadership on a regular basis to share information. In 2018,
a CSTS Associate Director was an invited contributor to the DHHS-sponsored National Summit on
Bio-incident Recovery titled, “What the Country’s
Thought Leaders See as the Top Priorities for Developing Guidance to Help Affected Communities
Recover.” The summit convened 50 leaders in a daylong conference that resulted in recommendations
regarding strategies, opportunities, and challenges
related to community-level health.

Substance Abuse and Mental Health Services
Administration (SAMHSA)SAMHSA is one of the oldest CSTS partners, going back to SAMHSA’s founding in 1992. SAMHSA
is the lead federal agency responsible for supporting and improving national mental health services.

CSTS regularly provided emerging evidence-based
articles and materials to assist SAMHSA in staying
current with information and guidance. In 2018, aCenter Associate Director continued to serve on the
Disaster Distress Helpline (DDH) Steering Committee to provide guidance, feedback and peer-review offunding requests. CSTS provided materials to DDH
which were incorporated into their Best Practices for distribution across their network of service
providers. The CSTS Assistant Director was invited
to serve as a Subject Matter Expert on SAMHSA’s“Disaster Behavioral Health Expert Panel” meetingthat brought together 18 national interagency andprivate sector experts to examine the current stateof research in the field of disaster behavioral health.
A CSTS Senior Scientist provided consultation to
SAMHSA regarding the possibility of a new DHHS
survey of mental and addictive disorders to address
major policy issues. In addition, CSTS participatedin an Expert Panel on Child, Adolescent, and Transition Aged Youth Trauma and Serious Emotional
Disturbance/Serious Mental Illness at a conference
sponsored by SAMHSA’s Center for Mental HealthServices.

THE NATIONAL CENTER FOR DISASTER
MEDICINE AND PUBLIC HEALTH(NCDMPH)
CSTS maintained a strong and growing partnership with NCDMPH in 2018 through several
important collaborations. CSTS, along with the
NCDMPH and the USU Leadership Education andDevelopment Program, sponsored a symposium at
USU entitled “Crisis Leadership Symposium: Promoting Emotional Well-Being” for a diverse audience that included military, government, civilian,and other stakeholders. The keynote speaker was
Admiral Thad Allen (ret.), former USCG Commandant, and the panels included leaders with significant field experience in disaster response as wellas program, policy and academic leaders. A CSTS
Associate Director was featured on the NCDMPH’s
2018 podcast, “Disaster Dialogues: Perspectives
from the Field.” At the request of CSTS partners at
NCDMPH, CSTS staff 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
based in NCDMPH.

NATIONAL CHILD TRAUMATIC STRESSNETWORK (NCTSN)The Center continued to work with NCTSN in
partnering with the Network’s Military and Veteran Families Program in their efforts to develop andimplement trauma-informed, evidenced-based interventions and approaches to 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
programs and providers that specialize in treatment
and services for military communities.

MILITARY CHILD EDUCATIONCOALITION (MCEC)MCEC’s mission is to support the educational, developmental, and social-emotional needs ofmilitary-connected children, worldwide. In 2018, a
CSTS Senior Scientist served on MCEC’s Scientific
Advisory Board and, in partnership with NCTSN,
CSTS sponsored a pre-conference workshop entitled, “Building Resilient Communities Facing Real
Problems” at MCEC’s annual meeting. This event
brought together researchers and practitioners
with expertise in youth substance use, bullying, andsuicidal behavior to discuss approaches to problems
faced by military children and families.

NATIONAL ACADEMIES OF SCIENCES(NAS)
A CSTS Scientist participated in the planningand implementation of a 2018 workshop at the
National Academies of Sciences, Engineering, andMedicine titled, “Strategies, Interventions andPolicies for Health Promotion, High Risk Behavior
2018 ANNUAL REPORT | 21

Prevention and Increased Performance of the DHS
Law Enforcement Workforce.” In addition, A CSTS
Associate Director represented the Center at the
National Academies of Sciences, Engineering andMedicine Committee on Military Family Well-being.

THE AMERICAN PSYCHIATRICASSOCIATION (APA)
CSTS worked with the APA and other national
medical associations to educate and train health professionals on disaster mental health. 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 eversince. In 2018, CSTS Scientists provided formal andinformal disaster consultation and education resources to APA District Branches in response a wide
range of disaster events, including mass violence andterrorist events in the U.S. and Canada, as well as climate-related disasters, such as hurricanes and wildfires. CSTS provided consultation services including
guidance and resources on enhancing preparedness,
response and recovery following disasters. CSTS
education fact sheets served as an important resource for District Branches to assist them in rapidly
disseminating critical, time-sensitive, 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 disastermental health, addressing fundamental issues suchas psychological and behavioral responses to disasters, vulnerable populations, and evidence-based
early interventions to reduce distress and enhancewell-being. The audience of 54 psychiatrists and other mental health professionals from across the globe
took part in the course, which offered a blend of
didactic learning, interactive polling, and case-based
small group exercises to reinforce content.
In addition, a Center Senior Scientist collaborated with colleagues from WRNMMC, Yale University,and the Veterans Health Administration to present
two workshops at the APA Annual Meeting. The
workshops presented communication strategies forphysicians to better understand risk-decision mak22 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

ing by their patients concerning firearms ownershipand storage practices and to help move their 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.

GLOBAL HEALTH
The reach of CSTS consultation activities extends
beyond our nation’s borders to the international
community. The following are examples of CSTS
international activities in
2018.

Global Health Engagement
The Global Health Engagement focus at USU
continued to evolve and solidify during 2018 with
development of the USU Center for Global HealthEngagement (CGHE). During 2018, the Center
regularly participated in briefings by CGHE for all
relevant USU stakeholders.

International Outreach
The Center Director participated in the International Ministerial (5-Eyes) Centres of Excellence
Conference on Veterans’ Issues in Sydney, Australia.
The conference involved the Australian Government
Minister for Veterans’ Affairs and delegations from
Canada, New Zealand, the United Kingdom, and theUnited States who discussed veterans’ mental healthissues and transition from military to civilian life.
The CSTS Director also presented the work CSTS
has been doing during the “Innovative ResearchConsortium,” an international working group on
military and veteran health.
The Center Director participated in a NATO
Advanced Research Workshop meeting in Odessa,

Ukraine and gave the keynote presentation titled,“Essential Issues on Terrorism.” Participants included experts from several NATO countries and scientific organizations. The purpose of the workshop was
to develop evidenced-based guidelines for treating
terrorism-induced stress and focused on bridging
clinical practice and non-scientific mechanisms underpinning long-lasting responses to terrorism-induced stress.
A CSTS Scientist participated in the NATO Research Task Group Meeting in Amsterdam, Netherlands. Participants included representatives fromother NATO countries and scientific organizations.
Virtual reality, simulation, and serious gaming werereviewed as part of a three-year effort to understandthe latest technologies available for the treatment ofmilitary-relevant mental health conditions.
The NATO Leveraging Technology in Military
Mental Health Research Task Group held a meetingon the topic of “Big Data and Machine Learning”
at the Canadian Embassy in Washington, DC. This
international meeting, which was hosted by a Center
Senior Scientist and sponsored in part by the Center, brought together panelists and presenters from
Canada, the Netherlands, Australia, and the UnitedStates to discuss the potential value and opportunities offered by big data and machine learning. Panelists and observers were given presentations on big
data, as well as how machine learning and big data

