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Open Access Research

Considering trauma exposure in the context of genetics studies of posttraumatic stress disorder: a systematic review

Julia DiGangi1*, Guia Guffanti2, Katie A McLaughlin3 and Karestan C Koenen4

Author Affiliations

1 DePaul University, Chicago, IL, USA

2 Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA

3 Division of General Pediatrics, Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

4 Department of Epidemiology, Mailman School of Public Health, New York, NY, USA

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Biology of Mood & Anxiety Disorders 2013, 3:2  doi:10.1186/2045-5380-3-2

Published: 3 January 2013

Abstract

Background

Posttraumatic stress disorder (PTSD) is a debilitating anxiety disorder. Surveys of the general population suggest that while 50-85% of Americans will experience a traumatic event in their lifetime, only 2-50% will develop PTSD. Why some individuals develop PTSD following trauma exposure while others remain resilient is a central question in the field of trauma research. For more than half a century, the role of genetic influences on PTSD has been considered as a potential vulnerability factor. However, despite the exponential growth of molecular genetic studies over the past decade, limited progress has been made in identifying true genetic variants for PTSD.

Methods

In an attempt to aid future genome wide association studies (GWAS), this paper presents a systematic review of 28 genetic association studies of PTSD. Inclusion criteria required that 1) all participants were exposed to Criterion A traumatic events, 2) polymorphisms of relevant genes were genotyped and assessed in relation to participants’ PTSD status, 3) quantitative methods were used, and 4) articles were published in English and in peer-reviewed journals. In the examination of these 28 studies, particular attention was given to variables related to trauma exposure (e.g. number of traumas, type of trauma).

Results

Results indicated that most articles did not report on the GxE interaction in the context of PTSD or present data on the main effects of E despite having data available. Furthermore, some studies that did consider the GxE interaction had significant findings, underscoring the importance of examining how genotypes can modify the effect of trauma on PTSD. Additionally, results indicated that only a small number of genes continue to be studied and that there were marked differences in methodologies across studies, which subsequently limited robust conclusions.

Conclusions

As trauma exposure is a necessary condition for the PTSD diagnosis, this paper identifies gaps in the current literature as well as provides recommendations for how future GWAS studies can most effectively incorporate trauma exposure data in both the design and analysis phases of studies.

Keywords:
Posttraumatic stress disorder; Trauma; Genetics; Genome-wide association studies; Gene–environment interaction