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Affiliation(s)
- Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
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102
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Glucocorticoid receptor gene methylation moderates the association of childhood trauma and cortisol stress reactivity. Psychoneuroendocrinology 2018; 90:68-75. [PMID: 29433075 DOI: 10.1016/j.psyneuen.2018.01.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 02/03/2023]
Abstract
Exposure to childhood trauma (CT) has been linked to sustained dysregulations of major stress response systems, including findings of both exaggerated and attenuated hypothalamus-pituitary-adrenal (HPA) axis activity. Likewise, CT constitutes a common risk factor for a broad range of psychiatric conditions that involve distinct neuroendocrine profiles. In this study, we investigated the role of epigenetic variability in a stress-related gene as a potential mediator or moderator of such differential trajectories in CT survivors. For this, we screened adult volunteers for CT and recruited a healthy sample of 98 exposed (67 with mild-moderate, 31 with moderate-severe exposure) and 102 control individuals, with an equal number of males and females in each group. DNA methylation (DNAM) levels of the glucocorticoid receptor exon 1F promoter (NR3C1-1F) at functionally relevant sites were analyzed via bisulfite pyrosequencing from whole blood samples. Participants were exposed to a laboratory stressor (Trier Social Stress Test) to assess salivary cortisol stress responses. The major finding of this study indicates that DNAM in a biologically relevant region of NR3C1-1F moderates the specific direction of HPA-axis dysregulation (hypo- vs. hyperreactivity) in adults exposed to moderate-severe CT. Those trauma survivors with increased NR3C1-1F DNAM displayed, on average, 10.4 nmol/l (62.3%) higher peak cortisol levels in response to the TSST compared to those with low DNAM. In contrast, unexposed and mildly-moderately exposed individuals displayed moderately sized cortisol stress responses irrespective of NR3C1-1F DNAM. Contrary to some prior work, however, our data provides no evidence for a direct association of CT and NR3C1-1F DNAM status. According to this study, epigenetic changes of NR3C1-1F may provide a more in-depth understanding of the highly variable neuroendocrine and pathological sequelae of CT.
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Fuchs A, Jaite C, Neukel C, Dittrich K, Bertsch K, Kluczniok D, Möhler E, Attar CH, Brunner R, Bödeker K, Resch F, Bermpohl F, Kaess M. Link between children's hair cortisol and psychopathology or quality of life moderated by childhood adversity risk. Psychoneuroendocrinology 2018; 90:52-60. [PMID: 29433073 DOI: 10.1016/j.psyneuen.2018.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 02/04/2018] [Accepted: 02/04/2018] [Indexed: 12/27/2022]
Abstract
The hypothalamus-pituitary-adrenal axis (HPAA) and its end product, the glucocorticoid cortisol, has been shown to be associated with psychopathology. Determining cortisol concentrations in hair (HCC) allows the investigation of long-term HPAA-activity. There is a significant scarcity of studies investigating the link between HCC and psychopathology and quality of life in child and adolescent samples. In addition, as the HPAA constitutes a feedback system enabling adaption to environmental demands, it is important to consider the socio-environmental context that the children grow up in. We therefore investigated the associations between child HCC and psychopathology/quality of life and compared these links in two groups of five to 12-year-olds: children living with mothers who report experiences of early life maltreatment (ELM) (high-risk group) and children whose mothers did not report any ELM (low-risk group). We expected that, under conditions of a high-risk environment, elevated HPAA-functioning would be associated with low levels of psychopathology and high levels of quality of life in children. Under low-risk conditions, elevated HPAA-functioning would be associated with high levels of psychopathology and low levels of quality of life in children. For the complete sample of N = 130 children, three-months HCC did not significantly predict child psychopathology or quality of life. However, there was a significant moderating effect of group membership: In the high-risk group, high levels of HCC were significantly associated with high levels of self-reported quality of life. In the low-risk group, there was no association between HCC and self-reported quality of life. For child psychopathology, in the low-risk group, high levels of HCC were significantly associated with high levels of teacher reported behavior problems, whereas in the high-risk group, the association did not reach significance. Our results underline the importance of accounting for the social environment children grow up in when investigating the link between HCC and child psychopathology and quality of life.
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Affiliation(s)
- Anna Fuchs
- Department of Child and Adolescent Psychiatry, Heidelberg University, Blumenstraße 8, 69115, Heidelberg, Germany.
