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Broeks CW, Kok R, Choenni V, Van R, Hoogendijk W, Hillegers M, Kamperman A, Lambregtse-Van den Berg MP. Salivary cortisol reactivity in 6-month-old infants of mothers with severe psychiatric disorders: findings from the face-to-Face Still-Face paradigm. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 7:100078. [PMID: 35757057 PMCID: PMC9216463 DOI: 10.1016/j.cpnec.2021.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/10/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background. Maternal psychopathology is associated with altered HPA axis functioning in offspring. Most studies have focused on mildly affected populations, but less is known about the effect of severe maternal psychopathology. In our explorative study we investigated in a heterogenic sample of mothers with severe and long-lasting psychiatric disorders, if a diagnosis of depression and severity of general maternal psychiatric symptomatology were associated with infant salivary cortisol reactivity to the Face-to-Face Still-Face (FFSF) paradigm at 6 months of age. Methods. A clinical sample of 36 mother-infant dyads was explored. All mothers fulfilled criteria for a severe psychiatric disorder and had psychiatric complaints for the last two consecutive years. Maternal diagnosis was established during pregnancy using a diagnostic interview and general maternal psychiatric symptom severity was established by self-report at the time of the FFSF procedure. The FFSF paradigm was used to assess infants’ response to social stress at the age of 6 months. Infant saliva samples were collected at three time points: 5 min before and 15 and 30 min after the social stressor. Cortisol reactivity was operationalized as incremental Area Under the Curve (AUCi). Potential confounders were identified and adjusted for. Results. In regression analyses, a negative relationship was found between infant cortisol reactivity (AUCi) during the FFSF paradigm at 6 months and general maternal symptom severity at time of the FFSF paradigm (unadjusted n = 36, ß = −0.331, B = −9.758, SE 4.8, p = .048; adjusted n = 36, ß = −0.335, B = −9.868, SE 4.5, p = .039) and for diagnosis of perinatal depression at trend level (unadjusted n = 36, ß = −0.293, B = −8.640, SE 4.8, p = .083; adjusted n = 36, ß = −0.317, B = −9.347, SE 4.6, p = .052). Analyses were adjusted for gestational age. Conclusions. Preliminary results on cortisol reactivity in 6-month-old infants of mothers with severe and long-lasting psychiatric disorders show a significant reduction in the group of mothers who experienced a high level of psychiatric symptoms in the post-partum period, compared to mothers with lower levels of psychiatric symptomatology. The same trend was found for mothers with and without a diagnosis of perinatal depression. Since these infants are considered to be at increased risk for later psychopathology, our study suggests that future longitudinal studies should investigate whether reduced cortisol reactivity in babies could be a marker for any adverse outcomes, besides other possible risk factors (e.g. (epi)genetic phenomena). Psychiatric symptom severity in mothers might affect infant cortisol reactivity during the Face-to-Face-Still-Face (FFSF) paradigm. Infants of mothers with a diagnosis of depression show borderline diminished reactivity of cortisol during the FFSF paradigm. Under-activation of cortisol reactivity in infants of severely affected mothers might point to early patterns of blunted HPA-axis functioning.
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Affiliation(s)
- Carlinde W. Broeks
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
- Arkin Institute for Mental Health, Amsterdam, the Netherlands
| | - Rianne Kok
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, the Netherlands
| | - Vandhana Choenni
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Rien Van
- Arkin Institute for Mental Health, Amsterdam, the Netherlands
| | - Witte Hoogendijk
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Astrid Kamperman
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
- Epidemiological and Social Psychiatric Research Institute, Erasmus MC, Rotterdam, the Netherlands
| | - Mijke P. Lambregtse-Van den Berg
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
- Corresponding author. PhD Address: P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
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Parental Stress and Scalp Hair Cortisol in Excessively Crying Infants: A Case Control Study. CHILDREN-BASEL 2021; 8:children8080662. [PMID: 34438553 PMCID: PMC8391563 DOI: 10.3390/children8080662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/14/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Caring for an excessively crying infant (ECI) can be stressful for mothers and fathers and is associated with mental and bonding problems. Hair cortisol offers a unique measure for the biological reaction of the body to stress over time. METHODS In this case-control study, scalp hair cortisol concentrations (HCC) were measured using liquid chromatography-tandem mass spectrometry (LC-MS) in 35 mothers and 23 fathers and their ECIs. The control group consisted of 64 mothers and 63 fathers of non-ECIs of similar age. Parental stress, depression, anxiety and bonding were assessed using validated questionnaires. RESULTS Mean HCC were significantly lower in mothers and fathers of ECIs (2.3 pg/mg, 95% CI 1.8-2.9 and 1.6 pg/mg, 95% CI 1.3-2.0) than that in control mothers and fathers (3.2 pg/mg, 95% CI 3.0-3.7 and 2.9 pg/mg, 95% CI 2.5-3.5). In the total group of parents and within the parents of ECIs, HCC were not associated with negative feelings. In the control group, HCC showed a positive association with stress and depression (r = 0.207, p = 0.020 and r = 0.221, p = 0.013). In infants, no differences were found in mean HCC between the ECI group and the control group. No associations were found between maternal and infant HCC, paternal and infant HCC and maternal and paternal HCC. CONCLUSION Parents of ECIs showed significantly lower HCC than control parents, reflecting a diminished response of the hypothalamic-pituitary-adrenal (HPA) axis. More research is needed to examine whether this decrease in response is pre-existing or caused by excessive infant crying.
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Postel C, Mary A, Dayan J, Fraisse F, Vallée T, Guillery-Girard B, Viader F, Sayette VDL, Peschanski D, Eustache F, Gagnepain P. Variations in response to trauma and hippocampal subfield changes. Neurobiol Stress 2021; 15:100346. [PMID: 34113695 PMCID: PMC8170416 DOI: 10.1016/j.ynstr.2021.100346] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 01/01/2023] Open
Abstract
Models of posttraumatic stress disorder (PTSD) suggest that the hippocampus is key to the persistence of traumatic memory. Yet very little is known about the precise changes that take place in this structure, nor their relation with PTSD symptoms. Previous studies have mostly used magnetic resonance imaging (MRI) at low resolutions, making it impossible to identify sensitive anatomical landmarks, or compared groups often unequally matched in terms of traumatic exposure. The present cross-sectional study included 92 individuals who had all been exposed to the terrorist attacks in Paris on November 13, 2015 (53 of whom subsequently developed PTSD) and 56 individuals who had not been exposed. Hippocampal subfield volumes were estimated using cross-validated automatic segmentation of high-resolution MRI images. Results revealed changes in CA1 and CA2-3/dentate gyrus (DG) volumes in individuals with PTSD, but not in resilient (i.e., exposed but without PTSD) individuals, after controlling for potential nuisance variables such as previous traumatic exposure and substance abuse. In line with current models of hippocampal subfield functions, CA1 changes were linked to the uncontrollable re-experiencing of intrusive memories, while CA2-3/DG changes, potentially exacerbated by comorbid depression, fostered the overgeneralization of fear linked to avoidance and hypervigilance behaviors. Additional analyses revealed that CA1 integrity was linked to optimum functioning of the memory control network in resilient individuals. These findings shed new light on potential pathophysiological mechanisms in the hippocampus subtending the development of PTSD and the failure to recover from trauma.
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Affiliation(s)
- Charlotte Postel
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Alison Mary
- Neuropsychology and Functional Neuroimaging Research Unit (UR2NF), Centre for Research in Cognition and Neurosciences (CRCN), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, 1050, Brussels, Belgium
| | - Jacques Dayan
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Florence Fraisse
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Thomas Vallée
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Bérengère Guillery-Girard
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Fausto Viader
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Vincent de la Sayette
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Denis Peschanski
- Université Paris I Panthéon Sorbonne, HESAM Université, EHESS, CNRS, UMR8209, Paris, France
| | - Francis Eustache
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Pierre Gagnepain
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
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Kothgassner OD, Pellegrini M, Goreis A, Giordano V, Edobor J, Fischer S, Plener PL, Huscsava MM. Hydrocortisone administration for reducing post-traumatic stress symptoms: A systematic review and meta-analysis. Psychoneuroendocrinology 2021; 126:105168. [PMID: 33626392 DOI: 10.1016/j.psyneuen.2021.105168] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/21/2021] [Accepted: 02/05/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a debilitating disorder that is often accompanied by alterations in the hypothalamic-pituitary (HPA) axis. While there is abundant evidence for the efficacy of psychological therapies in reducing post-traumatic stress symptoms, barely anything is known about pharmacological interventions. Given the role of the HPA axis in the pathophysiology of PTSD, the aim of this study was to provide the first meta-analysis of Hydrocortisone as a potential treatment for this condition. METHOD A systematic review of randomized-controlled trials (RCTs) was conducted to investigate the efficacy of hydrocortisone in the prevention and curative treatment of post-traumatic stress symptoms. This study was pre-registered with the OSF (doi:10.17605/OSF.IO/GJAZF). FINDINGS Eight studies (9 effect sizes) covering 362 participants met our inclusion criteria. We found that Hydrocortisone as compared to placebo significantly reduced PTSD symptoms (d = 0.96, 95% Cl 0.22-1.69 p = 0.011) and PTSD incidence (logRR = 0.85, 95% CI 1.12-1.59, p = 0.023). Subgroup analyses revealed a significant effect of Hydrocortisone when it was administered in a preventative context (d = 1.50; 95%CI 0.30-2.69, p = 0.014), but not when it was administered in a curative context (d = 0.28; 95%CI -0.11 to 0.66, p = 0.161). CONCLUSION Hydrocortisone appears to be a promising and efficient low-cost medication for the prevention of PTSD. However, the small number of included studies and their limited methodological quality emphasize the need for further rigorous studies in this field.
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Affiliation(s)
- Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.
| | - Marie Pellegrini
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Andreas Goreis
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria; Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Vito Giordano
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Joy Edobor
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Susanne Fischer
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Department of Child, and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Mercedes M Huscsava
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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Woud ML, Blackwell SE, Shkreli L, Würtz F, Cwik JC, Margraf J, Holmes EA, Steudte-Schmiedgen S, Herpertz S, Kessler H. The Effects of Modifying Dysfunctional Appraisals in Posttraumatic Stress Disorder Using a Form of Cognitive Bias Modification: Results of a Randomized Controlled Trial in an Inpatient Setting. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:386-402. [PMID: 33621970 DOI: 10.1159/000514166] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Dysfunctional appraisals about traumatic events and their sequelae are a key mechanism in posttraumatic stress disorder (PTSD). Experimental studies have shown that a computerized cognitive training, cognitive bias modification for appraisals (CBM-APP), can modify dysfunctional appraisals and reduce analogue trauma symptoms amongst healthy and subclinical volunteers. OBJECTIVE We aimed to test whether CBM-APP could reduce dysfunctional appraisals related to trauma reactions in PTSD patients, and whether this would lead to improvements in PTSD symptoms. METHODS We compared CBM-APP to sham training in a parallel-arm proof-of-principle double-blind randomized controlled trial amongst 80 PTSD patients admitted to an inpatient clinic. Both arms comprised a training schedule of 8 sessions over a 2-week period and were completed as an adjunct to the standard treatment programme. RESULTS In intention-to-treat analyses, participants receiving CBM-APP showed a greater reduction in dysfunctional appraisals on a scenario task from pre- to posttraining (primary outcome) assessments, compared to those receiving sham training (d = 1.30, 95% CI 0.82-1.80), with between-group differences also found on the Posttraumatic Cognitions Inventory (PTCI; d = 0.85, 95% CI 0.39-1.32) and the PTSD Checklist for DSM-5 (PCL-5; d = 0.68, 95% CI 0.23-1.14), but not for long-term cortisol concentrations (d = 0.25, 95% CI -0.28 to 0.78). Reductions in dysfunctional appraisals assessed via the scenario task correlated with reductions on the PTCI, PCL-5, and hair cortisol concentrations from pre- to posttraining time points. CONCLUSIONS Results support dysfunctional appraisals as a modifiable cognitive mechanism, and that their proximal modification transfers to downstream PTSD symptoms. These findings could open new avenues for improving present therapeutic approaches.
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Affiliation(s)
- Marcella L Woud
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany,
| | - Simon E Blackwell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Lorika Shkreli
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Felix Würtz
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Jan Christopher Cwik
- Clinical Psychology and Psychotherapy, Department of Human Sciences, University of Cologne, Cologne, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
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Castro-Vale I, Durães C, van Rossum EFC, Staufenbiel SM, Severo M, Lemos MC, Carvalho D. The Glucocorticoid Receptor Gene ( NR3C1) 9β SNP Is Associated with Posttraumatic Stress Disorder. Healthcare (Basel) 2021; 9:healthcare9020173. [PMID: 33562675 PMCID: PMC7915937 DOI: 10.3390/healthcare9020173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) has been associated with glucocorticoid (GC) hypersensitivity. Although genetic factors account for 30–46% of the variance in PTSD, no associations have been found between single nucleotide polymorphisms (SNPs) of the GC receptor (GR) gene (NR3C1) and risk for this disorder. We studied the association of five SNPs in the GR gene (rs10052957, rs6189/rs6190, rs6195, rs41423247, and rs6198) and haplotypes with PTSD, in a group of Portuguese male war veterans (33 with lifetime PTSD, 28 without). To determine whether the 9β SNP (rs6198) was associated with chronically altered cortisol levels, we evaluated hair cortisol concentrations (HCC) in a sample of 69 veterans’ offspring. The 9β variant (G allele) was significantly associated with lifetime PTSD under a dominant model of inheritance. The 9β variant was also significantly associated with severity of current PTSD symptoms. The haplotype analysis revealed an association between a common haplotype comprising the 9β risk allele and lifetime PTSD. Carriers of the 9β risk allele had significantly lower HCC than non-carriers. We found the 9β risk allele and a haplotype comprising the 9β risk allele of the GR gene to be associated with PTSD in veterans. This 9β risk allele was also associated with lower HCC in their offspring.
