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Bilodeau-Houle A, Raymond C, Marin MF. It's all in the hair: Association between changes in hair cortisol concentrations in reaction to the COVID-19 pandemic and post-traumatic stress symptoms in children over time. Psychoneuroendocrinology 2024; 164:107019. [PMID: 38518705 DOI: 10.1016/j.psyneuen.2024.107019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/26/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
After exposure to a stressful/traumatic event, some individuals will develop post-traumatic stress symptoms (PTSS). In adults, low cortisol levels appear to be a risk factor for the development of PTSS. Indeed, both lower pre-trauma cortisol levels and low cortisol levels in the aftermath of a traumatic event have been associated with greater PTSS. In contrast, studies conducted in children showed that elevated cortisol levels shortly after trauma exposure are associated with more severe post-traumatic stress symptomatology. The few studies that have examined how pre-trauma cortisol levels predict PTSS in children have found no effect. Given that a pandemic can induce PTSS in certain individuals, we investigated whether cortisol secretion prior to and in the early stages of the COVID-19 pandemic in Quebec (Canada) predicted PTSS in children. In June 2020, we collected a hair sample from 71 children (8-15 y/o, M = 11.65; 54.93% girls) without a history of psychopathology or exposure to previous traumatic events. Hair samples allowed us to derive cumulative measures of cortisol levels for the months prior to (from mid-December 2019 to mid-March 2020) and at the beginning of the pandemic (from mid-March 2020 to mid-June 2020). PTSS were assessed every 3 months between June 2020 (T1) and March 2021 (T4). The results showed that a greater increase in hair cortisol at the beginning of the pandemic predicted less PTSS at T1, with an increase in these symptoms over time. This study highlights the utility of using hair cortisol during future chronic stressful events to better understand its association with the evolution of distress.
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Affiliation(s)
- Alexe Bilodeau-Houle
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec H2X 3P2, Canada; Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Quebec H1N 3V2, Canada
| | - Catherine Raymond
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec H2X 3P2, Canada; Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Quebec H1N 3V2, Canada
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec H2X 3P2, Canada; Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Quebec H1N 3V2, Canada.
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de Graaff AM, Cuijpers P, Boschloo L, Elsawy M, Hunaidy S, Seedat S, Witteveen AB, Huizink AC, Sijbrandij M. The associations of hair cortisol and DHEA with posttraumatic stress disorder symptoms in refugees. Compr Psychiatry 2024; 129:152438. [PMID: 38104462 DOI: 10.1016/j.comppsych.2023.152438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/09/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Exposure to traumatic events, ongoing adversity, and posttraumatic stress disorder (PTSD) are associated with altered activity of the hypothalamic-pituitary-adrenal (HPA) axis, but findings are mixed. This may be explained in part by heterogeneity in PTSD symptom profiles. AIM The aim of this study was to investigate the complex relationships between the number of traumatic events and post-displacement stressors, individual symptoms of PTSD, and HPA-axis hormones cortisol and dehydroepiandrosterone (DHEA) in refugees. METHODS Adult (18+ years) Syrian refugees with increased levels of distress participating in a randomized controlled trial completed baseline measures to assess traumatic events (trauma checklist), post-displacement stressors (Post-Migration Living Difficulties checklist), symptoms of PTSD (PTSD Checklist for DSM-5; PCL-5), and provided a hair sample for additional stress hormone analyses. We used R-packages qgraph and bootnet to perform network analysis on the number of traumatic events and post-displacement stressors, individual symptoms of PTSD, and HPA-axis hormones cortisol and DHEA. The final network model was corrected for depression severity. RESULTS 115 (53% male, M age = 36.9, SD = 12.7) of 206 participants provided a hair sample. A higher number of traumatic events was directly associated with three symptoms of the PTSD cluster arousal and reactivity, i.e., sleep disturbance, hypervigilance and physiological reactivity, and with three other PTSD symptoms, namely flashbacks, avoidance of reminders, and self-destructive behavior. A higher number of post-displacement stressors was associated with four symptoms of the PTSD cluster cognition and mood, i.e., trauma-related amnesia, negative beliefs, blaming of