Posttraumatic stress disorder (PTSD) is linked to altered physiologic functioning, including increased blood pressure and heart rate, especially in response to stressors. Increased cardiovascular reactivity to trauma-related stressors may link PTSD to poorer cardiovascular health and thus an increased risk of cardiovascular disease. Prior work by our lab suggests that these effects of trauma may be due to persistent changes in the central and peripheral nervous systems’ stress-response system. While there is an urgent need to address these effects, limitations in our ability to effectively measure these changes have led to a paucity of data regarding the impact of current PTSD treatments on these important endpoints.
We propose to develop a novel emotional Stroop task that will quantify physiologic reactivity to interpersonal and affective cues, and quantify the impact of affective and physiologic reactivity on cognitive control. In a Veteran sample, we will characterize how performance on this task relates to PTSD symptom burden and physiologic reactivity to tilt-table testing, and gather pilot data assessing its response to pharmacologic treatment.
Children with comorbid mental health and neurodevelopmental disorders (NDDs) often require more intensive and coordinated care than those with mental health disorders alone. These two categories of disorders often present with comorbidity and engagement disparities in integrated behavioral health programs among this population remain poorly understood. This study examines differences in service utilization and attrition rates between these two populations using retrospective electronic health record (EHR) data from the SCCN study population (ages 6-18) across multiple primary care sites.
We will analyze visit frequency over a 6-12 month period to assess whether children with comorbid NDDs have higher service utilization. Additionally, early dropout rates will be examined using Kaplan-Meier survival analysis and Cox proportional hazards models to identify risk factors for attrition. Findings will provide critical insights into engagement patterns, informing strategies to enhance retention, reduce access disparities, and improve care coordination for children with complex behavioral needs. This study will contribute to investigating further integrated care model improvements in order to ensure more equitable and sustained mental health treatment for vulnerable pediatric populations.
Trauma and posttraumatic stress disorder (PTSD) are common in veteran and civilian populations. Meanwhile, observationally estimated half of people cared for at UW autonomic nervous system (ANS) disorder clinic have a history of trauma. Increasingly, research explains this observation through an evolving understanding of the complex interplay of peripheral and central catecholamine signaling that appear to underlie much of the persistent impact of trauma. An improved understanding of ANS changes in trauma and their relationship to the complex symptoms people experience is an important research frontiers to improve a) our understanding of PTSD, b) our ability to predict effective treatment for a given person, and c) the development of new treatments for PTSD. We propose implementing a novel analysis method for non-invasive autonomic testing in context of several clinical studies at VA Puget Sound. The proposed research aims to 1) make use of ANS testing results already available to provide quantitative data for adrenergic signaling, 2) test associations of extracted biomarkers with symptoms of PTSD, and 3) collect prospective data to test the relationship of peripheral autonomic signaling to quantitative measures of central nervous system (CNS) catecholamine signaling measured by event-related potential (ERP).
First-episode substance-induced psychosis (SIP) presents a clinical challenge in which treatment decisions cannot rely on evidence-based guidelines and long-term outcomes are not well understood. Preliminary findings from our retrospective study of psychiatry inpatients at Harborview Medical Center (HMC) suggest that patients with first-episode SIP had similar rehospitalization rates to those with first-episode psychosis (FEP) but were less likely to receive long-acting injectable antipsychotics (LAIs) even though LAIs may reduce the risk of 30- and 180-day rehospitalization. Our study has also revealed inconsistent assessment of key risk factors for rehospitalization—such as family history of psychosis and patterns of cannabis use—that may be limiting informed decision-making, including appropriate LAI use. This project seeks to improve the risk stratification of first-episode SIP by addressing these gaps. Aim 1 will use qualitative interviews with inpatient attending psychiatrists, psychiatry residents, and patients to explore factors influencing the management of first-episode SIP. Aim 2 will evaluate the acceptability and feasibility of implementing a standardized assessment of cannabis use and family history of psychosis on HMC inpatient psychiatry units. This project will lay the groundwork for future clinical interventions that optimize treatment decisions and improve patient outcomes in psychiatric inpatient settings.
Our project will seek to identify factors associated with gaps in transitions of care for psychiatric inpatients who presented with substance-induced psychosis (SIP) for the first time. We will analyze historical electronic health record data of patients who were treated for psychosis at Harborview Medical Center. We will test the hypotheses that (1) treatment with long-acting injectable antipsychotics (LAI) and referrals to outpatient behavioral health are lower for patients diagnosed with first-episode SIP compared to those diagnosed with first-episode psychosis and that (2) patients diagnosed with first-episode SIP will have worse post-discharge outcomes (rehospitalization, ED utilization), in part due to lower use of LAI.
The objective of this project is to leverage Artificial Intelligence (AI) to create COACH: an on-device AI-driven digital navigator system that will support patients’ effective use of Digital Mental Health Technologies. We aim to: 1. Develop a prototype chatbot-based digital navigator; 2. Conduct preliminary evaluation of the system including lab-based usability testing with healthy participants and “red-team” stress testing with project confederates.
The Canoe Journey study is an exploratory study aimed at examining the acceptability and fit of motivational interviewing (MI) and dialectical behavioral therapy (DBT) among American Indian and Alaska Native youth and young adult Canoe Journey participants. The team will develop a list of MI and DBT approaches in collaboration with Canoe Journey partners, and exploring the acceptability and fit of the approaches during Canoe Journey events in 2025, along with a list of tribally specific approaches to healing mental health in collaboration with Canoe Journey partners and confirm knowledge of these approaches among participants in 2026. The team will examine the relationship between measures of wellness with knowledge and use of MI, DBT, and tribally specific approaches to healing mental health in 2027, along with the acceptability and fit of a relational mental health intervention among Canoe Journey participants.
The CANOE Partnership: Cancer Awareness, Navigation, Outreach, and Equitable Indigenous Health Outcomes responds to the need to improve cancer outcomes for American Indian and Alaska Native (AI/AN) communities. Our Overall Specific Aims are: (1) Improve rates of cessation of commercial tobacco smoking among a nationally recruited sample of AI/AN adults (Research Project 1); 2) Improve rates of lung cancer screenings among our Tribal partner populations in the Consortium’s catchment area (Research Project 3); 3)Prepare the next generation of researchers in Indigenous cancer equity and provide them with resources to obtain preliminary data to inform future cancer equity research in Indian Country (Pilot Grant Program); and 4) Develop infrastructure to support equitable engagement of Tribal partners and Indigenous Frameworks in cancer research.
