Posttraumatic survivor guilt is associated with white matter microstructure alterations

Philine Rojczyk; Johanna Seitz-Holland; Carina Heller; Sofia Marcolini; Amy D Marshall; Valerie J Sydnor; Elisabeth Kaufmann; Leonard B Jung; Elena M Bonke; Luisa Berger; Lisa F Umminger; Tim L T Wiegand; Kang Ik K Cho; Yogesh Rathi; Sylvain Bouix; Ofer Pasternak; Sidney R Hinds; Catherine B Fortier; David Salat; William P Milberg; Martha E Shenton; Inga K Koerte

doi:10.1016/j.jad.2024.06.047

Posttraumatic survivor guilt is associated with white matter microstructure alterations

J Affect Disord. 2024 Sep 15:361:768-777. doi: 10.1016/j.jad.2024.06.047. Epub 2024 Jun 17.

Authors

Philine Rojczyk¹, Johanna Seitz-Holland², Carina Heller³, Sofia Marcolini⁴, Amy D Marshall⁵, Valerie J Sydnor⁶, Elisabeth Kaufmann⁷, Leonard B Jung¹, Elena M Bonke¹, Luisa Berger¹, Lisa F Umminger¹, Tim L T Wiegand¹, Kang Ik K Cho⁶, Yogesh Rathi⁸, Sylvain Bouix⁹, Ofer Pasternak⁸, Sidney R Hinds¹⁰, Catherine B Fortier¹¹, David Salat¹², William P Milberg¹³, Martha E Shenton¹⁴, Inga K Koerte¹⁵

Affiliations

¹ Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
² Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
³ Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Department of Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany; German Center for Mental Health (DZPG), Partner Site Jena-Magdeburg-Halle, Jena, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Partner Site Jena-Magdeburg-Halle, Jena, Germany.
⁴ Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁵ Department of Psychology, The Pennsylvania State University, PA, USA.
⁶ Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
⁸ Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁹ Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Software Engineering and Information Technology, École de technologie supérieure, Université du Québec, Montréal, QC, Canada.
¹⁰ Department of Neurology, Uniformed Services University, Bethesda, MD, USA.
¹¹ Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
¹² Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA; Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital Department of Radiology, Boston, MA, USA.
¹³ Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, USA.
¹⁴ Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, VA Boston Healthcare System, Brockton, MA, USA.
¹⁵ Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, VA Boston Healthcare System, Brockton, MA, USA; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University, Munich, Germany. Electronic address: [email protected].

PMID: 38897303
DOI: 10.1016/j.jad.2024.06.047

Abstract

Background: Military veterans with posttraumatic stress disorder (PTSD) commonly experience posttraumatic guilt. Guilt over commission or omission evolves when responsibility is assumed for an unfortunate outcome (e.g., the death of a fellow combatant). Survivor guilt is a state of intense emotional distress experienced by the weight of knowing that one survived while others did not.

Methods: This study of the Translational Research Center for TBI and Stress Disorders (TRACTS) analyzed structural and diffusion-weighted magnetic resonance imaging data from 132 male Iraq/Afghanistan veterans with PTSD. The Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV) was employed to classify guilt. Thirty (22.7 %) veterans experienced guilt over acts of commission or omission, 34 (25.8 %) experienced survivor guilt, and 68 (51.5 %) had no posttraumatic guilt. White matter microstructure (fractional anisotropy, FA), cortical thickness, and cortical volume were compared between veterans with guilt over acts of commission or omission, veterans with survivor guilt, and veterans without guilt.

Results: Veterans with survivor guilt had significantly lower white matter FA compared to veterans who did not experience guilt (p < .001), affecting several regions of major white matter fiber bundles. There were no significant differences in white matter FA, cortical thickness, or volumes between veterans with guilt over acts of commission or omission and veterans without guilt (p > .050).

Limitations: This cross-sectional study with exclusively male veterans precludes inferences of causality between the studied variables and generalizability to the larger veteran population that includes women.

Conclusion: Survivor guilt may be a particularly impactful form of posttraumatic guilt that requires specific treatment efforts targeting brain health.

Keywords: DTI; Moral injury; Posttraumatic stress disorder; dMRI; veterans.

MeSH terms

Adult
Afghan Campaign 2001-
Diffusion Magnetic Resonance Imaging
Guilt*
Humans
Iraq War, 2003-2011
Male
Middle Aged
Stress Disorders, Post-Traumatic* / pathology
Stress Disorders, Post-Traumatic* / psychology
Survivors* / psychology
Veterans* / psychology
White Matter* / diagnostic imaging
White Matter* / pathology