| | - Charlotte Jaite
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Heidelberg University, Voßstraße 4, 69115, Heidelberg, Germany
| | - Katja Dittrich
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Heidelberg University, Voßstraße 4, 69115, Heidelberg, Germany
| | - Dorothea Kluczniok
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Heidelberg University, Blumenstraße 8, 69115, Heidelberg, Germany
| | - Catherine Hindi Attar
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry, Heidelberg University, Blumenstraße 8, 69115, Heidelberg, Germany
| | - Katja Bödeker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Heidelberg University, Blumenstraße 8, 69115, Heidelberg, Germany
| | - Felix Bermpohl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Heidelberg University, Blumenstraße 8, 69115, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
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104
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Dajani R, Hadfield K, van Uum S, Greff M, Panter-Brick C. Hair cortisol concentrations in war-affected adolescents: A prospective intervention trial. Psychoneuroendocrinology 2018; 89:138-146. [PMID: 29358120 DOI: 10.1016/j.psyneuen.2017.12.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/06/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
Temporal examinations of the biological signature of stress or trauma in war-affected populations are seldom undertaken. Moreover, few studies have examined whether stress biomarkers track biological sensitivity to brief interventions targeting the improvement of psychosocial wellbeing. Our study is the first to prospectively examine, in war-affected adolescents, the associations between hair cortisol concentrations (HCC) and self-reports of stress, insecurity, posttraumatic reactions, and lifetime trauma. We conducted a randomized controlled trial to test the impact of an 8-week intervention based on profound stress attunement. We collected data for a gender-balanced sample of 733 Syrian refugee (n = 411) and Jordanian non-refugee (n = 322) adolescents (12-18 years), at three time-points. We used growth mixture models to classify cortisol trajectories, and growth models to evaluate intervention impact on stress physiology. We observed three trajectories of HCC: hypersecretion, medium secretion, and hyposecretion (9.6%, 87.5% and 2.9% of the cohort, respectively). For every one percent increase in levels of insecurity, adolescents were 0.02 times more likely to have a trajectory of hypersecretion (95% CI: 1.00, 1.03, p = 0.01). For each additional symptom of posttraumatic stress reported, they were 0.07 times less likely to show hyposecretion (95% CI: 0.89, 0.98, p = 0.01). Indeed, stronger posttraumatic stress reactions were associated with a pattern of within-individual cortisol dysregulation and medium secretion. Overall, HCC decreased by a third in response to the intervention (95% CI: -0.19, -0.03, p = 0.01). While the intervention decreased HCC for youth with hypersecretion and medium secretion, it increased HCC for youth with hyposecretion (95% CI: 0.22, 1.16, p = 0.004), relative to controls. This suggests a beneficial regularization of cortisol levels, corroborating self-reports of improved psychosocial wellbeing. We did not find evidence to suggest that gender, resilience, or posttraumatic stress disorder influenced the strength or direction of responses to the intervention. This robust impact evaluation exemplifies the utility of biomarkers for tracking physiological changes in response to interventions over time. It enhances the understanding of trajectories of endocrine response in adverse environments and patterns of stress responsivity to ecological improvement.
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Affiliation(s)
- Rana Dajani
- Department of Biology and Biotechnology, Hashemite University, Zarqa 13115 Jordan; Radcliffe Institute for Advanced Study, Harvard University, 10 Garden Street, Cambridge, MA 02138, USA.
| | - Kristin Hadfield
- Department of Biological and Experimental Psychology, Fogg Building, Queen Mary University of London, London, E1 4NS, UK.
| | - Stan van Uum
- Division of Clinical Pharmacology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada; Division of Endocrinology and Metabolism, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, 268 Grosvenor St., London, Ontario, N6G 4L1, Canada.
| | - Michael Greff
- Robarts Research Institute, Western University, 1151 Richmond St. N., London, Ontario, N6A 5B7, Canada; Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, 800 Commissioners Rd. E., London, Ontario, N6C 2R6, Canada.
| | - Catherine Panter-Brick
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT 06511, USA; Jackson Institute for Global Affairs, Yale University, 55 Hillhouse Avenue, New Haven, CT 06511, USA.
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105
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Hellewell SC, Cernak I. Measuring Resilience to Operational Stress in Canadian Armed Forces Personnel. J Trauma Stress 2018; 31:89-101. [PMID: 29465774 DOI: 10.1002/jts.22261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 11/06/2022]
Abstract
Adaptability to stress is governed by innate resilience, comprised of complex neuroendocrine and immune mechanisms alongside inherited or learned behavioral traits. Based on their capacity to adapt, some people thrive in stressful situations, whereas others experience maladaptation. In our study, we used state-of-the-art tools to assess the resilience level in individuals, as well as their susceptibility to developing military stress-induced behavioral and cognitive deficits. To address this complex question, we tested Canadian Armed Forces (CAF) personnel in three distinct stress environments (baselines): during predeployment training, deployment in Afghanistan, and readjustment upon return to Canada. Our comprehensive outcome measures included psychometric tests, saliva biomarkers, and computerized cognitive tests that used the Cambridge Neuropsychological Automated Test Battery. Participants were categorized based on initial biomarker measurements as being at low-, moderate-, or high stress-maladaptation risk. Biomarkers showed significant changes (ds = 0.56 to 2.44) between baselines, calculated as "delta" changes. Participants at low stress-maladaptation risk demonstrated minimal changes, whereas those at high stress-maladaptation risk showed significant biomarker variations. The psychometric patterns and cognitive functions were likewise affected across baselines, suggesting that the panel of saliva stress biomarkers could be a useful tool for determining the risk of stress maladaptation that can cause psychological and cognitive decline.
