Each year, more than a million Americans are at-risk of developing serious mental health problems after experiencing a terrifying event or serious physical injury. Once manifested, these psychiatric illnesses, such as post-traumatic stress disorder and depression, can be extremely crippling and difficult to treat and are a leading cause of disability in civilian, military and minority populations.
Recognizing these emerging disorders early on provides health care professionals the best opportunity for preventive interventions.
Now, a team of researchers, led by Dr. Vivek Shetty, a professor at the UCLA School of Dentistry, has received a $3.8 million research grant to develop a salivary-biomarker approach for identifying individuals at future risk of developing post-traumatic stress disorder and depression following a traumatic event.
Co-funded by the National Institute of Dental and Craniofacial Research and the National Institutes of Health's Office of Behavioral and Social Sciences Research, the study seeks to develop a panel of salivary stress biomarkers that will allow early recognition of emerging mental health disorders and permit preemptive psychological care.
"Current assessment strategies rely on subjective reports of symptoms by trauma survivors," Shetty said. "The symptom-based nature of psychological assessments presents significant challenges for trauma-care specialists attempting to differentiate between temporary distress and the early stages of mental health illnesses.
"Moreover," he added, "the time and resource constraints of the acute-care setting do not allow for the structured screening required for psychological assessments. If successful, our salivary stress biomarker panel will allow the development of practical decision-aid tools to complement subjective clinical evaluation and allow timely referrals of 'at-risk' individuals."
For the new five-year study, Shetty and his colleagues will repeatedly conduct psychological assessments and obtain corresponding saliva samples over a six-month period among a group of 600 individuals who have recently experienced a serious physical injury or sexual assault.
The team will use sophisticated analytical techniques to determine the levels of the individual salivary biomarkers at different points over the six months and to compare the biomarker patterns of individuals who subsequently develop PTSD and/or depression with those who do not.
The association of the biomarkers with mental disease would be used to develop mathematical models that utilize early stress biomarker levels to predict later development of traumatic psychopathology.
"Utilizing easily accessible saliva for evaluating stress reactions would allow front-line care providers to become more involved and proactive in the management of post-traumatic stress disorders, moving the focus away from treatment of unmanageable, late-stage conditions toward early identification and targeted interventions of vulnerable individuals," said Shetty.
"Enabling health care providers to objectively and readily assess the risk for future psychological problems will set the stage for integrated post-trauma care that provides for essential and tailored mental health interventions in trauma care centers, as well as timely referrals for psychological after-care."
The current research study builds on and complements Shetty's ongoing development of mobile devices for point-of-care assessment and management of post-traumatic stress disorders using salivary diagnostics — a program funded through NIH's Transdisciplinary Gene and Environment Initiative.
"Beyond the civilian population, post-traumatic mental health disorders are a significant problem for our military," said Dr. No-Hee Park, dean of the School of Dentistry. "The scope of the mental health problem is increasingly manifest as thousands of soldiers are coming back from Iraq and Afghanistan. This grant allows Dr. Shetty to focus the skills and abilities of his team to help solve a very serious problem with advanced technology in the cutting-edge area of salivary diagnostics. I am hopeful that the results of this research will inform mental health efforts not only in civilian populations but also in military settings.
"Faculty from the UCLA School of Dentistry," Park added, "have been at the forefront of the emerging field of salivary diagnostics in recent years, conducting groundbreaking research on the use of saliva as a diagnostic tool for the detection of oral cancer, early-stage pancreatic cancer, Sjogren's syndrome and a variety of other maladies."
Shetty's collaborators on the project include Dr. David Elashoff of the UCLA departments of biostatistics and internal medicine; Dr. Theodore Robles of the UCLA Department of Psychology; Dr. Debra Murphy of the UCLA Department of Psychiatry and Biobehavioral Sciences; Dr. Grant Marshall of the RAND Corp.; Dr. Michael Lynes of the University of Connecticut; and Drs. Demetriades and Yamashita at the trauma center at Los Angeles CountyUSC Medical Center.
The UCLA School of Dentistry is dedicated to improving the oral health of the people of California, the nation and the world through its teaching, research, patient care and public service initiatives. The school provides education and training programs that develop leaders in dental education, research, the profession and the community; conducts research programs that generate new knowledge, promote oral health and investigate the cause, prevention, diagnosis and treatment of oral disease in an individualized disease-prevention and management model; and delivers patient-centered oral health care to the community and the state.