are used in suicide prevention interventions, patient diagnoses, virtual reality, digital phenotyping,protein biomarkers, and neuroimaging. Presenters at
the meeting included the CSTS Director and several
CSTS Scientists.
A CSTS Associate Director continues ongoing
consultation and collaboration with Canada’s Earth
Sciences Sector, Natural Resources Canada. Consultation and collaboration involved using communications by seismologists to incorporate psychosocial
considerations in their communications following
earthquakes.
A CSTS Senior Scientist presented at a meetingat Columbia University of the World Psychiatric
Association Section on Epidemiology and Public
Health titled, “Emerging mental health challenges across the globe.” The presentation was titled,“Epidemiology links to nosology and mental healthpolicy: Historic Perspective.”
A CSTS Scientist participated in a conferenceof the Association of Medical Educators of Europe(AMEE) in Basel, Switzerland. He presented, “Entrustable Professional Activities in Undergraduate
Medical Education” that included a review on the
topic, the limitations of this new assessment modality, and areas for future research. He also ran a workshop titled, “I teach therefore I Am” that focusedon educator identity and how that can shift whentransitioning to online teaching. He helped education leaders identify and leverage the influence thatonline teaching has on educator identity.
A CSTS Scientist directed a five-day course on
Disaster Mental Health in Mauritius, Africa andconsulted with leaders of Mauritius’ Disaster Response Program. The course was part of the DoD’s
Defense Institute on Medical Operations (DIMO)
program. He re-designed the course for the specificneeds of Mauritius and helped with developmentof their mental health disaster response plan. The
course was a success and has been requested by fourother African nations for 2019.

CSTS group at the Canadian Embassy inWashington, DC for the NATO meeting on Big Data
and Machine Learning.

Extreme Weather-Related Disasters andMental HealthCenter Scientists developed the APA’s first continuing education module on, “Climate Change and2018 ANNUAL REPORT | 23

Disaster Mental Health.” This one-hour interactive
online learning activity provided content for healthcare and other professionals to better understandpsychological and behavioral effects, vulnerable
populations, evidence-based interventions, and preparedness measures with respect to climate-related
disasters. In 2018, a Center Scientist was invited

THE USS NAIFEH

to speak on the panel, “Is Climate Change a Threat
to Human Health?” at the Annual Conference of
the Association of Health Care Journalists in Phoenix, AZ. He presented, “Climate-Related Disasters:
Impact on Public Mental Health and How the MediaCan Help” to health care journalists.

CSTS Leadership recently learned
that a U.S. Navy ship was named aftera relative of Dr. James A. Naifeh, aCenter Scientist and Research AssistantProfessor in the USU Department of
Psychiatry. We asked Dr. Naifeh a few
questions about the story behind thenaming of this ship.
Dr. James A.
Naifeh.

What is the story of the Navy ship
named after your relative?

The USS Naifeh was a John C. Butler-classdestroyer escort named in honor of Navy Lieutenant, Junior Grade, Alfred Naifeh. Lt. Naifeh
was serving aboard the destroyer USS Meredith
when it sank during the Battle of the Solomons inWorld War II. For two days and nights, Lt. Naifeh
swam back and forth among the life rafts, fighting off shark attacks, in order to render aid to his
wounded and exhausted shipmates. As a result of
his continuous efforts, Lt. Naifeh was eventually
overcome by exhaustion and died on October 16,
1942. For his devotion to duty and courage, Lt.
Naifeh was posthumously awarded the Navy andMarine Corps Medal and a Purple Heart. The
USS Naifeh was commissioned on July 4, 1944.

which my great grandparents emigrated in the early twentieth century. The
population of Marjeyoun is small enoughthat it is safe to assume all Naifehs who
emigrated from there are related. In addition, Alfred Naifeh was born in Covington, Tennessee. My grandfather was bornin Hickman, Kentucky, about 90 miles
away, and he often spoke of his relatives
in Covington, Tennessee.

What was your reaction to learning
about the USS Naifeh?

The story of Alfred Naifeh and the shipthat bears my family’s name has always beena source of pride. Lt. Naifeh’s courage anddevotion to his shipmates are awe-inspiring.
My grandfather, an Army Staff Sargent, and my
grandmother’s four brothers, were also among
the many second-generation Lebanese-American immigrants who fought for the UnitedStates in World War II. I am deeply appreciative of their service and sacrifice.

What is your relationship to Alfred
Naifeh?

This remains somewhat of a mystery thatmy father and I are eager to solve. A framed
photograph of the USS Naifeh always hung in
the hallway at my grandmother’s home, but ourexact relationship to Alfred Naifeh has been
lost over time. He is a distant relative, perhaps
a second cousin of my paternal grandfather. We
know that Alfred Naifeh’s family emigrated from
Marjeyoun, Lebanon, the same small town from24 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

The USS Naifeh.

Publications(Names in bold text are CSTS personnel)

JOURNAL ARTICLES
Abraham, P. A., Russell, D. W., Huffman, S.,
Deuster, P., & Gibbons, S. W. (2018). Army
combat medic resilience: The process of forging
loyalty. Military Medicine, 183(suppl_1), 364370. doi: 10.1093/milmed/usx231
Bernecker, S. L., Rosellini, A. J., Nock, M. K., Chiu,
W. T., Gutierrez, P. M., Hwang, I., Joiner, T. E.,
Naifeh, J. A., Sampson, N. A., Zaslavsky, A.
M., Stein, M. B., Ursano, R. J., & Kessler, R. C.
(2018). Improving risk prediction accuracy for
new soldiers in the U.S. Army by adding selfreport survey data to administrative data. BMC
Psychiatry, 18(1), 87. doi: 10.1186/s12888-0181656-4
Bernecker, S. L., Zuromski, K. L., Gutierrez, P.
M., Joiner, T. E., King, A. J., Liu, H., Nock, M.
K., Sampson, N. A., Zaslavsky, A. M., Stein,
M. B., Ursano, R. J. & Kessler, R. C. (2018).
Predicting suicide attempts among soldiers who
deny suicidal ideation in the Army Study toAssess Risk and Resilience in Servicemembers(Army STARRS). Behaviour Research Therapy.
doi:10.1016/j.brat.2018.11.018
Cozza, S. J., Ogle, C. M., Fisher, J. E., Zhou, J.,
Whaley, G. L., Fullerton, C. S., & Ursano,R. J. (2019). Associations between family risk
factors and child neglect types in U.S. Armycommunities. Child Maltreatment, 24(1), 98-106.
doi: 10.1177/1077559518800617
Chu, K. M., Garcia, S. M. S., Koka, H., Wynn,
G. H. & Kao, T. C. (2018): Mental healthcare utilization and stigma in the military:Comparison of Asian Americans to other racial
groups. Ethnicity & Health. doi:10.1080/1355785
8.2018.1494823
Danandeh, A., Vozella, V., Lim, J., Oveisi, F.,
Ramirez, G. L., Mears, D., Wynn, G. H.,& Piomelli, D. (2018). Effects of fatty acidamide hydrolase inhibitor URB597 in a rat
model of trauma-induced long-term anxiety.

