Social Buffering of Posttraumatic Stress Disorder: Longitudinal Effects and Neural Mediators

Justin L C Santos¹, Nathaniel G Harnett², Sanne J H van Rooij¹, Timothy D Ely¹, Tanja Jovanovic³, Lauren A M Lebois², Francesca L Beaudoin⁴, Xinming An⁵, Thomas C Neylan⁶, Sarah D Linnstaedt⁵, Laura T Germine⁷, Kenneth A Bollen⁸, Scott L Rauch⁹, John P Haran¹⁰, Alan B Storrow¹¹, Christopher Lewandowski¹², Paul I Musey Jr¹³, Phyllis L Hendry¹⁴, Sophia Sheikh¹⁴, Christopher W Jones¹⁵, Brittany E Punches¹⁶, Jose L Pascual¹⁷, Mark J Seamon¹⁸, Erica Harris¹⁹, Claire Pearson²⁰, David A Peak²¹, Roland C Merchant²², Robert M Domeier²³, Niels K Rathlev²⁴, Brian J O'Neil²⁵, Paulina Sergot²⁶, Leon D Sanchez²⁷, Steven E Bruce²⁸, Diego A Pizzagalli², Steven E Harte²⁹, Kerry J Ressler², Karestan C Koenen³⁰, Samuel A McLean³¹, Jennifer S Stevens³²

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
² Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
³ Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan.
⁴ Department of Epidemiology, Brown University, Providence, Rhode Island; Department of Emergency Medicine, Brown University, Providence, Rhode Island.
⁵ Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁶ Department of Psychiatry and Department of Neurology, University of California San Francisco, San Francisco, California.
⁷ Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts; The Many Brains Project, Belmont, Massachusetts.
⁸ Department of Psychology and Neuroscience and Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁹ Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, McLean Hospital, Belmont, Massachusetts.
¹⁰ Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
¹¹ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
¹² Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan.
¹³ Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
¹⁴ Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida.
¹⁵ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey.
¹⁶ Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, Ohio; Ohio State University College of Nursing, Columbus, Ohio.
¹⁷ Department of Surgery and Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁸ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁹ Department of Emergency Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
²⁰ Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, Michigan.
²¹ Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
²² Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
²³ Department of Emergency Medicine, Trinity Health, Ann Arbor, Ypsilanti, Michigan.
²⁴ Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts.
²⁵ Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, Michigan.
²⁶ Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas.
²⁷ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
²⁸ Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, Missouri.
²⁹ Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan.
³⁰ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
³¹ Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
³² Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. Electronic address: jennifer.stevens@emory.edu.

PMID: 39603414
PMCID: PMC12058427 (available on 2026-05-01)
DOI: 10.1016/j.bpsc.2024.11.011

Multicenter Study

Social Buffering of Posttraumatic Stress Disorder: Longitudinal Effects and Neural Mediators

Justin L C Santos et al. Biol Psychiatry Cogn Neurosci Neuroimaging. 2025 May.

. 2025 May;10(5):531-541.

doi: 10.1016/j.bpsc.2024.11.011. Epub 2024 Nov 26.

Authors

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
² Division of Depression and Anxiety, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
³ Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan.
⁴ Department of Epidemiology, Brown University, Providence, Rhode Island; Department of Emergency Medicine, Brown University, Providence, Rhode Island.
⁵ Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁶ Department of Psychiatry and Department of Neurology, University of California San Francisco, San Francisco, California.
⁷ Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts; The Many Brains Project, Belmont, Massachusetts.
⁸ Department of Psychology and Neuroscience and Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁹ Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, McLean Hospital, Belmont, Massachusetts.
¹⁰ Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
¹¹ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
¹² Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan.
¹³ Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
¹⁴ Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida.
¹⁵ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey.
¹⁶ Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, Ohio; Ohio State University College of Nursing, Columbus, Ohio.
¹⁷ Department of Surgery and Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁸ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁹ Department of Emergency Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
²⁰ Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, Michigan.
²¹ Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
²² Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
²³ Department of Emergency Medicine, Trinity Health, Ann Arbor, Ypsilanti, Michigan.
²⁴ Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts.
²⁵ Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, Michigan.
²⁶ Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas.
²⁷ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
²⁸ Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, Missouri.
²⁹ Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan.
³⁰ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
³¹ Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
³² Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. Electronic address: jennifer.stevens@emory.edu.

PMID: 39603414
PMCID: PMC12058427 (available on 2026-05-01)
DOI: 10.1016/j.bpsc.2024.11.011

Abstract

Background: Posttraumatic stress disorder (PTSD) is a well-characterized psychiatric disorder that features changes in mood and arousal following traumatic events. Previous animal and human studies of social support during the peritraumatic window have demonstrated a buffering effect with regard to acute biological and psychological stress symptoms. Fewer studies have explored the magnitude of and mechanism through which early posttrauma social support can reduce longitudinal PTSD severity.

Methods: In this study, we investigated the beneficial impact of social support on longitudinal PTSD symptoms and probed brain regions sensitive to this buffering phenomenon, such as the amygdala and ventromedial prefrontal cortex. In the multisite AURORA study, 315 participants reported PTSD symptoms (PTSD Checklist for DSM-5) and perceived emotional support (Patient-Reported Outcomes Measurement Information System) at 2 weeks, 8 weeks, 3 months, and 6 months post emergency department visit. Additionally, neuroimaging data were collected at 2 weeks posttrauma.

Results: We hypothesized that early posttrauma social support would be linked with greater fractional anisotropic values in white matter tracts that have known connectivity between the amygdala and prefrontal cortex and would predict reduced neural reactivity to social threat cues in the amygdala. Interestingly, while we observed greater fractional anisotropy in the bilateral cingulum and bilateral uncinate fasciculus as a function of early posttrauma emotional support, we also identified greater threat reactivity in the precuneus/posterior cingulate, a component of the default mode network.

Conclusions: Our findings suggest that the neurocircuitry underlying the response to social threat cues is facilitated through broader pathways that involve the posterior hub of the default mode network.

Keywords: Diffusion-weighted imaging; Functional magnetic resonance imaging; Neuroimaging; Posttraumatic stress disorder; Social buffering.

Published by Elsevier Inc.

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References

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Social Buffering of Posttraumatic Stress Disorder: Longitudinal Effects and Neural Mediators

Affiliations

Social Buffering of Posttraumatic Stress Disorder: Longitudinal Effects and Neural Mediators

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical