Journal
BRITISH JOURNAL OF PSYCHIATRY
Volume 214, Issue 6, Pages 347-353Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1192/bjp.2018.260
Keywords
Firefighter; post-traumatic stress disorder; functional magnetic resonance imaging; functional connectivity; fear network
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Funding
- Brain Research Program through the National Research Foundation of Korea - Ministry of Science and ICT [2015M3C7A1028373, 2015M3C7A1028376]
- Field-oriented Support of Fire Fighting Technology Research and Development Program - National Fire Agency [MPSS-Fire Fighting Safety-2016-86]
- National Research Foundation of Korea [2015M3C7A1028376] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)
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Background Firefighters are routinely exposed to various traumatic events and often experience a range of trauma-related symptoms. Although these repeated traumatic exposures rarely progress to the development of post-traumatic stress disorder, firefighters are still considered to be a vulnerable population with regard to trauma. Aims To investigate how the human brain responds to or compensates for the repeated experience of traumatic stress. Method We included 98 healthy firefighters with repeated traumatic experiences but without any diagnosis of mental illness and 98 non-firefighter healthy individuals without any history of trauma. Functional connectivity within the fear circuitry, which consists of the dorsal anterior cingulate cortex, insula, amygdala, hippocampus and ventromedial prefrontal cortex (vmPFC), was examined using resting-state functional magnetic resonance imaging. Trauma-related symptoms were evaluated using the Impact of Event Scale -Revised. Results The firefighter group had greater functional connectivity between the insula and several regions of the fear circuitry including the bilateral amygdalae, bilateral hippocampi and vmPFC as compared with healthy individuals. In the firefighter group, stronger insula-amygdala connectivity was associated with greater severity of trauma-related symptoms (beta = 0.36, P = 0.005), whereas higher insula-vmPFC connectivity was related to milder symptoms in response to repeated trauma (beta = -0.28, P = 0.01). Conclusions The current findings suggest an active involvement of insular functional connectivity in response to repeated traumatic stress. Functional connectivity of the insula in relation to the amygdala and vmPFC may be potential pathways that underlie the risk for and resilience to repeated traumatic stress, respectively.
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