Psychopharmacology, 235(11), 3211-3221. doi:
10.1007/s00213-018-5020-7
Driggers, K., & Meyer, E. (2018). Seizure on abenzodiazepine-sparing alcohol-detoxification
protocol: A case report. Psychosomatics. doi:
10.1016/j.psym.2018.10.005
Dunn, E. C., Sofer, T., Wang, M., Soare, T. S.,
Gallo, L. C., Gogarten, S. M., Kerr, K. F., Chen,
C., Stein, M. B., Ursano, R. J., Guo, X., Jia, Y.,
Yao, J., Rotter, J. I., Argos, M., Cai, J., Perreira,K., Wassertheil-Smoller, S., & Smoller, J. W.
(2018). Genome-wide association study (GWAS)
of depressive symptoms in the Hispanic
Community Health Study/Study of Latinos(HCHS/SOL). Journal of Psychiatric Research, 99,
167-176. doi: 10.1016/j.jpsychires.2017.12.010
Fisher, J. E. (2018). Music as biology: The tones welike and why. Psychiatry, 81(3), 297-298. doi:
10.1080/00332747.2018.1502554
Fullerton, C. S., Mash, H. B. Herberman,
Morganstein, J. C., & Ursano, R. J.
(2018). Active shooter and terrorist event-related
posttraumatic stress and depression: Televisionviewing and perceived safety. Disaster Medicine
and Public Health Preparedness. doi:10.1017/
dmp.2018.121
Hefner, K. R., Sollazzo, A., Mullaney, S., Coker, K.
L., & Sofuoglu, M. (2018). E-cigarettes, alcoholuse, and mental health: Use and perceptionsof e-cigarettes among college students, byalcohol use and mental health status. Addictive
Behaviors. doi: 10.1016/j.addbeh.2018.10.040
Howlett, J. R., Campbell-Sills, L., Jain, S., Heeringa,
S. G., Nock, M. K., Sun, X., Ursano, R. J. & Stein,
M. B. (2018). Attention deficit hyperactivity
disorder and risk of posttraumatic stress andrelated disorders: A prospective longitudinalevaluation in U.S. Army soldiers. Journal ofTraumatic Stress, 31(6), 909-918. doi:10.1002/
jts.22347
Krauss, S. W., Russell, D. W., Kazman, J. B.,
Russell, C. A., Schuler, E. R., & Deuster, P. A.
2018 ANNUAL REPORT | 25

(2018). Longitudinal effects of deployment,
recency of return, and hardiness on mental
health symptoms in U.S. Army combat medics.
Traumatology. doi: 10.1037/trm0000173
Krueger, R. F., Kotov, R., Watson, D., …
Regier, D. A., et al. (2018). Progress inachieving quantitative classification of
psychopathology. World Psychiatry, 17(3), 282293. doi: 10.1002/wps.20566
Mash, H. B. Herberman, Fullerton, C. S., &Ursano, R. J. (2018). Posttraumatic stresssymptoms following sniper attacks: Effects
of television viewing and identification
with victims. American Journal of Disaster
Medicine, 13(1), 29-36. doi: 10.5055/
ajdm.2018.0285
Mauro, C., Reynolds, C. F., Maercker, A., Skritskaya,N., Simon, N., Zisook, S., Lebowitz, B., Cozza,
S. J., & Shear., M. K. (2018). Prolonged griefdisorder: clinical utility of ICD-11 diagnostic
guidelines. Psychological Medicine, 1-7.
doi:10.1017/s0033291718001563
Meyer, E. G., Cozza, K. L., Konara, R. M. R.,
Hamaoka, D., & West, J. C. (2018) Inflated
clinical evaluations: A comparison of facultyselected and mathematically calculated overall
evaluations based on behaviorally anchoredassessment data. Academic Psychiatry. doi:
10.1007/s40596-018-0957-8
Meyer, E. G., Kelly, W. F., Hemmer, P. A., & Pangaro,
L. N. (2018). The RIME model provides a context
for entrustable professional activities acrossundergraduate medical education. Academic
Medicine, 93(6), 954. doi: 10.1097/
ACM.0000000000002211
Naifeh, J. A., Mash, H. B. H., Stein, M. B.,
Fullerton, C. S., Kessler, R. C., & Ursano, R.
J. (2019). The Army Study to Assess Risk andResilience in Servicemembers (Army STARRS):
Progress toward understanding suicide amongsoldiers. Molecular Psychiatry, 24(1), 34-48.
doi:10.1038/s41380-018-0197-z
Naifeh, J. A., Ursano, R. J., Kessler, R. C., Zaslavsky,
A. M., Nock, M. K., Dempsey, C. L., Bartolanzo,D., Ng, T. H. H., Aliaga, P. A., Zuromski, K. L.,
Dinh, H. M., Fullerton, C. S., Kao, T. C., Mash,
26 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

H. B. H., Sampson, N. A., Wynn, G. H., & Stein,
M. B. (2018). Transition to suicide attempt fromrecent suicide ideation in U.S. Army soldiers:
Results from the Army Study to Assess Risk andResilience in Servicemembers (Army STARRS).
Depression and Anxiety. doi:10.1002/da.22870
Nock, M. K., Han, G., Millner, A. J., Gutierrez, P.
M., Joiner, T. E., Hwang, I., King, A., Naifeh,
J. A., Sampson, N.A., Zaslavsky, A. M., Stein,
M. B., Ursano, R. J., & Kessler, R. C. (2018).
Patterns and predictors of persistence of suicide
ideation: Results from the Army Study to Assess
Risk and Resilience in Servicemembers (ArmySTARRS). Journal of Abnormal Psychology,
127(7), 650-658. doi: 10.1037/abn0000379
Nock, M. K., Millner, A. J., Joiner, T. E., Gutierrez,
P. M., Han, G., Hwang, I., King, A., Naifeh, J. A.,
Sampson, N. A., Zaslavasky, A. M., Stein, M. B.,
Ursano, R. J., & Kessler, R. C. (2018). Risk factors
for the transition from suicide ideation to suicide
attempt: Results from the Army Study to Assess
Risk and Resilience in Servicemembers (ArmySTARRS). Journal of Abnormal Psychology,
127(2), 139-149. doi: 10.1037/abn0000317
Pinto-Coelho, K., Hill, C. E., Kearney, M. S.,
Sauber, E., Sarno, E. L., Brady, J., Baker, S. M.,
Ireland, G. W., Hoffman, M. A., Spangler, P. T.
& Thompson, B. J. (2018). When in doubt, sit
quietly: A qualitative exploration of experienced
therapists’ successful and unsuccessful
disclosures. Journal of Counseling Psychology,
65(4); 440-452. doi: 10.1037/cou0000288
Radford, K. D., Park, T. Y., Jaiswal, S., Pan, H.,
Knutsen, A., Zhang, M., Driscoll, M., OsborneSmith, L. A., Dardzinski, B. J., & Choi, K.
H. (2018). Enhanced fear memories andbrain glucose metabolism (18 F-FDG-PET)
following sub-anesthetic intravenous ketamine
infusion in sprague-dawley rats. Translational
Psychiatry, 8(1), 1-12. doi: 10.1038/s41398-0180310-8
Regier D. A. (2017). Uncertainty as adriver of mental disorder diagnostic
strategies. Psychiatry, 80(4), 309-314. doi:
10.1080/00332747.2017.1397453
Rosellini, A. J., Stein, M. B., Benedek, D. M.,

