The brain at war: effects of stress on brain structure in soldiers deployed to a war zone.

In search of the neural basis of severe trauma exposure and post-traumatic stress disorder (PTSD), a multitude of cross-sectional studies have been conducted, most of them pointing at structural deficits in the hippocampus and medial prefrontal cortex including the anterior cingulate cortex (ACC) and ventromedial prefrontal cortex (vmPFC). Since cross-sectional studies are silent to causality, the core question remains: which brain structural alterations constitute a risk factor for disease and therewith precede the stressor, and which brain regions may undergo alterations as a consequence of exposure to the stressor. We assessed 121 soldiers before and after deployment to regions of war and 40 soldiers as controls, who were not deployed. Analysis using voxel-based morphometry revealed volumetric reductions in the ACC, vmPFC (region of interest analysis, effect does not survive conservative multiple test correction) and in bilateral thalamus (whole-brain analysis) in the deployment group. Remarkably, the ACC and vmPFC volume decrease was not limited to the period of deployment, but continued over the following 6 months after deployment. Volumetric reductions did not correlate with increases in PTSD symptoms. The volume decreases in medial prefrontal cortex and thalamus seem to be driven by trauma exposure rather than a vulnerability factor for PTSD. However, data indicate that the volume decrease in medial prefrontal cortex surpasses the time period of deployment. This may hint at an initiated pathobiological process below a symptom threshold, potentially paving the way to future mental health problems.