Robert J Ursano

Robert J Ursano
Uniformed Services University of the Health Sciences | USUHS · Center for the Study of Traumatic Stress

MD

About

860
Publications
148,837
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Introduction
Professor Psychiatry & Neuroscience; Director Center for the Study of Traumatic Stress (USUHS), First Chairman of the APA's Psychiatric Dimensions of Disaster; Chaired first APA's Treatment Guidelines for PTSD and ASD, Past member Board of Scientific Counselors, Coordinating Office for Terrorism Preparedness and Emergency Response (CDC). Awarded Humanitarian Service Award (DoD), Lifetime Achievement Award (AMSUS), Lifetime Achievement Award (ISTSS), William C. Porter Award (ASMUS), American College of Physicians William C Menninger Award. Published the first Textbook of Disaster Psychiatry (Cambridge Press)
Additional affiliations
January 1985 - present
September 1979 - present
Walter Reed National Military Medical Center
Position
  • Faculty Member
July 1979 - present
Uniformed Services University of the Health Sciences
Position
  • Managing Director
Education
September 1969 - June 1973
Yale University
Field of study
  • Medicine
September 1965 - May 1969
University of Notre Dame
Field of study
  • Chemistry/PreProf

Publications

Publications (860)
Article
IMPORTANCE: Suicide attempts in the US Army have risen in the past decade. Understanding the association between suicide attempts and deployment, as well as method and timing of suicide attempts, can assist in developing interventions. OBJECTIVE: To examine suicide attempt risk factors, methods, and timing among soldiers currently deployed, previou...
Article
IMPORTANCE The rate of suicide attempts in the US Army increased sharply during the wars in Afghanistan and Iraq. Research on this important health outcome has been hampered by the lack of integration among Army administrative data systems. OBJECTIVE To identify risk factors for suicide attempts among active-duty members of the regular Army from J...
Article
IMPORTANCE: The US Army experienced a sharp increase in soldier suicides beginning in 2004. Administrative data reveal that among those at highest risk are soldiers in the 12 months after inpatient treatment of a psychiatric disorder. OBJECTIVE: To develop an actuarial risk algorithm predicting suicide in the 12 months after US Army soldier inpati...
Article
Importance: Posttraumatic stress disorder (PTSD) is a prevalent, serious public health concern, particularly in the military. The identification of genetic risk factors for PTSD may provide important insights into the biological foundation of vulnerability and comorbidity. Objective: To discover genetic loci associated with the lifetime risk for...
Article
Full-text available
Teaching is a part of nearly every professional's activities and, for some, it is a career. At its core, psychotherapy itself is a teaching activity and its therapeutic alliance can provide a useful concept from which to consider the teacher student relationship. From this perspective, the teaching alliance is the fundamental relationship between t...
Article
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Posttraumatic stress disorder (PTSD) is a heritable (h² = 24–71%) psychiatric illness. Copy number variation (CNV) is a form of rare genetic variation that has been implicated in the etiology of psychiatric disorders, but no large-scale investigation of CNV in PTSD has been performed. We present an association study of CNV burden and PTSD symptoms...
Article
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Background Personality traits (e.g. neuroticism) and the social environment predict risk for internalizing disorders and suicidal behavior. Studying these characteristics together and prospectively within a population confronted with high stressor exposure (e.g. U.S. Army soldiers) has not been done, yet could uncover unique and interactive predict...
Article
Introduction Active duty service members transitioning to civilian life can experience significant readjustment stressors. Over the past two decades of the United States’ longest sustained conflict, reducing transitioning veterans’ suicidal behavior and homelessness became national priorities. However, it remains a significant challenge to identify...
Preprint
Full-text available
Most genome-wide association studies (GWAS) of major depression (MD) have been conducted in samples of European ancestry. Here we report a multi-ancestry GWAS of MD, adding data from 21 studies with 88,316 MD cases and 902,757 controls to previously reported data from individuals of European ancestry. This includes samples of African (36% of effect...
Article
Objective: In times of repeated disaster events, including natural disasters and pandemics, public health workers must recover rapidly to respond to subsequent events. Understanding predictors of time to recovery and developing predictive models of time to recovery can aid planning and management. Methods: We examined 681 public health workers (...