self/others, and detachment, as well as with intrusive thoughts, sleep disturbance, hypervigilance, and exaggerated startle response. The number of traumatic events and post-displacement stressors were not associated with cortisol or DHEA. Cortisol was positively associated with two symptoms of the PTSD cluster cognition and mood, i.e., negative beliefs and negative trauma-related emotions, and negatively associated with avoidance of reminders. DHEA was positively associated with restricted affect and with three symptoms of the PTSD symptom cluster arousal and reactivity, i.e., irritability/anger, sleep disturbance, and self-destructive behavior, and negatively associated with avoidance of thoughts. CONCLUSIONS This study demonstrated that exposure to traumatic events and post-displacement stressors is not related to cortisol and DHEA, but that cortisol and DHEA are differentially related to individual symptoms of PTSD. While lower levels of both cortisol and DHEA were associated with increased avoidance, higher levels of cortisol were mostly associated with symptoms of the PTSD cluster cognition and mood and higher levels of DHEA were mostly associated with symptoms of the PTSD cluster arousal and reactivity. These findings contribute to explaining the variability of findings in the literature on HPA-axis activity in PTSD. ETHICS The study was approved by the Research Ethics Review Committee at VU Medical Center, the Netherlands (Protocol ID: NL61361.029.17, 7 September 2017) and prospectively registered online (https://www.trialregister.nl/trial/6665).
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Affiliation(s)
- Anne M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands.
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Strada Mihail Kogălniceanu 1, Cluj-Napoca 400347, Romania
| | - Lynn Boschloo
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, Utrecht 3584 CS, the Netherlands
| | - Mariam Elsawy
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Sam Hunaidy
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Soraya Seedat
- SAMRC Genomics of Brain Disorders Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Clinical Building, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Anke B Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Anja C Huizink
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
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3
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Emal LM, Tamminga SJ, Schaafsma FG, Jakasa I, Peremin I, Kirschbaum C, van der Molen HF, Kezic S. Exploring the potential of stratum corneum biomarkers for assessing psychological distress in health care workers: An observational pilot study. Health Sci Rep 2024; 7:e1710. [PMID: 38186941 PMCID: PMC10764658 DOI: 10.1002/hsr2.1710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 01/09/2024] Open
Abstract
Backgrounds The detection of biomarkers of a stress response in the stratum corneum (SC) could be used as objective assessment of early stress symptoms and monitoring of stress reduction interventions in health care workers (HCWs). Aim The aim of this study is to explore SC biomarkers of immune and hormonal response and skin barrier for assessment of psychological distress (PD) in HCWs. Methods Twenty-five female HCWs and 25 non-HCWs participated. SC samples were collected using adhesive tapes at baseline and 3-5 days later (T1). We analyzed 24 biomarkers (immunological, vascular, hormones, and natural moisturizing factors). Stress symptoms were assessed using three scales of Copenhagen Psychosocial Questionnaire. The study involved: identifying SC biomarkers, correlating stress symptoms and biomarkers at baseline and T1, examining stress symptoms between the groups with a Mann-Whitney test, comparing stress symptoms and biomarkers between groups using Ordinary Least Regression and investigating temporal variability of SC biomarkers at baseline and T1 using a Wilcoxon-signed rank. Results Fourteen SC biomarkers were identified. We found correlations between general stress and "IL18" (r = 0.55) physical stress and "IL1b" (r = 0.36) and cognitive stress and "MIP3a" (r = 0.38) at baseline and general stress and cortisol (r = -0.49), physical stress and cortisol (r = -0.60) and cortisone (r = -0.67) at T1. We found no differences in stress symptoms and biomarkers between the groups, except for "MIP3a" at baseline. Differences in the biomarker levels between two time points were found for "TARC," "VEGFA," "ILRA," "IL1RA/IL1a," "NMF," and "DHEA." Conclusion The SC can be suitable biological material to assess biomarkers related to immune response, hormonal response, and skin barrier function. The SC biomarkers, showed strong, moderate and weak correlations with stress symptoms. Notably, these associations include cytokines of innate immunity and well-known stress hormones, cortisol and cortisone.
