Post Traumatic Stress DisorderNCT05213858
Biological Markers for Post-Traumatic Stress Disorder
An observational study of Post Traumatic Stress Disorder, run by Assaf-Harofeh Medical Center at 1 site in Israel.
Trial summary
The current study aims to evaluate the sensitivity and specificity of a combination of various objective biomarkers for the diagnosis of PTSD. Read more about this study
- Who is it for?
- Ages 20 to 60 years, men onlyHealthy volunteers can take part
- Conditions the study is for
- Post Traumatic Stress Disorder
- What is being tested?
- CAPS questionnaire, Beck Depression Inventory and The Fibromyalgia Impact Questionnaire
- How many people
- 300 participants
- Where
- 1 siteIsrael
- Study dates
- 1 Jan 2022to 1 Jan 2026
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 60 years
- Men only
- Healthy volunteers accepted
- Adult
Study population: Male combatants aged 20-60 years, with a history of exposure to an apparently life threatening-combat event, with or without PTSD.
Who may be able to join
- The willingness and ability to read, understand and sign an informed consent form.
- Age 20-60 years.
- A history of more than 2 years of combat service, and of at least one potentially life-threatening combat experience.
- One year or more after the last combat experience.
Who cannot join
- Inability to attend scheduled clinic visits or comply with the study protocol
- A history of traumatic brain injury or any other known brain pathology.
- Substance use, except for prescribed cannabis, if it can be withheld for at least 24 hours prior to the study evaluation.
- A current psychiatric disorder other than PTSD.
- The inability to perform an awake brain MRI.
Trial locations and contacts
1 site in 1 country.
Israel1 site, 1 recruiting
- Recruiting
Assaf-Harofeh Medical Center
Ramla, 70300
Shai Efrati, MD, 97289779395, hbo@asaf.health.gov.il
keren doenyas-barak, MD, 97289779395, PTSD-hbo@shamir.gov.il
About this study
The current study aims to evaluate the sensitivity and specificity of a combination of various objective biomarkers for the diagnosis of PTSD.
Read the detailed description
PTSD affects a major fraction of military combatants and is also very common in the general population. Like other psychiatric conditions, the diagnosis of PTSD is currently based on an interview and questionnaires. However, the validity of these tools is limited since it depends on the evaluator's skills, and on patient compliance and mental status; and may be prone to exaggeration or minimization of symptoms. This prompts an urgent need for evaluation that will combine biomarkers for objective diagnosis, and follow up of individuals with PTSD.
Knowledge has grown in recent years regarding the biologic pathophysiological cascade responsible for the development of a "non-healing wound in the brain" that characterizes PTSD. Shortly after the traumatic experience, fundamental changes in autonomic nervous and endocrine activity are evident, together with changes in brain function; these can become chronic in those with long-standing unremitting PTSD. Several studies indicate good correlations of the diagnosis and severity of PTSD, with objective biological measures such as heart rate variability (HRV), brain connectivity and endocrine activity. However, the currently available data on these biological variables are still not sufficient to be used for diagnosis of PTSD.
The aim of the current study is to characterize the biological fingerprint of PTSD, by using a combination of biological measures, for an objective diagnosis.
- Conditions
- Post Traumatic Stress Disorder
- Being tested
- CAPS questionnaire, Beck Depression Inventory, The Fibromyalgia Impact Questionnaire, The Pittsburgh Sleep Quality Index, Depression, Anxiety and Stress Scale-21 items
- Medical subject headings
- Stress Disorders, Post-Traumatic
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
CAPS questionnaireDiagnostic test
PTSD diagnosis and severity will be done using the CAPS-5 questionnaire.
Beck Depression InventoryDiagnostic test
depression symptoms will be measured by the BDI-II. The BDI-II consists of 21 items and uses a 0 to 3 severity scale. Total scores range from 0 to 63, with higher scores indicating more severe depression.
The Fibromyalgia Impact QuestionnaireDiagnostic test
The FIQ was developed from information gathered from patient reports, functional status instruments and clinical observations. This instrument measures physical functioning, work status (missed days of work and job difficulty), depression, anxiety, morning tiredness, pain, stiffness, fatigue and well-being over the past week.
