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Posttraumatic Stress Disorder and Inflammation: Untangling Issues of Bidirectionality
Open accessAbstract
Posttraumatic stress disorder (PTSD) has increasingly been linked to heightened systemic inflammation. It matters whether this association is causal (and either bidirectional or unidirectional) or correlational. Investigators have hypothesized that chronic systemic low-grade inflammation may contribute to greater risk of developing PTSD after experiencing trauma and/or serve as a mechanism linking PTSD to adverse physical health outcomes. However, if the PTSD-inflammation relation is correlational, it may not warrant further research aimed at understanding inflammation as a PTSD risk factor or as a pathway linking PTSD with poor health. In this review, we first assess the longitudinal evidence related to PTSD and inflammation to understand more clearly the directionality and causal nature of this relation. Overall, few longitudinal studies rigorously assess the direction of the PTSD-inflammation relation. Some of the evidence indicates that elevated inflammation assessed pretrauma or in the acute aftermath of trauma increases risk for developing PTSD. Fewer studies evaluate the influence of PTSD on subsequent inflammation levels, and findings are mixed. Sample characteristics and study designs, and also the type of inflammation-related measure, vary widely across studies. Based on current evidence, we then recommend several statistical and study design approaches that may help untangle issues of bidirectionality and aid in determining the direction of causality between PTSD and inflammation. Last, we conclude with future research directions and consider potential implications for interventions or treatment approaches based on this growing body of literature.
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“Although numerous studies note that associations between negative psychological health and factors that increase cardiovascular risk are likely bidirectional, recent longitudinal studies provide strong evidence that factors such as depression and PTSD precede and predict higher levels of inflammation in both healthy and patient populations. 118,119,124”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [118]
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“Specifically, chronic distress is associated with detrimental processes, including hypercoagulability, dyslipidemia, 112-114 impaired glucose control, 115,116 and increased inflammatory processes and impaired immune responses. 95,117,118”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [118]
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Metadata
- Authors
- Sumner, J. A., Nishimi, K. M., Koenen, K. C., Roberts, A. L., & Kubzansky, L. D.
- Affiliations
- University of California, Los Angeles (US)
- Harvard University (US)
- Corresponding author
- Sumner, Jennifer A.
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 87
- Issue
- 10
- Pages
- 885-897
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC7211139
- OpenAlex
- W2985450080
- Cited by
- 131
- References
- 76
- Citations by year
- 2026: 13 · 2025: 20 · 2024: 20 · 2023: 32 · 2022: 25 · 2021: 15 · 2020: 5
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- post-traumatic stress disorder, systemic inflammation, bidirectionality, causal direction, low-grade inflammation, trauma exposure, PTSD risk factors, physical health outcomes, longitudinal evidence, study design recommendations, inflammatory markers
- MeSH terms
- Humans, Inflammation, Longitudinal Studies, Risk Factors, Stress Disorders, Post-Traumatic
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