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Affiliation(s)
- Lima M. Emal
- Department of Public and Occupational health, Amsterdam UMC, Amsterdam Public Health Research InstituteUniversity of AmsterdamAmsterdamNoord‐HollandNetherlands
| | - Sietske J. Tamminga
- Department of Public and Occupational health, Amsterdam UMC, Amsterdam Public Health Research InstituteUniversity of AmsterdamAmsterdamNoord‐HollandNetherlands
| | - Frederieke G. Schaafsma
- Department of Public and Occupational health, Amsterdam UMC, Amsterdam Public Health Research InstituteUniversity of AmsterdamAmsterdamNoord‐HollandNetherlands
| | - Ivone Jakasa
- Laboratory for Analytical Chemistry, Department of Chemistry and Biochemistry, Faculty of Food Technology and BiotechnologyUniversity of ZagrebZagrebCroatia
| | - Ines Peremin
- Laboratory for Analytical Chemistry, Department of Chemistry and Biochemistry, Faculty of Food Technology and BiotechnologyUniversity of ZagrebZagrebCroatia
| | | | - Henk F. van der Molen
- Department of Public and Occupational health, Amsterdam UMC, Amsterdam Public Health Research InstituteUniversity of AmsterdamAmsterdamNoord‐HollandNetherlands
| | - Sanja Kezic
- Department of Public and Occupational health, Amsterdam UMC, Amsterdam Public Health Research InstituteUniversity of AmsterdamAmsterdamNoord‐HollandNetherlands
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Kuckuck S, Lengton R, Boon MR, Boersma E, Penninx BWJH, Kavousi M, van Rossum EFC. Long-term glucocorticoids in relation to the metabolic syndrome and cardiovascular disease: A systematic review and meta-analysis. J Intern Med 2024; 295:2-19. [PMID: 37926862 DOI: 10.1111/joim.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The striking link of Cushing's syndrome with the metabolic syndrome (MetS) and cardiovascular disease (CVD) suggests that long-term exposure to extremely high cortisol levels catalyzes cardiometabolic deterioration. However, it remained unclear whether the findings from the extreme glucocorticoid overabundance observed in Cushing's syndrome could be translated into more subtle variations in long-term glucocorticoid levels among the general population, for example, due to chronic stress. Here, we performed a systematic review (PROSPERO: CRD42023425541) of evidence regarding the role of subtle variations in long-term biological stress, measured as levels of scalp hair cortisol (HairF) and cortisone (HairE), in the context of MetS and CVD in adults. We also performed a meta-analysis on the cross-sectional difference in HairF levels between individuals with versus without CVD. Seven studies were included regarding MetS, sixteen regarding CVD, and one regarding both. Most articles indicated a strong, consistent cross-sectional association of higher HairF and HairE levels with CVD, which was confirmed by our meta-analysis for HairF (eight studies, SMD = 0.48, 95% confidence intervals [CIs]: 0.16-0.79, p = 0.0095). Moreover, these relationships appear largely independent of standard risk factors. Age seems relevant as the effect seems stronger in younger individuals. Results regarding the associations of HairF and HairE with MetS were inconsistent. Altogether, long-term biological stress, measured as HairF and HairE, is associated with the presence of CVD, and less consistently with MetS. Prospective studies need to evaluate the directionality of this relationship and determine whether HairF and HairE can be used in addition to standard risk factors in predicting future cardiometabolic deterioration.
