Risk and Resilience in Urban Black American Acute Trauma Survivors - PROJECT ABSTRACT
Trauma is common and increases risk for a host of negative health outcomes, most notably posttraumatic
stress disorder (PTSD). Given the potential harmful sequelae of trauma exposure, it is crucial to identify acute
post-trauma risk factors that predict chronic PTSD. Moreover, urban racial/ethnic minorities can experience
significant environmental stress that puts them at particularly high risk for PTSD. At this juncture relatively little
data exists to aid in prediction of risk specific to urban racial minorities, or that takes into account how
disadvantage and minority stress may impact neurobiological stress systems in the months following trauma,
and how that affects risk for long-term distress. Thus, under the guidance of a community advisory board our
team will 1) identify acute post-trauma neurobehavioral predictors of risk for chronic PTSD among urban Black
Americans, with a focus on prefrontal-subcortical function during processing of threat, 2) characterize how the
longitudinal interaction of socioenvironmental risk and resilience factors and biological stress markers following
trauma impacts risk, and 3) use machine learning to identify the most robust set of predictors of chronic PTSD
drawn from a comprehensive assessment of neuroimaging, biomarkers, self-report and geocoded risk and
resilience variables. We will recruit 190 adults who identify as Black or African American from the Emergency
Department at Froedtert Hospital/Medical College of Wisconsin in Milwaukee, and conduct comprehensive
assessments at 2 weeks, and 3, 6, and 12 months following trauma exposure. The two-week and 12-month
assessments will include measures of neural systems for threat processing, including both anticipation of and
reactivity to threat. All visits will include measures of PTSD and other symptoms, neurobiological stress
markers, particularly endocannabinoids, and socioenvironmental risk and resilience factors, especially those
relevant for urban Black Americans. We will examine how acute post-trauma neurocircuitry variables (2 week)
predict PTSD and other outcomes twelve months later, and how pre-trauma environmental variables (resource
deprivation, child maltreatment, violence exposure) moderate this relationship (Aim 1). We will also assess
how, in the months following trauma, socio-environmental risk and resilience factors influence neurobiological
stress systems, and how this interaction impacts risk for PTSD, poor physical health, and emotion regulation
neurocircuitry at twelve months (Aim 2). We will use both hypothesis-driven analyses focusing on a priori
specified predictors (Aims 1 and 2), as well as comprehensive data-driven machine learning analyses (Aim 3).
This approach will allow for determination of the additional utility of neurobiological markers for predicting risk
beyond previously identified self-report indicators. We expect this project to lead to identification of predictors
of PTSD following trauma for urban Black Americans at high risk that are linked to underlying processes
(hyper-responsivity to threat, aberrant neurobiological stress response) that can inform preventive
interventions, ultimately improving the quality of life for urban Black American trauma survivors.
