More than 2.6 million servicemen and women have deployed to Iraq or Afghanistan since Sept. 11, 2001. Post-traumatic stress, depression, chronic regional and widespread pain, and traumatic brain injury symptoms are common among these veterans. They also are common among civilian trauma survivors.
The National Institutes of Health, in response to an executive order from President Barack Obama to initiate major research efforts to better understand and treat these disorders, recently funded the most comprehensive longitudinal study of trauma survivors ever performed.
This study, funded by the National Institute of Mental Health, will be based at UNC.
The $21 million AURORA Study will employ the efforts of 19 institutions and more than 40 scientists. Trauma survivors will be enrolled during the immediate aftermath of trauma and followed longitudinally for one year. Sophisticated adaptive sampling methods will be used to perform a comprehensive, state-of-the-art assessment of genomic, neuroimaging, physiologic, neurocognitive, psychophysical, behavioral and self-report markers.
In addition to its unparalleled scope, the study differs from previous efforts in that it will broadly assess for adverse effects of trauma rather than focus on only one or a few diseases.
“We want to be patient-centered and not diagnosis-centered,” said Dr. Samuel McLean, associate professor in UNC’s department of anesthesiology and lead principal investigator of the study. “We also recognize that a trauma survivor with depression, who also has a lot of post-traumatic stress symptoms and traumatic brain injury symptoms, is likely to be a lot different in terms of underlying biology than a trauma survivor with depression alone. We believe that only by looking at an individual globally can we achieve great advances in treatment.”
Rather than traditional symptom checklists used to define illness, the study will use the wealth of biologic data collected to create new diagnostic categories.
“Assessing biologic and physiologic processes directly, during the critical period of time after trauma when these disorders develop, is the best way to gain the breakthroughs in understanding that we need to prevent and treat these outcomes,” McLean said. Another major goal of the study is to develop tools that clinicians in emergency departments, military hospitals and military aid stations can use at the bedside to identify trauma survivors at high risk of persistent suffering. Such tools are urgently needed so that trauma survivors at high risk can be identified for early preventive treatments.
McLean and his colleagues currently are pursuing additional foundation and philanthropic support.
“Twenty-one million dollars sounds like a heck of a lot of money, and it is,” McLean said, “but given the very high costs of the latest science — comprehensive molecular, neuroimaging and bioinformatic methods — we actually need to leverage these public dollars with private support so that we can take full advantage of this once-in-a-generation opportunity to advance care for veterans and civilian survivors of traumas such as sexual assault.”