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Affiliation(s)
- Ivone Castro-Vale
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto, 4200-135 Porto, Portugal; (C.D.); (D.C.)
- Correspondence: ; Tel.: +351-220426920
| | - Cecília Durães
- i3S—Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto, 4200-135 Porto, Portugal; (C.D.); (D.C.)
- Ipatimup—Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135 Porto, Portugal
| | - Elisabeth F. C. van Rossum
- Erasmus MC, Division of Endocrinology, Department of Internal Medicine, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; (E.F.C.v.R.); (S.M.S.)
| | - Sabine M. Staufenbiel
- Erasmus MC, Division of Endocrinology, Department of Internal Medicine, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands; (E.F.C.v.R.); (S.M.S.)
| | - Milton Severo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Department of Medical Education and Simulation, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Manuel C. Lemos
- CICS-UBI—Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal;
| | - Davide Carvalho
- i3S—Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto, 4200-135 Porto, Portugal; (C.D.); (D.C.)
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar S. João, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Bartlett R, Sarnyai Z, Momartin S, Ooi L, Schwab SG, Matosin N. Understanding the pathology of psychiatric disorders in refugees. Psychiatry Res 2021; 296:113661. [PMID: 33373807 DOI: 10.1016/j.psychres.2020.113661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Displacement of people from their homes, families and countries is a current global crisis, with over 70 million people forcibly on the move. A substantial proportion of these people will end up in regions with a different language and culture, where they are registered as refugees or asylum seekers. Due to the underlying reasons for displacement (including conflicts, persecution or violation of human rights), displaced people are severely stress-exposed, which continues into their post-migration life and increases risk for developing psychiatric disorders such as post-traumatic stress disorder and other anxiety disorders and mood disorders. While landmark studies have illustrated the increased prevalence of psychopathology in asylum seeker and refugee populations following pre-/post-displacement stress, few studies add to our understanding of the basic biological mechanisms underpinning risk to psychiatric disorders in these populations. Additionally, the mechanisms underlying resilience despite significant adversity remain unclear. Understanding the molecular mechanisms underpinning the development of psychiatric disorders in refugees can propel treatments (both drug and non-drug) that are capable of influencing biology at the molecular level, and the design of interventions. In the following review, we summarise the status quo of research investigating the pathophysiology of psychiatric disorders in refugees, and propose new ways to address gaps in knowledge with multidisciplinary research.
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Affiliation(s)
- Rachael Bartlett
- Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW 2522, Australia; Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Zoltan Sarnyai
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Discovery, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
| | - Shakeh Momartin
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), 152-168 The Horsley Drive, Carramar, NSW 2163, Australia
| | - Lezanne Ooi
- Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW 2522, Australia; Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Sibylle G Schwab
- Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW 2522, Australia; Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Natalie Matosin
- Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW 2522, Australia; Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia; Max Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, Germany.
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Broeks CW, Choenni V, Kok R, van der Voorn B, de Kruijff I, van den Akker ELT, van Rossum EFC, Hoogendijk WJG, Hillegers MHJ, Kamperman AM, Lambregtse-Van den Berg MP. An exploratory study of perinatal hair cortisol concentrations in mother-infant dyads with severe psychiatric disorders versus healthy controls. BJPsych Open 2021; 7:e28. [PMID: 33407971 PMCID: PMC8058941 DOI: 10.1192/bjo.2020.159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Maternal psychopathology during pregnancy is associated with negative outcomes in offspring. Increased placental transfer of maternal cortisol may contribute to mediate this association. Hair cortisol concentrations (HCCs) appear to be a good biomarker of long-term prenatal stress exposure. Little is known about the associations between severe maternal psychopathology and perinatal infant HCCs. AIMS We assessed HCCs in the perinatal period in mother-infant dyads with and without severe psychiatric disorders. METHOD We examined group differences in HCCs of mother-infant dyads (n = 18) subjected to severe maternal psychiatric disorders versus healthy control dyads (n = 27). We assessed the correlation of HCCs between mother and infant within both groups, and the association between current maternal symptoms and HCCs in patient dyads. RESULTS Median (interquartile range) and distribution of HCC differed in patients compared with control mothers (U = 468.5, P = 0.03). HCCs in infants of patients did not differ from control infants (U = 250.0, P = 0.67). Subsequently, we found that HCCs within healthy control dyads were correlated (n = 27, r 0.55 (0.14), P = 0.003), but were not within patient dyads (n = 18, r 0.082 (0.13), P = 0.746). HCCs in infants of patients showed a positive correlation with maternal symptoms (n = 16, r = 0.63 (0.06), P = 0.008). CONCLUSIONS These preliminary findings suggest that infant HCC reflect perinatal stress exposure. In infants, these early differences could influence lifetime hypothalamic-pituitary-adrenal axis functioning, which might be associated with increased susceptibility to later disease.
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Affiliation(s)
- Carlinde W Broeks
- Department of Psychiatry, Erasmus University Medical Center, the Netherlands; and Department of Psychiatry, Arkin Institute for Mental Health, the Netherlands
| | - Vandhana Choenni
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, the Netherlands
| | - Rianne Kok
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, the Netherlands
| | - Bibian van der Voorn
- Department of Pediatric Endocrinology, Obesity Center CGG, Erasmus MC-Sophia Children's Hospital, the Netherlands; and Division of Endocrinology, Department of Internal Medicine, Erasmus University Medical Center, the Netherlands
| | - Ineke de Kruijff
- Department of Pediatrics, St Antonius Hospital Nieuwegein, the Netherlands
| | | | - Elisabeth F C van Rossum
- Division of Endocrinology, Department of Internal Medicine, Erasmus University Medical Center, the Netherlands
| | | | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, the Netherlands
| | - Astrid M Kamperman
- Department of Psychiatry, Erasmus University Medical Center, the Netherlands; and Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Center, the Netherlands
| | - Mijke P Lambregtse-Van den Berg
- Department of Psychiatry, Erasmus University Medical Center, the Netherlands; and Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, the Netherlands
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Associating Emergency Medical Services personnel's workload, trauma exposure, and health with the cortisol, endocannabinoid, and N-acylethanolamine concentrations in their hair. Sci Rep 2020; 10:22403. [PMID: 33376241 PMCID: PMC7772331 DOI: 10.1038/s41598-020-79859-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/07/2020] [Indexed: 12/22/2022] Open
Abstract
In their line of duty, Emergency Medical Services (EMS) personnel are exposed to chronically stressful working conditions and recurrent traumatic events, which increase their risk for detrimental health outcomes. Here, we investigated whether this risk is due to altered regulation of the hypothalamus–pituitary–adrenal (HPA) axis and the endocannabinoid system. Therefore, 1 cm hair strands were collected from a cohort of 72 German EMS personnel in order to measure concentrations of cortisol, endocannabinoids [i.e., anandamide (AEA), 2-arachidonoylglycerol (2-AG)], and N-acylethanolamines [i.e., stearoylethanolamide (SEA), oleoylethanolamide (OEA), and palmitoylethanolamide (PEA)]. Rank correlation analyses were conducted to test associations of cortisol, endocannabinoid, and N-acylethanolamine concentrations with the EMS personnel’s workload, lifetime trauma exposure, and mental and physical health problems. We found a negative correlation between cortisol and 2-AG concentrations in hair. Higher hair cortisol was associated with higher workload. Reported traumatic stress during childhood and later in life as well as more severe depressive and physical stress symptoms were associated with elevated 2-AG, SEA, OEA, and PEA concentrations. Future longitudinal research needs to address the prospect of tracing biomolecular markers of glucocorticoid, endocannabinoid, and N-acylethanolamine activity as a predicting value of the long-term course of mental and physical well-being.
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White LO, Schulz CC, Schoett MJS, Kungl MT, Keil J, Borelli JL, Vrtička P. Conceptual Analysis: A Social Neuroscience Approach to Interpersonal Interaction in the Context of Disruption and Disorganization of Attachment (NAMDA). Front Psychiatry 2020; 11:517372. [PMID: 33424647 PMCID: PMC7785824 DOI: 10.3389/fpsyt.2020.517372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 11/18/2020] [Indexed: 12/22/2022] Open
Abstract
Humans are strongly dependent upon social resources for allostasis and emotion regulation. This applies especially to early childhood because humans-as an altricial species-have a prolonged period of dependency on support and input from caregivers who typically act as sources of co-regulation. Accordingly, attachment theory proposes that the history and quality of early interactions with primary caregivers shape children's internal working models of attachment. In turn, these attachment models guide behavior, initially with the set goal of maintaining proximity to caregivers but eventually paving the way to more generalized mental representations of self and others. Mounting evidence in non-clinical populations suggests that these mental representations coincide with differential patterns of neural structure, function, and connectivity in a range of brain regions previously associated with emotional and cognitive capacities. What is currently lacking, however, is an evidence-based account of how early adverse attachment-related experiences and/or the emergence of attachment disorganization impact the developing brain. While work on early childhood adversities offers important insights, we propose that how these events become biologically embedded crucially hinges on the context of the child-caregiver attachment relationships in which the events take place. Our selective review distinguishes between direct social neuroscience research on disorganized attachment and indirect maltreatment-related research, converging on aberrant functioning in neurobiological systems subserving aversion, approach, emotion regulation, and mental state processing in the wake of severe attachment disruption. To account for heterogeneity of findings, we propose two distinct neurobiological phenotypes characterized by hyper- and hypo-arousal primarily deriving from the caregiver serving either as a threatening or as an insufficient source of co-regulation, respectively.
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Affiliation(s)
- Lars O. White
- Department of Child and Adolescent Psychiatry, University of Leipzig, Leipzig, Germany
| | - Charlotte C. Schulz
- Department of Child and Adolescent Psychiatry, University of Leipzig, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Melanie T. Kungl
- Department of Psychology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jan Keil
- Department of Child and Adolescent Psychiatry, University of Leipzig, Leipzig, Germany
| | - Jessica L. Borelli
- THRIVE Laboratory, Psychology and Social Behavior, University of California, Irvine, Irvine, CA, United States
| | - Pascal Vrtička
- Research Group “Social Stress and Family Health”, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Psychology, Centre for Brain Science, University of Essex, Colchester, United Kingdom
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Qing Y, van Zuiden M, Eriksson C, Lopes Cardozo B, Simon W, Ager A, Snider L, Sabin ML, Scholte W, Kaiser R, Rijnen B, Olff M. Cortisol awakening response over the course of humanitarian aid deployment: a prospective cohort study. Eur J Psychotraumatol 2020; 11:1816649. [PMID: 33680342 PMCID: PMC7875048 DOI: 10.1080/20008198.2020.1816649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Internationally deployed humanitarian aid (HA) workers are routinely confronted with potentially traumatic stressors. However, it remains unknown whether HA deployment and related traumatic stress are associated with long-term changes in hypothalamic-pituitary-adrenal (HPA) axis function. Therefore, we investigated whether cortisol awakening response (CAR) decreased upon deployment and whether this was moderated by previous and recent trauma exposure and parallel changes in symptom severity and perceived social support. Methods: In this prospective study, n = 86 HA workers (68% females) completed questionnaires regarding trauma exposure, posttraumatic stress disorder (PTSD), anxiety and depressive symptoms and perceived social support, as well as salivary cortisol assessments at awakening and 30 minutes post-awakening at before, early and 3-6 months post-deployment. Results: Linear mixed models showed significantly decreased CAR (b(SE) = -.036(.011), p = .002) and awakening cortisol over time (b(SE) = -.007(.003), p = .014). The extent of awakening cortisol change was significantly moderated by interactions between previous and recent trauma exposure. Also, a steeper awakening cortisol decrease was significantly associated with higher mean anxiety and PTSD symptoms across assessments. No significant effects were found for social support. Conclusions: We observed attenuated CAR and awakening cortisol upon HA deployment, with a dose-response effect between trauma exposure before and during the recent deployment on awakening cortisol. Awakening cortisol change was associated with PTSD and anxiety symptom levels across assessments. Our findings support the need for organizational awareness that work-related exposures may have long-lasting biological effects. Further research assessing symptoms and biological measures in parallel is needed to translate current findings into guidelines on the individual level.