Bliese, P. D., Chiu, W. T., Hwang, I., Monahan,J., Nock, M. K., Sampson, N. A., Street, A. E.,
Zaslavsky, A. M., Ursano, R. J., & Kessler, R. C.
(2018). Predeployment predictors of psychiatricdisorder-symptoms and interpersonal violence
during combat deployment. Depression andAnxiety, 35(11), 1073- 1080. doi:10.1002/
da.22807
Russell, C. A., & Russell, D. W. (2018). It’s not justshowing up: How social identification with aveteran’s service organization relates to benefitfinding and social isolation among veterans.
Psychological Services, 15(2), 154-162. doi:
10.1037/ser0000176
Russell, C. A., & Russell, D. W. (2018). Sensation
seeking moderates television’s cultivation of
alcohol and tobacco beliefs: Evidence from anational study of French adolescents. Drug &Alcohol Dependence, 186, 193-200. doi: 10.1016/j.
drugalcdep.2018.01.031
Spangler, P. T., Thompson, B. T., Vivino, B. L., &Wolf, J. A. (2017). Navigating the minefield ofpolitics in the therapy session. Psychotherapy
Bulletin, 52(4), 20-25.
Stein, M. B., McCarthy, M. J., Chen, C. Y., Jain, S.,
Gelernter, J., He, F., Heeringa, S. G., Kessler, R.
C, Nock, M. K., Ripke, S., Sun, X., Wynn, G. H.,
Smoller, J. W., & Ursano, R. J. (2018). Genomewide analysis of insomnia disorder. MolecularPsychiatry, 23(11), 2238-2250. doi: 10.1038/
s41380-018-0033-5
Ursano, R. J., Kessler, R. C., Naifeh, J. A., Mash,
H. B. H., Fullerton, C. S., Aliaga, P. A., Wynn,
G. H., Ng, T. H. H., Dinh, H. M., Sampson,
N. A., Kao, T. C., Bliese, P. D. & Stein, M. B.
(2018). Associations of time-related deployment
variables with risk of suicide attempt amongsoldiers: Results from the Army Study to Assess
Risk and Resilience in Servicemembers (ArmySTARRS). JAMA Psychiatry, 75(6), 596-604.
doi:10.1001/jamapsychiatry.2018.0296
Ursano, R. J., Kessler, R. C., Naifeh, J. A., Mash,
H. B. H., Nock, M. K., Aliaga, P. A., Fullerton,
C. S., Wynn, G. H., Ng, T. H. H., Dinh, H.
M., Sampson, N. A., Kao, T., Heeringa, S. G.,& Stein, M. B. (2018). Risk factors associatedwith attempted suicide among U.S. Armysoldiers without a history of mental healthdiagnosis. JAMA Psychiatry, 75(10), 1022-1032.
doi:10.1001/jamapsychiatry.2018.2069
Ursano, R. J., Naifeh, J. A., Kessler, R. C.,
Gonzalez, O. I., Fullerton, C. S., Mash, H. H.,
Riggs-Donovan, C. A., Ng, T. H. H., Wynn, G.
H., Dinh, H. M., Kao, T. C., Sampson, N. A.,
Heeringa, S. G., & Stein, M. B. (2018). Nonfatal
suicidal behaviors in the administrative recordsof activated U.S. Army National Guard and Army
Reserve soldiers, 2004–2009. Psychiatry, 81(2),173-192. doi:10.1080/00332747.2018.1460716
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. (2018). Pre-deployment
insomnia is associated with post-deployment
PTSD and suicidal ideation in U.S. Army soldiers.
Sleep. doi:10.1093/sleep/zsy229
Wang, J., Ursano, R. J., Gonzalez, O. I., Russell,
D. W., Dinh, H., Hernandez, L., Gifford, R. K.,
Cohen, G. H. Sampson, L., Galea, S. & Fullerton,
C. S. (2018). Association of suicidal ideation
with trajectories of deployment-related PTSD
symptoms. Psychiatry Research, 267, 455-460.
doi: 10.1016/j.psychres.2018.06.034
Wolf, E. J., Maniates, H., Nugent, N., … Ursano, R.
J., et. al. (2018). Traumatic stress and accelerated
DNA methylation age: A meta-analysis.
Psychoneuroendocrinology, 92, 123-134. doi:
10.1016/j.psyneuen.2017.12.007
Yang, S., Wynn, G. H., & Ursano, R. J. (2018). A
clinician’s guide to PTSD biomarkers and theirpotential future use. FOCUS, 16(2), 143-152.
doi:10.1176/appi.focus.20170045

BOOK CHAPTERS
Benedek, D. M., (2018). Epidemiology of traumaand stressor-related disorders. In F. Stoddard,
D. Benedek, M. Milad, & R. Ursano (Eds.).
Trauma- and stressor- related disorders (Primeron) (pp. 73-84). New York, NY: Oxford University
Press
Benedek, D. M., & Wynn, G. H. (2018).
Pharmacologic treatment of adults with2018 ANNUAL REPORT | 27

trauma- and stressor-related disorders: PTSD,
ASD, and Adjustment Disorder. In F. Stoddard,
D. Benedek, M. Milad, & R. Ursano (Eds.).
Trauma- and stressor- related disorders (Primeron) (pp. 271-282). New York, NY: Oxford
University Press
Cozza, S. J. (2018). Family-based interventions for
PTSD. In F. Stoddard, D. Benedek, M. Milad, &R. Ursano (Eds.). Trauma- and stressor- relateddisorders (Primer on) (pp. 350-361). New York,
NY: Oxford University Press
Howe, E. G. (2018). Ethical issues in the forensic
assessment of posttraumatic symptoms. In F.
Stoddard, D. Benedek, M. Milad, & R. Ursano(Eds.). Trauma- and stressor- related disorders(Primer on) (pp. 363-373). New York, NY: Oxford
University Press
Mash, H. B. H., Naifeh, J. A., Fullerton, C. S.,
Morganstein, J. C., Ursano, R. J. (2018). Suicidal
behaviors in military and veteran populations:
Risk factors and strategies for prevention andintervention. In L. Roberts & C. Warner (Eds.),
Military and veteran mental health (pp. 401419). New York, NY: Springer
Regier, D. A., Morris S. E., & Schultz S. K. (2018)
DSM-5 overview and goals. In D. S. Charney,
P. Sklar, J. D. Buxbaum, & E. J. Nestler (Eds),
Charney & Nestler’s neurobiology of mental illness
5th Edition (pp. 935-940). New York, NY: Oxford
University Press
Spangler, P. T., & West, J. C. (2018). Nightmare
deconstruction and reprocessing for PTSD
nightmares. In E. Vermetten, A. Germain, &T. Neylan (Eds), Sleep and combat-related
posttraumatic stress disorder. (pp. 311-316). New
York: Springer
Stoddard, F. J., Benedek, D. M., Milad, M. R., &Ursano, R. J. (2018). Future directions in clinicalcare, research, and nosology. In F. Stoddard,
D. Benedek, M. Milad, & R. Ursano (Eds.).
Trauma- and stressor- related disorders (Primeron) (pp. 374-380). New York, NY: Oxford
University Press
Stoddard, F. J., Benedek, D. M., Milad, M. R., &Ursano, R .J. (2018). History and evolution of
the trauma- and stressor-related disorders. In F.
28 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Stoddard, D. Benedek, M. Milad, & R. Ursano(Eds.). Trauma- and stressor- related disorders(Primer on) (pp. 1-5). New York, NY: Oxford
University Press
Stoddard, F. J., Benedek, D. M., Milad, M. R.,
Ursano, R. J. (2018). Posttraumatic stressdisorder. In F. Stoddard, D. Benedek, M. Milad,& R. Ursano (Eds.). Trauma- and stressorrelated disorders (Primer on) (pp. 19-35). New
York, NY: Oxford University Press
Stoddard, F. J., Ursano, R. J., Cozza, S. J. (2018).
Population trauma: Disasters. In F. Stoddard,
D. Benedek, M. Milad, & R. Ursano (Eds.).
Trauma- and stressor- related disorders (Primeron) (pp. 113-130). New York, NY: Oxford
University Press
Wynn, G. H., & Benedek, D. M. (2018).
Complementary and alternative medicine fortrauma- and stressor-related disorders. In F.
Stoddard, D. Benedek, M. Milad, & R. Ursano(Eds.). Trauma- and stressor- related disorders(Primer on) (pp. 310-318). New York, NY: Oxford
University Press
Wynn, G. H., Benedek, D. M., Morganstein, J.
C., & Ursano, R. J. (2018). PTSD and War. In C.
B. Nemeroff, C. Marmar (Eds.) Post-TraumaticStress Disorder. New York, NY: Oxford University
Press

