Persistent Dissociation and Its Neural Correlates in Predicting Outcomes After Trauma Exposure
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Participants
Measures
MRI
Statistical Analysis
Neural correlates of derealization.
Derealization self-report and 3-month outcomes.
vmPFC and 3-month outcomes.
Results
Sample Characteristics
Characteristic | Self-Report Sample (N=1,464) | MRI Sample (N=145) | ||
---|---|---|---|---|
Mean | SD | Mean | SD | |
Age (years) | 35.39 | 12.94 | 34.66 | 12.62 |
N | % | N | % | |
Sex assigned at birth | ||||
Female | 954 | 65.2 | 97 | 66.9 |
Male | 510 | 34.8 | 48 | 33.1 |
Race/ethnicity | ||||
Asian, Hawaiian, American Indian, other | 49 | 3.3 | 6 | 4.1 |
Black/African American | 765 | 52.3 | 59 | 40.7 |
Hispanic/Latino | 174 | 11.9 | 26 | 17.9 |
White | 472 | 32.2 | 54 | 37.2 |
Missing | 4 | 0.3 | 0 | 0.0 |
Education | ||||
Less than high school | 171 | 11.7 | 5 | 3.4 |
High school diploma/GED | 369 | 25.2 | 37 | 25.5 |
Some college | 412 | 28.1 | 50 | 34.5 |
Associate’s degree | 213 | 14.5 | 14 | 9.7 |
Bachelor’s degree | 192 | 13.1 | 25 | 17.2 |
Master’s degree | 79 | 5.4 | 11 | 7.6 |
Professional/doctoral degree | 22 | 1.5 | 2 | 1.3 |
Missing | 6 | 0.4 | 0 | 0.0 |
Annual family income | ||||
<$19,000 | 497 | 33.9 | 37 | 25.5 |
$19,001–$35,000 | 434 | 29.6 | 43 | 29.7 |
$35,001–$50,000 | 194 | 13.3 | 25 | 17.2 |
$50,001–$75,000 | 114 | 7.8 | 13 | 9.0 |
$75,001–$100,000 | 84 | 5.7 | 10 | 6.9 |
>$100,000 | 88 | 6.0 | 16 | 11.0 |
Missing | 53 | 3.6 | 1 | 0.7 |
Trauma type | ||||
Motor vehicle collision | 1,138 | 77.7 | 107 | 73.8 |
Physical assault | 139 | 9.5 | 16 | 11.0 |
Sexual assault | 12 | 0.8 | 2 | 1.4 |
Fall, >10 feet | 16 | 1.1 | 1 | 0.7 |
Fall, <10 feet | 48 | 3.3 | 4 | 2.8 |
Incident causing traumatic stress exposure to many people | 5 | 0.3 | 1 | 0.7 |
Nonmotorized collision (e.g., bicycle, skateboard) | 17 | 1.2 | 5 | 3.4 |
Burns | 7 | 0.5 | 1 | 0.7 |
Animal-related | 29 | 2.0 | 3 | 2.1 |
Other | 53 | 3.6 | 5 | 3.4 |
Neural Correlates of Persistent Derealization
Emotion reactivity task activity.
Resting-state connectivity.
Prediction of 3-Month Outcomes by Self-Reported and Neural Correlates of Persistent Derealization
Self-reported derealization.
Correlation | ||||||||
---|---|---|---|---|---|---|---|---|
Measure | Mean | SD | 1 | 2 | 3 | 4 | 5 | 6 |
Derealization self-report at 2 weeks and outcomes at 3 months | ||||||||
1.Derealization at 2 weeks | 1.73 | 2.12 | ||||||
2.PTSD at 3 months | 25.13 | 19.13 | 0.53** | |||||
3.Pain extent at 3 months | 7.54 | 6.50 | 0.32** | 0.55** | ||||
4.Impairment at 3 months | 11.87 | 9.37 | 0.29** | 0.66** | 0.52** | |||
5.Anxiety at 3 months | 6.63 | 4.70 | 0.42** | 0.83** | 0.45** | 0.62** | ||
6.Depression at 3 months | 53.34 | 11.09 | 0.42** | 0.67** | 0.31** | 0.48** | 0.63** | |
Ventromedial prefrontal cortex activity and outcomes at 3 months | ||||||||
1.vmPFC fear > neutral | −0.01 | 0.23 | ||||||
2.PTSD at 3 months | 23.40 | 16.86 | 0.23* | |||||
3.Pain extent at 3 months | 7.10 | 6.08 | 0.14 | 0.63** | ||||
4.Impairment at 3 months | 11.93 | 10.06 | 0.05 | 0.65** | 0.57** | |||
5.Anxiety at 3 months | 6.46 | 4.58 | 0.11 | 0.84** | 0.52** | 0.64** | ||
6.Depression at 3 months | 53.31 | 10.66 | 0.19* | 0.78** | 0.49** | 0.62** | 0.82** |
Measure | B | Robust SE | t | p | η2p | Adj. R2 | Model Without Derealization Adj. R2 | F | df | p |
---|---|---|---|---|---|---|---|---|---|---|
PTSD at 3 months | ||||||||||