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Affiliation(s)
- Yulan Qing
- Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience and Public Health Research Institutes, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience and Public Health Research Institutes, University of Amsterdam, Amsterdam, The Netherlands
| | - Cynthia Eriksson
- Graduate School of Psychology, Fuller Theological Seminary, Pasadena, CA, USA
| | - Barbara Lopes Cardozo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Alastair Ager
- Mailman School of Public Health, Columbia University, New York, NY, USA.,Institute for Global Health and Development, Queen Margaret University, Scotland, UK
| | - Leslie Snider
- The MHPSS Collaborative for Children and Families in Adversity, Save the Children Denmark, København, Denmark
| | - Miriam Lewis Sabin
- The Partnership for Maternal, Newborn & Child Health (PMNCH), Geneva 27, Switzerland
| | - Willem Scholte
- Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience and Public Health Research Institutes, University of Amsterdam, Amsterdam, The Netherlands.,The Antares Foundation, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Reinhard Kaiser
- Division of Global Health Protection, Centers for Disease Control and Prevention (CDC), Dulles, VA, USA
| | - Bas Rijnen
- Namibia University of Science and Technology, Windhoek, Namibia
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience and Public Health Research Institutes, University of Amsterdam, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
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Alhalal E, Falatah R. Intimate partner violence and hair cortisol concentration: A biomarker for HPA axis function. Psychoneuroendocrinology 2020; 122:104897. [PMID: 33068953 DOI: 10.1016/j.psyneuen.2020.104897] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/21/2020] [Accepted: 09/22/2020] [Indexed: 02/07/2023]
Abstract
Intimate partner violence (IPV) is associated with various health issues, which may be explained by hypothalamic-pituitary-adrenal (HPA) axis dysfunction. There is a lack of research examining hair cortisol concentrations as a biomarker of HPA function alterations in the context of IPV with consideration to women's resilience. The study assessed whether IPV severity and resilience are associated with hair cortisol concentrations among Saudi women. This cross-sectional explanatory design used a convenience sample of 156 Saudi women from health care settings. A structured interview that included self-reported responses was performed, and hair samples were collected. The samples were analyzed using a salivary ELISA kit. The result showed a significant difference in hair cortisol concentration between women who have experienced IPV and women who have not experienced IPV. As well, controlling for depressive and post-traumatic stress disorder, IPV severity (β = -.281, 95 % CI = -.046 to -.003) and resilience (β = -.225, 95 % CI = -.038 to -.005) were significant predictors of lower hair cortisol concentrations. The effect of IPV severity on cortisol levels as a biomarker of HPA axis function could explain the poor health conditions among IPV survivors. This study highlights that IPV victimization leads to physiological changes and that hair cortisol is an indicator of women's health status.
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Affiliation(s)
- Eman Alhalal
- Community and Mental Health Nursing Department, Nursing College, King Saud University, Saudi Arabia.
| | - Rawaih Falatah
- Nursing Administration and Education Department, Nursing College, King Saud University, Saudi Arabia.
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Fuchs A, Dittrich K, Neukel C, Winter S, Zietlow AL, Kluczniok D, Herpertz SC, Hindi Attar C, Möhler E, Fydrich T, Bermpohl F, Kaess M, Resch F, Bödeker K. Hair cortisol moderates the association between obstetric complications and child wellbeing. Psychoneuroendocrinology 2020; 121:104845. [PMID: 32861165 DOI: 10.1016/j.psyneuen.2020.104845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/25/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Obstetric complications (OC) may have implications for later health outcomes. However, there is a lack of research examining the association between OC and behavior problems or quality of life (HRQoL). We aimed to close this gap and further investigate functioning of the hypothalamus-pituitary-adrenal (HPA)-axis as a potential physiological vulnerability moderating the association between OC and behavior problems and HRQoL. We investigated 232 mothers and their five to 12-year-old children. Presence of OC during the pre-, peri-, and postnatal phases was determined by interviewing mothers. Children's behavior problems (CBCL, TRF) and HRQoL (Kidscreen rated by mothers and children) were assessed. Children gave 3 cm strands of hair for analysis of hair cortisol (HC). Structural equation modeling analyses with a latent variable of child outcome ("distress"), OC as predictor and HC as a potential moderator were conducted. OC significantly predicted distress (β = .33, p < .01). The model showed a good fit to the data: χ2(14)=15.66, p < .33, CFI=.99, TLI=.99, RMSEA=.02, 90 %CI [.00, .06], SRMR=.04. In addition, HC moderated the association between OC and distress (β=-.32, p < .01). The moderation model also showed a good fit: χ2(14) =7.13, p = .93, CFI=1.00, TLI=1.06, RMSEA=.00, 90 %CI [.00, .02], SRMR=.03. Results indicated that the association between OC and distress was significant only when children had low HC-levels. This was also the case for both externalizing and internalizing behavior problems. Our results underline the notion of OC as a risk factor for child behavior problems and wellbeing and point to an important role of the children's physiological set-up such as HPA-functioning.
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Affiliation(s)
- Anna Fuchs
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany; Department of Psychology, Pennsylvania State University, University Park, PA, USA.
| | - Katja Dittrich
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Corinne Neukel
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of General Psychiatry, Heidelberg, Germany
| | - Sibylle Winter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Anna-Lena Zietlow
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg, Germany
| | - Dorothea Kluczniok
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Sabine C Herpertz
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of General Psychiatry, Heidelberg, Germany
| | - Catherine Hindi Attar
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Eva Möhler
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Michael Kaess
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franz Resch
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Katja Bödeker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
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64
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Monteleone AM, Cascino G, Marciello F, D'Agostino G, Caivano V, Monteleone P, Maj M. Clinical and neuroendocrine correlates of childhood maltreatment history in adults with bipolar disorder. Bipolar Disord 2020; 22:749-756. [PMID: 32365252 DOI: 10.1111/bdi.12923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Childhood maltreatment has been associated to an increased risk of developing bipolar disorder (BD). A role of the hypothalamus-pituitary-adrenal (HPA) axis in mediating trauma-related risk for adult psychopathology has been suggested but scarcely investigated in BD. Therefore, we explored the impact of childhood maltreatment on clinical features of BD and on the activity of the HPA axis. METHODS One hundred and six patients participated in the study. On the basis of their history of childhood trauma, as assessed by the Childhood Trauma Questionnaire (CTQ), they were divided into a group with a history of childhood maltreatment (CM+) and a group without (CM-). Twenty-nine participants (16 with a history of childhood trauma and 13 without) underwent the cortisol awakening response (CAR) test. RESULTS Sixty-two patients had a history of childhood maltreatment and 44 had not. Maltreatment was significantly more frequent in females than males. CM+ patients showed a significant higher body mass index, a significant higher number of suicide attempts, and more severe mania symptoms than CM- ones. Logistic regression indicated a significant association between lifetime suicide attempts and any type of childhood maltreatment and between emotional abuse and the presence of psychotic symptoms or mixed mood episodes. CM+ individuals with BD exhibited a significantly reduced CAR with respect to CM- ones. DISCUSSION Our results add to literature findings showing a worse clinical course in BD patients with a history of childhood maltreatments and show for the first time that childhood trauma exposure is associated to an impaired CAR in adults with BD.
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Affiliation(s)
| | - Giammarco Cascino
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Francesca Marciello
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Giulia D'Agostino
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Vito Caivano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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EMDR Versus Treatment-as-Usual in Patients With Chronic Non-Malignant Pain: A Randomized Controlled Pilot Study. JOURNAL OF EMDR PRACTICE AND RESEARCH 2020. [DOI: 10.1891/emdr-d-20-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In recent years, different studies have observed a strong association between chronic pain (CP) and psychological trauma. Therefore, a trauma-focused psychotherapy, such as eye movement desensitization and reprocessing (EMDR), could be an innovative treatment option. The aim of this pilot study was to assess whether a specific EMDR protocol for CP leads to (a) a reduction in pain intensity, (b) an improvement in anxiety and depressive symptoms, and (c) an improvement in quality of life. 28 CP patients were randomly assigned to EMDR + treatment as usual (TAU; n = 14) or to TAU alone (n = 14). Patients in the EMDR group received 12 psychotherapeutic sessions of 90 minutes over 3 months. Pain intensity was measured using the Visual Analog Scale and the Pain Disability index, quality of life using the EQ-5D-5L, and anxiety and depressive symptoms using the Hamilton Anxiety and Depression Scale. Measures were taken for both conditions at pre- and post-treatment, and a follow-up in the EMDR condition was taken at 3 months post-treatment. Patients in the EMDR group showed significantly reduced pain intensity and improved quality of life and anxiety and depressive symptoms compared to TAU alone at post-treatment. Improvements were largely maintained at 3-month follow-up. This study suggests that EMDR may be an effective and safe psychological intervention to be used within the multidisciplinary treatment plan of patients with CP.
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66
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Castro-Vale I, van Rossum EFC, Staufenbiel SM, Severo M, Mota-Cardoso R, Carvalho D. Hair Cortisol as a Marker of Intergenerational Heritage of War? A Study of Veterans and Their Offspring. Psychiatry Investig 2020; 17:976-986. [PMID: 33017887 PMCID: PMC7596280 DOI: 10.30773/pi.2020.0212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/06/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) has been associated with lower circulating cortisol levels in specific subgroups, which have also been found in the offspring of people with PTSD. The analysis of hair cortisol concentrations (HCC) is a recent methodology which is used to assess long-term systemic cortisol levels. We aimed to study veterans with war-related lifetime PTSD and their respective offspring with regards to HCC. We also studied the influence of lifetime major depressive disorder (MDD), war experiences, and childhood adversities on HCC in these groups. METHODS 31 male veterans with PTSD and 28 without PTSD and 69 adult offspring were studied. HCC were quantified by liquid chromatography tandem-mass spectrometry. RESULTS No differences in HCC were found between veterans with and without PTSD, or between their respective offspring. Veterans without MDD showed a positive association between total war exposure and HCC. Veterans reporting more frequent childhood physical abuse had lower HCC. Veterans-with-PTSD's offspring with MDD had increased HCC compared to offspring without MDD. Offspring's exposure to more frequent childhood physical abuse was negatively associated with HCC in those without MDD. CONCLUSION HCC did not appear to constitute a marker of intergenerational heritage of war-related PTSD, except in the case of veteranswith-PTSD's offspring with MDD. Our data suggest that HCC is a marker of adult reported childhood physical abuse.
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Affiliation(s)
- Ivone Castro-Vale
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sabine M Staufenbiel
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Milton Severo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health and Department of Medical Education and Simulation, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Mota-Cardoso
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Davide Carvalho
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Department of Endocrinology, Diabetes and Metabolism, São João University Hospital Centre, Faculty of Medicine, University of Porto, Porto, Portugal
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Castro-Vale I, Carvalho D. The Pathways between Cortisol-Related Regulation Genes and PTSD Psychotherapy. Healthcare (Basel) 2020; 8:healthcare8040376. [PMID: 33019527 PMCID: PMC7712185 DOI: 10.3390/healthcare8040376] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 01/30/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) only develops after exposure to a traumatic event in some individuals. PTSD can be chronic and debilitating, and is associated with co-morbidities such as depression, substance use, and cardiometabolic disorders. One of the most important pathophysiological mechanisms underlying the development of PTSD and its subsequent maintenance is a dysfunctional hypothalamic-pituitary-adrenal (HPA) axis. The corticotrophin-releasing hormone, cortisol, glucocorticoid receptor (GR), and their respective genes are some of the mediators of PTSD's pathophysiology. Several treatments are available, including medication and psychotherapies, although their success rate is limited. Some pharmacological therapies based on the HPA axis are currently being tested in clinical trials and changes in HPA axis biomarkers have been found to occur in response not only to pharmacological treatments, but also to psychotherapy-including the epigenetic modification of the GR gene. Psychotherapies are considered to be the first line treatments for PTSD in some guidelines, even though they are effective for some, but not for all patients with PTSD. This review aims to address how knowledge of the HPA axis-related genetic makeup can inform and predict the outcomes of psychotherapeutic treatments.
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Affiliation(s)
- Ivone Castro-Vale
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- i3S-Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal
- Correspondence:
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, São João Hospital University Centre, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;
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Awasthi S, Pan H, LeDoux JE, Cloitre M, Altemus M, McEwen B, Silbersweig D, Stern E. The bed nucleus of the stria terminalis and functionally linked neurocircuitry modulate emotion processing and HPA axis dysfunction in posttraumatic stress disorder. NEUROIMAGE-CLINICAL 2020; 28:102442. [PMID: 33070099 PMCID: PMC7569227 DOI: 10.1016/j.nicl.2020.102442] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022]
Abstract
Task-based functional cooccurrence (tbFC) elucidates role of BNST in human PTSD neurocircuitry. The BNST is hyperactive during the processing of trauma-related words in PTSD. BNST activity correlates to PTSD symptom severity and reduced diurnal cortisol index. The BNST has positive tbFC with negative emotion- and stress-related neurocircuitry. The BNST has negative tbFC with executive function and stress regulation neurocircuitry.