BOOKS/VOLUMES
Stoddard, F. J., Benedek, D., Milad, M., & Ursano,
R. (Eds.). (2018). Trauma- and stressor-relateddisorders (Primer on). New York, NY: Oxford
University Press

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

PRESENTATIONSClimate-related disasters: Impact on public
mental health and how the media can help.
Morganstein, J. C. Presented at the Annual
Conference of the Association of Health Care
Journalists, Phoenix, AZ, April 2018
Daily influence of sleep duration on post-traumaticstress symptoms in individuals with and without
post-traumatic stress disorder. Wang, J., Ursano,R. J., Biggs, Q. M., Krantz, D. S., Carr, R. B.,
Wynn, G. H., Probe Adams, D., Dacuyan,
N. M., & Fullerton, C. S. Presented at the 13th
Annual Amygdala, Stress and PTSD Conference:
The Sequela of Trauma, Bethesda, MD, April
2018
Daily variation in post-traumatic stress symptoms
in individuals with and without post-traumaticstress disorder. Biggs, Q. M., Ursano, R. J.,
Wang, J., Krantz, D. S., Carr, R. B., Wynn,
G. H., Probe Adams, D., Dacuyan, N. M., &Fullerton, C. S. Presented at the 13th Annual
Amygdala, Stress and PTSD Conference: The
Sequela of Trauma, Bethesda, MD, April 2018
Recent stressful experiences and resilience among
US Army soldiers at risk for suicide. Dempsey,
C. L., Benedek, D. M., Nock, M. K., Ng, T. H.,
Riggs, C., Aliaga, P., Caulfield, N., DeStefano,S. & Ursano, R. J. Presented at the 13th Annual
Amygdala, Stress and PTSD Conference: The
Sequela of Trauma, Bethesda, MD, April 2018
Family risk factors and child neglect type. Ogle,
C. M., Zhou, J., Burris, A. L., Fisher, J. E.,& Cozza, S. J. Presented at the 13th Annual
Amygdala, Stress and PTSD Conference: The
Sequela of Trauma, Bethesda, MD, April 2018
Clinical response profiles in bereaved family
members fourteen years after the September
11th terrorist attacks. Fisher, J. E., Chen, S.,

Zhou, J., Churan, A., Fetchet, M., Fullerton,
Ursano, R. J., & Cozza, S. J. Presented at the 13th
Annual Amygdala, Stress and PTSD Conference:
The Sequela of Trauma, Bethesda, MD, April
2018
Prevalence of psychiatric conditions in bereaved
military service widows: A longitudinal casecontrolled study. Hefner, K., Fisher, J., Ogle,
C., Stephens, T., Zhou, J., Lee, A., Krantz, D.,
Fullerton, C. S., Ursano, R. J., & Cozza, S. J.
Presented at the 13th Annual Amygdala, Stressand PTSD Conference: The Sequela of Trauma,
Bethesda, MD, April 2018
PTSD, Suicide, TBI… DSM and other Trauma
Disorders. Ursano, R. J. Presented at theInternational Conference on Dutch Veterans
Health Care, Amsterdam, Netherlands, April
2018
Complicated grief and depression differentiate typesof cognitive failures in bereaved family members.
Fisher, J., Zhou, J., Liu, A., Ali, B., Fullerton,
C. S., Ursano, R. J., & Cozza, S. J. Presented
at the 13th Annual Amygdala, Stress and PTSD
Conference: The Sequela of Trauma, Bethesda,
MD, April 2018
Recent stressful experiences and resilience among
U.S. Army soldiers at risk for suicide. Dempsey,
C. L., Benedek, D. M., Nock, M. K., Ng, T. H.,
Riggs, C., Aliaga, P., Caulfield, N., DeStefano,S. & Ursano, R. J. Presented at the 38th
Annual Anxiety and Depression Conference,
Washington, DC, April 2018
Disaster psychiatry review and updates: Terrorist
mass killing, climate change, and ebola. Ursano,R. J., Morganstein, J. C., West, J. C. Presented at
the annual meeting of the American Psychiatric
Association Committee on PsychiatricDimensions of Disasters, New York City, NY,
May 2018
2018 ANNUAL REPORT | 29

