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. 2020 Mar;5(3):311-319.
doi: 10.1016/j.bpsc.2019.11.003. Epub 2019 Nov 20.

Neuroanatomical Risk Factors for Posttraumatic Stress Disorder in Recent Trauma Survivors

Ziv Ben-Zion  1 , Moran Artzi  2 , Dana Niry  3 , Nimrod Jackob Keynan  4 , Yoav Zeevi  5 , Roee Admon  6 , Haggai Sharon  7 , Pinchas Halpern  8 , Israel Liberzon  9 , Arieh Y Shalev  10 , Talma Hendler  11
Affiliations

Neuroanatomical Risk Factors for Posttraumatic Stress Disorder in Recent Trauma Survivors

Ziv Ben-Zion et al. Biol Psychiatry Cogn Neurosci Neuroimaging. 2020 Mar.

Abstract

Background: Low hippocampal volume could serve as an early risk factor for posttraumatic stress disorder (PTSD) in interaction with other brain anomalies of developmental origin. One such anomaly may well be the presence of a large cavum septum pellucidum (CSP), which has been loosely associated with PTSD. We performed a longitudinal prospective study of recent trauma survivors. We hypothesized that at 1 month after trauma exposure the relation between hippocampal volume and PTSD symptom severity will be moderated by CSP volume, and that this early interaction will account for persistent PTSD symptoms at subsequent time points.

Methods: One hundred seventy-one adults (87 women, average age 34.22 years [range, 18-65 years of age]) who were admitted to a general hospital's emergency department after a traumatic event underwent clinical assessment and structural magnetic resonance imaging within 1 month after trauma. Follow-up clinical evaluations were conducted at 6 (n = 97) and 14 (n = 78) months after trauma. Hippocampal and CSP volumes were measured automatically by FreeSurfer software and verified manually by a neuroradiologist (D.N.).

Results: At 1 month after trauma, CSP volume significantly moderated the relation between hippocampal volume and PTSD severity (p = .026), and this interaction further predicted symptom severity at 14 months posttrauma (p = .018). Specifically, individuals with a smaller hippocampus and larger CSP at 1 month posttrauma showed more severe symptoms at 1 and 14 months after trauma exposure.

Conclusions: Our study provides evidence for an early neuroanatomical risk factors for PTSD, which could also predict the progression of the disorder in the year after trauma exposure. Such a simple-to-acquire neuroanatomical signature for PTSD could guide early management as well as long-term monitoring.

Trial registration: ClinicalTrials.gov NCT03756545.

Keywords: Cavum septum pellucidum; Hippocampus; Posttraumatic stress symptoms; Resilience; Trauma; Vulnerability.

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Conflict of interest statement

Disclosures: The authors declare that they have no biomedical financial interests or potential conflict of interests. As mentioned in the participants section, the present study is part of a larger on-going project that examines PTSD development in trauma survivors. The authors declare that they report all measures, conditions and data exclusions, as pertain to outlined hypotheses, obtained from all the participants who completed assessments within one-month after-trauma (n=171). Moreover, results of 97 and 78 individuals which completed six- and fourteen months post-trauma follow-ups, up to date, were reported in the manuscript.

Figures

Figure 1:
Figure 1:. Cavum Septum Pellucidum (CSP).
Coronal view of the T1-weighted (MPRAGE) image of an example subject. A red line marks the CSP as identified by Freesurfer automatic volumetric segmentation.
Figure 2:
Figure 2:. Interaction between hippocampus and CSP volumes at TP1 in predicting TP1 PTSD symptoms.
Conditional effects of TP1 CSP volume on TP1 CAPS-4 total scores at different TP1 hippocampal volumes of 133 individuals (Q1=Low Hippocampal Volume in red, Q2=Median Hippocampal Volume in green, Q3=High Hippocampal Volume in blue). Both hippocampal and CSP volumes are centered. Hippocampal volume is presented as a categorical variable with three-levels for illustration purposes, even though it was used as continuous variable in the analyses. *significant at p<0.05
Figure 3:
Figure 3:. Interaction between hippocampus and CSP volumes at TP1 in predicting TP PTSD symptoms.
Conditional effects of TP1 CSP volume on TP3 CAPS-4 total scores at different TP1 hippocampal volumes of 78 individuals (Q1=Low Hippocampal Volume in red, Q2=Median Hippocampal Volume in green, Q3=High Hippocampal Volume in blue). Both hippocampal and CSP volumes are centered. Hippocampal volume is presented as a categorical variable with three-levels for illustration purposes, even though it was used as continuous variable in the analyses. *significant at p<0.10
See this image and copyright information in PMC

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