Background The bed nucleus of the stria terminalis (BNST) plays an important role in rodent posttraumatic stress disorder (PTSD), but evidence to support its relevance to human PTSD is limited. We sought to understand the role of the BNST in human PTSD via fMRI, behavioral, and physiological measurements. Methods 29 patients with PTSD (childhood sexual abuse) and 23 healthy controls (HC) underwent BOLD imaging with an emotional word paradigm. Symptom severity was assessed using the Clinician-Administered PTSD Scale and HPA-axis dysfunction was assessed by measuring the diurnal cortisol amplitude index (DCAI). A data-driven multivariate analysis was used to determine BNST task-based functional co-occurrence (tbFC) across individuals. Results In the trauma-versus-neutral word contrast, patients showed increased activation compared to HC in the BNST, medial prefrontal cortex (mPFC), posterior cingulate gyrus (PCG), caudate heads, and midbrain, and decreased activation in dorsolateral prefrontal cortex (DLPFC). Symptom severity positively correlated with activity in the BNST, caudate head, amygdala, hippocampus, dorsal anterior cingulate gyrus (dACG), and PCG, and negatively with activity in the medial orbiotofrontal cortex (mOFC) and DLPFC. Patients and HC showed marked differences in the relationship between the DCAI and BOLD activity in the BNST, septal nuclei, dACG, and PCG. Patients showed stronger tbFC between the BNST and closely linked limbic and subcortical regions, and a loss of negative tbFC between the BNST and DLPFC. Conclusions Based upon novel data, we present a new model of dysexecutive emotion processing and HPA-axis dysfunction in human PTSD that incorporates the role of the BNST and functionally linked neurocircuitry.
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Affiliation(s)
- Samir Awasthi
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hong Pan
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph E LeDoux
- Center for Neural Science, New York University, New York, NY, USA
| | - Marylene Cloitre
- National Center for PTSD, Veteran Affairs Palo Alto Health Care System, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Margaret Altemus
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - David Silbersweig
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Emily Stern
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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van den Heuvel LL, Stalder T, du Plessis S, Suliman S, Kirschbaum C, Seedat S. Hair cortisol levels in posttraumatic stress disorder and metabolic syndrome. Stress 2020; 23:577-589. [PMID: 32008379 DOI: 10.1080/10253890.2020.1724949] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Individuals with post-traumatic stress disorder (PTSD) evidence increased rates of metabolic syndrome (MetS), and both PTSD and MetS are associated with alterations in hypothalamic-pituitary-adrenal (HPA) axis function. Few investigations have examined the possible role of HPA-axis dysfunction in the co-occurrence of PTSD and MetS. In a case-control study, we aimed to determine whether hair cortisol concentrations (HCC) were associated with (i) PTSD caseness and severity and (ii) PTSD and MetS co-occurrence. We used the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) to determine PTSD diagnoses and severity scores in 216 females of mixed ancestry aged between 20 and 79 years (M = 43.8, SD =13.3). Hair samples, representing a three-month retrospective window of cortisol levels, were obtained and analyzed utilizing liquid chromatography-tandem mass spectrometry. We constructed multivariate linear regression models to evaluate whether PTSD diagnosis, PTSD severity, and MetS comorbidity were associated with HCC, controlling for potential confounders. HCC were significantly higher (adj β = 0.154, p = .033; Cohen's d = 0.44) in PTSD patients (n = 110) than trauma-exposed controls (n = 106) and CAPS severity scores (adj β = 0.207, p = .005) were significantly associated with HCC. MetS was not associated with HCC and there were no significant interactions between PTSD and MetS on HCC. This study provides evidence of a chronically dysregulated neuroendocrine mediated stress response in PTSD, with a clear dose-response relationship. HCC do not, however, appear to have specificity for the comorbidity of PTSD and MetS in this sample.LAY SUMMARYWe found that levels of the stress hormone, cortisol, measured in hair samples were significantly higher in South African women with post-traumatic stress disorder (PTSD) than in women who had also experienced trauma but did not have PTSD. Hair cortisol levels were, however, not associated with metabolic syndrome, a cluster of risk factors for heart disease, in the women studied. We thus show that South African women with PTSD have elevated long-term stress hormone levels and that this effect is related to PTSD and not solely due to trauma exposure.
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Affiliation(s)
- Leigh Luella van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tobias Stalder
- Department of Clinical Psychology, University of Siegen, Siegen, Germany
| | - Stéfan du Plessis
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sharain Suliman
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Petrowski K, Wichmann S, Pyrc J, Steudte-Schmiedgen S, Kirschbaum C. Hair cortisol predicts avoidance behavior and depressiveness after first-time and single-event trauma exposure in motor vehicle crash victims. Stress 2020; 23:567-576. [PMID: 31939338 DOI: 10.1080/10253890.2020.1714585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The role of cortisol as a premorbid vulnerability factor for trauma sequelae remains unclear. Furthermore, the onset of long-term endocrine changes in response to first-time trauma as a function of later psychopathology is not clarified yet. Thus the predictive value of pre- and post-traumatic hair cortisol concentrations (HCCs) for psychological trauma sequelae was investigated in response to motor vehicle crash (MVC). A total of N= 62 MVC survivors participated in this study (46 females, mean age (SD): 43.94(12.95)). Subsequent trauma sequelae were measured with a structured clinical interview and self-report questionnaires to evaluate psychological symptoms (pre-MVC and three months post-MVC). Hair strands were taken immediately after MVC and three months post-MVC, reflecting cumulative cortisol secretion over the three-month period before and after the MVC. A total of 22.6% of the participants developed a trauma sequela with an affective disorder (14.5%) and/or anxiety disorder (16.1%). We observed a significant main effect of group and diagnosis × time interaction with an increase of HCC in those individuals who presented a subsequent psychiatric disorder. Regression analyses revealed that post-MVC increased HCC were significantly predictive of higher levels of subsequent depressiveness, and that pre-MVC increased HCC were predictive of higher levels of subsequent avoidance behavior. Our findings demonstrate that individual differences in long-term cortisol secretion in response to a first-time traumatic event (MVC) contribute to subsequent psychopathology. Specifically, higher long-term cortisol secretion before and after first-time MVC was a risk factor for subsequent development of avoidance behavior and depressiveness, respectively.Lay summaryHigher cortisol secretion and stress experience before a motor vehicle crash was a risk factor for subsequent development of psychological symptoms.
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Affiliation(s)
- Katja Petrowski
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
- Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Susann Wichmann
- Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jaroslav Pyrc
- Department of Trauma & Reconstructive Surgery, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
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Buchmüller T, Lembcke H, Busch J, Kumsta R, Wolf OT, Leyendecker B. Exploring hair steroid concentrations in asylum seekers, internally displaced refugees, and immigrants. Stress 2020; 23:538-545. [PMID: 32116089 DOI: 10.1080/10253890.2020.1737008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The study of physiology in response to war and forced displacement can yield insight into the origin of stress-related mental health disorders. Previous studies found alterations in hair cortisol concentrations (HCC) in refugees. However, the direction of this alteration in HCC, as well as the association between HCC and psychological stress, remain unclear. Mixed findings can potentially be explained by the lack of contextual factors that have been taken into account. In this explorative study, we investigated HCCs in three female refugee samples (N = 89) in different contexts. Samples were i) asylum seekers from Syria, who sought protection in Germany two years ago (n = 37), ii) internally displaced persons (IDPs), who fled a genocide and lived in conditions of onging insecurity in Iraq (n = 14), and iii) Kurdish immigrants and former asylum seekers, who resettled to Germany 18 years ago and were used as reference group (n = 38). HCC was assessed in the scalp-nearest 6 cm of hair (2*3 cm segments). Data on mental and physical health, exposure to traumatic events, and time between immigration and HCC assessments were collected. Syrian asylum seekers had lower HCC than immigrant controls (η2 = .06). PTSD symptoms and perceived stress were associated with elevated cortisol levels in IDPs (r = .66 and r = .56), while time since immigration was associated with cortisol levels only in immigrant controls (r = .38). We discuss our findings with regard to the importance of contextual factors, particularly time since displacement and on-going insecurity, when studying physiological reactions in refugees.Lay summaryFemale Syrian asylum seekers had lower levels of hair cortisol concentration than Kurdish immigrants in Germany. Hair cortisol concentration was associated with post-traumatic stress symptoms only in internally displaced women who were exposed to ongoing stress and insecurity in Iraq.
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Affiliation(s)
- Thimo Buchmüller
- Center for Child and Family Research, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Hanna Lembcke
- Department for Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Julian Busch
- Center for Child and Family Research, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Robert Kumsta
- Department for Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Oliver T Wolf
- Department for Cognitive Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Birgit Leyendecker
- Center for Child and Family Research, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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Brass KE, Herndon N, Gardner SA, Grindstaff JL, Campbell P. Intergenerational effects of paternal predator cue exposure on behavior, stress reactivity, and neural gene expression. Horm Behav 2020; 124:104806. [PMID: 32534838 DOI: 10.1016/j.yhbeh.2020.104806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/27/2022]
Abstract
Predation threat impacts prey behavior, physiology, and fitness. Stress-mediated alterations to the paternal epigenome can be transmitted to offspring via the germline, conferring a potential advantage to offspring in predator-rich environments. While intergenerational epigenetic transmission of paternal experience has been demonstrated in mammals, how paternal predator exposure might alter offspring phenotypes across development is unstudied. We exposed male mice to a predator odor (2,4,5-trimethylthiazoline, TMT) or a neutral odor (banana extract) prior to mating and measured offspring behavioral phenotypes throughout development, together with adult stress reactivity and candidate gene expression in the prefrontal cortex, hippocampus, amygdala, and hypothalamus. We predicted that offspring of TMT-exposed males would be less active, would display elevated anxiety-like behaviors, and would have a more efficient stress response relative to controls, phenotypes that should enhance predator avoidance in a high predation risk environment. Unexpectedly, we found that offspring of TMT-exposed males are more active, exhibit less anxiety-like behavior, and have decreased baseline plasma corticosterone relative to controls. Effects of paternal treatment on neural gene expression were limited to the prefrontal cortex, with increased mineralocorticoid receptor expression and a trend towards increased Bdnf expression in offspring of TMT-exposed males. These results suggest that fathers exposed to predation threat produce offspring that are buffered against non-acute stressors and, potentially, better adapted to a predator-dense environment because they avoid trade-offs between predator avoidance and foraging and reproduction. This study provides evidence that ecologically relevant paternal experience can be transmitted through the germline, and can impact offspring phenotypes throughout development.
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Affiliation(s)
- Kelsey E Brass
- Oklahoma State University, Department of Integrative Biology, Stillwater, OK 74078, USA
| | - Nathan Herndon
- Oklahoma State University, Department of Integrative Biology, Stillwater, OK 74078, USA
| | - Sarah A Gardner
- Oklahoma State University, Department of Integrative Biology, Stillwater, OK 74078, USA; University of California Riverside, Department of Evolution, Ecology, and Organismal Biology, Riverside, CA 92521, USA
| | - Jennifer L Grindstaff
- Oklahoma State University, Department of Integrative Biology, Stillwater, OK 74078, USA
| | - Polly Campbell
- Oklahoma State University, Department of Integrative Biology, Stillwater, OK 74078, USA; University of California Riverside, Department of Evolution, Ecology, and Organismal Biology, Riverside, CA 92521, USA.
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Rothe N, Steffen J, Penz M, Kirschbaum C, Walther A. Examination of peripheral basal and reactive cortisol levels in major depressive disorder and the burnout syndrome: A systematic review. Neurosci Biobehav Rev 2020; 114:232-270. [DOI: 10.1016/j.neubiorev.2020.02.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/27/2020] [Accepted: 02/19/2020] [Indexed: 12/15/2022]
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Panter-Brick C, Wiley K, Sancilio A, Dajani R, Hadfield K. C-reactive protein, Epstein-Barr virus, and cortisol trajectories in refugee and non-refugee youth: Links with stress, mental health, and cognitive function during a randomized controlled trial. Brain Behav Immun 2020; 87:207-217. [PMID: 30797045 PMCID: PMC7327518 DOI: 10.1016/j.bbi.2019.02.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 11/26/2022] Open
Abstract
Experiencing childhood adversity has been associated with significant changes in inflammation, cell-mediated immunocompetence, and cortisol secretion. Relatively few studies have examined, longitudinally, alterations to inflammatory processes during adolescence, especially outside Western contexts; none have evaluated biomarker trajectories for at-risk youth in response to a structured behavioral intervention. We conducted a randomized controlled trial evaluating the efficacy of a humanitarian intervention targeting stress-alleviation, with 12-18 year-old Syrian refugees (n = 446) and Jordanian non-refugees (n = 371) living side-by-side in war-affected communities in Jordan. We measured C-reactive protein (CRP), Epstein-Barr virus antibodies (EBV), and hair cortisol concentration (HCC) at three timepoints (pre/post intervention and 11 month follow-up), and assessed three main outcomes (psychosocial stress, mental health, and cognitive function). Using growth mixture models, regressions, and growth curve models, we identified three distinct trajectories for CRP, two for EBV, and three for HCC, and examined their associations with age, gender, BMI, poverty, and trauma. We found associations with BMI for CRP, refugee status for EBV, and BMI and gender with HCC trajectory. In terms of health outcomes, we found associations between rising CRP levels and perceived stress (B = -2.92, p = .007), and between HCC hypersecretion and insecurity (B = 7.21, p = .017). In terms of responses to the intervention, we observed no differential impacts by CRP or EBV trajectories, unlike HCC. These results suggest that commonly-assayed biomarkers do not associate with health outcomes and respond to targeted interventions in straightforward ways. Our study is the first to examine multiple biomarker trajectories in war-affected adolescents, in order to better evaluate the extent, timing, and malleability of the biological signatures of poverty, conflict, and forced displacement.