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Affiliation(s)
- Susanne Kuckuck
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Obesity Center CGG, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robin Lengton
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Obesity Center CGG, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mariëtte R Boon
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Obesity Center CGG, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, 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
- Obesity Center CGG, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Schindler-Gmelch L, Capito K, Steudte-Schmiedgen S, Kirschbaum C, Berking M. Hair Cortisol Research in Posttraumatic Stress Disorder - 10 Years of Insights and Open Questions. A Systematic Review. Curr Neuropharmacol 2024; 22:1697-1719. [PMID: 37550910 PMCID: PMC11284720 DOI: 10.2174/1570159x21666230807112425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Cortisol is one of the most extensively studied biomarkers in the context of trauma/posttraumatic stress disorder (PTSD). For more than a decade, hair cortisol concentrations (HCC) have been measured in this context, leading to a two-staged dysregulation model. Specifically, an elevated secretion during/immediately after trauma exposure eventually reverts to hyposecretion with increasing time since trauma exposure has been postulated. OBJECTIVE The aim of our systematic review was to re-evaluate the two-staged secretion model with regard to the accumulated diagnostic, prognostic, and intervention-related evidence of HCC in lifetime trauma exposure and PTSD. Further, we provide an overview of open questions, particularly with respect to reporting standards and quality criteria. METHOD A systematic literature search yielded 5,046 records, of which 31 studies were included. RESULTS For recent/ongoing (traumatic) stress, the predictions of cortisol hypersecretion could be largely confirmed. However, for the assumed hyposecretion temporally more distal to trauma exposure, the results are more ambiguous. As most studies did not report holistic overviews of trauma history and confounding influences, this may largely be attributable to methodological limitations. Data on the prognostic and intervention-related benefits of HCC remain sparse. CONCLUSION Over the last decade, important insights could be gained about long-term cortisol secretion patterns following lifetime trauma exposure and PTSD. This systematic review integrates these insights into an updated secretion model for trauma/PTSD. We conclude with recommendations for improving HCC research in the context of trauma/PTSD in order to answer the remaining open questions.
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Affiliation(s)
- Lena Schindler-Gmelch
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Klara Capito
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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van Sleeuwen C, van Zuiden M, Koch SBJ, Frijling JL, Veltman DJ, Olff M, Nawijn L. How does it feel? An exploration of neurobiological and clinical correlates of alexithymia in trauma-exposed police-officers with and without PTSD. Eur J Psychotraumatol 2023; 14:2281187. [PMID: 38154073 PMCID: PMC10990451 DOI: 10.1080/20008066.2023.2281187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/25/2023] [Indexed: 12/30/2023] Open
Abstract
Background: Alexithymia, an inability to recognise one's emotions, has been associated with trauma-exposure and posttraumatic stress disorder (PTSD). Previous research suggests involvement of the oxytocin system, and socio-emotional neural processes. However, the paucity of neurobiological research on alexithymia, particularly in trauma-exposed populations, warrants further investigation.Objective: Explore associations between alexithymia, endogenous oxytocin levels, and socio-emotional brain function and morphometry in a trauma-exposed sample.Method: Dutch trauma-exposed police officers with (n = 38; 18 females) and without PTSD (n = 40; 20 females) were included. Alexithymia was assessed with the Toronto Alexithymia Scale (TAS-20). Endogenous salivary oxytocin was assessed during rest, using radioimmunoassay. Amygdala and insula reactivity to socio-emotional stimuli were assessed with functional MRI, amygdala and insula grey matter volume were derived using Freesurfer.Results: Alexithymia was higher in PTSD patients compared to trauma-exposed controls (F(1,70) = 54.031, p < .001). Within PTSD patients, alexithymia was positively associated with PTSD severity (ρ(36) = 0.497, p = .002). Alexithymia was not associated with childhood trauma exposure (β = 0.076, p = .509), police work-related trauma exposure (β = -0.107, p = .355), oxytocin levels (β = -0.164, p = .161), insula (β = -0.170, p = .158) or amygdala (β = -0.175, p = .135) reactivity, or amygdala volume (β = 0.146, p = .209). Insula volume was positively associated with alexithymia (β = 0.222, p = .016), though not significant after multiple testing corrections. Bayesian analyses supported a lack of associations.Conclusions: No convincing neurobiological correlates of alexithymia were observed with any of the markers included in the current study. Yet, the current study confirmed high levels of alexithymia in PTSD patients, independent of trauma-exposure, substantiating alexithymia's relevance in the clinical phenotype of PTSD.
