Predicting risk for post-traumatic stress disorder in African American women with breast cancer

PI – Jennifer Stevens, PhD

Recent data suggest that the emotional and physical stress of being diagnosed and treated for breast cancer is associated with the development of PTSD symptoms, which can last for months to years after treatment. PTSD has been shown to negatively impact quality of life in cancer survivors, impairing work, social, and physical functioning. Because African American women experience a greater burden of PTSD relative to other racial and ethnic groups, we hypothesize that they may be at especially high risk for the development or worsening of PTSD during breast cancer diagnosis and treatment. Nevertheless, very little research has addressed the development of PTSD in populations of breast cancer patients already at risk, including those with high levels of prior trauma, high current life stress, and low economic and social support.

Accordingly, we propose to investigate risk factors for PTSD related to breast cancer diagnosis and treatment in women recruited from Grady Memorial Hospital, a major urban medical center serving primarily African American patients with low socioeconomic status who are at high risk for prior trauma and PTSD. Our goal is to identify biological predictors of PTSD at the onset of treatment that can identify those most at risk.

Our prior work indicates that, during the peri-traumatic period, hyper-reactivity of the amygdala (a fear-regulating brain region) and its outputs to the sympathetic nervous system, are predictive of poor PTSD recovery trajectories. Similarly, patients with heightened levels of blood-based immune inflammatory markers also show greater PTSD symptoms that may be linked to amygdala hyperresponsiveness. Thus, we hypothesize that, in addition to psychosocial risk factors, biomarkers in the brain and blood indicating hyper-reactivity of the amygdala (sympathetic hyperactivity and inflammatory activation) will predict PTSD symptoms following breast cancer diagnosis and treatment.