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Affiliation(s)
| | - Kyle Wiley
- Department of Anthropology, Yale University, New Haven, USA
| | | | - Rana Dajani
- Department of Biology and Biotechnology, Hashemite University, Zarqa, Jordan
| | - Kristin Hadfield
- Department of Biological and Experimental Psychology, Queen Mary University of London, UK
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Peyrot C, Brouillard A, Morand-Beaulieu S, Marin MF. A review on how stress modulates fear conditioning: Let's not forget the role of sex and sex hormones. Behav Res Ther 2020; 129:103615. [PMID: 32334278 DOI: 10.1016/j.brat.2020.103615] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/27/2020] [Accepted: 04/05/2020] [Indexed: 12/12/2022]
Abstract
Stress and fear are two fields of research that have evolved simultaneously. It was not until the eighties that these domains converged in order to better characterize the impact of stress on fear memory formation. Here, we reviewed the effects of stress occurring before fear acquisition on the main phases of fear conditioning protocols (acquisition training, extinction training, extinction retention test), with a specific focus on sex and sex hormones. We also paid close attention to methodological aspects in order to better understand and characterize discrepant findings across studies. In men, stress appears to potentiate fear acquisition at a physiological level but induces lower activations of fear-related brain regions. In women, results are inconsistent. Although some studies have shown that stress lowers physiological fear responses and heightens brain activations in women during fear acquisition, many studies report no significant effects. Irrespective of sex, pre-acquisition stress seems to induce fear extinction learning resistance. Overall, few studies have taken into account sex hormones, despite their impact on both the fear and stress brain networks. As methodological variability makes it complex to draw strong conclusions, several methodological aspects are discussed with the aim of orienting future research.
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Affiliation(s)
- Clémence Peyrot
- Research Center, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada, H1N 3J4; Department of Psychiatry and Addictology, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Montreal, Quebec, Canada, H3T 1J4.
| | - Alexandra Brouillard
- Research Center, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada, H1N 3J4; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montreal, Quebec, Canada, H2X 2P3.
| | - Simon Morand-Beaulieu
- Research Center, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada, H1N 3J4; Department of Neuroscience, Université de Montréal, 2960 de la Tour Rd, Montreal, Quebec, Canada, H3T 1J4; Currently with the Child Study Center, Yale University School of Medicine, 230 S Frontage Rd, New Haven, CT, 06519, USA.
| | - Marie-France Marin
- Research Center, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada, H1N 3J4; Department of Psychiatry and Addictology, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Montreal, Quebec, Canada, H3T 1J4; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montreal, Quebec, Canada, H2X 2P3.
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de Graaff AM, Cuijpers P, Acarturk C, Bryant R, Burchert S, Fuhr DC, Huizink AC, de Jong J, Kieft B, Knaevelsrud C, McDaid D, Morina N, Park AL, Uppendahl J, Ventevogel P, Whitney C, Wiedemann N, Woodward A, Sijbrandij M. Effectiveness of a peer-refugee delivered psychological intervention to reduce psychological distress among adult Syrian refugees in the Netherlands: study protocol. Eur J Psychotraumatol 2020; 11:1694347. [PMID: 32082506 PMCID: PMC7006761 DOI: 10.1080/20008198.2019.1694347] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/09/2019] [Accepted: 09/14/2019] [Indexed: 11/03/2022] Open
Abstract
Background: Syrian refugees face multiple hardships and adversities which put them at risk for the development of mental health problems. However, access to adequate mental health care in host countries is limited. The WHO has developed Problem Management Plus (PM+), a brief, scalable psychological intervention, delivered by non-specialist helpers, that addresses common mental disorders in people affected by adversity. This study is part of the STRENGTHS project, that aims to evaluate peer-refugee delivered psychological interventions for Syrian refugees in Europe and the Middle East. Objective: To evaluate the effectiveness and cost-effectiveness of the peer-refugee delivered PM+ intervention among Syrian refugees with elevated levels of psychological distress in the Netherlands. Methods: PM+ will be tested in a randomized controlled trial (RCT) among Arabic-speaking Syrian refugees in the Netherlands aged 18 years and above with self-reported psychological distress (Kessler Psychological Distress Scale; K10 >15) and impaired daily functioning (WHO Disability Assessment Schedule; WHODAS 2.0 >16). Participants (N = 380) will be randomized into care as usual with PM+ (CAU/PM+, n = 190) or CAU only (CAU, n = 190). Baseline, 1-week post-intervention, and 3-month and 12-month follow-up assessments will be conducted. Primary outcomes are symptoms of depression and anxiety. Secondary outcomes are functional impairment, posttraumatic stress disorder symptoms, self-identified problems, anger, health and productivity costs, and hair cortisol concentrations. A process evaluation will be carried out to evaluate treatment dose, protocol fidelity and stakeholder views on barriers and facilitators to implementing PM+. Results and Conclusions: PM+ has proved effectiveness in other populations and settings. After positive evaluation, the adapted manual and training materials for individual PM+ will be made available through the WHO to encourage further replication and scaling up. Trial registration: Trial registration Dutch Trial Registry, NL7552, registered prospectively on March 1, 2019. Medical Ethics Review Committee VU Medical Center Protocol ID 2017.320, 7 September 2017.
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Affiliation(s)
- Anne M. de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ceren Acarturk
- Department of Psychology, Koç University, Sariyer/Istanbul, Turkey
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Sebastian Burchert
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Daniela C. Fuhr
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anja C. Huizink
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Christine Knaevelsrud
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Jana Uppendahl
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | | | - Nana Wiedemann
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Aniek Woodward
- KIT Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Lembcke H, Buchmüller T, Leyendecker B. Refugee mother-child dyads' hair cortisol, post-traumatic stress, and affectionate parenting. Psychoneuroendocrinology 2020; 111:104470. [PMID: 31610408 DOI: 10.1016/j.psyneuen.2019.104470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 01/06/2023]
Abstract
Refugees are a special population who experience adversity before, during and after forced displacement. Hence, many of them show post-traumatic stress symptoms (PTSS). PTSS can be transmitted from the mother to the child and are associated with alterations in cortisol responses. Positive parenting practices, such as maternal affection, counteracts psychopathology in early childhood. The aim of this explorative study was to investigate how children's cortisol is associated with mothers' cortisol after forced displacement, and whether or not an association depends on maternal affection. A total of 42 Arabic-speaking mother-child dyads, who came to Germany as refugees from Syria or Iraq within the past four years, participated in the present cross-sectional study. All children were below the age of 5 years. We assessed children's and mothers' hair cortisol concentration (HCC) and PTSS. Additionally, we observed and objectively rated maternal affection during mother-child interactions. The association between mothers' and children's HCC, as well as their associations with maternal affection, depended on the difference between children's and mothers' HCC. Furthermore, this HCC difference significantly predicted children's PTSS. Hence, in order to understand the mechanisms underlying children's PTSS, it is essential to consider maternal variables and differential effects within samples. We discussed possible explanations for those findings.
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Affiliation(s)
- Hanna Lembcke
- Center for Child and Family Research, Faculty of Psychology, Ruhr-University Bochum, Germany.
| | - Thimo Buchmüller
- Center for Child and Family Research, Faculty of Psychology, Ruhr-University Bochum, Germany
| | - Birgit Leyendecker
- Center for Child and Family Research, Faculty of Psychology, Ruhr-University Bochum, Germany
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Deleemans JM, Chleilat F, Reimer RA, Henning JW, Baydoun M, Piedalue KA, McLennan A, Carlson LE. The chemo-gut study: investigating the long-term effects of chemotherapy on gut microbiota, metabolic, immune, psychological and cognitive parameters in young adult Cancer survivors; study protocol. BMC Cancer 2019; 19:1243. [PMID: 31870331 PMCID: PMC6927187 DOI: 10.1186/s12885-019-6473-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/17/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The gut microbiota is an important modulator of immune, metabolic, psychological and cognitive mechanisms. Chemotherapy adversely affects the gut microbiota, inducing acute dysbiosis, and alters physiological and psychological function. Cancer among young adults has risen 38% in recent decades. Understanding chemotherapy's long-term effects on gut microbiota and psycho-physiological function is critical to improve survivors' physical and mental health, but remains unexamined. Restoration of the gut microbiota via targeted therapies (e.g. probiotics) could potentially prevent or reverse the psycho-physiological deficits often found in young survivors following chemotherapy, ultimately leading to reduced symptom burden and improved health. METHODS This longitudinal study investigates chemotherapy induced long-term gut dysbiosis, and associations between gut microbiota, and immune, metabolic, cognitive and psychological parameters using data collected at < 2 month (T1), 3-4 months (T2), and 5-6 months (T3) post-chemotherapy. Participants will be 18-39 year old blood or solid tumor cancer survivors (n = 50), and a healthy sibling, partner or friend as a control (n = 50). Gut microbiota composition will be measured from fecal samples using 16 s RNA sequencing. Psychological and cognitive patient reported outcome measures will include depression, anxiety, post-traumatic stress disorder symptoms, pain, fatigue, and social and cognitive function. Dual-energy X-ray Absorptiometry (DXA) will be used to measure fat and lean mass, and bone mineral concentration. Pro-inflammatory cytokines, C-reactive protein (CRP), lipopolysaccharide (LPS), serotonin, and brain derived neurotrophic factor (BDNF) will be measured in serum, and long-term cortisol will be assayed from hair. Regression and linear mixed model (LMM) analyses will examine associations across time points (T1 - T3), between groups, and covariates with gut microbiota, cognitive, psychological, and physiological parameters. CONCLUSION Knowing what bacterial species are depleted after chemotherapy, how long these effects last, and the physiological mechanisms that may drive psychological and cognitive issues among survivors will allow for targeted, integrative interventions to be developed, helping to prevent or reverse some of the late-effects of treatment that many young cancer survivors face. This protocol has been approved by the Health Research Ethics Board of Alberta Cancer Committee (ID: HREBA.CC-19-0018).
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Affiliation(s)
- Julie M. Deleemans
- Cumming School of Medicine, Division of Medical Science, University of Calgary, Calgary, Canada
- Cumming School of Medicine, Division of Psychosocial Oncology, University of Calgary, Calgary, Canada
| | - Faye Chleilat
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Raylene A. Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, Calgary, Canada
| | | | - Mohamad Baydoun
- Cumming School of Medicine, Division of Psychosocial Oncology, University of Calgary, Calgary, Canada
| | - Katherine-Ann Piedalue
- Cumming School of Medicine, Division of Psychosocial Oncology, University of Calgary, Calgary, Canada
| | - Andrew McLennan
- Cumming School of Medicine, Division of Psychosocial Oncology, University of Calgary, Calgary, Canada
| | - Linda E. Carlson
- Cumming School of Medicine, Division of Psychosocial Oncology, University of Calgary, Calgary, Canada
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Penz M, Siegrist J, Wekenborg MK, Rothe N, Walther A, Kirschbaum C. Effort-reward imbalance at work is associated with hair cortisol concentrations: Prospective evidence from the Dresden Burnout Study. Psychoneuroendocrinology 2019; 109:104399. [PMID: 31394489 DOI: 10.1016/j.psyneuen.2019.104399] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/18/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
Abstract
Chronic stress experienced at work is considered a major health challenge for modern societies. In fact there is ample evidence that deleterious work environments, based on high efforts in relation to few rewards, substantially augment the risk for a number of highly prevalent diseases (e.g. ischemic heart disease, stroke). One potential pathway mediating these associations involves the stress-related activation of the hypothalamus-pituitary-adrenocortical (HPA) axis with proceeding alterations in the secretion of its main effector hormone cortisol. In this study we assessed a prospective, two-year effect of effort-reward imbalance (ERI) on cortisol secretion, based on a sub sample (N = 150; mean ± SD age: 42.4 ± 11.1; 84.0% female) of the ongoing Dresden Burnout Study (DBS). The provided ERI measures were collected as part of the online baseline and first follow up assessment. Further, cortisol secretion patterns over prolonged periods of time were evaluated in three consecutive years of laboratory baseline and follow up visits. Our findings suggest prospective associations between ERI and cortisol, indicating a blunted cortisol secretion in response to long-term work stress (p < 0.001). Given the regulatory properties of cortisol on various central and peripheral target tissues (e.g. cardiovascular system, liver, adipose tissue), a long-term decrease of cortisol availability can be hypothesized to cause multiple health-challenging consequences. Based on our findings, providing work environments where high efforts are always linked with high rewards have to be considered an important issue for employees health.
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Affiliation(s)
- Marlene Penz
- Institute of Biological Psychology, Technische Universität Dresden, Germany.
| | - Johannes Siegrist
- Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Germany
| | | | - Nicole Rothe
- Institute of Biological Psychology, Technische Universität Dresden, Germany
| | - Andreas Walther
- Institute of Biological Psychology, Technische Universität Dresden, Germany
| | - Clemens Kirschbaum
- Institute of Biological Psychology, Technische Universität Dresden, Germany
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80
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Thomas S, Höfler M, Schäfer I, Trautmann S. Childhood maltreatment and treatment outcome in psychotic disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 2019; 140:295-312. [PMID: 31357235 DOI: 10.1111/acps.13077] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Childhood maltreatment (CM) plays an important role in the aetiology and course of psychotic disorders and is associated with characteristics that could be relevant for treatment. We aimed to conduct a systematic review and meta-analysis on the association between CM and treatment outcome in psychotic disorders. METHODS Treatment outcome was defined as change in psychotic symptoms or in social or occupational functioning between first and last reported measurement in the course of a pharmacological and/or psychological treatment. RESULTS Twelve treatment results from seven studies (636 patients, average treatment duration: 59.2 weeks) were included. CM was related to poorer treatment outcomes in psychotic disorders (OR = 1.51, 95% CI = [1.08, 2.10]). There is evidence that this association might increase with illness duration and increasing age and might be stronger in schizophrenia samples. CONCLUSIONS Childhood maltreatment is highly understudied with regard to treatment outcome in psychotic disorders. The need for more studies is emphasized by the fact that this meta-analysis reveals evidence for a poorer treatment response in patients with CM. If this association is confirmed, the identification of patients with CM and the consideration of associated clinical and biological conditions could contribute to improve treatment outcome in psychotic disorders.