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Affiliation(s)
- Sarah C Hellewell
- Canadian Military and Veterans' Clinical Rehabilitation Research Program, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ibolja Cernak
- Canadian Military and Veterans' Clinical Rehabilitation Research Program, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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106
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Determinants of hair cortisol concentration in children: A systematic review. Psychoneuroendocrinology 2018; 87:204-214. [PMID: 29112905 DOI: 10.1016/j.psyneuen.2017.10.022] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/01/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several factors are known contribute to hair cortisol concentration (HCC) in adults. However, there is less research on determinants of HCC in children and adolescents. HCC is a valuable tool for medical research pertaining to the hypothalamic-pituitary-adrenal (HPA) axis. This review aims to assess the extent to which established determinants of HCC in adults have been consistently reported in children (birth - 18 years) and to identify determinants of HCC specific to this age group. METHODS Eligible studies were identified, selected and appraised as per PRISMA-P guidelines and as detailed in our systematic review protocol, registered on PROSPERO (registration number CRD42017056220). In view of contrasting methods and measures, a meta-analysis could not be done but a qualitative synthesis was performed. RESULTS Thirty-six studies were included in the analysis. Higher HCC is associated with male sex and anthropometry, particularly increased body mass index and waist circumference. There is preliminary evidence to suggest that socio-economic status is inversely related to child HCC, particularly with reference to caregiver education and income. Of note, most of the studies analysing socio-economic variables were performed in relatively equal societies. Hair wash frequency and use of hair products and treatments do not affect HCC when proximal segments of hair are used. There is conflicting evidence regarding the relationship between HCC and age in children and adolescents. Further investigation is required to better delineate if and how the following are associated with HCC in children: hair colour, hair type, exposure to trauma and stressors, psychiatric illness, atopic illness, steroid use (including topical and inhaled steroids) and perinatal variables. CONCLUSIONS Sex and anthropometry are potential confounders and should be considered for adjustment in hair cortisol research. Hair wash frequency and use of hair products and treatments are not important confounders when proximal hair segments are used. A better understanding of HCC in children in relation to exposure to trauma and stressors is required before it can be used as a biomarker, particularly in terms of vulnerable developmental stages, definition and measurement of stress, and temporal relationship to stressors. Age, SES and other correlates also warrant further investigation.
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107
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van Leijden MJ, Penninx BWJH, Agyemang C, Olff M, Adriaanse MC, Snijder MB. The association of depression and posttraumatic stress disorder with the metabolic syndrome in a multi-ethnic cohort: the HELIUS study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:921-930. [PMID: 29796849 PMCID: PMC6133160 DOI: 10.1007/s00127-018-1533-y] [Citation(s) in RCA: 7] [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: 10/23/2017] [Accepted: 05/09/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE Depression and posttraumatic stress disorder (PTSD) may be linked to the metabolic syndrome (MetS). Consistency of this association across ethnic groups and the influence of comorbidity of depression/PTSD were examined. METHODS Cross-sectional baseline data from the HELIUS study were used (4527 Dutch, 2999 South-Asian Surinamese, 4058 African Surinamese, 2251 Ghanaian, 3522 Turkish and 3825 Moroccan participants). The Patient Health Questionnaire-9 (PHQ-9) (score range 0-27) measured depressive symptoms. A 9-item questionnaire (score range 0-9) measured PTSD symptoms. The MetS was defined according to the International Diabetes Federation. The association of a depressed mood (PHQ-9 sum score ≥ 10) and severe PTSD symptoms (sum score ≥ 7) with the MetS was examined using logistic regression. Interaction with ethnicity and between a depressed mood and severe PTSD symptoms was tested. RESULTS A depressed mood was associated with the MetS [OR (95% CI) = 1.37 (1.24-1.51)] in the total sample and consistent across ethnic groups (p values for interaction all > 0.05). Severe PTSD symptoms were significantly associated with the MetS in the Dutch [OR (95% CI) = 1.71 (1.07-2.73)]. The South-Asian Surinamese, Turks and Moroccans showed weaker associations than the Dutch (p values for interaction all < 0.05). A depressed mood and severe PTSD symptoms did not interact in the association with the MetS (p values for interaction > 0.05). CONCLUSIONS A depressed mood was consistently associated with the MetS across ethnic groups, but the association between severe PTSD symptoms and the MetS maybe ethnicity dependent. The association with the MetS was not different in case of depressed mood/severe PTSD symptoms comorbidity.
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Affiliation(s)
- Marieke J. van Leijden
- 0000000404654431grid.5650.6Department of Public Health, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Brenda W. J. H. Penninx
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Oldenaller 1, 1081 HL Amsterdam, The Netherlands
| | - Charles Agyemang
- 0000000404654431grid.5650.6Department of Public Health, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Miranda Olff
- 0000000404654431grid.5650.6Department of Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
| | - Marcel C. Adriaanse
- 0000 0004 1754 9227grid.12380.38Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Marieke B. Snijder
- 0000000404654431grid.5650.6Department of Public Health, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
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108
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Affiliation(s)
- Nicolas Rohleder
- Chair of Health Psychology, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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109
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Trautmann S, Muehlhan M, Kirschbaum C, Wittchen HU, Höfler M, Stalder T, Steudte-Schmiedgen S. Biological stress indicators as risk markers for increased alcohol use following traumatic experiences. Addict Biol 2018; 23:281-290. [PMID: 28105726 DOI: 10.1111/adb.12487] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/30/2016] [Accepted: 11/28/2016] [Indexed: 12/31/2022]
Abstract
Alcohol misuse is a common sequela of traumatic event experiences causing considerable morbidity and mortality. Although biological stress indicators have been identified as useful risk markers for the development of trauma-related disorders, no such biological indicators exist for the risk of increased alcohol use after trauma exposure. This is the first study to prospectively investigate the predictive value of long-term cortisol levels and acute stress reactivity for the risk of increased alcohol use following traumatic events. Male soldiers were examined before and 12 months following deployment using a standardized diagnostic interview. We analyzed the moderating role of baseline hair cortisol concentrations (HCCs, n = 153) as well as baseline salivary cortisol and alpha-amylase stress reactivity in response to a laboratory stressor (n = 145) in the association between new-onset traumatic events (according to the DSM-IV A1 criterion) and subsequent daily alcohol use. No main effects of pre-traumatic HCC or salivary stress markers on subsequent change in alcohol use were observed. However, we found that with decreasing HCC, the number of new-onset traumatic events was more strongly associated with subsequent alcohol use independent from changes in posttraumatic stress disorder symptoms. No such relation was seen for the acute stress reactivity data. Taken together, this study provides first evidence suggesting that individual differences in long-term cortisol regulation are involved in the association between traumatic experiences and subsequent alcohol use. HCC may thus serve as a potential target in the early identification of individuals vulnerable for increased alcohol use following traumatic events.