Article
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Background Although much has been learned about the physical and psychological impacts of deployment and combat injury on military service members, less is known about the effects of these experiences on military spouses. Methods The present study examined self‐reported mental health symptoms (using the Brief Symptom Inventory [BSI]‐18 and the pos...
Article
Importance: Approximately one-third of US soldiers who attempt suicide have not received a mental health diagnosis (MH-Dx) before their suicide attempt (SA), yet little is known about risk factors for SA in those with no MH-Dx. Objective: To examine whether premilitary mental health is associated with medically documented SA among US Army soldie...
Article
Background The transition from military service to civilian life is a high-risk period for suicide attempts (SAs). Although stressful life events (SLEs) faced by transitioning soldiers are thought to be implicated, systematic prospective evidence is lacking. Methods Participants in the Army Study to Assess Risk and Resilience in Servicemembers (ST...
Article
Objective: Among U.S. Army soldiers suicide attempts (SAs) are a significant public health concern, particularly early in service. We examined the association of attachment style with SA and suicide ideation (SI) among U.S. Army soldiers. Methods: We analyzed survey data from new soldiers who participated in the Army Study to Assess Risk and Res...
Article
Stress, especially the extreme stress of traumatic events, can alter both neurobiology and behavior. Such extreme environmental situations provide a useful model for understanding environmental influences on human biology and behavior. This paper will review some of the evidence of brain alterations that occur with exposure to environmental stress....
Article
Background Posttraumatic stress disorder (PTSD) is heritable and a potential consequence of exposure to traumatic stress. Evidence suggests that a quantitative approach to PTSD phenotype measurement and incorporation of lifetime trauma exposure (LTE) information could enhance the discovery power of PTSD genome-wide association studies (GWAS). Meth...
Article
Post-traumatic stress disorder (PTSD) develops after an exposure to a life-threatening event and is characterized by intrusive memories. According to memory reconsolidation theory retrieval of memory under certain conditions leads to its labilization and subsequent re-storage which could be disrupted by drugs. Propranolol has been the most commonly...
Article
Introduction The ability to predict and prevent homelessness has been an elusive goal. The purpose of this study was to develop a prediction model that identified U.S. Army soldiers at high risk of becoming homeless after transitioning to civilian life based on information available before the time of this transition. Methods The prospective cohor...
Article
Post-traumatic stress disorder (PTSD), characterized by abnormally persistent and distressing memories, is a chronic debilitating condition in need of new treatment options. Current treatment guidelines recommend psychotherapy as first line management with only two drugs, sertraline and paroxetine, approved by U.S. Food and Drug Administration (FDA...
Presentation
Full-text available
ECNP Traumatic Stress Network Virtual Meeting "Hot topics" (17 March 2022) with Robert Ursano, professor of Psychiatry and Neuroscience, Director, Center for the Study of Traumatic Stress at the Uniformed Services University, Bethesda, Maryland; David Benedek, professor of Psychiatry and Neuroscience, and Associate Director/Senior Scientist at the...
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Preprint
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For a limited time, full text of this article is available at: https://authors.elsevier.com/a/1epe89UUG-vl9H The DOI for published article: https://doi.org/10.1016/j.jaclp.2022.02.007
Article
Full-text available
Epigenetic factors modify the effects of environmental factors on biological outcomes. Identification of epigenetic changes that associate with PTSD is therefore a crucial step in deciphering mechanisms of risk and resilience. In this study, our goal is to identify epigenetic signatures associated with PTSD symptom severity (PTSS) and changes in PT...
Article
Full-text available
Suicide risk is elevated among military service members who recently transitioned to civilian life. Identifying high-risk service members before this transition could facilitate provision of targeted preventive interventions. We investigated the feasibility of doing this by attempting to develop a prediction model for self-reported suicide attempts...
Article
Background Bereavement has been associated with increases in immune/inflammatory and neuroendocrine reactions, cardiovascular events, non-specific physical symptoms, mental conditions, and healthcare utilization. However, little is known about bereavement effects in younger samples, multiple health effects within samples, or health changes from pre...
Chapter
Coronavirus SARS-CoV-2 disease (COVID-19) has caused injury, death, and distress in millions around the globe. Adverse mental health effects are substantial, with distress, health risk behaviors, and mental disorders exacerbating the threat of morbidity and mortality related to infection itself. The unique impacts of COVID-19, as well as the measur...
