C-Reactive Protein as a Potential Risk Factor for Post-Traumatic Stress Disorder Symptoms and Diagnosis: A Prospective Study Open Access

Abstract

Background: Post-traumatic stress disorder (PTSD) is a debilitating psychological disorder with potentially severe psychological, physiological, and community-wide impacts. Physiological co-morbidities with PTSD have led to research showing that heightened inflammation is associated with PTSD symptoms and diagnosis. While it has previously been demonstrated that PTSD can dysregulate the hypothalamic-pituitary-adrenal (HPA) axis and lead to heightened inflammation, more recent findings show that heightened baseline inflammation, specifically heightened levels of the pro-inflammatory marker C-reactive protein (CRP), may also contribute to PTSD symptom development.

Methods: Participants were recruited from the Marcus Trauma Center at Grady Memorial Hospital in Atlanta, GA. During enrollment, blood samples were taken from participants for blood plasma CRP concentration determination. As well, participants underwent various psychological evaluations. All participants were invited to follow-up assessments every three months for the year following enrollment. Psychological assessments were repeated during follow-up appointments to track PTSD symptom progression.

Results: No significant effect of CRP level (high vs. low) was found for any measure of PTSD outcome (total symptoms, symptom clusters, diagnosis, and trajectory).

Conclusion: The present study undertakes one of the first prospective explorations of inflammation and PTSD in a civilian population. Compared to a similar prospective study examining the relationship between CRP levels and PTSD outcomes, the current sample is extremely limited by extensive demographic variation. Moreover, the present study is limited by a small enrollment sample size and low retention rate throughout the year post enrollment. Further investigation within the ongoing project should re-examine the effect of CRP levels on PTSD outcomes. With larger sample sizes, future analysis will be better able to account for population variability and will yield a more generalizable result.

Table of Contents

Introduction ..........................................................................................................................1

Post-Traumatic Stress Disorder ...............................................................................1

PTSD Risk, Prevalence, and Co-Morbidity .............................................................2

Stress Sensitization and the Psychophysiology of PTSD ........................................5

Stress sensitization.......................................................................................5

Fear potentiated startle (FPS) and transfer of fear inhibition ......................6

Hypothalamic-pituitary-adrenal (HPA) axis and PTSD ..............................8

Glucocorticoids and memory formation ......................................................9

The immune system, C-reactive protein (CRP), and PTSD ......................10

Methods..............................................................................................................................13

Participants.............................................................................................................13

Procedures & Measures .........................................................................................13

CRP Assays and Concentrations............................................................................14

Statistical Analysis.................................................................................................15

Results ................................................................................................................................17

Demographic Characteristics .................................................................................17

CRP Level and PTSD Outcomes ...........................................................................17

Discussion ..........................................................................................................................19

Limitations .............................................................................................................19

Future Directions ...................................................................................................23

References ..........................................................................................................................28

Tables and Figures .............................................................................................................36

About this Honors Thesis

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School	Emory College
Department	Neuroscience and Behavioral Biology
Degree	BS
Submission	Honors Thesis
Language	English
Research Field	Psychology, Psychobiology Health Sciences, Immunology Health Sciences, Mental Health
Keyword	C-Reactive Protein Inflammation Post-Traumatic Stress Disorder
Committee Chair / Thesis Advisor	Michopoulos, Vasiliki, Emory University
Committee Members	Frenzel, Kristen E, Emory University McQuaide, Michael M, Emory University

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