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Affiliation(s)
- Sebastian Trautmann
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - Markus Muehlhan
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - Clemens Kirschbaum
- Institute of Biological Psychology; Technische Universität Dresden; Dresden Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - Michael Höfler
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - Tobias Stalder
- Institute of Biological Psychology; Technische Universität Dresden; Dresden Germany
- Clinical Psychology; University of Siegen; Siegen Germany
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Rietschel L, Streit F, Zhu G, McAloney K, Frank J, Couvy-Duchesne B, Witt SH, Binz TM, McGrath J, Hickie IB, Hansell NK, Wright MJ, Gillespie NA, Forstner AJ, Schulze TG, Wüst S, Nöthen MM, Baumgartner MR, Walker BR, Crawford AA, Colodro-Conde L, Medland SE, Martin NG, Rietschel M. Hair Cortisol in Twins: Heritability and Genetic Overlap with Psychological Variables and Stress-System Genes. Sci Rep 2017; 7:15351. [PMID: 29127340 PMCID: PMC5703444 DOI: 10.1038/s41598-017-11852-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/30/2017] [Indexed: 12/19/2022] Open
Abstract
Hair cortisol concentration (HCC) is a promising measure of long-term hypothalamus-pituitary-adrenal (HPA) axis activity. Previous research has suggested an association between HCC and psychological variables, and initial studies of inter-individual variance in HCC have implicated genetic factors. However, whether HCC and psychological variables share genetic risk factors remains unclear. The aims of the present twin study were to: (i) assess the heritability of HCC; (ii) estimate the phenotypic and genetic correlation between HPA axis activity and the psychological variables perceived stress, depressive symptoms, and neuroticism; using formal genetic twin models and molecular genetic methods, i.e. polygenic risk scores (PRS). HCC was measured in 671 adolescents and young adults. These included 115 monozygotic and 183 dizygotic twin-pairs. For 432 subjects PRS scores for plasma cortisol, major depression, and neuroticism were calculated using data from large genome wide association studies. The twin model revealed a heritability for HCC of 72%. No significant phenotypic or genetic correlation was found between HCC and the three psychological variables of interest. PRS did not explain variance in HCC. The present data suggest that HCC is highly heritable. However, the data do not support a strong biological link between HCC and any of the investigated psychological variables.
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Affiliation(s)
- Liz Rietschel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Research Department, University of Bern, Bern, Switzerland.
- SRH University Heidelberg, Academy for Psychotherapy, Heidelberg, Germany.
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Gu Zhu
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
| | - Kerrie McAloney
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Baptiste Couvy-Duchesne
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tina M Binz
- Zurich Institute of Forensic Medicine, Centre for Forensic Hair Analysis, University of Zurich, Zurich, Switzerland
| | - John McGrath
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Narelle K Hansell
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Margaret J Wright
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Nathan A Gillespie
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Life & Brain Center, Department of Genomics, University of Bonn, Bonn, Germany
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Thomas G Schulze
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, USA
- Institute of Psychiatric Phenomics and Genomics (IPPG), Medical Center of the University of Munich, Campus Innenstadt, Munich, DE, Germany
- Human Genetics Branch, NIMH Division of Intramural Research Programs, Bethesda, USA
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Goettingen, DE, Germany
| | - Stefan Wüst
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Institute of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Life & Brain Center, Department of Genomics, University of Bonn, Bonn, Germany
| | - Markus R Baumgartner
- Zurich Institute of Forensic Medicine, Centre for Forensic Hair Analysis, University of Zurich, Zurich, Switzerland
| | - Brian R Walker
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew A Crawford
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Medical Research Council Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Lucía Colodro-Conde
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
| | - Sarah E Medland
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
| | - Nicholas G Martin
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Moran JK, Crombach A, Elbert T, Nandi C, Bambonyé M, Wienbruch C, Lommen U, Weierstall R. The individual contribution of DSM 5 symptom clusters of PTSD, life events, and childhood adversity to frontal oscillatory brain asymmetry in a large sample of active combatants. Biol Psychol 2017; 129:305-313. [PMID: 28958482 PMCID: PMC5678498 DOI: 10.1016/j.biopsycho.2017.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 08/14/2017] [Accepted: 09/23/2017] [Indexed: 12/11/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD) has been linked to deviations in lateralized frontal functional oscillatory activity. This is possibly because left and right DLPFC have differential roles in regulating both memory and stress response, which are both dysfunctional in PTSD. However, previous results are heterogeneous, and could be attributable to individual symptom clusters, traumatic or aggressive life events, early life stress, or the interaction of these factors. In a large sample of active combatants (N=401), we regressed these factors on frontal electroencephalography (EEG) asymmetry across 5 frequency bands (delta: 2-4Hz; theta: 4-8Hz; alpha: 8-12Hz; beta: 12-24Hz; gamma: 24-48Hz). Negative cognition and mood was associated with stronger relative left delta and theta band power. Traumatic life events showed stronger right alpha and beta band power. Traumatic life events in interaction with hyperarousal predicted stronger relative right left-right imbalance (theta, alpha, and beta bands), whereas childhood adversity, in interaction with negative cognition and mood, predicted stronger relative left left-right imbalance (delta, theta, alpha and beta bands). The contribution of lateralized DLPFC dysfunction to PTSD is thus dependent on the individual complexities of subsymptom clusters and life history, and future studies need to take these factors into account.