Research
Full-text available
Exposure to war causes a wide range of harmful mental health effects. Those working with refugees and people directly impacted in Ukraine can protect mental health by using the following evidence-based actions and other resources. Resources include: (1) Rapid Psychological First Aid: Help for You, Family, and Friends (2) Helping Others Calm an Ac...
Chapter
Therapeutic alliance plays a key role in understanding and addressing treatment resistance in depression, both for psychotherapeutic and pharmacologic interventions. By considering the shared goals, agreed-upon tasks, and trusting bond between therapist and patient, it is possible to identify factors contributing to reduced treatment response. Rega...
Article
Objective: Since 2004 increased rates of suicide have been noted in the US Armed Forces. We examined the association of social support (SS) trajectories and suicide ideation (SI) over a four-year period in Reserve Component (RC) servicemembers (National Guard and Reserve). We also examined baseline mental health measures, as predictors of the ident...
Article
Introduction Emotion reactivity (ER) and distress intolerance (DI) may be associated with increased suicide attempt (SA) risk among U.S. Army soldiers. Method In this case–control study, 74 soldiers recently hospitalized for SA (cases) were compared with 133 control soldiers from the same Army installations selected based on either propensity scor...
Article
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Background Problematic anger is frequently reported by soldiers who have deployed to combat zones. However, evidence is lacking with respect to how anger changes over a deployment cycle, and which factors prospectively influence change in anger among combat-deployed soldiers. Methods Reports of problematic anger were obtained from 7298 US Army sol...
Article
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Importance Rates of suicidal thoughts and behaviors (STBs) in US soldiers have increased sharply since the terrorist attacks on September 11, 2001, and postdeployment posttraumatic stress disorder (PTSD) remains a concern. Studies show that soldiers with greater combat exposure are at an increased risk for adverse mental health outcomes, but little...
Article
Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the...
Chapter
Post-traumatic stress disorder (PTSD) is a serious mental health concern worldwide among civilians and military personnel. Gaps in our understanding of its biological basis create significant obstacles for accurate diagnosis and assessment of therapeutic interventions. In light of this, investigation of biological factors associated with possible m...
Article
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Objectives Major Depressive Disorder (MDD) is a complex neuropsychiatric disease with known genetic associations, but without known links to rare variation in the human genome. Here we aim to identify rare genetic variants associated with MDD using deep whole-genome sequencing data in an independent population. Methods We report the sequencing of...
Article
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Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is un...
Article
Objectives. To examine associations of current mental and substance use disorders with self-reported gun ownership and carrying among recently separated US Army soldiers. Veterans have high rates of both gun ownership and mental disorders, the conjunction of which might contribute to the high suicide rate in this group. Methods. Cross-sectional sur...
Article
Importance Most previous genome-wide association studies (GWAS) of depression have used data from individuals of European descent. This limits the understanding of the underlying biology of depression and raises questions about the transferability of findings between populations. Objective To investigate the genetics of depression among individual...
Article
Full-text available
Importance Anger is linked to adverse outcomes in military populations; however, whether pre-enlistment anger attacks are associated with postenlistment mental disorders and suicidality is unknown. Objective To explore the associations of pre-enlistment anger attacks with postenlistment mental health. Design, Setting, and Participants In this obs...
Article
Objective: The authors sought to identify predictors of imminent suicide attempt (within 30 days) among U.S. Army soldiers following their first documented suicidal ideation. Methods: Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers, the authors identified 11,178 active-duty Regular Army enlisted sold...
Article
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Background Suicide is a leading cause of death worldwide, and non-fatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genom...
Article
Suicide is a major public health problem. The contribution of common genetic variants for major depressive disorder (MDD) independent of personal and parental history of MDD has not been established. Polygenic risk score (using PRS-CS) for MDD was calculated for US Army soldiers of European ancestry. Associations between polygenic risk for MDD and...
Article
Posttraumatic stress disorder (PTSD) is characterized by a persistent maladaptive reaction after exposure to severe psychological trauma. Traumatic events that may precipitate PTSD include violent personal assaults, natural and human-made disasters, and exposure to military combat or warfare. There is a growing body of evidence for associations of...