Ethical issues for psychiatrists in the treatmentof transgender persons. Howe, E., Benedek,
D. Presented at the American Psychiatric
Association (APA) Annual Meeting in New York
City, NY, May 2018
Patients and personal firearms: Approaches to thephysician-patient conversation to reduce risk.
West, J. C. Presentation given at the American
Psychiatric Association (APA) Annual Meeting in
New York City, NY, May 2018
Improving suicide risk management skills. West,
J. C. American Psychiatric Association (APA)
Annual Meeting in New York City, NY, May 2018
Should I stay or should I go: Decision-making on
Active duty service extension. Benedek, D.
Presented at the Society of Uniformed Services
Psychiatrists Tri-Service meeting in New York
City, NY, May 2018
Epidemiology links to nosology and mental healthpolicy: Historic perspective. Regier, D. A.
Presented at the meeting of the World Psychiatric
Association Section on Epidemiology and Public
Health, New York City, NY, May 2018
Patients and gun safety: What medical students (andpsychiatrists) need to know. Goldenberg, M. N.,& West, J. C. Presented at the annual Meetingof the Association of Directors of Medical
Student Education in Psychiatry (ADMSEP) in
Minneapolis, MN, June 2018
Does pretesting impact study behaviors andsubject examination scores in clerkship?
West, J. C., Dudek, M., Gilliland, W. R., &Roman, B. J. Presented at the Annual Meetingof the Association of Directors of Medical
Student Education in Psychiatry (ADMSEP),
Minneapolis, MN, June 2018
Therapists’ needs and how they meet them.
Spangler, P. T. Presented at the 49th Annual
International Meeting of the Society for
Psychotherapy Research in Amsterdam,
Netherlands, July 2018
Psychiatric dimensions of disaster: Individual andcommunity responses. West, J. C. Presented
at the 116th Annual Convention and Scientific
Assembly of the National Medical Association in
Orlando, FL, August 201830 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Association of N-Acetylaspartate concentrationin anterior cingulate and amygdala withtreatment response to Riluzole augmentation
for posttraumatic stress disorder. West, J.
C., Spangler, P. T., Cole, J., Dempsey, C. L.,
Andrews-Shigaki, B., Kohls, G. H., & Benedek,
D. M. Presented at the Military Health System
Research Symposium (MHSRS), Orlando, FL,
August 2018
Riluzole for PTSD: Efficacy of glutamatergic
modulator as augmentation treatment for
combat-related PTSD. Dempsey, C. L. Presented
at the Military Health System Research
Symposium (MHSRS), Orlando, FL, August 2018
Essential Issues on Terrorism. Ursano, R. J.
Presented at the NATO Advanced ResearchWorkshop Meeting, Odessa, Ukraine, September
2018
Entrustable professional activities in undergraduate
medical education. Meyer, E.G. Presented
at the Association of Medical Educators ofEurope (AMEE) conference, Basel, Switzerland,
September 2018
The protective effect of social and support networks
among U.S. Army soldiers at risk for suicide.
Dempsey, C. L., Benedek, D. M., Nock, M. K.,
Ng, T. H., Riggs, C., Brent, D. A., Heeringa, S.
G., Kessler, R. C., Stein, M. B., & Ursano, R. J.
Presented at the USU Centers Forum, Bethesda,
MD, September 2018
Daily variation in post-traumatic stress symptoms
in individuals with and without post-traumaticstress disorder. Biggs, Q. M., Ursano, R. J.,
Wang, J., Krantz, D. S., Carr, R. B., Wynn,
G. H., Probe Adams, D., Dacuyan, N, M., &Fullerton, C. S. Presented at the USU Centers
Forum, Bethesda, MD, September 2018
Firearm accessibility and suicide: Results from the
Army Study to Assess Risk and Resilience inServicemembers (Army STARRS). Dempsey,
C. L., Benedek, D. M., Zuromski, K. L, Riggs,
C., Ng, T. H., Nock, M. K., & Ursano, R. J.
Presented at the Department of Psychiatry
Meeting, Bethesda, MD, October 2018
Traumatic stress: Education for trauma informedcare... from Macro to micro, personalizedmedicine to public health. Ursano, R. J., &Benedek, D. M. Presented at the National
Academies’ Global Forum on Innovationin Health Professional Education meeting,Washington, DC, November 2018
PTSD aka ‘Soldier’s Heart’ and other (non PTSD)
trauma related disorders and dimensions.
Ursano, R. J. Presented at the NHLBI Workshop,“The Cardiovascular Consequences of PostTraumatic Stress Disorder, Bethesda, MD,
November 2018
Association of N-Acetylaspartate concentrationin anterior cingulate and amygdala withtreatment response to Riluzole augmentation
for posttraumatic stress disorder. Spangler,P., West, J., Cole, J., Andrews-Shigaki, B.,
Kohls, G., & Benedek, D. Presented at the 34th
Annual Meeting of the International Society forTraumatic Stress Studies (ISTSS), Washington,
DC, November 2018
Daily influence of sleep duration on posttraumaticstress symptoms in individuals with andwithout post-traumatic stress disorder. Wang,
J., Ursano, R. J., Biggs, Q. M., Krantz, D. S.,
Carr, R. B., Wynn, G. H., Probe, D., Dacuyan,
N. M., & Fullerton, C. S. Presented at the 34th
Annual Meeting of the International Society forTraumatic Stress Studies (ISTSS), Washington,
DC, November 2018
Daily variation in posttraumatic stresssymptoms (PTSS) in individuals with andwithout posttraumatic stress disorder. Biggs,
Q. M., Ursano, R. J., Wang, J., Krantz, D. S.,
Carr, R. B., Wynn, G. H., Probe, D., Dacuyan,
N. M., & Fullerton, C. S. Presented at the 34th
Annual Meeting of the International Society forTraumatic Stress Studies (ISTSS), Washington,
DC, November 2018
Effects of media coverage on traumatic bereavement
due to 9/11. Fisher, J. E., Chen, S., Zhou, J.,
Fetchet, M. & Cozza, S. J. Presented at the 34th
Annual Meeting of the International Society forTraumatic Stress Studies (ISTSS), Washington,
DC, November 2018
Firearm accessibility and suicide: Results from the
Army Study to Assess Risk and Resilience inServicemembers (Army STARRS). Dempsey, C.
L., Benedek, D. M., Zuromski, K. L., Nock, M.
K., Riggs, C., Ng, T. H., Exley, S. L., Broshek,
C. E., & Ursano, R. J. Presented at the 34th
Annual Meeting of the International Society forTraumatic Stress Studies (ISTSS), Washington,
DC, November 2018
Riluzole for PTSD: Efficacy of a glutamatergic
modulator as augmentation treatment for
combat-related posttraumatic stress disorder.
West, J., Spangler, P., Dempsey, C., Possemato,K., McKenzie, S., & Benedek, D. Presented atthe 34th Annual Meeting of the International
Society for Traumatic Stress Studies (ISTSS),
Washington, DC, November 2018
Sniper-related television viewing, perceived safety,social support, and psychological responses
following active shooter events. Fullerton, C. S.,
Mash, H. B. H., Morganstein, J. C., & Ursano,R. J. Presented at the 34th Annual Meeting of theInternational Society for Traumatic Stress Studies(ISTSS) in Washington, DC, November 2018
Testing criteria for a persistent grief disorder ina traumatically bereaved sample. Cozza, S. J.,
Fisher, J. E., Zhou, J., Mauro, C., Simon, N.
& Shear, M. K. Presented at the 34th Annual
Meeting of the International Society forTraumatic Stress Studies (ISTSS), Washington,
DC, November 2018
Mental health and substance abuse among those
who died by suicide and tested positive for
opioids. Stokes, C. M., Warfield, S. C., &Bossarte, R. M. Presented at the 2018 American
Public Health Association Conference, San
Diego, CA, November 2018
Adverse childhood experienced and mental healthconditions among veterans. Warfield, S.C.,
Blosnich, J., Stokes, C. M., Barth, S., & Bossarte
R. M. Presented at the 2018 American Public
Health Association Conference, San Diego, CA,
November 2018
Formative research to inform the design of suicide
prevention messaging targeting U.S. veteransin midlife. Karras, E., Stokes, C. M., Warfield,
S. C., Barth, S., & Bossarte, R. M. Presented atthe 2018 American Public Health Association2018 ANNUAL REPORT | 31

Conference, San Diego, CA, November 2018
Daily variation in posttraumatic stress symptoms inindividuals with and without posttraumatic stressdisorder. Biggs, Q. M., Ursano, R. J., Wang, J.,
Krantz, D. S., Carr, R. B., Wynn, G. H., Probe
Adams, D., Dacuyan, N, M., & Fullerton, C.
S. Presented at the Neuroscience 28th Annual
Open House at USU, Bethesda, MD, December
2018
Influence of number of awakenings during theprevious 1-3 nights on posttraumatic stresssymptoms among individuals with PTSD.
Wang, J., Ursano, R. J., Biggs, Q. M., Krantz,
D. S., Wynn, G. H., Carr, R. B., GoverChamlou, A., Martinez, S., Pokorny,
K., Stephens, T. B., & Fullerton, C. S. Presented
at the Neuroscience 28th Annual Open House at
USU, Bethesda, MD, December 2018

■■

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BRIEFINGS/INTERVIEWS
Dr. Flynn, CSTS Associate Director for Health
Systems, was featured on the National Center for
Disaster Medicine’s podcast “Disaster Dialogues:
Perspectives from the Field.” In the podcast,Dr. Flynn discussed his long career in disaster
preparedness and response, and identified key
changes and current challenges in the field of
disaster behavioral health. The podcast can befound at https://soundcloud.com/hjfmilmed.
■■ Dr. Wynn made a Grand Rounds presentation
for the Carolina Health Partners, the largest provider of mental healthcare in Charlotte, NC.
■■ Dr. Ursano was interviewed by the The New
York Times for an article titled “A Guide to
Dealing with Trauma through Art.” The story is
about how a commuter, who witnessed a mass
shooting on the Long Island Railroad (6 passengers died and 19 were wounded), used art as arecovery mechanism to process the tragedy andovercome his fears and trauma.
■■ Dr. S. J. Cozza presented a progress update on
the Stepping Forward in Grief (SFG) research
project to the Military Operational Medicine
Research Program (MOMRP) at Ft. Detrick,
MD. MOMRP was pleased that the Randomized■■

