Altered functional connectivity in the fear network of firefighters with repeated traumatic stress

Hyeonseok Jeong, Shinwon Park, Stephen R. Dager, Soo Mee Lim, Suji L. Lee, Haejin Hong, Jiyoung Ma, Eunji Ha, Young Sun Hong, Ilhyang Kang, Eun Hee Lee, Sujung Yoon, Jieun E. Kim, Jungyoon Kim, In Kyoon Lyoo

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background Firefighters are routinely exposed to various traumatic events and often experience a range of trauma-related symptoms. Although these repeated traumatic exposures rarely progress to the development of post-traumatic stress disorder, firefighters are still considered to be a vulnerable population with regard to trauma.Aims To investigate how the human brain responds to or compensates for the repeated experience of traumatic stress.Method We included 98 healthy firefighters with repeated traumatic experiences but without any diagnosis of mental illness and 98 non-firefighter healthy individuals without any history of trauma. Functional connectivity within the fear circuitry, which consists of the dorsal anterior cingulate cortex, insula, amygdala, hippocampus and ventromedial prefrontal cortex (vmPFC), was examined using resting-state functional magnetic resonance imaging. Trauma-related symptoms were evaluated using the Impact of Event Scale-Revised.Results The firefighter group had greater functional connectivity between the insula and several regions of the fear circuitry including the bilateral amygdalae, bilateral hippocampi and vmPFC as compared with healthy individuals. In the firefighter group, stronger insula-amygdala connectivity was associated with greater severity of trauma-related symptoms (β = 0.36, P = 0.005), whereas higher insula-vmPFC connectivity was related to milder symptoms in response to repeated trauma (β =-0.28, P = 0.01).Conclusions The current findings suggest an active involvement of insular functional connectivity in response to repeated traumatic stress. Functional connectivity of the insula in relation to the amygdala and vmPFC may be potential pathways that underlie the risk for and resilience to repeated traumatic stress, respectively.Declaration of interest None.

Original languageEnglish
Pages (from-to)347-353
Number of pages7
JournalBritish Journal of Psychiatry
Issue number6
StatePublished - 1 Jun 2019

Bibliographical note

Publisher Copyright:
© 2018 The Royal College of Psychiatrists.


  • Firefighter
  • fear network
  • functional connectivity
  • functional magnetic resonance imaging
  • post-traumatic stress disorder


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