Association of Prospective Risk for Chronic PTSD Symptoms With Low TNFα and IFNγ Concentrations in the Immediate Aftermath of Trauma Exposure

Am J Psychiatry. 2020 Jan 1;177(1):58-65. doi: 10.1176/appi.ajp.2019.19010039. Epub 2019 Jul 29.


Objective: Although several reports have documented heightened systemic inflammation in posttraumatic stress disorder (PTSD), few studies have assessed whether inflammatory markers serve as prospective biomarkers for PTSD risk. The present study aimed to characterize whether peripheral immune factors measured in blood samples collected in an emergency department immediately after trauma exposure would predict later chronic development of PTSD.

Methods: Participants (N=505) were recruited from a hospital emergency department and underwent a 1.5-hour assessment. Blood samples were drawn, on average, about 3 hours after trauma exposure. Follow-up assessments were conducted 1, 3, 6, and 12 months after trauma exposure. Latent growth mixture modeling was used to identify classes of PTSD symptom trajectories.

Results: Three distinct classes of PTSD symptom trajectories were identified: chronic (N=28), resilient (N=160), and recovery (N=85). Multivariate analyses of covariance revealed a significant multivariate main effect of PTSD symptom trajectory class membership on proinflammatory cytokines. Univariate analyses showed a significant main effect of trajectory class membership on plasma concentrations of proinflammatory tumor necrosis factor α (TNFα) and interferon-γ (IFNγ). Concentrations of proinflammatory TNFα and IFNγ were significantly lower in individuals in the chronic PTSD class compared with those in the recovery and resilient classes. There were no significant differences in interleukin (IL) 1β and IL-6 concentrations by PTSD symptom trajectory class. Anti-inflammatory and other cytokines, as well as chemokines and growth factor concentrations, were not associated with development of chronic PTSD.

Conclusions: Overall, the study findings suggest that assessing the proinflammatory immune response to trauma exposure immediately after trauma exposure, in the emergency department, may help identify individuals most at risk for developing chronic PTSD in the aftermath of trauma.

Keywords: Neuroimmunology; Posttraumatic Stress Disorder; Prospective Risk Factors.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biomarkers / blood
  • Chronic Disease
  • Disease Susceptibility
  • Female
  • Humans
  • Inflammation Mediators / blood*
  • Interferon-gamma / blood*
  • Male
  • Middle Aged
  • Risk
  • Stress Disorders, Post-Traumatic / blood*
  • Stress Disorders, Post-Traumatic / psychology*
  • Time Factors
  • Tumor Necrosis Factor-alpha / blood*
  • Wounds and Injuries / blood*
  • Wounds and Injuries / psychology*
  • Young Adult


  • Biomarkers
  • Inflammation Mediators
  • Tumor Necrosis Factor-alpha
  • Interferon-gamma