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Affiliation(s)
- James K Moran
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany; Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany.
| | - Anselm Crombach
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany; Department of Psychology, University Lumière of Bujumbura, Burundi
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany; Department of Psychology, University Lumière of Bujumbura, Burundi
| | - Corina Nandi
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany
| | - Manassé Bambonyé
- Department of Psychology, University Lumière of Bujumbura, Burundi
| | - Christian Wienbruch
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany
| | - Ursula Lommen
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany
| | - Roland Weierstall
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany; MSH Medical School Hamburg, University of Applied Sciences and Medical University, Germany
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112
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White LO, Ising M, von Klitzing K, Sierau S, Michel A, Klein AM, Andreas A, Keil J, Resch L, Müller-Myhsok B, Uhr M, Gausche R, Manly JT, Crowley MJ, Kirschbaum C, Stalder T. Reduced hair cortisol after maltreatment mediates externalizing symptoms in middle childhood and adolescence. J Child Psychol Psychiatry 2017; 58:998-1007. [PMID: 28244601 PMCID: PMC5570647 DOI: 10.1111/jcpp.12700] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The enduring impact of childhood maltreatment on biological systems and ensuing psychopathology remains incompletely understood. Long-term effects of stress may be reflected in cumulative cortisol secretion over several months, which is now quantifiable via hair cortisol concentrations (HCC). We conducted a first comprehensive investigation utilizing the potential of hair cortisol analysis in a large sample of maltreated and nonmaltreated children and adolescents. METHOD Participants included 537 children and adolescents (3-16 years; 272 females) with maltreatment (n = 245) or without maltreatment histories (n = 292). Maltreated subjects were recruited from child protection services (CPS; n = 95), youth psychiatric services (n = 56), and the community (n = 94). Maltreatment was coded using the Maltreatment Classification System drawing on caregiver interviews and complemented with CPS records. Caregivers and teachers reported on child mental health. HCC were assessed in the first 3 cm hair segment. RESULTS Analyses uniformly supported that maltreatment coincides with a gradual and dose-dependent reduction in HCC from 9 to 10 years onwards relative to nonmaltreated controls. This pattern emerged consistently from both group comparisons between maltreated and nonmaltreated subjects (27.6% HCC reduction in maltreated 9-16-year-olds) and dimensional analyses within maltreated subjects, with lower HCC related to greater maltreatment chronicity and number of subtypes. Moreover, both group comparisons and dimensional analyses within maltreated youth revealed that relative HCC reduction mediates the effect of maltreatment on externalizing symptoms. CONCLUSIONS From middle childhood onwards, maltreatment coincides with a relative reduction in cortisol secretion, which, in turn, may predispose to externalizing symptoms.
