Background Smaller hippocampal volume is associated with more severe posttraumatic stress disorder (PTSD) symptoms years after traumatic experiences. Posttraumatic stress symptoms appear early following trauma, but the relationship between hippocampal volume and PTSD symptom severity during early post-trauma periods is not well understood. It is possible that the inverse relationship between hippocampal volume and PTSD symptom severity is already present soon after trauma. To test this possibility we prospectively examined the association between hippocampal volumes and severity of PTSD symptoms within weeks to months after trauma due to motor vehicle collision (MVC). Methods Structural MRI scans of 44 survivors were collected about 2 weeks and again at 3 months after MVC to measure hippocampal volumes. The PTSD checklist (PCL) was used to evaluate PTSD symptoms at each scan time. Full (n=5) or partial (n=6) PTSD was evaluated using CAPS at 3 months. Results Left hippocampal volumes at both time points negatively correlated with PCL scores, and with subscores for re-experiencing symptoms at 3 months. Left hippocampal volumes at 3 months also negatively correlated with hyperarousal symptoms at 3 months. Finally, neither left nor right hippocampal volumes significantly changed between 2 weeks and 3 months post trauma. Conclusions The results suggest that small hippocampal volume at early post-trauma weeks is associated with increased risk for PTSD development. Furthermore, the inverse relationship between hippocampal volume and PTSD symptoms at 3 months did not arise from post-trauma shifts in hippocampal volume between 2 weeks and 3 months after trauma.

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Aims: Compared to the general U.S. population, military veterans and those living in rural areas disproportionately smoke cigarettes at higher rates, leading to increased health consequences. In the current study, prevalence and severity of cigarette smoking in Iraq and Afghanistan era veterans was assessed across rural and urban areas and comorbid mental health disorders. Method: Iraq/Afghanistan era veterans who participated in the Post-Deployment Mental Health study from 2005-2017 (N = 3229) were cross-sectionally assessed for the probability of being a current cigarette smoker based on locality status and psychiatric comorbidity. Multivariate logistic and linear regressions, adjusted for demographic characteristics, were used to model the odds of being a current smoker and the severity of nicotine dependence, respectively. Results: Veterans residing in rural regions, veterans with psychiatric comorbidities, and the interaction of locality and psychiatric disorders were significantly associated with smoking rates. Those veterans living in extremely rural areas and, independently, those living with psychiatric comorbidities were also more severely dependent on nicotine compared to urban veterans and veterans without psychiatric conditions. Conclusions: Rural veterans and veterans with psychiatric comorbidities are at increased risk of smoking and are more severely dependent on nicotine than urban veterans. These findings underscore the need to reduce barriers for treatment both for smoking cessation and mental healthcare for veterans residing in the most rural areas.