Overall model | 0.519 | 0.515 | 222.71 | 5, 1022 | <0.001 | |||||
Sex | 0.47 | 0.89 | 0.52 | 0.601 | 0.00 | |||||
Age | 0.09 | 0.03 | 3.25 | 0.001 | 0.01 | |||||
Childhood maltreatment | 0.13 | 0.05 | 2.64 | 0.009 | 0.01 | |||||
Posttraumatic stress at 2 weeks | 0.62 | 0.03 | 19.86 | <0.001 | 0.28 | |||||
Derealization at 2 weeks | 0.82 | 0.32 | 2.58 | 0.010b | 0.01 | |||||
Pain extent at 3 months | ||||||||||
Overall model | 0.223 | 0.220 | 58.69 | 5, 1000 | <0.001 | |||||
Sex | −0.77 | 0.39 | 0.92 | 0.355 | 0.00 | |||||
Age | 0.36 | 0.01 | 5.79 | <0.001 | 0.03 | |||||
Childhood maltreatment | 0.08 | 0.02 | 3.68 | <0.001 | 0.01 | |||||
Posttraumatic stress at 2 weeks | 0.11 | 0.01 | 8.06 | <0.001 | 0.06 | |||||
Derealization at 2 weeks | 0.27 | 0.13 | 2.08 | 0.038c | 0.00 | |||||
Impairment at 3 months | ||||||||||
Overall model | 0.246 | 0.246 | 68.59 | 5, 1029 | <0.001 | |||||
Sex | 0.75 | 0.54 | 1.39 | 0.165 | 0.00 | |||||
Age | 0.10 | 0.02 | 5.22 | <0.001 | 0.03 | |||||
Childhood maltreatment | 0.11 | 0.03 | 3.92 | <0.001 | 0.02 | |||||
Posttraumatic stress at 2 weeks | 0.23 | 0.02 | 11.97 | <0.001 | 0.12 | |||||
Derealization at 2 weeks | −0.22 | 0.17 | −1.28 | 0.202 | 0.00 | |||||
Anxiety at 3 months | ||||||||||
Overall model | 0.372 | 0.373 | 125.64 | 5, 1046 | <0.001 | |||||
Sex | 0.25 | 0.24 | 1.06 | 0.291 | 0.00 | |||||
Age | 0.02 | 0.01 | 2.32 | 0.020 | 0.01 | |||||
Childhood maltreatment | 0.04 | 0.01 | 3.01 | 0.003 | 0.01 | |||||
Posttraumatic stress at 2 weeks | 0.14 | 0.01 | 16.16 | <0.001 | 0.20 | |||||
Derealization at 2 weeks | 0.05 | 0.08 | 0.59 | 0.557 | 0.00 | |||||
Depression at 3 months | ||||||||||
Overall model | 0.394 | 0.389 | 138.32 | 5, 1050 | <0.001 | |||||
Sex | −0.77 | 0.58 | −1.33 | 0.183 | 0.01 | |||||
Age | 0.02 | 0.02 | 1.20 | 0.231 | 0.00 | |||||
Childhood maltreatment | 0.14 | 0.03 | 4.87 | <0.001 | 0.02 | |||||
Posttraumatic stress at 2 weeks | 0.29 | 0.02 | 14.36 | <0.001 | 0.16 | |||||
Derealization at 2 weeks | 0.56 | 0.19 | 2.88 | 0.004b | 0.01 |
vmPFC activity.
Measure | B | Robust SE | t | p | η2p | Adj. R2 | Model Without vmPFC Activity Adj. R2 | F | df | p |
---|---|---|---|---|---|---|---|---|---|---|
PTSD at 3 months | ||||||||||
Overall model | 0.390 | 0.366 | 10.34 | 8, 109 | <0.001 | |||||
MRI scanner | ||||||||||
1 vs. 4 | 4.93 | 3.31 | 1.49 | 0.139 | 0.02 | |||||
2 vs. 4 | 1.53 | 5.89 | 0.26 | 0.795 | 0.00 | |||||
3 vs. 4 | 1.16 | 3.21 | 0.36 | 0.719 | 0.00 | |||||
Sex | −2.26 | 2.82 | −0.80 | 0.425 | 0.01 | |||||
Age | 0.01 | 0.11 | 0.07 | 0.943 | 0.00 | |||||
Childhood maltreatment | <0.001 | 0.14 | 0.003 | 0.998 | 0.00 | |||||
Posttraumatic stress at 2 weeks | 0.61 | 0.09 | 7.10 | <0.001 | 0.32 | |||||
vmPFC activity | 12.55 | 4.88 | 2.57 | 0.011b | 0.06 | |||||
Depression at 3 months | ||||||||||
Overall model | 0.298 | 0.288 | 7.20 | 8, 109 | <0.001 | |||||
MRI scanner | ||||||||||
1 vs. 4 | 0.09 | 2.45 | 0.04 | 0.971 | 0.00 | |||||
2 vs. 4 | 0.12 | 5.00 | 0.02 | 0.981 | 0.00 | |||||
3 vs. 4 | −1.13 | 2.10 | −0.54 | 0.593 | 0.00 | |||||
Sex | 0.19 | 1.93 | 0.10 | 0.920 | 0.00 | |||||
Age | −0.01 | 0.07 | −0.15 | 0.882 | 0.00 | |||||
Childhood maltreatment | 0.11 | 0.11 | 1.06 | 0.290 | 0.01 | |||||
Posttraumatic stress at 2 weeks | 0.32 | 0.07 | 4.93 | <0.001 | 0.18 | |||||
vmPFC activity | 5.80 | 2.28 | 1.77 | 0.080 | 0.03 |
Discussion
Conclusions
Acknowledgments
Supplementary Material
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