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Marine Resiliency Study

Dewleen G. Baker M.D1. & William P. Nash M.D.2

Co-Principal Investigators

VA Center of Excellence for Stress & Mental Health &University of California San Deigo1

Headquarters Marine Corps, Quantico & University of

California San Diego2

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Why a Marine

Resiliency Study?

Improved knowledge about risk and resiliencyImproved knowledge about risk and resiliencywill help towill help to

PreventPreventIdentifyIdentify

TreatTreatOperational and Combat Stress InjuriesOperational and Combat Stress Injuries

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Why a Resiliency Study?

In theater: Daily hardships and combatIn theater: Daily hardships and combatoperations trigger acute and chronic stressoperations trigger acute and chronic stress

Physical: dehydration & wetness, dirt and mud, sleepPhysical: dehydration & wetness, dirt and mud, sleepdeprivation, noise & blasts, fumes & smells, bright light &deprivation, noise & blasts, fumes & smells, bright light &

darkness, malnutrition, illness & injurydarkness, malnutrition, illness & injuryCognitive: lack of information or too much information,Cognitive: lack of information or too much information,ambiguous or changing mission or role, ambiguous or changingambiguous or changing mission or role, ambiguous or changingrules of engagement,rules of engagement, loyalityloyalityconflicts, boredom & monotony,conflicts, boredom & monotony,

experience that dont make senseexperience that dont make sense

Emotional: losses of friends to death or injury, fear, shame &Emotional: losses of friends to death or injury, fear, shame &guilt, helplessness, horror, killingguilt, helplessness, horror, killing

Social: isolation from social supports, lack of privacy, the medSocial: isolation from social supports, lack of privacy, the mediaia& public opinion& public opinion

from Nash 2007from Nash 2007

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Why a Resiliency Study?

The adaptive responses to chronic andThe adaptive responses to chronic andintermittent stress is not fully understoodintermittent stress is not fully understood

Retrospective studies associate genotype,Retrospective studies associate genotype,physiology and personality traits with conditionsphysiology and personality traits with conditions--anxiety, depression and posttraumatic stressanxiety, depression and posttraumatic stresssymptomssymptomsthought to result from stressthought to result from stress

Age, genderAge, gender

Reactivity to stress, tendency to dissociateReactivity to stress, tendency to dissociate

Childhood stress and/or traumaChildhood stress and/or trauma

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Why a Resiliency Study?

The retrospective studies provide clues aboutThe retrospective studies provide clues aboutresilience but a better understanding of the fullresilience but a better understanding of the fullrange of adaptive responses to combatrange of adaptive responses to combat

operational stress is needed in order to designoperational stress is needed in order to designprograms that promote resiliencyprograms that promote resiliency

Prospective studies could fill in knowledge gapsProspective studies could fill in knowledge gapsabout the trajectories of adaptation to combatabout the trajectories of adaptation to combatoperational stressoperational stress

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Why a Resiliency Study?

As yet, there are no prospective studiesAs yet, there are no prospective studiesshowing the various trajectories of adaptation toshowing the various trajectories of adaptation tocombatcombatthis proposed study would be the firstthis proposed study would be the first

Components (projects) that are likely impactComponents (projects) that are likely impactadaptationadaptation

Cognitive, psychological, socialCognitive, psychological, socialBiologicalBiological

GeneticGenetic

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Trajectories of Adaptation toOperational Stress and Trauma

SYM

PTO

M

BURD E

N Hig

h

M

od

er

ate

Lo

w

Gr

ow

th PRE-DEPLOY

MENT

DEPLOYMENT

RETURN

3MOS.POST

6MOS.POST

CHRONIC COURSE

RECOVERY COURSE

INNOCULATION COURSE

RESILIENT COURSE

GROWTH COURSE

Diagram courtesy of Brett Litz, PhD, NCPTSD, Boston

DELAYED COURSE

PTSD

SYMPTOM

BURD

EN

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Study Who/when?

1600 Members (2 Infantry Battalions) of the 11600 Members (2 Infantry Battalions) of the 1ststMarine Division will be offered invitations toMarine Division will be offered invitations toparticipate in the prospective studyparticipate in the prospective study

Information (data) will be gathered at four timeInformation (data) will be gathered at four timepointspoints

Time 1: Within the month prior to deploymentTime 1: Within the month prior to deploymentTime 2: One weekTime 2: One weekpostdeploymentpostdeployment(questionnaires only)(questionnaires only)

Time 3: Three monthsTime 3: Three monthspostdeploymentpostdeployment

Time 4: Six monthsTime 4: Six monthspostdeploymentpostdeployment

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The projects?Project 1Psychiatric, psychosocial and cognitivePsychiatric, psychosocial and cognitive

predictors of adaptation trajectoriespredictors of adaptation trajectories

Brett Litz Ph.D.; Boston University andBrett Litz Ph.D.; Boston University and

National Center for PTSD; William P. NashNational Center for PTSD; William P. NashM.D., Headquarters Marine Corps, Quantico &M.D., Headquarters Marine Corps, Quantico &