Article
Objective We tested the aspects of social support, unit cohesion, and religiosity hypothesized to be protective factors for suicide among U.S. service members. Methods This case–control study compared U.S. Army soldiers who died by suicide while on active duty (n = 135) to controls of two types: those propensity score-matched on known sociodemogra...
Article
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Importance Physicians are exposed to traumatic events during their work, but the impact and outcomes of these exposures are understudied. Objective To determine the prevalence and associations of work-related trauma exposure and posttraumatic stress disorder (PTSD) among a cohort of resident physicians in their internship year of training. Design...
Article
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Background Sleep disturbances are common in individuals with post traumatic stress disorder (PTSD). However, little is known about how daily variation in sleep characteristics is related to PTSD. This study examined the night-to-night and weekday versus weekend variation in sleep duration, sleep quality, trouble falling asleep, and difficulty stayi...
Article
Objective Suicide and suicide attempts among U.S. Army soldiers are a significant concern for public health. This study examined the association of parental suicide attempt prior to age 13 of the soldier with subsequent risk of pre-enlistment suicide attempt. Method We conducted secondary analyses of survey data from new soldiers who participated...
Article
Background: Definition of disorder subtypes may facilitate precision treatment for posttraumatic stress disorder (PTSD). We aimed to identify PTSD subtypes and evaluate their associations with genetic risk factors, types of stress exposures, comorbidity, and course of PTSD. Methods: Data came from a prospective study of three U.S. Army Brigade C...
Article
Introduction Little is known about the degree to which U.S. Army soldiers in the Reserve Components (Army National Guard and Army Reserve) and Active Component (Regular Army) differ with respect suicide attempt (SA) risk during high-stress times, such as deployment. Method Using administrative person-month records of enlisted soldiers on active du...
Article
Objective Community characteristics, such as collective efficacy, a measure of community strength, can affect behavioral responses following disasters. We measured collective efficacy 1 month before multiple hurricanes in 2005, and assessed its association to preparedness 9 months following the hurricane season. Methods Participants were 631 Flori...
Article
Objective: To examine sex differences in risk for administratively documented suicide attempt (SA) among US Army soldiers during the Iraq/Afghanistan wars. Method: Using administrative person-month records of Regular Army enlisted soldiers from 2004 to 2009, we identified 9650 person-months with a first documented SA and an equal-probability con...
Article
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Substance dependence diagnoses (SDs) are important risk factors for suicidality. We investigated the associations of multiple SDs with different suicidality outcomes, testing how genetic background moderates these associations. The Yale-Penn cohort ( N = 15,557) was recruited to investigate the genetics of SDs. The Army STARRS (Study to Assess Risk...
Preprint
Full-text available
Suicide is a leading cause of death worldwide and non-fatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both are known to have a substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. We conducted a genome-wide...
Article
Full-text available
Epigenetic differences may help to distinguish between PTSD cases and trauma-exposed controls. Here, we describe the results of the largest DNA methylation meta-analysis of PTSD to date. Ten cohorts, military and civilian, contribute blood-derived DNA methylation data from 1,896 PTSD cases and trauma-exposed controls. Four CpG sites within the aryl...
Article
Objective This study examined the relationship of perceived safety and confidence in local law enforcement and government to changes in daily life activities during the Washington, DC, sniper attacks. Methods Participants were 1238 residents from the Washington, DC metropolitan area who were assessed using an Internet survey that included items re...
Article
Background Suicide is a serious public health problem, including among U.S. Army personnel. There is great interest in discovering objective predictors of suicide and non-fatal suicidal behaviors. The current study examined the association between neurocognitive functioning and pre-military history of suicide attempts (SA) and post-enlistment onset...
Article
Full-text available
Army STARRS (2009-2015) was the largest and most comprehensive research project of mental health ever conducted in the U.S. Army. The project was designed to examine a broad range of risk and resilience (protective) factors across a complex set of outcomes. Army STARRS scientists created a series of extensive databases with the potential to achieve...
Article
Objective: Rates of some psychological disorders are higher among enlisted U.S. military personnel than socio-demographically matched civilians. Indirect evidence suggests some internalizing and externalizing psychological problems among enlistees onset prior to enlistment. However, the consistency and strength of the associations between pre-enlis...