Sandro Galea’s research while affiliated with Washington University in St. Louis and other places

Objective: There is tremendous public health interest in cost-efficient, scalable interventions to improve post-disaster mental health. The authors examined the efficacy of Bounce Back Now (BBN), a mobile application, versus an enhanced usual care app (EUC). Methods: A population-based trial was conducted with a diverse sample of 1,357 adults affected by Hurricane Harvey, Irma, Maria, Florence, or Michael in 2017 and 2018. Participants were eligible if they were ≥18 years of age, had access to an Internet-accessible device, were English speaking, and lived in a hurricane-affected area. BBN is designed to address symptoms of posttraumatic stress, depression, and sleep disturbance using evidence-based techniques grounded in behavioral and cognitive principles. Depressive, posttraumatic stress, and sleep symptoms were measured. Results: Participants' accessing of the BBN and EUC apps was similar. Active engagement was significantly greater among BBN users than EUC users (d=0.31), but BBN users engaged more actively in coping skills activities than in more time-intensive elements designed to promote behavior change. Moderate symptom reduction was observed in both conditions; Cohen's d values for the 3-month postbaseline assessment ranged from 0.49 to 0.60 in the BBN condition and from 0.36 to 0.41 in the EUC condition. Latent change models revealed that BBN users had significantly greater reductions in depression, sleep difficulty, and PTSD symptoms than EUC users, and these differences were maintained at the 6-month and 12-month postbaseline assessments. Conclusions: Population impact is driven by reach and effectiveness. The potential reach of BBN is high, which heightens opportunity for population-level impact, but per-user symptom reduction was modest. Per-user impact may be improved by embedding digital health resources in the context of a broader health care strategy.

This cohort study evaluated the association between medical debt among US adults and forgoing mental health care due to cost in the subsequent year.

The understanding of responses to traumatic events has been greatly influenced by the introduction of the diagnosis of post‐traumatic stress disorder (PTSD). In this paper we review the initial versions of the diagnostic criteria for this condition and the associated epidemiological findings, including sociocultural differences. We consider evidence for post‐traumatic reactions occurring in multiple contexts not previously defined as traumatic, and the implications that these observations have for the diagnosis. More recent developments such as the DSM‐5 dissociative subtype and the ICD‐11 diagnosis of complex PTSD are reviewed, adding to evidence that there are several distinct PTSD phenotypes. We describe the psychological foundations of PTSD, involving disturbances to memory as well as to identity. A broader focus on identity may be able to accommodate group and communal influences on the experience of trauma and PTSD, as well as the impact of resource loss. We then summarize current evidence concerning the biological foundations of PTSD, with a particular focus on genetic and neuroimaging studies. Whereas progress in prevention has been disappointing, there is now an extensive evidence supporting the efficacy of a variety of psychological treatments for established PTSD, including trauma‐focused interventions – such as trauma‐focused cognitive behavior therapy (TF‐CBT) and eye movement desensitization and reprocessing (EMDR) – and non‐trauma‐focused therapies, which also include some emerging identity‐based approaches such as present‐centered and compassion‐focused therapies. Additionally, there are promising interventions that are neither psychological nor pharmacological, or that combine a pharmacological and a psychological approach, such as 3,4‐methylenedioxymethamphetamine (MDMA)‐assisted psychotherapy. We review advances in the priority areas of adapting interventions in resource‐limited settings and across cultural contexts, and of community‐based approaches. We conclude by identifying future directions for work on trauma and mental health.

Background The occurrence of post-traumatic stress disorder (PTSD) following a traumatic event is associated with biological differences that can represent the susceptibility to PTSD, the impact of trauma, or the sequelae of PTSD itself. These effects include differences in DNA methylation (DNAm), an important form of epigenetic gene regulation, at multiple CpG loci across the genome. Moreover, these effects can be shared or specific to both central and peripheral tissues. Here, we aim to identify blood DNAm differences associated with PTSD and characterize the underlying biological mechanisms by examining the extent to which they mirror associations across multiple brain regions. Methods As the Psychiatric Genomics Consortium (PGC) PTSD Epigenetics Workgroup, we conducted the largest cross-sectional meta-analysis of epigenome-wide association studies (EWASs) of PTSD to date, involving 5077 participants (2156 PTSD cases and 2921 trauma-exposed controls) from 23 civilian and military studies. PTSD diagnosis assessments were harmonized following the standardized guidelines established by the PGC-PTSD Workgroup. DNAm was assayed from blood using Illumina HumanMethylation450 or MethylationEPIC (850 K) BeadChips. Within each cohort, DNA methylation was regressed on PTSD, sex (if applicable), age, blood cell proportions, and ancestry. An inverse variance-weighted meta-analysis was performed. We conducted replication analyses in tissue from multiple brain regions, neuronal nuclei, and a cellular model of prolonged stress. Results We identified 11 CpG sites associated with PTSD in the overall meta-analysis (1.44e − 09 < p < 5.30e − 08), as well as 14 associated in analyses of specific strata (military vs civilian cohort, sex, and ancestry), including CpGs in AHRR and CDC42BPB. Many of these loci exhibit blood–brain correlation in methylation levels and cross-tissue associations with PTSD in multiple brain regions. Out of 9 CpGs annotated to a gene expressed in blood, methylation levels at 5 CpGs showed significant correlations with the expression levels of their respective annotated genes. Conclusions This study identifies 11 PTSD-associated CpGs and leverages data from postmortem brain samples, GWAS, and genome-wide expression data to interpret the biology underlying these associations and prioritize genes whose regulation differs in those with PTSD. Supplementary Information The online version contains supplementary material available at 10.1186/s13073-024-01417-1.

Financial, material, and social assets are core drivers of access to salutary resources. However, there is a paucity of research about how non-income financial assets shape mental health. We explore the relation of financial assets with symptoms of depression and of anxiety using a nationally representative, longitudinal survey of U.S. adults fielded annually from 2020 to 2023 (n = 1,296 unique participants). We used multivariable logistic regression models to estimate the association of financial assets and financial stress separately and together with symptoms of depression (PHQ-9 > 9), anxiety (GAD-7 > 9), and their co-occurrence, controlling for demographic indicators and year fixed effects. We found, first, that adults with <$5,000 in accrued financial assets reported over two times the odds of positive screen for depression, anxiety, and co-occurring depression and anxiety, respectively, as adults with ≥$100,000 in financial assets. Second, when controlling for accrued financial assets, annual household income was not associated with symptoms of anxiety. Third, the gap in positive screen for depression between household financial assets groups stayed consistent and did not differ significantly over the study period. Annual income alone does not capture the influence of all financial assets on mental health.

This JAMA Forum discusses the philosophy and ethics of population health, approaches that may improve the health of populations, ideas for improving decision-making for better health outcomes, and the partnerships needed to improve population health.