The Pittsburgh Sleep Quality IndexDiagnostic test
sleep patterns will be measured using the PSQI. This index assesses the quality and patterns of sleep in adults. It differentiates "poor" from "good" sleep quality by measuring seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, the use of sleeping medications and daytime dysfunction over the last month. Items are rated using a 0 to 3 scale. The component scores are summed to produce a global score (range 0 to 21). Higher scores indicate worse sleep quality.
Depression, Anxiety and Stress Scale-21 itemsDiagnostic test
The DASS-21 is a three-scale self-report questionnaire designed to measure the emotional state of depression, anxiety and stress. Each scale contains 7 items, divided into subscales with similar content. Scores range between 0 and 21 in each subcategory.
Traumatic Events QuestionnaireDiagnostic test
The TEQ examines experiences of traumatic events (e.g. sexual abuse, accidents and crime) that are considered potential triggers of PTSD symptoms. To assess trauma intensity, respondents provide information for each event that was experienced, as well as their age at the time of the event. The items are measured on a 9-point Likert scale from "not at all" to "severely/extremely". The TEQ has previously been used in Israel.
Clinician Administered Dissociative States ScaleDiagnostic test
The CADSS is a 28-item structured clinical interview to assess state dissociation.
A diary will be used for seven consecutive nightsDiagnostic test
A diary will be used for seven consecutive nights for the evaluation of:
- Mean sleep latency
- The number and duration of awakenings.
- Subjective total sleep time
- Subjective wake after sleep onset
- Sleep efficiency
MRIDiagnostic test
Brain imaging will include DTI and resting state for structural and functional MRI scanning. Images will be acquired on MAGNETOM Vida 3T Scanner, configured with 64-channel receiver head coils (Siemens Healthcare, Erlangen, Germany) at the Department of Radiology at Shamir Medical Center.
Functional brain imagingDiagnostic test
Functional magnetic resonance imaging (fMRI) is widely used to study the operational organization of the human brain. This technology measures brain activity by detecting changes associated with blood oxygenation, using blood-oxygen-level-dependent imaging (BOLD) contrast.
EEG analysisDiagnostic test
EEG will be obtained using a point-of care device that consists of an EEG-Sense Headset, EEG-Sense Single-Use brush sensors, a pneumatic sensor positioning mechanism, EEG sampling electronics and software. The EEG-Sense Headset is an EEG electrode positioning system that quickly places electrodes in a uniform and consistent manner, to transfer electrophysiological EEG signals from an individual to a suitable EEG data collection device. The device is nonsterile, non-invasive and non-radiation emitting, and was developed for use in healthcare facilities and hospitals. Typical set-up and procedure time is several minutes. The device does not contain biologics, drugs, coatings or any claim of sterility. The EEG-Sense Single-Use brush sensors are made from well-established medical-grade materials; the Headset is made from Nylon 101. Electronic components and harnesses are embedded between two layers of nylon and are attached to each electrode port.
Autonomic nervous system monitorsDiagnostic test
Data will be collected using Empatica's E4 wristband. Each of the study participants will wear the wristband for 7 days.
Data collected from the band will include:
ACC - Data from 3-axis accelerometer sensor in the range [-2g, 2g]. (sampled at 32 Hz) BVP - Data from photoplethysmography (PPG). (sampled at 64 Hz) EDA - Data from the electrodermal activity sensor in μS. (sampled at 4 Hz) IBI - Inter-beat intervals. (intermittent output with 1/64 second resolution) TEMP - Data from temperature sensors, expressed in degrees on the Celsius (°C) scale. (sampled at 4 Hz)
What is being measured
The primary outcome is the main question the study is designed to answer.
