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
 Why a Marine
Resiliency Study?

Improved knowledge about risk and resiliency

will help to
¾Prevent

¾Identify

¾Treat

Operational and Combat Stress Injuries

 Why a Resiliency Study?
¾Intheater: Daily hardships and combat
operations trigger acute and chronic stress
¾Physical: dehydration & wetness, dirt and mud, sleep
deprivation, noise & blasts, fumes & smells, bright light &
darkness, malnutrition, illness & injury
¾Cognitive: lack of information or too much information,
ambiguous or changing mission or role, ambiguous or changing
rules of engagement, loyality conflicts, boredom & monotony,
experience that don’t make sense
¾Emotional: losses of friends to death or injury, fear, shame &
guilt, helplessness, horror, killing
¾Social: isolation from social supports, lack of privacy, the media
& public opinion
from Nash 2007
 Why a Resiliency Study?

¾The adaptive responses to chronic and

intermittent stress is not fully understood
¾Retrospective studies associate genotype,
physiology and personality traits with conditions -
anxiety, depression and posttraumatic stress
symptoms – thought to result from stress
¾Age, gender
¾Reactivity to stress, tendency to dissociate
¾Childhood stress and/or trauma
 Why a Resiliency Study?

¾The retrospective studies provide clues about

resilience but a better understanding of the full
range of adaptive responses to combat
operational stress is needed in order to design
programs that promote resiliency
¾Prospective studies could fill in knowledge gaps
about the trajectories of adaptation to combat
operational stress
 Why a Resiliency Study?

¾As yet, there are no prospective studies

showing the various trajectories of adaptation to
combat – this proposed study would be the first
¾ Components (projects) that are likely impact
adaptation
¾Cognitive, psychological, social
¾Biological

¾Genetic
 Trajectories of Adaptation to
Operational Stress and Trauma
P
T CHRONIC COURSE
High

S
D DELAYED COURSE
SYMPTOM BURDEN
Moderate

S
Y
M
P RECOVERY COURSE
T
O
INNOCULATION COURSE
Low

M
RESILIENT COURSE
B
U DE RE 3M 6M
Growth

PR
R E-D PL TU OS OS
EP OY RN .P .P
D LO ME OS OS
YM NT T T
E EN
N T GROWTH COURSE
Diagram courtesy of Brett Litz, PhD, NCPTSD, Boston
 Study – Who/when?

¾1600 Members (2 Infantry Battalions) of the 1st

Marine Division will be offered invitations to
participate in the prospective study
¾ Information (data) will be gathered at four time
points
¾Time 1: Within the month prior to deployment
¾Time 2: One week postdeployment (questionnaires only)
¾Time 3: Three months postdeployment
¾Time 4: Six months postdeployment
 The projects?
Project 1
Psychiatric, psychosocial and cognitive
predictors of adaptation trajectories
Brett Litz Ph.D.; Boston University and
National Center for PTSD; William P. Nash
M.D., Headquarters Marine Corps, Quantico &
University of California San Diego; Jennifer
Vasterling; Boston University & National
Center for PTSD); Paul Hammer M.D.,
Division Psychiatrist, 1st Marine Corps, Camp
Pendleton
 The projects?
Project 2
Startle thresholds, sensorimotor gating, heart
rate (HR) reactivity, baseline as predictors
of adaptation trajectory
Victoria Risbrough Ph.D., San Diego VA
CESAMH & University of California San Diego
(UCSD); Mark Geyer Ph.D, San Diego VA
CESAMH & UCSD; Dewleen Baker M.D., San
Diego VA CESAMH & UCSD
 The projects?
Project 3
Characterization of catecholamine
(norepinephrine) genotype, stress-related
proteins and blood pressure (BP) as
predictors of intermediate biological traits
(phenotype) and adaptation trajectory
Daniel O’Connor M.D.,San Deigo VA &
Department of Medicine, UCSD; Nicholas
Schork M.D.,San Diego VA CESAMH, Scripps
Institute & UCSD; Dewleen Baker M.D.,San
Diego VA CESAMH & UCSD
 Rationale?
Project 3
There is considerable evidence for the
involvement of catecholamines
(norepinephrine) in arousal, memory
formation, startle, blood pressure and
pulse, and in PTSD
Daniel O’Connor M.D.,San Deigo VA &
Department of Medicine, UCSD; Nicholas
Schork M.D.,San Diego VA CESAMH, Scripps
Institute & UCSD; Dewleen Baker M.D.,San
Diego VA CESAMH & UCSD
 CSF Norepinephrine in PTSD and Control Subjects
0.700

0.650 PTSD
CSF Norepinephrine (pmol/ml)
0.600

0.550

0.500

0.450
CONTROL
0.400

0.350

0.300

0.250
11:40 12:40 13:40 14:40 15:40 16:40

TIME

Geracioti, Baker et al
2001
 Relationship Between Mean CSF Norepinephrine
Concentration and PTSD Symptoms in 11 Patients with PTSD
1.0

CSF Norepinephrine (pmol/ml)

Mean Concentration of

0.8

0.6

0.4

0.2
20 40 60 80 100 120
Total Score on Clinician-Administered PTSD Scale

Geracioti, Baker et al 2001

 Special aspects
of this study

¾ Prospective
¾ Multisystem
¾ Integrated (examination of data across
projects)
 Pia Santiago
William Nash
Fengwen Rao
Gerald Larson
Caroline Nievergelt
Brett Litz
Michele Frybarger
Mark Geyer
Todd May
Jennifer Vasterling
Patricia Gorman
Victoria Risbrough
Juan Montgomery
Daniel O’Connor
Michaelangelo Maamo
Nicholas Schork
Paul Hammer
Edward Hessel
Thomas Gaskin