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Affiliation(s)
- S Thomas
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - M Höfler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - I Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Trautmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychology, Medical School Hamburg, Hamburg, Germany
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81
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Early neglect is a key determinant of adult hair cortisol concentration and is associated with increased vulnerability to trauma in a transdiagnostic sample. Psychoneuroendocrinology 2019; 108:35-42. [PMID: 31226659 DOI: 10.1016/j.psyneuen.2019.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Childhood adversities and traumatic events have each been associated with hypothalamus-pituitary-adrenal (HPA) axis dysregulation and trauma-related symptoms in adulthood. Hair cortisol concentration (HCC) reflects cumulative cortisol levels over the course of months and is discussed as a potential marker between trauma-induced neuroendocrine dysfunction and trauma-related symptoms. The present study examines this hypothetical link by delineating the impact of exposure to categories of abuse and neglect during development and lifetime traumatic experiences on HCC and trauma-related symptoms. METHODS The Maltreatment and Abuse Chronology Exposure (MACE) scale, Life Events Checklist, and predictive analytics were used to evaluate the importance of type and timing of maltreatment and trauma load on HCC in inpatients (n = 183) with different psychiatric diagnoses. Additionally, a comparison group of n = 75 controls were recruited from the community. The extent to which the relationship between trauma load and trauma-related symptoms was influenced by childhood adversities and HCC was determined by analysis of variance. RESULTS Early neglect, in particular neglect at 3 years, emerged as the most important predictor of adult HCC. Post-hoc explanatory analysis showed that patients with high neglect at age 3 had lower HCC compared to patients with low neglect at age 3 and controls. Patients with high neglect at age 3 and low cortisol reported increased trauma-related symptoms upon trauma exposure. CONCLUSION Results strengthen evidence that inadequate care and neglect during critical periods alter HPA axis biology towards enduring reduction in cortisol, the latter being associated with augmented trauma-related symptoms upon trauma exposure. If validated by longitudinal assessments these cross-sectional findings suggest biological mechanisms of childhood adversities into psychopathology in adulthood.
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82
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Adrenal function links to early postnatal growth and blood pressure at age 6 in children born extremely preterm. Pediatr Res 2019; 86:339-347. [PMID: 30631138 PMCID: PMC6561840 DOI: 10.1038/s41390-018-0243-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/09/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Low birth weight in term-born individuals correlates with adverse cardiometabolic outcomes; excess glucocorticoid exposure has been linked to these relationships. We hypothesized that cortisol and adrenal androgens would correlate inversely with birthweight and directly with markers of cardiometabolic risk in school-aged children born extremely preterm; further, preterm-born would have increased cortisol and adrenal androgens compared to term-born children. METHODS Saliva samples were obtained at age 6 from 219 preterm-born children followed since birth and 40 term-born children and analyzed for dehydroepiandrosterone (DHEA) and cortisol. Cortisol was also measured at home (awakening, 30' later, evening). RESULTS For preterm-born children, cortisol and DHEA correlated inversely with weight and length Z-scores at 36 weeks PMA and positively with systolic BP. DHEA was higher in preterm-born than term-born children (boys p < 0.01; girls p = 0.04). Cortisol was similar between preterm-born and term-born at study visit; however, preterm-born children showed a blunted morning cortisol. In term-born children, DHEA correlated with BMI (p = 0.04), subscapular, and abdominal skinfold thicknesses (both p < 0.01). CONCLUSION Cortisol and DHEA correlated inversely with early postnatal growth and directly with systolic BP in extremely preterm-born children, suggesting perinatal programming. Blunted morning cortisol may reflect NICU stress, as seen after other adverse childhood experiences (ACEs).
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83
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From serendipity to clinical relevance: How clinical psychology and neuroscience converged to illuminate psychoneuroendocrinology. Psychoneuroendocrinology 2019; 105:36-43. [PMID: 30309685 DOI: 10.1016/j.psyneuen.2018.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/01/2018] [Accepted: 09/10/2018] [Indexed: 01/01/2023]
Abstract
Dirk Hellhammer and his colleagues have played a major role in creating the field of psychoneuroendocrinology from their roots in psychology. In this review, using examples from the history of the McEwen laboratory and neuroscience and neuroendocrinology colleagues, I summarize my own perspective as to how the fields of neuroscience and neuroendocrinology have contributed to psychoneuroendocrinology and how they converged with the contributions from Dirk Hellhammer and his colleagues.
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84
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Voss M, Wild B, von Hirschhausen E, Fuchs T, Ong P. [Effect of humor training on stress, cheerfulness and depression in patients with coronary artery disease and refractory angina pectoris]. Herz 2019; 45:80-87. [PMID: 31187195 DOI: 10.1007/s00059-019-4813-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/22/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Angina pectoris refractory to conventional medical treatment is a common phenomenon in patients with stable coronary artery disease (CAD). Many of these patients suffer from depression and generate substantial costs in the healthcare system. Therefore, the development of new therapeutic concepts is of particular importance. This study investigated whether professional, structured humor training has a positive effect on the symptoms of patients with treatment refractory angina pectoris. METHODS Between 2013 and 2014 a total of 35 patients with stable CAD were included. Enrolment was possible if patients suffered from treatment refractory angina pectoris (Canadian Cardiovascular Society, CCS grades II-IV) despite optimal antianginal medication and exhaustion of options for myocardial revascularization. Previously, 25.8% of the patients had had a myocardial infarction. In this study, a professional humor coaching was conducted with a duration of 7 weeks. In order to evaluate the effects of the coaching, the following examinations were performed before and after the intervention: exercise stress test (treadmill), hair segment cortisol analysis, Beck Depression Inventory (BDI), the Trier Inventory for the Assessment of Chronic Stress (TICS) and the State-Trait-Cheerfulness Inventory (STCI). RESULTS Out of the 35 initially recruited patients 31 completed the study. The mean age was 65.5 years and 94.5% were female. There was a significant improvement in cheerfulness (STCI, pre 23.3 ± 5.4, post 27.5 ± 5, p = 0,03). This effect was even stronger in a subgroup analysis in which only female patients were included (pre 23.6 ± 5.5, post 27.7 ± 4.6, p = 0.003). The results of the BDI showed a remarkable improvement in the pre-post analysis (pre 14.6 ± 8.1, post 11.0 ± 6.5, p = 0.064). Analyzing only the female patients, this difference became significant (pre 13.1 ± 6.4, post 9.9 ± 4.6 p = 0,037). The hair segment investigations showed that patients who had a higher cortisol level in the beginning (>25. percentile, n = 22) showed a significant reduction of the cortisol concentration (pre 6.54 pg/mg, 3.78-12.12 pg/mg, post 3.65 pg/mg, 2.82-7.68 pg/mg, p = 0.029). CONCLUSION Patients with refractory angina pectoris and stable CAD benefit from a professional humor coaching. This effect was shown in a) a significant decrease in cortisol concentrations in the hair segment analysis, b) an improvement in cheerfulness in the STCI and c) a significant difference in the BDI between pre-post values.
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Affiliation(s)
- M Voss
- Abteilung für Kardiologie, Zentrum für Innere Medizin III, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland
| | - B Wild
- , Strohberg 27e, 70180, Stuttgart, Deutschland
| | | | | | - P Ong
- Abteilung für Kardiologie, Zentrum für Innere Medizin III, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland.
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85
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Kress V, Steudte-Schmiedgen S, Kopp M, Förster A, Altus C, Schier C, Wimberger P, Kirschbaum C, von Soest T, Weidner K, Junge-Hoffmeister J, Garthus-Niegel S. The Impact of Parental Role Distributions, Work Participation, and Stress Factors on Family Health-Related Outcomes: Study Protocol of the Prospective Multi-Method Cohort "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Front Psychol 2019; 10:1273. [PMID: 31263435 PMCID: PMC6584823 DOI: 10.3389/fpsyg.2019.01273] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/14/2019] [Indexed: 12/12/2022] Open
Abstract
The Dresden Study on Parenting, Work, and Mental Health (“DResdner Studie zu Elternschaft, Arbeit, und Mentaler Gesundheit”, DREAM) aims to prospectively investigate the relationship between parental work participation, role distribution, stress factors, and their effects on perinatal outcomes and long-term family mental and somatic health in a community sample targeting N = 4,000 individuals, i.e., 2,000 couples, expecting a child and residing in Dresden, Germany (interim sample of N = 1,410 participants, recruitment ongoing). Various questionnaires are completed at four measurement points from pregnancy to 2 years postpartum (prolongation into middle childhood planned). Applying a multi-method approach, long-term endocrinological data (analyses of hair cortisol concentrations and other endogenous hormones, “DREAMHAIR”) and qualitative interview data (regarding gender role attitudes and distribution of domestic work, child care, and paid employment; “DREAMTALK”) are obtained. In this study protocol, the theoretical background, methods, and preliminary results considering sociodemographic characteristics during pregnancy and birth-related factors at 8 weeks postpartum are presented. Additionally, there is a focus on our endocrinological sub-study DREAMHAIR. In this sub-study currently comprising N = 152 participants, i.e., 88 families (recruitment ongoing), we want to gain knowledge on the transgenerational processes of stress regulation and psychopathology in the whole family by analyzing hair cortisol concentrations in both parents and children during the course from pregnancy (or after birth regarding children) to at least 2 years postpartum. By comparing data of the community sample to a clinical sample of mothers with postpartum mental disorders, their children, and their partners during the period between admission and discharge from a mother-baby unit and post-treatment (“DREAMMBU”), the course of mothers' psychopathology, parent-infant interaction, and infant regulation disorders with special regard to long-term endocrine correlates will be examined. With previous studies neglecting the fathers or partners involved, a major advantage of DREAM is the use of a multi-method and multi-level approach by examining the whole family in a longitudinal design. Therefore, the DREAM study will contribute to a better understanding of the role of social, work, and stress factors for mental and somatic health and its long-term endocrine correlates in the natural course of becoming a family.
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Affiliation(s)
- Victoria Kress
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany.,Institute of Biological Psychology, Faculty of Psychology of the Technische Universität Dresden, Dresden, Germany
| | - Marie Kopp
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Anke Förster
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Caroline Altus
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Caroline Schier
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Clemens Kirschbaum
- Institute of Biological Psychology, Faculty of Psychology of the Technische Universität Dresden, Dresden, Germany
| | - Tilmann von Soest
- Department of Psychology, PROMENTA Research Center, University of Oslo, Oslo, Norway
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Juliane Junge-Hoffmeister
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany.,Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
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86
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Sierau S, Glaesmer H, Klucken T, Stalder T. Hair cortisol, lifetime traumatic experiences and psychopathology in unaccompanied refugee minors. Psychoneuroendocrinology 2019; 104:191-194. [PMID: 30856425 DOI: 10.1016/j.psyneuen.2019.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/13/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
Attenuated cortisol secretion has been linked to traumatic experiences and the developmental psychopathology. Unaccompanied refugee minors (URM) form a highly vulnerable group in this context, usually exposed to multiple and severe traumatic experiences and characterized by a high, comorbid symptom-load. Here, we provide a first investigation in URM seeking to elucidate associations between long-term cortisol output, assessed through hair cortisol concentrations (HCC), lifetime traumatic events and psychological symptoms. Ninety-one male URM from Syria and Afghanistan (mean age = 17.4 years), living in group homes of the Child Protection Services in Leipzig, Germany, were examined. HCC were measured from scalp-near 3 cm hair segments and data on LTE, PTSD symptoms, depression, anxiety and somatic symptoms as well as emotional and conduct problems assessed. Results revealed HCC to be negatively related to lifetime traumatic events (total number, trauma types). In addition, a tentative finding of a positive association between HCC and emotional problems emerged. Results are discussed with regard to their relevance for HCC as a biomarker of the long-term endocrine consequences of chronic adversity and trauma exposure.