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Affiliation(s)
- Lars O. White
- Department of Child and Adolescent Psychiatry, University of Leipzig, Germany,Corresponding Author:
| | - Marcus Ising
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, University of Leipzig, Germany
| | - Susan Sierau
- Department of Child and Adolescent Psychiatry, University of Leipzig, Germany
| | - Andrea Michel
- Department of Child and Adolescent Psychiatry, University of Leipzig, Germany, Department of Developmental Psychology, University of Jena, Germany
| | - Annette M. Klein
- Department of Child and Adolescent Psychiatry, University of Leipzig, Germany
| | - Anna Andreas
- Department of Child and Adolescent Psychiatry, University of Leipzig, Germany
| | - Jan Keil
- Department of Child and Adolescent Psychiatry, University of Leipzig, Germany
| | - Leonhard Resch
- Department of Child and Adolescent Psychiatry, University of Leipzig, Germany
| | - Bertram Müller-Myhsok
- Max Planck Institute of Psychiatry, Munich, Germany, Munich Cluster for Systems Neurology (SyNergy), Germany, Institute of Translational Medicine, University of Liverpool, UK
| | - Manfred Uhr
- Max Planck Institute of Psychiatry, Munich, Germany
| | | | - Jody T. Manly
- Mt. Hope Family Center, University of Rochester, NY, USA
| | - Michael J. Crowley
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | | | - Tobias Stalder
- Institute of Psychology, TU Dresden, Germany, Clinical Psychology, University of Siegen, Siegen, Germany
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113
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Rapcencu AE, Gorter R, Kennis M, van Rooij SJH, Geuze E. Pre-treatment cortisol awakening response predicts symptom reduction in posttraumatic stress disorder after treatment. Psychoneuroendocrinology 2017; 82:1-8. [PMID: 28482208 DOI: 10.1016/j.psyneuen.2017.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 01/16/2023]
Abstract
Dysfunction of the HPA-axis has frequently been found in the aftermath of trauma exposure with or without PTSD. Decreasing HPA-axis reactivity to different stress cues has been reported during PTSD treatment. The cortisol awakening response (CARi) is a well-validated, standardized measure of HPA-axis reactivity which can be easily acquired in the clinical setting. Whether CARi changes over time in traumatized individuals are specific to PTSD treatment is unknown. Furthermore, a possible role for the baseline CARi in predicting symptom reduction after treatment in PTSD has not been examined before. To answer these questions, a cohort study was conducted in which the awakening cortisol was measured in both PTSD (N=41) and non-PTSD (N=25) combat-exposed male subjects. Measurements took place at inclusion and 6-8 months after inclusion for both the PTSD and the non-PTSD group. During the 6-8 months interval, PTSD patients received trauma-focused focused psychotherapy, whereas non-PTSD patients received no treatment. We found a decrease in the CARi over time in both groups, suggesting it was not specific to PTSD or the effect of treatment. Therefore, caution is warranted when attributing diminished HPA-axis reactivity over time to effects of PTSD treatment. Second, CARi prior to treatment predicted PTSD symptom reduction (CAPS score change) after treatment, and accounted for 10% of the variance, even when adjusted for changes in depressive symptoms and medication use during the study period. A putative role emerges for CARi as a predictive biomarker of symptom reduction in male individuals with combat-related PTSD.
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Affiliation(s)
- A E Rapcencu
- Research Centre Military Mental Healthcare, Ministry of Defense, Utrecht, The Netherlands; Netherlands Institute for Forensic Psychiatry and Psychology, Utrecht, The Netherlands
| | - R Gorter
- Research Centre Military Mental Healthcare, Ministry of Defense, Utrecht, The Netherlands; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Kennis
- Department of Clinical Psychology, Utrecht University, The Netherlands; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - E Geuze
- Research Centre Military Mental Healthcare, Ministry of Defense, Utrecht, The Netherlands; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
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114
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Straub J, Klaubert LM, Schmiedgen S, Kirschbaum C, Goldbeck L. Hair cortisol in relation to acute and post-traumatic stress symptoms in children and adolescents. ANXIETY STRESS AND COPING 2017; 30:661-670. [PMID: 28745078 DOI: 10.1080/10615806.2017.1355458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND We report on the preliminary results of two independent studies that (1) compare the hair cortisol concentrations (HCC) of healthy controls with patients displaying post-traumatic stress symptoms (PTSS, study 1+2), (2) investigate whether pre-trauma HCC are predictive for the development of acute stress symptoms (ASS) and PTSS (study 1) and (3) determine whether HCC correlate with PTSS in a clinical sample of children (study 2). METHODS In study 1, the clinical symptoms of 35 minors were examined one (T1) and seven weeks (T2) after surgery following an accident. Hair samples were taken after the accident that reflect cortisol secretion over the past three months before the accident (healthy controls). In study 2, HCC and PTSS symptoms were cross-sectionally assessed in 22 minors who had experienced a psychological trauma. RESULTS The HCC of patients with PTSS were lower than the HCC of healthy controls (study 1+2). Secondary analyses showed that HCC were significantly lower in male PTSS patients than in male healthy controls, whereas the HCC in females were comparably low in both groups. Pre-trauma HCC did not predict the total ASS and PTSS scores (study 1) and HCC were not directly related to the total PTSS scores (study 2).
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Affiliation(s)
- Joana Straub
- a Department of Child and Adolescent Psychiatry and Psychotherapy , University of Ulm , Ulm , Germany
| | - Lena Marie Klaubert
- a Department of Child and Adolescent Psychiatry and Psychotherapy , University of Ulm , Ulm , Germany
| | - Susann Schmiedgen
- b Institute of Biological Psychology, Technische Universität Dresden , Dresden , Germany
| | - Clemens Kirschbaum
- b Institute of Biological Psychology, Technische Universität Dresden , Dresden , Germany
| | - Lutz Goldbeck
- a Department of Child and Adolescent Psychiatry and Psychotherapy , University of Ulm , Ulm , Germany
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115
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Stress-related and basic determinants of hair cortisol in humans: A meta-analysis. Psychoneuroendocrinology 2017; 77:261-274. [PMID: 28135674 DOI: 10.1016/j.psyneuen.2016.12.017] [Citation(s) in RCA: 526] [Impact Index Per Article: 75.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/25/2016] [Accepted: 12/21/2016] [Indexed: 01/02/2023]
Abstract
The analysis of hair cortisol concentrations (HCC) is a relatively new strategy to measure long-term cumulative cortisol levels, which is increasingly used in psychoneuroendocrinological research. Here, we conduct a first comprehensive meta-analysis of HCC research based on aggregated data from a total of 124 (sub)samples (66 independent studies; total N=10,289). We seek to answer two central questions: (i) Which covariates and basic features of HCC need to be considered in future research? (ii) What are the main determinants of HCC in terms of chronic stress exposure and mental health? Concerning basic characteristics, our findings identify several covariates to be considered (age, sex, hair washing frequency, hair treatment, oral contraceptive use), confirm a decline of HCC from the first to the second proximal 3cm hair segment, and show positive associations between HCC and short-term salivary cortisol measures. Regarding chronic stress, we show that stress-exposed groups on a whole exhibit 22% increased HCC. This long-term cortisol hypersecretion emerges particularly when stress is still ongoing at the time of study (+43% HCC) but is not present in conditions of past/absent stress (-9% HCC, n.s.). We also report evidence for 17%-reduced HCC in anxiety disorders, such as PTSD. Interestingly, no consistent associations with mood disorders and self-reports of perceived stress, depressiveness or social support are found. However, our findings reveal positive associations of HCC with stress-related anthropometric (body mass index, waist-to-hip ratio) and hemodynamic measures (systolic blood pressure). These meta-analytic results are discussed in the light of their practical implications and important areas for future inquiry are outlined.
