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SDR 07-326 – HSR&D Study

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SDR 07-326
Planning/Pilot-Prospective Study of the Psychological, Social, and Biological Markers (Genomic Determinants) of Risk and Resilience for Operational Stress in Marines
Dewleen G Baker MD
VA San Diego Healthcare System, San Diego, CA
San Diego, CA
Funding Period: July 2007 - September 2007

BACKGROUND/RATIONALE:
Combat is emotionally and physically challenging, often transformative for those who serve in battle. Adaptation to these challenges range from trajectories of successful post-combat function or even growth, to functional disability and chronic Posttraumatic Stress Disorder (PTSD). Prior research has been retrospective, cross-sectional and insular, in that it has focused on single systems (psychiatric, psychosocial, or biological), which constrains causal inference and limits useful information to commanders and medical science. The program will examine the possibility that there are easily identifiable biomarkers of risk for poor long-term outcome, biomarkers that may be monitored and managed not only prior to deployment, but also during training throughout military careers as well as during treatment. The project is the planning/pilot phase of a study that seeks to identify predictors of resiliency or recovery that ultimately can be used to guide military training programs as well as tactics, techniques, and procedures for military leadership.

OBJECTIVE(S):
The objective of this program is to complete three interrelated projects using a prospective longitudinal design in order to better understand risk and resilience in an initial cohort of an estimated 1600 Marines bound for Iraq. The primary aim is to identify the individual (genetic and genomic, biologic, psychological, psychiatric, trauma and prior deployment history), social (e.g., social supports), and deployment (e.g., cohesion, various dimensions of war-zone stress) factors that predict trajectories of mental health response, particularly PTSD. A closely related specific aim is to integrate and analyze the data across the three projects, to develop a broad multi-system understanding of the phenomenology of adaptation to operational stress. The objectives of the HSR&D funded planning/pilot phase are to put into place the infrastructure for this large project. Tasks to be accomplished include
1) resubmission to IRB for final approval, 2) equipment purchase, inventory and set-up, 2) supply purchase, inventory and 3) set up, pre-piloting test battery using study staff to ensure that testing can be completed in 4 hours, 5) contruction of data base and web site and preparation of questionnaires for the entire cohort, 6) identification of units to be studied, 7) acculturation to the units, 8) hiring of study staff 9) staff training and determination of interrater reliability, 9) setting up equipment at 29 Palms or Camp Pendleton,
10) Assurance of quality -- flow and acceptability of battery to Marines, and
11) Administration to small unit 30-40 Marine study volunteers to assure efficiency and quality control 12) Data analysis of initial data.

METHODS:
The bulk of the effort in this planning-pilot phase will be spent on tasks to include: 1) resubmission to IRB for final approval, 2) equipment purchase, inventory and set-up, 2) supply purchase, inventory and 3) set up, pre-piloting test battery using study staff to ensure that testing can be completed in 4 hours, 5) contruction of data base and web site and preparation of questionnaires for the entire cohort, 6) identification of units to be studied, 7) acculturation to the units, 8) hiring of study staff 9) staff training and determination of interrater reliability, 9) setting up equipment at 29 Palms or Camp Pendleton, and
10) Assurance of quality -- flow and acceptability of battery to Marines

A small study will be done to assure that qaulity and flow of the measurement will be acceptable to Marines. For this pilot a small group of 30-40 Marines will be offered participation. The exclusion criterion will be Marines who do not want to participate will not be included. Pre-deployment data including study interviews, questionnaires, startle, heart rate variability and blood pressure, and blood will be obtained. The study flow, timing and acceptability of the battery will be assessed.

FINDINGS/RESULTS:
All aspects of the planning/pilot phase of the study have been completed. The project is moving forward to the full data gathering phase.


IMPACT:
This is the planning/pilot phase of a unique, prospective study. The practical application of results of the planned study would be to reduce future rates of chronic PTSD by: 1) providing answers to military commanders about specific individual biological and psychiatric, and psychosocial vulnerability factors potentially amenable to modification by improved training techniques; and 2) providing validated biomarkers associated with risk and resilience to combat-related PTSD. The assessment of genetic and physiological measures in conjunction with psychological outcomes in such a large population makes this study unique and potentially very powerful for both hypothesis testing and future hypothesis generation regarding the pathology linked to maladaptive post-combat mental health. We posit that assessment of biomarkers that predict change post-trauma will be critical for identification of factors underlying risk and resilience, as well as aid in early identification and treatment interventions for PTSD. Because of its prospective design, this study will provide a test of the validity of the PTSD construct in combat veterans and identify useful behavioral, biological, and/or psychosocial predictors of PTSD.


PUBLICATIONS:

Journal Articles

  1. Toomey R, Kang HK, Karlinsky J, Baker DG, Vasterling JJ, Alpern R, Reda DJ, Henderson WG, Murphy FM, Eisen SA. Mental health of US Gulf War veterans 10 years after the war. The British Journal of Psychiatry; The Journal of Mental Science. 2007 May 1; 190:385-93.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Diagnosis
Keywords: Deployment, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms: none

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