Post-traumatic stress disorder (PTSD) is unique among the psychiatric disorders, in that it requires an environmental exposure (trauma) for diagnosis, and is thus ideal for investigating the gene-environment (G x E) predictors of pathology1. Despite the high national prevalence of trauma, studies such as the South African Stress &Health Study (SASH) found that only 2.3% of South Africans suffer from PTSD in their lifetimes (2,3). PTSD and depression have been found to be highly co-morbid4,5 and there is evidence to suggest significant gender-related variation in these disorders2,6-9. Overall, females have been found to be at higher risk than males, which may be compounded by the high prevalence of intimate partner violence (IPV) perpetrated again women10-12. Pregnant women, in particular, have been shown to be particularly vulnerable to IPV and its adverse mental and physical health outcomes (10-12). While a number of studies have been conducted in the developed, high-income world to investigate the etiology of these disorders (13-21), there is a paucity of data in developing, low- to middle-income (LMIC) countries. Nonetheless, there is evidence to suggest an element of heritability in individuals with PTSD and co-morbid depression (4,6,22-29), which may be due to genetic predisposition or to environmental conditioning such as learned behaviour. In this study, we shall examine the hypothesis that vulnerability to PTSD and co-morbid depression results from interactions between specific candidate genetic polymorphisms and environmental/psychological risk factors, which combine to enhance the risk for PTSD and co-morbid depression following trauma. Pregnant female South Africans, aged 18-65, will be recruited from specified community health centres. Those who wish to participate will complete a battery of self-report measures, including the Modified PTSD Symptom Scale (MPSS), Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI-II), MINI (Mini International Neuropsychiatric Interview) Depression Scale, Intimate Partner Violence (IPV) Questionnaire and Clinician-Administered PTSD Scale (CAPS). Each participant will also be asked to provide a saliva sample for DNA extraction and genetic analysis. Despite the adversity faced by many Africans and South Africans, some cope and function remarkably well. Thus, identifying genetic or other factors that allow these individuals t cope may elucidate the underpinnings of resilience, which could inform the search for novel preventative and therapeutic interventions for these prevalent and debilitating disorders.

Public Health Relevance

Much of the population of Africa and South Africa has been exposed to traumatic events, whether political or domestic. Post-traumatic stress disorder (PTSD) is one of the most important and debilitating sequelae of such exposure, and is often confounded by co-morbid depression. A better understanding of the mechanisms involved in resilience or vulnerability to PTSD and co-morbid depression, including genetic mechanisms, will address the remarkable paucity of health-related candidate gene data in Africa, thereby enhancing the research infrastructure to address issues of African and South African health and disease.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-BDCN-N (55))
Program Officer
Addington, Anjene M
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Cape Town
South Africa
Zip Code
Koen, Nastassja; Brittain, Kirsty; Donald, Kirsten A et al. (2017) Maternal posttraumatic stress disorder and infant developmental outcomes in a South African birth cohort study. Psychol Trauma 9:292-300
Kilaru, V; Iyer, S V; Almli, L M et al. (2016) Genome-wide gene-based analysis suggests an association between Neuroligin 1 (NLGN1) and post-traumatic stress disorder. Transl Psychiatry 6:e820
Koen, Nastassja; Brittain, Kirsty; Donald, Kirsten A et al. (2016) Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study. Eur J Psychotraumatol 7:28720
Wingo, Aliza P; Almli, Lynn M; Stevens, Jennifer S et al. (2015) DICER1 and microRNA regulation in post-traumatic stress disorder with comorbid depression. Nat Commun 6:10106
Stein, D J; Koen, N; Donald, K A et al. (2015) Investigating the psychosocial determinants of child health in Africa: The Drakenstein Child Health Study. J Neurosci Methods 252:27-35
Koen, Nastassja; Wyatt, Gail E; Williams, John K et al. (2014) Intimate partner violence: associations with low infant birthweight in a South African birth cohort. Metab Brain Dis 29:281-99