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116
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Olff M, van Zuiden M. Neuroendocrine and neuroimmune markers in PTSD: pre-, peri- and post-trauma glucocorticoid and inflammatory dysregulation. Curr Opin Psychol 2017; 14:132-137. [PMID: 28813312 DOI: 10.1016/j.copsyc.2017.01.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 01/04/2023]
Abstract
We review current knowledge on how posttraumatic stress disorder (PTSD) is associated with dysregulation of the most commonly studied markers of the endocrine and immune systems pre-, peri- and post-trauma. Lower basal cortisol output, enhanced glucocorticoid receptor function, and a proinflammatory state have been most consistently found in PTSD, with considerable variability among studies and participants. Longitudinal research is scarce, but there is converging evidence that biological dysregulation is present before PTSD onset. Biological dysregulation may become more apparent with increasing time since trauma, and may be reversible with and predict effective treatment. However, considering the variability of findings and the complex interplay of these systems with other factors, the current clinical application of these findings remains limited.
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Affiliation(s)
- Miranda Olff
- Department of Psychiatry, Academic Medical Center at the University of Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands.
| | - Mirjam van Zuiden
- Department of Psychiatry, Academic Medical Center at the University of Amsterdam, The Netherlands
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117
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Pacella ML, Hruska B, Steudte-Schmiedgen S, George RL, Delahanty DL. The utility of hair cortisol concentrations in the prediction of PTSD symptoms following traumatic physical injury. Soc Sci Med 2017; 175:228-234. [PMID: 28109728 DOI: 10.1016/j.socscimed.2016.12.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/12/2016] [Accepted: 12/29/2016] [Indexed: 01/05/2023]
Abstract
RATIONALE Although cortisol alterations have been associated with posttraumatic stress disorder (PTSD) and PTSD symptoms (PTSS), the direction of association is mixed. Cortisol which is measured in blood, saliva, or urine is subject to transient factors that may confound results. Recent advances in cortisol sampling techniques provide novel opportunities to address these inconsistencies. Hair cortisol sampling is a non-invasive method for the retrospective assessment of long-term integrated cortisol, yet its utility at predicting PTSS has not been assessed in acute injury victims. OBJECTIVE The aim of this prospective study was to examine whether higher levels of hair cortisol concentrations (HCC) were associated with increases in PTSS following traumatic physical injury. METHOD From January 2012 to May 2013, injury victims admitted to a level-1 Midwestern trauma center were recruited during their routine trauma clinic appointment within 30-days post-injury. Thirty participants had sufficient hair length to obtain 3-cm hair samples for cortisol assay. These participants completed PTSS assessments in relation to their recent injury at both the baseline and follow-up assessments (within 30- and 60-days post-injury, respectively). RESULTS Hierarchical regression analyses - which controlled for baseline PTSS, age, and sex - revealed that higher HCC predicted significant increases in overall PTSS at follow-up. Higher HCC also predicted increases in the avoidance/numbing subscale symptoms of PTSS. Dividing the avoidance symptoms and numbing symptoms into two separate clusters (consistent with the 4-factor DSM-5 model of PTSD) revealed that HCC was only marginally associated with numbing, but not with avoidance symptoms. CONCLUSION Hair sampling is a feasible method for assessing integrated cortisol levels soon after traumatic physical injury. This study suggests that elevated HCC may serve as a biomarker of risk for the development of posttraumatic symptomatology, and identifies specific symptoms that may be targeted for intervention in those with high HCC in the aftermath of injury.
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Affiliation(s)
- Maria L Pacella
- Kent State University, Department of Psychological Sciences, Kent, OH, USA.
| | - Bryce Hruska
- Kent State University, Department of Psychological Sciences, Kent, OH, USA
| | | | - Richard L George
- Northeastern Ohio Medical University (NEOMED), Department of Surgery, Rootstown, OH, USA; Summa Health System, Akron City Hospital, Department of Surgery, Division of Trauma Services, Akron, OH, USA
| | - Douglas L Delahanty
- Kent State University, Department of Psychological Sciences, Kent, OH, USA; Northeastern Ohio Medical University (NEOMED), Department of Psychology in Psychiatry, Rootstown, OH, USA; Summa Health System, Medical Research Staff, Akron, OH, USA
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118
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Koch SBJ, Klumpers F, Zhang W, Hashemi MM, Kaldewaij R, van Ast VA, Smit AS, Roelofs K. The role of automatic defensive responses in the development of posttraumatic stress symptoms in police recruits: protocol of a prospective study. Eur J Psychotraumatol 2017; 8:1412226. [PMID: 29321826 PMCID: PMC5757225 DOI: 10.1080/20008198.2017.1412226] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/20/2017] [Indexed: 12/24/2022] Open
Abstract
Background: Control over automatic tendencies is often compromised in challenging situations when people fall back on automatic defensive reactions, such as freeze-fight-flight responses. Stress-induced lack of control over automatic defensive responses constitutes a problem endemic to high-risk professions, such as the police. Difficulties controlling automatic defensive responses may not only impair split-second decisions under threat, but also increase the risk for and persistence of posttraumatic stress disorder (PTSD) symptoms. However, the significance of these automatic defensive responses in the development and maintenance of trauma-related symptoms remains unclear due to a shortage of large-scale prospective studies. Objective: The 'Police-in-Action' study is conducted to investigate the role of automatic defensive responses in the development and maintenance of PTSD symptomatology after trauma exposure. Methods: In this prospective study, 340 police recruits from the Dutch Police Academy are tested before (wave 1; pre-exposure) and after (wave 2; post-exposure) their first emergency aid experiences as police officers. The two waves of data assessment are separated by approximately 15 months. To control for unspecific time effects, a well-matched control group of civilians (n = 85) is also tested twice, approximately 15 months apart, but without being frequently exposed to potentially traumatic events. Main outcomes are associations between (changes in) behavioural, psychophysiological, endocrine and neural markers of automatic defensive responses and development of trauma-related symptoms after trauma exposure in police recruits. Discussion: This prospective study in a large group of primary responders enables us to distinguish predisposing from acquired neurobiological abnormalities in automatic defensive responses, associated with the development of trauma-related symptoms. Identifying neurobiological correlates of (vulnerability for) trauma-related psychopathology may greatly improve screening for individuals at risk for developing PTSD symptomatology and offer valuable targets for (early preventive) interventions for PTSD.
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Affiliation(s)
- Saskia B J Koch
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Floris Klumpers
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Wei Zhang
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Mahur M Hashemi
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Reinoud Kaldewaij
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Vanessa A van Ast
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Annika S Smit
- Police Academy of the Netherlands, Apeldoorn, The Netherlands
| | - Karin Roelofs
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
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119
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Steudte-Schmiedgen S, Wichmann S, Stalder T, Hilbert K, Muehlhan M, Lueken U, Beesdo-Baum K. Hair cortisol concentrations and cortisol stress reactivity in generalized anxiety disorder, major depression and their comorbidity. J Psychiatr Res 2017; 84:184-190. [PMID: 27744230 DOI: 10.1016/j.jpsychires.2016.09.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/08/2016] [Accepted: 09/23/2016] [Indexed: 01/05/2023]
Abstract
Studies investigating cortisol secretion in patients with generalized anxiety disorder (GAD) have reported heterogeneous findings. Further, current knowledge on the specificity of endocrine changes for GAD and/or comorbid major depression (MD) is limited. Hence, the current study investigated long-term integrated cortisol secretion, as indexed by hair cortisol concentrations (HCC), and experimentally-induced cortisol stress reactivity in relation to GAD, MD and their comorbidity. Carefully characterized groups of 17 GAD patients including 8 with comorbid MD (GAD-MD), 12 MD patients and 21 healthy controls were recruited. Alongside psychometric data, HCC (N = 43) and salivary cortisol stress reactivity in response to the Trier Social Stress Test (N = 45) were determined. Findings revealed that MD patients exhibited lower HCC compared to controls and GAD patients, with no differences between the latter two groups. Interestingly, when the GAD group was separated into two groups based on MD comorbidity, lower HCC in MD patients were found compared to controls and GAD-noMD patients, but did not show differences when compared to GAD-MD patients. No HCC differences were seen between GAD-MD or GAD-noMD patients and healthy controls. No TSST group differences emerged. Our findings suggest MD to be related to long-term attenuation in cortisol secretion. While no group differences emerged between patients with GAD, neither with nor without MD, and controls, the current results provide tentative evidence that MD determines long-term endocrine changes, with pure GAD showing a distinct pattern. Future studies are needed to confirm our findings in larger samples of pure and comorbid groups.
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Affiliation(s)
- Susann Steudte-Schmiedgen
- Department of Psychology, Institute of Biological Psychology, Technische Universität Dresden, Germany.
| | - Susann Wichmann
- Department of Psychology, Institute of Biological Psychology, Technische Universität Dresden, Germany
| | - Tobias Stalder
- Department of Psychology, Institute of Biological Psychology, Technische Universität Dresden, Germany; Department of Educational Science, Institute of Clinical Psychology, University of Siegen, Germany
| | - Kevin Hilbert
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany; Department of Psychology, Behavioral Epidemiology, Technische Universität Dresden, Germany
| | - Markus Muehlhan
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Ulrike Lueken
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany; Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Germany
| | - Katja Beesdo-Baum
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany; Department of Psychology, Behavioral Epidemiology, Technische Universität Dresden, Germany
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