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Affiliation(s)
- Susan Sierau
- Department for Medical Psychology and Medical Sociology, University of Leipzig, Germany.
| | - Heide Glaesmer
- Department for Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Tim Klucken
- Clinical Psychology, University of Siegen, Germany
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87
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Khoury JE, Bosquet Enlow M, Plamondon A, Lyons-Ruth K. The association between adversity and hair cortisol levels in humans: A meta-analysis. Psychoneuroendocrinology 2019; 103:104-117. [PMID: 30682626 PMCID: PMC6450779 DOI: 10.1016/j.psyneuen.2019.01.009] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 01/04/2023]
Abstract
Adverse life events are associated with a constellation of negative health outcomes. Theory and research suggest that the hypothalamic-pituitary-adrenal (HPA) axis acts as one mechanism connecting adverse experiences with negative health outcomes. However, this relation is complicated by the potential for adversity to be associated with both hyperactivity and hypoactivity of the HPA axis, as assessed in both animal and human studies. Over the past decade, methodological advances have enabled the sampling of cortisol stored in hair, which provides a marker of HPA axis activity over a several-month period. The present meta-analysis included 28 studies to assess the strength and direction of the relation between adverse experiences and hair cortisol levels. Analyses were conducted using multilevel modeling (MLM) to quantify the magnitude of effects and mixture modeling to identify distinct subgroups of studies. Results of MLM analyses indicated that the overall effect size was small but significant d = 0.213, 95% CI [0.034, 0.397]. There was also significant between-study variance (τ = 0.155, 95% CI [0.065, 0.367]). Mixture modeling to identify distinct classes of studies based on effect size and direction resulted in a 2-class model: The first class included four studies with an overall negative and moderate effect size (d = -0.478, 95% CI [-0.639, -0.318]), and the second class included the remaining 24 studies with an overall positive and significant, albeit small, effect size (d = 0.141, 95% CI [0.084, 0.199]). Moderator analyses indicated that the strength and direction of the association between adversity and hair cortisol were moderated by features of the adversity exposure (e.g., type of adversity, timing of adversity), characteristics of the samples (e.g., clinical status, racial distribution), and features of the publication (e.g., publication type, geographic region of study). The findings refine our understanding of the long-term impact of adversity on dysregulation of the HPA axis, particularly as reflected in hair cortisol measures.
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Affiliation(s)
- Jennifer E Khoury
- Harvard Medical School, Cambridge Hospital 1035 Cambridge Street, Cambridge, MA, 02141 United States.
| | | | - André Plamondon
- Université Laval, University of Toronto (Status Only) Canada
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88
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HPA axis regulation in posttraumatic stress disorder: A meta-analysis focusing on potential moderators. Neurosci Biobehav Rev 2019; 100:35-57. [DOI: 10.1016/j.neubiorev.2019.02.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 01/15/2019] [Accepted: 02/11/2019] [Indexed: 02/07/2023]
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89
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van Zuiden M, Savas M, Koch SB, Nawijn L, Staufenbiel SM, Frijling JL, Veltman DJ, van Rossum EF, Olff M. Associations Among Hair Cortisol Concentrations, Posttraumatic Stress Disorder Status, and Amygdala Reactivity to Negative Affective Stimuli in Female Police Officers. J Trauma Stress 2019; 32:238-248. [PMID: 30883913 PMCID: PMC6593697 DOI: 10.1002/jts.22395] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 12/19/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with altered hypothalamic-pituitary-adrenal (HPA) axis function. Measurement of hair cortisol concentrations (HCC) allows retrospective assessment of HPA axis regulation over prolonged periods of time. Currently, research investigating HCC in PTSD remains sparse. Previous cross-sectional studies have included only civilian populations, although it is known that trauma type moderates associations between PTSD status and HPA axis function. We investigated differences in HCC between trauma-exposed female police officers with current PTSD (n = 13) and without current and lifetime PTSD (n = 15). To investigate whether HCC was associated with neural correlates of PTSD, we additionally performed exploratory correlational analyses between HCC and amygdala reactivity to negative affective stimuli. We observed significantly lower HCC in participants with PTSD than in participants without PTSD, d = 0.89. Additionally, within participants with PTSD, we observed positive correlations between HCC and right amygdala reactivity to negative affective (vs. happy/neutral) faces, r = .806 (n = 11) and left amygdala reactivity to negative affective (vs. neutral) pictures, r = .663 (n = 10). Additionally, left amygdala reactivity to negative faces was positively correlated with HCC in trauma-exposed controls, r = .582 (n = 13). This indicates that lower HCC is associated with diminished amygdala differentiation between negative affective and neutral stimuli. Thus, we observed lower HCC in trauma-exposed noncivilian women with PTSD compared to those without PTSD, which likely reflects prolonged HPA axis dysregulation. Additionally, HCC was associated with hallmark neurobiological correlates of PTSD, providing additional insights into pathophysiological processes in PTSD.
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Affiliation(s)
- Mirjam van Zuiden
- Department of Psychiatry Amsterdam University Medical Centers–Academic Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
| | - Mesut Savas
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical CenterUniversity Medical Center RotterdamRotterdamthe Netherlands
| | - Saskia B.J. Koch
- Department of Psychiatry Amsterdam University Medical Centers–Academic Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands,Donders Institute for Brain, Cognition and BehaviourRadboud University–NijmegenNijmegenthe Netherlands
| | - Laura Nawijn
- Department of Psychiatry Amsterdam University Medical Centers–Academic Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
| | - Sabine M. Staufenbiel
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical CenterUniversity Medical Center RotterdamRotterdamthe Netherlands
| | - Jessie L. Frijling
- Department of Psychiatry Amsterdam University Medical Centers–Academic Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
| | - Dick J. Veltman
- Department of PsychiatryAmsterdam University Medical Centers–VU University Medical CenterAmsterdamthe Netherlands
| | - Elisabeth F.C. van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical CenterUniversity Medical Center RotterdamRotterdamthe Netherlands
| | - Miranda Olff
- Department of Psychiatry Amsterdam University Medical Centers–Academic Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands,Arq Psychotrauma Expert GroupDiementhe Netherlands
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90
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Dunlop BW, Wong A. The hypothalamic-pituitary-adrenal axis in PTSD: Pathophysiology and treatment interventions. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:361-379. [PMID: 30342071 DOI: 10.1016/j.pnpbp.2018.10.010] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/26/2022]
Abstract
Questions of how altered functioning of the hypothalamic pituitary adrenal (HPA) axis contribute to the development and maintenance of posttraumatic stress disorder (PTSD) have been the focus of extensive animal and human research. As a rule, results have been inconsistent across studies, likely due to a variety of confounding variables that have received inadequate attention. Important confounding factors include the effects of early life stress, biological sex, and the glucocorticoid used for interventions. In this manuscript we review: 1) the literature on identified abnormalities of HPA axis function in PTSD, both in terms of basal functioning and as part of challenge paradigms; 2) the role of HPA axis function pre- and immediately post-trauma as a risk factor for PTSD development; 3) the impact of HPA axis genes' allelic variants and epigenetic modifications on PTSD risk; 4) the contributions of HPA axis components to fear learning and extinction; and 5) therapeutic manipulations of the HPA axis to both prevent and treat PTSD, including the role of glucocorticoids as part of medication enhanced psychotherapy.
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Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Andrea Wong
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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91
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Decoding the impact of adverse childhood experiences on the progression of schizophrenia. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.mhp.2019.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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92
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Gerritsen L, Staufenbiel SM, Penninx BWJH, van Hemert AM, Noppe G, de Rijke YB, van Rossum EFC. Long-term glucocorticoid levels measured in hair in patients with depressive and anxiety disorders. Psychoneuroendocrinology 2019; 101:246-252. [PMID: 30472466 DOI: 10.1016/j.psyneuen.2018.11.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Depressive and anxiety disorders have been linked to a dysregulated hypothalamus-pituitary-adrenal (HPA)-axis. Hair cortisol levels (HairF) reflect integrated long-term cortisol regulation and are therefore promising endocrine markers of chronic (psychological and physical) stress. Our aim was to assess hair cortisol levels in persons with a depressive and/or anxiety disorder and to compare their levels with that of persons in remission and healthy controls. METHODS Data from 1166 participants of the Netherlands Study of Depression and Anxiety (NESDA) were used, including 266 participants with a recent (1-month) diagnosis of a depressive and/or anxiety disorder, 655 participants with a diagnosis in remission, and 245 healthy controls. HairF was measured in the proximal three cm of scalp hair, using LC-MS/MS. RESULTS Compared to the healthy controls no differences on HairF or HairE levels were found for depressive and anxiety disorders alone. However the presence of a comorbid depressive and anxiety disorder was significantly associated with increased HairF levels (β = 0.07; p = .031), as was the severity of depressive symptoms (β = 0.06; p = .029), but no differences were found on HairE nor the HairF:HairE ratio. CONCLUSIONS Persons with current diagnosis of comorbid depression and anxiety show moderately higher levels of cortisol than patients with only depression or anxiety, or patients in remission and healthy controls, which may be indicative of a chronic state of hyperactivation of the HPA axis.
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Affiliation(s)
- Lotte Gerritsen
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
| | - Sabine M Staufenbiel
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Gerard Noppe
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Yolanda B de Rijke
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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93
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Schindler L, Shaheen M, Saar-Ashkenazy R, Bani Odeh K, Sass SH, Friedman A, Kirschbaum C. Victims of War: Dehydroepiandrosterone Concentrations in Hair and Their Associations with Trauma Sequelae in Palestinian Adolescents Living in the West Bank. Brain Sci 2019; 9:brainsci9020020. [PMID: 30678071 PMCID: PMC6406342 DOI: 10.3390/brainsci9020020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 12/17/2022] Open
Abstract
Due to its anti-glucocorticoid properties, the steroid hormone dehydroepiandrosterone (DHEA) might play a role for coping with traumatic stress and posttraumatic stress disorder (PTSD). The majority of studies report elevated DHEA secretion and decreased cortisol/DHEA ratio associated with traumatic stress, however, contrasting results have also been published. One reason for this heterogeneity might be that in past studies, DHEA has been measured in plasma or saliva samples reflecting acute hormone levels. In comparison, the current study assessed the hair levels of DHEA and cortisol as long-term markers along with self-reported data on psychopathology and coping in 92 female adolescents aged 11–16 from the West Bank affected by the Israeli–Palestinian conflict. Results showed that trauma-exposed individuals had significantly higher DHEA levels (p = 0.013) and lower cortisol/DHEA ratios (p = 0.036) than participants from the non-trauma group. Furthermore, DHEA and cortisol/DHEA ratio emerged as associated with trauma load and timing, but not with coping. By applying the novel method of DHEA analysis from hair samples, this study adds to the growing literature on the interplay of DHEA, cortisol, traumatic stress and coping, and provides valuable starting points for further research.
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Affiliation(s)
- Lena Schindler
- Faculty of Psychology, Technische Universität Dresden, 01069 Dresden, Germany.
| | - Mohammed Shaheen
- Faculty of Public Health, Al-Quds University, P.O. Box 4006, 90612 Abu Dees, West Bank, Palestine.
| | - Rotem Saar-Ashkenazy
- Department of Cognitive Neuroscience and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, P.O. Box 653, 8410501 Beer-Sheva, Israel.
- Faculty of Social Work, Ashkelon Academic College, 7821100 Ashkelon, Israel.
| | - Kifah Bani Odeh
- Faculty of Public Health, Al-Quds University, P.O. Box 4006, 90612 Abu Dees, West Bank, Palestine.
| | - Sophia-Helen Sass
- Faculty of Psychology, Technische Universität Dresden, 01069 Dresden, Germany.
| | - Alon Friedman
- Department of Cognitive Neuroscience and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, P.O. Box 653, 8410501 Beer-Sheva, Israel.
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, P.O. Box 15000, Halifax, NS B3H 4R2, Canada.
| | - Clemens Kirschbaum
- Faculty of Psychology, Technische Universität Dresden, 01069 Dresden, Germany.
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94
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Lorenz P, Schindler L, Steudte-Schmiedgen S, Weidner K, Kirschbaum C, Schellong J. Ecological momentary assessment in posttraumatic stress disorder and coping. An eHealth study protocol. Eur J Psychotraumatol 2019; 10:1654064. [PMID: 31528269 PMCID: PMC6735333 DOI: 10.1080/20008198.2019.1654064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 12/23/2022] Open
Abstract
Background: It is well known from cross-sectional studies that individual coping strategies significantly influence the pathogenesis of posttraumatic stress disorder (PTSD). Equally, undisputed is the role of biological processes, e.g. of the so-called 'stress hormone' cortisol for the trajectory of PTSD. Ecological momentary assessment (EMA), the repeated collection of self-reported momentary states via smartphones, is ideal for shedding light upon symptom fluctuations and coping strategies. EMA may also constitute a promising approach to provide closer associations to biomarkers than retrospective self-report. The mobile application 'CoachPTBS', created to facilitate transition into health-care systems, bridges waiting periods for trauma-specific psychotherapy. CoachPTBS offers tools akin to EMA that could elucidate coping with stress symptoms. Moreover, the app's self-management tools may improve coping strategies. However, these processes have never been examined in a combined, longitudinal fashion. Objective: The aim of the current study is to assess symptom fluctuations, coping strategies and long-term endocrine correlates of PTSD by a longitudinal, multimodal approach, combining traditional, online and EMA self-report with hair cortisol data and CoachPTBS as a possible novel mHealth tool. Method: 120 participants waiting for PTSD psychotherapy will be randomly grouped. After in-situ assessment and hair sample collection, 40 will receive CoachPTBS, using it daily throughout 4 weeks. A parallel group of 40 will participate in EMA, completing daily questionnaires on symptoms and coping. In between, online surveys will be conducted. After 6 weeks, a final interview and another hair sample collection will follow. Comparisons between these groups and waitlist-control, also consisting of 40 PTSD participants, and 40 non-traumatized participants assessed via EMA regarding aversive emotions and coping are planned. Discussion: Novel insights into the interplay of biological and coping strategies in PTSD are expected due to the innovative multimodal study design. Results will further explore benefits of eHealth tools on coping with PTSD.