University of California San Diego; JenniferUniversity of California San Diego; Jennifer

Vasterling; Boston University & NationalVasterling; Boston University & National

Center for PTSD); Paul Hammer M.D.,Center for PTSD); Paul Hammer M.D.,

Division Psychiatrist, 1Division Psychiatrist, 1stst Marine Corps, CampMarine Corps, Camp

PendletonPendleton

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The projects?Project 2Startle thresholds,Startle thresholds, sensorimotorsensorimotor gating, heartgating, heart

rate (HR) reactivity, baseline as predictorsrate (HR) reactivity, baseline as predictors

of adaptation trajectoryof adaptation trajectory

Victoria Risbrough Ph.D., San Diego VAVictoria Risbrough Ph.D., San Diego VACESAMH & University of California San DiegoCESAMH & University of California San Diego

(UCSD); Mark Geyer Ph.D, San Diego VA(UCSD); Mark Geyer Ph.D, San Diego VA

CESAMH & UCSD; Dewleen Baker M.D., SanCESAMH & UCSD; Dewleen Baker M.D., San

Diego VA CESAMH & UCSDDiego VA CESAMH & UCSD

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The projects?Project 3Characterization of catecholamineCharacterization of catecholamine

((norepinephrinenorepinephrine) genotype, stress) genotype, stress--relatedrelated

proteins and blood pressure (BP) asproteins and blood pressure (BP) as

predictors of intermediate biological traitspredictors of intermediate biological traits

(phenotype) and adaptation trajectory(phenotype) and adaptation trajectory

Daniel OConnor M.D.,SanDaniel OConnor M.D.,SanDeigoDeigoVA &VA &

Department of Medicine, UCSD; NicholasDepartment of Medicine, UCSD; Nicholas

Schork M.D.,San Diego VA CESAMH, ScrippsSchork M.D.,San Diego VA CESAMH, Scripps

Institute & UCSD; Dewleen Baker M.D.,SanInstitute & UCSD; Dewleen Baker M.D.,San

Diego VA CESAMH & UCSDDiego VA CESAMH & UCSD

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Rationale?Project 3There is considerable evidence for theThere is considerable evidence for the

involvement ofinvolvement of catecholaminescatecholamines

((norepinephrinenorepinephrine) in arousal, memory) in arousal, memory

formation, startle, blood pressure andformation, startle, blood pressure and

pulse, and in PTSDpulse, and in PTSD

Daniel OConnor M.D.,SanDaniel OConnor M.D.,SanDeigoDeigoVA &VA &

Department of Medicine, UCSD; NicholasDepartment of Medicine, UCSD; Nicholas

Schork M.D.,San Diego VA CESAMH, ScrippsSchork M.D.,San Diego VA CESAMH, Scripps

Institute & UCSD; Dewleen Baker M.D.,SanInstitute & UCSD; Dewleen Baker M.D.,San

Diego VA CESAMH & UCSDDiego VA CESAMH & UCSD

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CSF Norepinephrine in PTSD and Control Subjects

0.250

0.300

0.350

0.400

0.450

0.500

0.550

0.600

0.650

0.700

CSFNorepineph

rine(pmol/ml)

TIME

11:40 12:40 13:40 14:40 15:40 16:40

PTSD

CONTROL

GeraciotiGeracioti, Baker et al, Baker et al20012001

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Total Score on Clinician-Administered PTSD Scale

20 40 60 80 100 120

MeanC

oncentrationof

CSFNorep

inephrine(pmol/ml

)

0.2

0.4

0.6

0.8

1.0

Relationship Between Mean CSF NorepinephrineConcentration and PTSD Symptoms in 11 Patients with PTSD

GeraciotiGeracioti, Baker et al 2001, Baker et al 2001

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Special aspectsof this study

ProspectiveProspective

MultisystemMultisystem

Integrated (examination of data acrossIntegrated (examination of data across

projects)projects)

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Pia SantiagoPia Santiago

FengwenFengwenRaoRao

Caroline NievergeltCaroline Nievergelt

Michele FrybargerMichele Frybarger

Todd MayTodd May

Patricia GormanPatricia Gorman

Juan MontgomeryJuan Montgomery

MichaelangeloMichaelangeloMaamoMaamo

William NashWilliam Nash

Gerald LarsonGerald Larson

Brett LitzBrett Litz

Mark GeyerMark GeyerJennifer VasterlingJennifer Vasterling

Victoria RisbroughVictoria Risbrough

Daniel OConnorDaniel OConnor

Nicholas SchorkNicholas Schork

Paul HammerPaul Hammer

EdwardEdwardHesselHessel

Thomas GaskinThomas Gaskin