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

Controlled Trial (RCT) has begun and was impressed by the enrollment progress so far.
CAPT West gave a presentation on the Riluzole
for PTSD Study to MOMRP at their Interim
Progress Review (IPR) at Ft Detrick, MD. Dr.
West shared preliminary results, heard presentations from other investigators on biomarkers for
PTSD, and received feedback on progress from apanel of experts convened to review our work onbehalf of MOMRP.
Drs. Morganstein and West met with the Surgeon General of Singapore and his colleagues toshare current education, consultation, training
and research activities of CSTS and learn more
about the Singapore military and issues of concern to their personnel and leadership regarding
psychological health and resilience.
Dr. Ursano was interviewed about veterans andsuicide by Dr. Charles Marmar for the “Doctor
Radio” show on SiriusXM powered by NYU
Langone Medical Center. Dr. Marmar is the hostof the segment of the show called “Psychiatry.”
Dr. Ursano was in U.S. Medicine in reference to
the CSTS/STARRS study on Suicide Attempts
Among those with No Mental Health Diagnosis.
An article written by Stars and Stripes featured
the Stepping Forward in Grief Study. https://www.stripes.com/lifestyle/new-study-aims-tohelp-military-families-grieve-1.546485

AWARDS
Dr. Ursano was selected as the recipient of the2018 American Psychiatric Association’s (APA)
Bruno Lima Award in Disaster Psychiatry. The
APA Bruno Lima Award recognizes the outstanding contributions of APA members in thecare and understanding of the victims of disaster. Dr. Ursano received the award because of
his demonstrated leadership and exceptional
achievements as a disaster mental health educator, researcher, leader and responder, and because of his contributions to the psychiatric careof victims of disasters throughout the world.
■■ The CSTS Poster, “Does pretesting impact study
behaviors and subject examination scores in
■■

■■

■■

■■

■■

clerkship” was awarded first place for original
research at the Annual Meeting of Directors ofMedical Student Education in Psychiatry in Minneapolis, MN.
Dr. Spangler was selected as a Fellow for the2018 NIH Summer Institute on Randomized
Behavioral Clinical Trials.
At the AACAP Annual Meeting, the Disasterand Trauma Issues committee was named the2018 recipient of the Catchers in the Rye Awardin recognition of its ongoing support to AACAP
members and communities around the country
affected by human and natural disasters. The
Catchers in the Rye Award was established in
1996 to recognize a committee or group within AACAP for outstanding efforts on behalf ofchildren and adolescents. Dr. S. J. Cozza spearheaded the development of the committee after
the events of September 11. He served as Chair/
Co-chair of the committee for many years andcontinues to support the committee’s response
efforts.
The CSTS poster, “Firearm accessibility and suicide: Results from the Army Study to Assess Risk
and Resilience in Servicemembers” was selected
as one of two Military SIG posters presented at
the ISTSS conference in Washington, DC.
Dr. Ursano was named an Emeritus Fellow of
the American College of Psychiatrists, one of themost distinguished medical organizations forpsychiatrists.

■■

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■■

The book Dr. Flynn developed and edited with
Mr. Ronald Sherman titled “Integrating Emergency Management and Disaster Behavioral
Health: One Picture Through Two Lenses”(2017) was selected as a textbook for the Emergency Management degree program at Oklahoma State University in Oklahoma City.
The CSTS publication in the American Journalof Psychiatry by Dr. S. J. Cozza et al, “Performance of DSM-5 persistent complex bereavement disorder criteria in a community sample of
bereaved military family members,” was awardedan Honorable Mention in the Military Family
Research Institute’s Excellence in Research on
Military and Veteran Families.
Dr. Russell was appointed to the U.S. Food andDrug Administration’s Drug Safety and Risk
Management Advisory Committee to advise theCommissioner’s leadership on behavioral aspects of risk management, risk communication,and quantitative evaluation of reports for drugs
for human use and any other products for which
the agency has regulatory responsibility.
Dr. Russell was appointed to the State of Maryland’s Medical Reserve Corps’ advisory council
which provides strategic direction for the State’s
Medical Reserve Corps.
The 2017 CSTS Annual Report won an “American Graphic Design Award” from Graphic
Design USA (GDUSA).

CSTS data analysts.
2018 ANNUAL REPORT | 33

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 ofTraumatic Stress
Uniformed Services University
David M. Benedek, MD
COL, MC, USA
Chair, Professor
Department of Psychiatry
Associate Director, Consultationand Education
Center for the Study ofTraumatic Stress
Uniformed Services University
Stephen J. Cozza, MD
Professor, Department of
Psychiatry
Associate Director, Child andFamily Program
Center for the Study ofTraumatic Stress
Uniformed Services University
Brian W. Flynn, EdD
Adjunct Professor, Departmentof Psychiatry
Associate Director, Health
Systems
Center for the Study ofTraumatic Stress
Uniformed Services University
Carol S. Fullerton, PhD
Research Professor, Departmentof Psychiatry
Scientific Director
Center for the Study ofTraumatic Stress
Uniformed Services University

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

34 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

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

Brian Crowley, MD
Adjunct Associate Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Catherine L. Dempsey, PhD,
MPH
Research Assistant Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Connie C. Duncan, PhD
Research Associate Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Joscelyn E. Fisher, PhD
Research Assistant Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Brian W. Flynn, EdD
Adjunct Professor, Departmentof Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Michael C. Freed, PhD
Research Assistant Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Carol S. Fullerton, PhD
Research Professor, Departmentof Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Frances Gabbay, PhD
Research Associate Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University

Traumatic Stress
Uniformed Services University

Robert K. Gifford, PhD
Assistant Professor, Departmentof Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University

Tomoko I. Hooper, MD
Professor, Department ofPreventive Medicine &Biostatistics
Center for the Study ofTraumatic Stress
Uniformed Services University

Oscar I. Gonzalez, PhD
CPT, USA
Assistant Professor, Departmentof Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Derrick Hamaoka, MD
Lt Col, USAF, MC, FS
Associate Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Jill Harrington-LaMorie, DSW,LCSW
Senior Field Researcher,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Kathryn Hefner, PhD
Research Assistant Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Harry C. Holloway, MD
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Marjan G. Holloway, PhD
Associate Professor,
Department of Medical &Clinical Psychology
Center for the Study of

Edmund G. Howe III, MD, JD
Professor, Department of
Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Luke Johnson, PhD
Adjunct Assistant Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Tzu Cheg Kao, PhD
Professor, Department ofPreventive Medicine andBiometrics
Center for the Study ofTraumatic Stress
Uniformed Services University
Elie Karam, MD
Professor and Chairman,
Department of Psychiatry
American University, Beirut
Beirut, Lebanon
David S. Krantz, PhD
Professor, Department ofMedical and ClinicalPsychology
Center for the Study ofTraumatic Stress
Uniformed Services University
He Li, MD, PhD
Associate Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
2018 ANNUAL REPORT | 35

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 ofTraumatic Stress
Uniformed Services University
James E. McCarroll, PhD, MPH
Research Professor, Departmentof Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Eric Meyer II, MD
Maj, USAF, MC
Assistant Professor, Departmentof Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Joshua C. Morganstein, MD
CAPT, USPHSAssociate Professor of
Psychiatry, Department of
Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
James A. Naifeh, PhD
Research Assistant Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Christin M. Ogle, PhD
Child Research Psychologist,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Darrel A. Regier, MD, MPH
Adjunct Professor, Departmentof Psychiatry

Center for the Study ofTraumatic Stress
Uniformed Services University
Dori B. Reissman, MD, MPH
CAPT, USPHS
Medical Director, World Trade
Center Responder Health
Program
Senior Medical Advisor,
National Institute ofOccupational Safety and
HealthDepartment of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Dale Russell, PhD
Behavioral Science Researcher,
Department of Psychiatry
Center for the Study ofTraumatic Stress
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 ofTraumatic Stress
Uniformed Services University
Keke L. Schuler, PhD
Clinical Research Psychologist,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Patricia Spangler, PhD
Research Assistant Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University

36 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Cara M. Stokes, PhD, MPH
Postdoctoral Fellow, Departmentof Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
John A. Stuart, PhD
Research Assistant Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
E. Fuller Torrey, MD
Executive Director
Stanley Medical ResearchInstitute
Robert J. Ursano, MD
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Director, Center for the Studyof Traumatic Stress
Uniformed Services University
Jing Wang, PhD
Research Assistant Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Maree J. Webster, PhD
Research Assistant Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
Director, Laboratory of Brain
Research
Stanley Medical ResearchInstituteLars Weisaeth, MD
Professor, Division of Disaster
Psychiatry
University of Oslo
Oslo, Norway
James (Curt) West, MD
CAPT, MC, USN
Deputy Chair

Associate Professor of
Psychiatry
Clerkship Director
Department of Psychiatry
Center for the Study ofTraumatic Stress
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 Traumatic Stress
Uniformed Services University
Lei Zhang, MD
Associate Professor,
Department of Psychiatry
Center for the Study ofTraumatic Stress
Uniformed Services University
SCIENCE COLLABORATIVEMEMBERSJames E. Barrett, PhD
Professor and Chairman,
Department ofPharmacology andPhysiology
Drexel University, College ofMedicine
Paul D. Bliese, PhD
Associate Professor,
Department of Management
University of South Carolina,

Darla Moore School ofBusiness
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 ofPharmacology & Toxicology
Dartmouth University, Geisel
School of Medicine
Director, Leahy-Friedman
National PTSD Brain Bank
Senior Advisor, National Center
for Post-traumatic Stress
DisorderU.S. Department of Veterans
Affairs
Harry C. Holloway, MD
COL, MC, USA (Ret.)
Professor Emeritus,
Department of Psychiatry
Uniformed Service University
Ronald C. Kessler, PhD
McNeil Family Professor,
Department of Health Care
PolicyHarvard Medical School

David S. Krantz, PhD
Professor, Department ofMedical and ClinicalPsychology
Uniformed Services University
Craig H. Llewellyn, MD
Professor, Department ofMilitary and Emergency
Medicine
Uniformed Services University
Irwin Lucki, PhD
Professor and Chair,
Department ofPharmacology & Molecular
Therapeutics
Uniformed Services University
Matthew K. Nock, PhD
Professor, Department of
Psychology
Harvard University
Francis O’Conner, MD, MPH
COL, MC, USA
Professor and Chairman,
Department of Military andEmergency Medicine
Uniformed Services University
Harvey B. Pollard, MD, PhD
Professor and Chair, Departmentof Anatomy, Physiology andGenetics
Director, Collaborative Health
Initiative Research Program(CHIRP)
Uniformed Services University
Robert M. Post, MD
Head, Bipolar Collaborative
Network
Former Chief, BiologicalPsychiatry Branch
National Institute of Mental
HealthDavid Riggs, PhD
Professor and Chair,
Department of Medical
Clinical Psychology
Executive Director, Center for
Deployment Psychology
2018 ANNUAL REPORT | 37

Uniformed Services University
Arieh Y. Shalev, MD
Professor, Department of
Psychiatry
New York University
Professor, Department of
Psychiatry
Hadassah University School of
Medicine
Jerusalem, Israel
Murray B. Stein, MD, MPH
VA San Diego Healthcare
SystemDistinguished Professor,
Department of Psychiatry
Distinguished Professor,
Department of Family
Medicine and Public Health
University of California, San
Diego

Lars Weisaeth, MD
Professor, Division of Disaster
Psychiatry
University of Oslo
Oslo, Norway
DISTINGUISHED FORMERSCIENCE COLLABORATIVEMEMBERS & EMERITUS
FRIENDS OF CSTS
Herbert A. Hauptman, PhD(1917-2011)1985 Nobel Laureate,
Chemistry
President, HauptmanWoodward Medical
Research InstituteResearch Professor,
Department of BiophysicalSciences
Adjunct Professor, Departmentof Computer Science
University of Buffalo

Joshua Lederberg, PhD,
ForMenRS (1925-2008)
1958 Nobel Laureate, Physiology
or Medicine
Professor Emeritus, Departmentof Molecular Genetics andInformatics
Rockefeller University
Founder, Department ofMedical Genetics
University of Wisconsin,
MadisonDavid H. Marlowe, PhD (19312014)
Senior Lecturer, Department of
Psychiatry
Uniformed Services University
Former Chief, Department ofMilitary Psychiatry
Walter Reed Army Institute of
Research
Fellow, American
Anthropological Association

STAFF
Deborah Probe Adams
Bilal Ali
Pablo Aliaga
Eva Asabre
Danielle Bartolanzo
Sara Bessman
Angela Brittain
Catherine Broshek
Alexandra Burris
Jessica Canales
Nicole Caulfield
Alexa Churan
Melissa Collier
Sara Conley
Cecilia Cozza
Sarah Cupples
Nicole Dacuyan
Hieu Dinh
Sydney DeStefano
Kathryn DeWitte

Maria Dudek
Shannon Exley
Sumr Farooq
Alice Fladung
Dana Gordon
Matthew Georg
Andrea Gould
Ametisse Gover-Chamlou
MSgt Jorge Hastings
Lizabelle Hernandez
Xianzhang Hu
Paul Hurwitz
Mark Jimerson
Megan Lindberg
Alex Liu
Samantha Martinez
Diana Monday
Susan Moss
Alysa Mullen
Ami Neiberger-Miller
Alison Neuwirth

38 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Stanley Ng
Ashley Phares
Joseph Piemontese
Katherine Pokorny
Charlotte Riggs-Donovan
Michelle Rusk
Caleb Saguil
Trevor Stephens
TSgt Amy Steward
Natara Strother-Ware
Christopher Thomas
Tung Tu
Lydia Umhau
Alexis Walker
Kirsten Ward
Leming Wang
Sydney West
Holly Wu
Shemsiya Yimam
Michael Zhang
Jing Zhou

Funded Grants
GRANT		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)
Family Violence and Trauma Project		

DHP

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 Post-traumatic 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		
USAMRMC
Identifying Predictors of Treatment Response in Service members with 		
Post-traumatic 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		

DHP2018 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.
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
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 Supportof 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 ofDC
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

2018 CSTS Army 10-Miler Team.

CSTS staff and scientist presenting a poster.

Dr. Wynn.

Drs. Cozza and Benedek.

Dr. Stokes making a presentation at CSTS.

Trauma team weekly meeting.

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