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Affiliation(s)
- Patrick Lorenz
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lena Schindler
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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95
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Psychotherapeutic treatment and HPA axis regulation in posttraumatic stress disorder: A systematic review and meta-analysis. Psychoneuroendocrinology 2018; 98:186-201. [PMID: 30193225 DOI: 10.1016/j.psyneuen.2018.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/29/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) has been associated with dysregulation of the hypothalamic-pituitary- adrenal (HPA) axis. Research over the past years has investigated potential changes of these alterations in the context of psychotherapy. Yet, no systematic review has been conducted. To summarize the current state of research on psychotherapy and HPA hormones, namely cortisol, dehydroepiandrosterone and its sulfate form (DHEA(S)), we searched for studies investigating predictions or changes in hormones over treatment course within the databases PubMed, Scopus, Medline, PsychINFO, Pilots/ProQuest, and Web of Science, and in the grey literature up to May 2018. Controlled and uncontrolled trials investigating adult samples with a clinical status of PTSD were eligible for inclusion. Twelve studies (428 participants) were included. Study quality was overall sufficient. Hormone assessment designs differed considerably. Treatment efficacy on PTSD symptom reduction was mostly high, but predictions of pre-treatment hormone concentrations on treatment efficacy were largely non-significant. Changes from pre- to post-test in basal cortisol (g = -0.07, 95% CI = -0.36; 0.21) and in the cortisol awakening response (g = -0.07, 95% CI = -0.48; 0.35) were also non-significant. Future studies require comparable designs and need to be sufficiently powered to be able to detect potential associations with HPA regulation.
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96
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Shaheen M, Schindler L, Saar-Ashkenazy R, Bani Odeh K, Soreq H, Friedman A, Kirschbaum C. Victims of war-Psychoendocrine evidence for the impact of traumatic stress on psychological well-being of adolescents growing up during the Israeli-Palestinian conflict. Psychophysiology 2018; 57:e13271. [PMID: 30101980 DOI: 10.1111/psyp.13271] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 12/20/2022]
Abstract
Violent conflicts are severe traumatic stressors with detrimental effects on physical and mental health, with children and adolescents being particularly at risk. For the hypothalamic-pituitary-adrenal (HPA) axis, characteristic patterns of dysregulation in trauma-exposed individuals have been shown. This study set out to investigate self-reported mental well-being in Palestinian adolescents growing up during the Israeli-Palestinian conflict. Hair cortisol concentrations (HCC) as a psychoendocrine marker for long-term HPA axis aberrations along with the potential protective factor sense of coherence (SoC; i.e., the global mindset to interpret the world and emerging stressors as comprehensible, manageable, and meaningful) were examined. Between 2014 and 2016, posttraumatic stress disorder (PTSD), depression, anxiety, HCC, and SoC were examined in 233 adolescents aged 11 to 16 from the West Bank. More than half of the participants reported trauma exposure, with 40% fulfilling the criteria of a preliminary PTSD diagnosis and a high prevalence of anxiety and depression. HCC was significantly elevated in the PTSD subgroup compared to the subgroup not exposed to any traumatic events (p = 0.046), with trauma-exposed individuals in between. HCC was further associated with typical sequelae of traumatic stress. Notably, SoC was inversely related to self-reported psychopathology, as well as to HCC in the trauma group. The results illustrate the situation of adolescents exposed to chronic traumatic stress and extend the literature on aberrant HPA axis functioning under such conditions. They also point out a central role of SoC, which may imply new strategies to aid individuals exposed to ongoing conflicts.
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Affiliation(s)
- Mohammed Shaheen
- Faculty of Public Health, Al-Quds University, Abu Dees, West Bank-Palestine
| | - Lena Schindler
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Rotem Saar-Ashkenazy
- Department of Cognitive Neuroscience and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Psychology and School of Social Work, Ashkelon Academic College, Ashkelon, Israel
| | - Kifah Bani Odeh
- Faculty of Public Health, Al-Quds University, Abu Dees, West Bank-Palestine
| | - Hermona Soreq
- The Edmond and Lily Safra Center of Brain Science and the Department of Biological Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alon Friedman
- Department of Cognitive Neuroscience and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
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97
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Woud ML, Blackwell SE, Cwik JC, Margraf J, Holmes EA, Steudte-Schmiedgen S, Herpertz S, Kessler H. Augmenting inpatient treatment for post-traumatic stress disorder with a computerised cognitive bias modification procedure targeting appraisals (CBM-App): protocol for a randomised controlled trial. BMJ Open 2018; 8:e019964. [PMID: 29961004 PMCID: PMC6042580 DOI: 10.1136/bmjopen-2017-019964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Influential theories of post-traumatic stress disorder (PTSD) suggest that dysfunctional appraisals of trauma play a key role in the maintenance of symptoms, and this suggestion is increasingly supported by research. Experimental studies have indicated that a simple computerised cognitive training procedure, here termed cognitive bias modification-appraisals (CBM-App), can modify trauma-relevant appraisals and reduce analogue trauma symptoms among healthy volunteers. This suggests the possibility that CBM-App could improve outcomes in PTSD via targeting the key process of dysfunctional appraisals, for example, if applied as an adjunct to treatment. METHODS AND ANALYSIS The study is a randomised controlled trial with two parallel arms. It is planned to randomise 80 patients admitted for treatment for PTSD to an inpatient treatment clinic to complete either sessions of CBM-App or a sham-training control condition, the peripheral vision task. Both interventions comprise eight sessions scheduled over a 2-week period and are completed in addition to the standard treatment programme in the clinic. Outcome assessment occurs pretraining, after 1 week of training, post-training, at discharge from the inpatient clinic and 6 weeks and 3 months postdischarge. The primary outcome is dysfunctional trauma-relevant appraisals at post-training, measured using a scenario completion task. Secondary outcomes include symptom measures and hair cortisol. Outcome analyses will be primarily via mixed linear models and conducted with both intention to treat and per protocol samples. ETHICS AND DISSEMINATION The trial has been approved by the Ethics Committee for the Faculty of Psychology, Ruhr-Universität Bochum (approval no 204) and the Ethics Committee for the Faculty of Medicine, Ruhr-Universität Bochum (approval no 15-5477). Results will be published in peer-reviewed journals and will inform future clinical and experimental studies into targeting maladaptive appraisals for the reduction of PTSD symptoms. TRIAL REGISTRATION NUMBER NCT02687555.
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Affiliation(s)
- Marcella L Woud
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Simon E Blackwell
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Jan C Cwik
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Jürgen Margraf
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Emily A Holmes
- Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Susann Steudte-Schmiedgen
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
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98
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Köbach A, Ruf-Leuschner M, Elbert T. Psychopathological sequelae of female genital mutilation and their neuroendocrinological associations. BMC Psychiatry 2018; 18:187. [PMID: 29895282 PMCID: PMC5998450 DOI: 10.1186/s12888-018-1757-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 05/22/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Anecdotal evidence suggests the frequently traumatic nature of female genital mutilation (FGM). At present, systematic research on the psychological sequelae of this tradition has remained limited. The study provides preliminary, high-quality psychodiagnostic data on potential psychopathological consequences of FGM, with a focus on posttraumatic stress disorder (PTSD), shutdown dissociation and other stress-related variables. METHODS We investigated a convenience sample of N = 167 women, supported by the women's affairs headquarters in Jijiga (capital of the Ethiopian Somali Region) and a local Ethiopian non-governmental organization. Our main outcome measures were PTSD (PSS-I) and shutdown dissociation (ShuD). We also assessed depression and anxiety (HSCL-25), major depression, substance abuse and dependence, suicidality and psychotic disorders (M.I.N.I.; sub-scales A., B., K., and L.). In addition, we collected hair samples to assess hair cortisol concentrations (HCC) as a neuroendocrinological measure. RESULTS The majority of women endured FGM (FGM I: 36%, FGM II/III: 52%) and, regardless of the level of the physical invasiveness, almost all women reported having felt intense fear and/or helplessness. FGM II/III, the more invasive form, was associated with a greater vulnerability to PTSD symptoms (p < .001) and shutdown dissociation (p < .001). Symptoms of depression (p < .05) and anxiety (p < .01) were also elevated. Random forest regression with conditional inference trees revealed evidence of an alteration of the cortisol levels in relation to the age when FGM was experienced (< 1 year) and the invasiveness of the procedure. CONCLUSION More extensive forms of FGM are associated with more severe psychopathological symptoms - particularly with an increased vulnerability to PTSD. Higher hair cortisol levels in women who experienced FGM before their first year of age or had more severe forms of FGM indicate long-term neuroendocrinological consequences of FGM and trauma in general on the stress system.
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Affiliation(s)
- Anke Köbach
- Department of Clinical and Neuropsychology, University Konstanz, Universitätsstraße 10, 78457, Konstanz, Germany. .,Vivo international e.V., Postfach 5108, 78430, Konstanz, Germany.
| | - Martina Ruf-Leuschner
- 0000 0001 0658 7699grid.9811.1Department of Clinical and Neuropsychology, University Konstanz, Universitätsstraße 10, 78457 Konstanz, Germany ,Vivo international e.V., Postfach 5108, 78430 Konstanz, Germany
| | - Thomas Elbert
- 0000 0001 0658 7699grid.9811.1Department of Clinical and Neuropsychology, University Konstanz, Universitätsstraße 10, 78457 Konstanz, Germany ,Vivo international e.V., Postfach 5108, 78430 Konstanz, Germany
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99
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Mustonen P, Karlsson L, Scheinin NM, Kortesluoma S, Coimbra B, Rodrigues AJ, Karlsson H. Hair cortisol concentration (HCC) as a measure for prenatal psychological distress - A systematic review. Psychoneuroendocrinology 2018; 92:21-28. [PMID: 29609112 DOI: 10.1016/j.psyneuen.2018.03.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 03/26/2018] [Accepted: 03/26/2018] [Indexed: 01/12/2023]
Abstract
Prenatal environment reportedly affects the programming of developmental trajectories in offspring and the modification of risks for later morbidity. Among the increasingly studied prenatal exposures are maternal psychological distress (PD) and altered maternal hypothalamus-pituitary-adrenal (HPA) axis functioning. Both prenatal PD and maternal short-term cortisol concentrations as markers for HPA axis activity have been linked to adverse child outcomes and it has been assumed that maternal PD affects the offspring partially via altered cortisol secretion patterns. Yet, the existing literature on the interrelations between these two measures is conflicting. The assessment of cortisol levels by using hair cortisol concentration (HCC) has gained interest, as it offers a way to assess long-term cortisol levels with a single non-invasive sampling. According to our review, 6 studies assessing the associations between maternal HCC during pregnancy and various types of maternal PD have been published so far. Measures of prenatal PD range from maternal symptoms of depression or anxiety to stress related to person's life situation or pregnancy. The aim of this systematic review is to critically evaluate the potential of HCC as a biomarker for maternal PD during pregnancy. We conclude that HCC appears to be inconsistently associated with self-reported symptoms of prenatal PD, especially in the range of mild to moderate symptom levels. Self-reports on PD usually cover short time periods and they seem to depict partly different phenomena than HCC. Thus, methodological aspects are in a key role in future studies evaluating the interconnections across different types of prenatal PD and maternal HPA axis functioning. Further, studies including repetitive measurements of both HCC and PD during the prenatal period are needed, as timing of the assessments is one important source of variation among current studies. The significance of prenatal HCC in the context of offspring outcomes needs to be further investigated.
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Affiliation(s)
- Paula Mustonen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Finland; Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Finland; Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Noora M Scheinin
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Finland; Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Susanna Kortesluoma
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Finland
| | - Bárbara Coimbra
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Ana João Rodrigues
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Finland; Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
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100
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Abstract
OBJECTIVE Childhood trauma has been associated with greater psychological and physical morbidity, including a greater risk of developing cardiovascular disease (CVD). This may partially reflect trauma-induced disturbances in how stress is later perceived and regulated. This study evaluated the associations of childhood trauma with perceived stress and hair cortisol concentrations (HCC) in a large sample of adults with coronary artery disease (CAD) and in non-CVD patients experiencing other nonfatal illnesses. Whether sex, age, or CVD status influenced these associations was also examined. METHODS A total of 1124 men and women (aged 65.2 [6.9] years) recruited from a hospital cohort completed the Childhood Trauma and Perceived Stress Questionnaires, whereas hair samples were obtained from 598 participants. Health status was confirmed via medical records. RESULTS Moderate to severe childhood trauma was experienced by 359 participants. Childhood trauma was associated with greater perceived stress levels for the past 2 years (r = .308, p = .01; β = 0.263, p < .001), but not 3-month cortisol secretion in hair. Perceived stress correlated negatively with age (r = -.241, p < .001). In secondary analyses, age moderated the relation between sexual abuse and perceived stress (β = -0.067, p = .016). Although sexual abuse was associated with greater levels of perceived stress among all participants, this relation was strongest in younger individuals. CONCLUSIONS Participants who experienced trauma in their youth reported greater levels of perceived stress, but not HCC, in late adulthood. Whether this suggests intact hypothalamic-pituitary-adrenal regulation in those exposed to childhood trauma or whether this reflects the characteristics of our sample requires further investigation.
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