Stress-induced change in salience network coupling prospectively predicts trauma-related symptoms.

Abstract Substantial individual differences exist in how acute stress affects large-scale neurocognitive networks, including Salience (SN), Default Mode (DMN) and Central Executive Networks (CEN). These network-level changes upon acute stress may predict vulnerability to long-term stress effects, which can only be tested in prospective longitudinal studies. Using a longitudinal design, we investigated whether the magnitude of acute-stress induced functional connectivity changes (delta-FC) predicts the development of posttraumatic stress disorder (PTSD) symptoms in a relatively resilient group of young police recruits that are known to be at high risk for trauma-exposure. Using resting-state fMRI, we measured acute-stress induced delta-FC in 190 police recruits before (baseline) and after trauma exposure during repeated emergency aid services (16-month follow-up). Delta-FC was then linked to the changes in perceived stress levels (PSS) and post-traumatic stress symptoms (PCL and CAPS). Weakened connectivity between the SN and DMN core regions upon acute stress induction at baseline predicted longitudinal increases in perceived stress level but not of post-traumatic stress symptoms, whereas increased coupling between the overall SN and anterior cerebellum was observed in participants with higher clinician-rated PTSD symptoms, particularly intrusion levels. All effects remained significant when controlling for trauma exposure-levels and cortisol stress-reactivity. Except these neural effects, neither hormonal nor subjective measures were relevant. The reconfiguration of large-scale neural networks upon acute stress induction is relevant for assessing and detecting risk and resilience factors for PTSD. This study highlights the SN connectivity-changes as a potential marker for trauma-related symptom-development, which is sensitive even in a relatively resilient sample.