correlation between CAPS score and mean heart rate variability
the correlation between CAPS score and mean heart rate variability will be evaluated
Measured: at baseline
Secondary outcomes (3)
correlation between CAPS score and fronto-limbic connectivity
the correlation between CAPS score and fronto-limbic connectivity will be evaluated using DTI
Measured: at baseline
correlation between CAPS score and frontal activity
the correlation between CAPS score and frontal activity will be evaluated using BOLD MRI
Measured: at baseline
correlation between CAPS score and depression score
the correlation between CAPS score and depression score will be evaluated using back depression inventory
Measured: at baseline
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Jan 2022
- Study start1 Jan 2022
- Primary completion1 Dec 2025 (estimated)
- Study completion1 Jan 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Post Traumatic Stress DisorderStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 300 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Assaf-Harofeh Medical Center
- Sponsor type
- Other government
- Responsible party
- Sponsor
- Investigators
- keren doenyas-barak, md, Principal investigator, sagol center for hyperbaric medicine
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05213858
- Sponsor's protocol ID
- 178-21
- Status last verified
- Jan 2024
- First submitted
- 16 Jan 2022
- Last updated
- 6 Feb 2024
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 6 Feb 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Biological Markers for Post-Traumatic Stress Disorder
- ClinicalTrials.gov ID
- NCT05213858
- Acronym / sponsor ID
- 178-21
- Conditions
- Post Traumatic Stress Disorder
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 300 participants (estimated)
- Lead sponsor
- Assaf-Harofeh Medical CenterOther government
- Study start
- 1 Jan 2022 (actual)
- Primary completion
- 1 Dec 2025 (estimated)
- Study completion
- 1 Jan 2026 (estimated)
- First posted
- 28 Jan 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The current study aims to evaluate the sensitivity and specificity of a combination of various objective biomarkers for the diagnosis of PTSD.
Detailed description
PTSD affects a major fraction of military combatants and is also very common in the general population. Like other psychiatric conditions, the diagnosis of PTSD is currently based on an interview and questionnaires. However, the validity of these tools is limited since it depends on the evaluator's skills, and on patient compliance and mental status; and may be prone to exaggeration or minimization of symptoms. This prompts an urgent need for evaluation that will combine biomarkers for objective diagnosis, and follow up of individuals with PTSD.
Knowledge has grown in recent years regarding the biologic pathophysiological cascade responsible for the development of a "non-healing wound in the brain" that characterizes PTSD. Shortly after the traumatic experience, fundamental changes in autonomic nervous and endocrine activity are evident, together with changes in brain function; these can become chronic in those with long-standing unremitting PTSD. Several studies indicate good correlations of the diagnosis and severity of PTSD, with objective biological measures such as heart rate variability (HRV), brain connectivity and endocrine activity. However, the currently available data on these biological variables are still not sufficient to be used for diagnosis of PTSD.
The aim of the current study is to characterize the biological fingerprint of PTSD, by using a combination of biological measures, for an objective diagnosis.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
Who may qualify
- Ages
- 20 to 60 years
- Sex
- Male only
- Healthy volunteers
- Accepted
- Age groups
- Adult
- Study population
- Male combatants aged 20-60 years, with a history of exposure to an apparently life threatening-combat event, with or without PTSD.
Key inclusion criteria (4 listed)
- The willingness and ability to read, understand and sign an informed consent form.
- Age 20-60 years.
- A history of more than 2 years of combat service, and of at least one potentially life-threatening combat experience.
- One year or more after the last combat experience.
Key exclusion criteria (5 listed)
- Inability to attend scheduled clinic visits or comply with the study protocol
- A history of traumatic brain injury or any other known brain pathology.
- Substance use, except for prescribed cannabis, if it can be withheld for at least 24 hours prior to the study evaluation.
- A current psychiatric disorder other than PTSD.
- The inability to perform an awake brain MRI.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| CAPS questionnairePTSD diagnosis and severity will be done using the CAPS-5 questionnaire. | Diagnostic test | – |
| Beck Depression Inventorydepression symptoms will be measured by the BDI-II. The BDI-II consists of 21 items and uses a 0 to 3 severity scale. Total scores range from 0 to 63, with higher scores indicating more severe depression. | Diagnostic test | – |
| The Fibromyalgia Impact QuestionnaireThe FIQ was developed from information gathered from patient reports, functional status instruments and clinical observations. This instrument measures physical functioning, work status (missed days of work and job difficulty), depression, anxiety, morning tiredness, pain, stiffness, fatigue and well-being over the past week. | Diagnostic test | – |
| The Pittsburgh Sleep Quality Indexsleep patterns will be measured using the PSQI. This index assesses the quality and patterns of sleep in adults. It differentiates "poor" from "good" sleep quality by measuring seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, the use of sleeping medications and daytime dysfunction over the last month. Items are rated using a 0 to 3 scale. The component scores are summed to produce a global score (range 0 to 21). Higher scores indicate worse sleep quality. | Diagnostic test | – |
| Depression, Anxiety and Stress Scale-21 itemsThe DASS-21 is a three-scale self-report questionnaire designed to measure the emotional state of depression, anxiety and stress. Each scale contains 7 items, divided into subscales with similar content. Scores range between 0 and 21 in each subcategory. | Diagnostic test | – |
| Traumatic Events QuestionnaireThe TEQ examines experiences of traumatic events (e.g. sexual abuse, accidents and crime) that are considered potential triggers of PTSD symptoms. To assess trauma intensity, respondents provide information for each event that was experienced, as well as their age at the time of the event. The items are measured on a 9-point Likert scale from "not at all" to "severely/extremely". The TEQ has previously been used in Israel. | Diagnostic test | – |
| Clinician Administered Dissociative States ScaleThe CADSS is a 28-item structured clinical interview to assess state dissociation. | Diagnostic test | – |
| A diary will be used for seven consecutive nightsA diary will be used for seven consecutive nights for the evaluation of: * Mean sleep latency * The number and duration of awakenings. * Subjective total sleep time * Subjective wake after sleep onset * Sleep efficiency | Diagnostic test | – |
| MRIBrain imaging will include DTI and resting state for structural and functional MRI scanning. Images will be acquired on MAGNETOM Vida 3T Scanner, configured with 64-channel receiver head coils (Siemens Healthcare, Erlangen, Germany) at the Department of Radiology at Shamir Medical Center. | Diagnostic test | – |
| Functional brain imagingFunctional magnetic resonance imaging (fMRI) is widely used to study the operational organization of the human brain. This technology measures brain activity by detecting changes associated with blood oxygenation, using blood-oxygen-level-dependent imaging (BOLD) contrast. | Diagnostic test | – |
| EEG analysisEEG will be obtained using a point-of care device that consists of an EEG-Sense Headset, EEG-Sense Single-Use brush sensors, a pneumatic sensor positioning mechanism, EEG sampling electronics and software. The EEG-Sense Headset is an EEG electrode positioning system that quickly places electrodes in a uniform and consistent manner, to transfer electrophysiological EEG signals from an individual to a suitable EEG data collection device. The device is nonsterile, non-invasive and non-radiation emitting, and was developed for use in healthcare facilities and hospitals. Typical set-up and procedure time is several minutes. The device does not contain biologics, drugs, coatings or any claim of sterility. The EEG-Sense Single-Use brush sensors are made from well-established medical-grade materials; the Headset is made from Nylon 101. Electronic components and harnesses are embedded between two layers of nylon and are attached to each electrode port. | Diagnostic test | – |
| Autonomic nervous system monitorsData will be collected using Empatica's E4 wristband. Each of the study participants will wear the wristband for 7 days. Data collected from the band will include: ACC - Data from 3-axis accelerometer sensor in the range [-2g, 2g]. (sampled at 32 Hz) BVP - Data from photoplethysmography (PPG). (sampled at 64 Hz) EDA - Data from the electrodermal activity sensor in μS. (sampled at 4 Hz) IBI - Inter-beat intervals. (intermittent output with 1/64 second resolution) TEMP - Data from temperature sensors, expressed in degrees on the Celsius (°C) scale. (sampled at 4 Hz) | Diagnostic test | – |
Primary outcome
correlation between CAPS score and mean heart rate variability
Time frame: at baseline
the correlation between CAPS score and mean heart rate variability will be evaluated
3 secondary outcomes
correlation between CAPS score and fronto-limbic connectivity
Time frame: at baseline
correlation between CAPS score and frontal activity
Time frame: at baseline
correlation between CAPS score and depression score
Time frame: at baseline
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 Feb 2024.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
keren doenyas-barak, md principal investigator
sagol center for hyperbaric medicine
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Post Traumatic Stress Disorder, run by Assaf-Harofeh Medical Center at 1 site in Israel.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 6 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Israel. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact keren doenyas-barak, MD (+972544215487, kerendoenyas@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
correlation between CAPS score and mean heart rate variability (time frame: at baseline). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Feb 2024.