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Affiliation(s)
- Cindy van Sleeuwen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Saskia B. J. Koch
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
| | - Jessie L. Frijling
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, the Netherlands
| | - Dick J. Veltman
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Arq National Psychotrauma Centre, Diemen, the Netherlands
| | - Laura Nawijn
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Rodríguez-Rabassa M, Torres-Marrero E, López P, Muniz-Rodriguez K, Borges-Rodríguez M, Appleton AA, Avilés-Santa L, Alvarado-Domenech LI. Stressors and Impact of the COVID-19 Pandemic on Vulnerable Hispanic Caregivers and Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1838. [PMID: 36767218 PMCID: PMC9914744 DOI: 10.3390/ijerph20031838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 06/18/2023]
Abstract
Psychological sequelae are important elements of the burden of disease among caregivers. Recognition of the impact of adversity and stress biomarkers is important to prevent mental health problems that affect rearing practices and child well-being. This cross-sectional study explored social determinants of health (SDoH)-mediated stressors during COVID-19 and risks for mental health problems among caregivers of children with prenatal Zika virus exposure. Twenty-five Hispanic caregivers completed surveys assessing SDoH vulnerabilities, COVID-exposures and impact, post-traumatic stress disorder (PTSD) symptomatology, and provided a hair sample for cortisol concentration (HCC). Most caregivers had low education, household income < $15,000/year, and were unemployed. Stressors included disrupted child education and specialized services, and food insecurity. While most reported PTSD symptomatology, multivariate linear regression models adjusted for the caregiver's age, education, and the child's sex, revealed that caregivers with high symptomatology had significantly lower HCC than those with low symptomatology and those with food insecurity had significantly higher HCC than participants without food insecurity. The impact of COVID-19 on daily life was characterized on average between worse and better, suggesting variability in susceptibility and coping mechanisms, with the most resilient identifying community support and spirituality resources. SDoH-mediators provide opportunities to prevent adverse mental health outcomes for caregivers and their children.
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Affiliation(s)
- Mary Rodríguez-Rabassa
- Clinical Psychology Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, PR 00732, USA
- RCMI Center for Research Resources, Ponce Health Sciences University, P.O. Box 7004, Ponce, PR 00732, USA
- Department of Pediatrics, Ponce Health Sciences University, P.O. Box 7004, Ponce, PR 00732, USA
| | - Estefanía Torres-Marrero
- Clinical Psychology Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, PR 00732, USA
| | - Pablo López
- RCMI Center for Research Resources, Ponce Health Sciences University, P.O. Box 7004, Ponce, PR 00732, USA
| | | | | | - Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, 1 University Place, Rensselaer, NY 12144, USA
| | - Larissa Avilés-Santa
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, 6707 Democracy Blvd. Suite 800, Bethesda, MD 20892, USA
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8
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Schumacher S, Engel S, Klusmann H, Niemeyer H, Küster A, Burchert S, Skoluda N, Rau H, Nater UM, Willmund GD, Knaevelsrud C. Trauma-related but not PTSD-related increases in hair cortisol concentrations in military personnel. J Psychiatr Res 2022; 150:17-20. [PMID: 35344923 DOI: 10.1016/j.jpsychires.2022.02.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/11/2022] [Accepted: 02/28/2022] [Indexed: 01/10/2023]
Abstract
Dysregulated hypothalamic-pituitary-adrenal (HPA) axis functioning has been associated with posttraumatic stress disorder (PTSD). The current literature is inconsistent regarding this association, possibly due to confounding influences. Hair cortisol concentrations (HCC) allow for retrospective assessment of cumulative HPA axis secretion over several weeks and are considered a trait-like marker of HPA axis activity. Three groups of active and former German Armed Forces service members, comprising PTSD patients (n = 19), healthy controls with deployment-related trauma exposure (n = 10), and non-deployed healthy controls (n = 10) provided samples for HCC analysis. We observed significantly higher HCC in the PTSD and the deployed compared to the non-deployed group. HCC was neither significantly correlated with perceived chronic stress, nor with PTSD severity within patients. The results suggest a differential impact of trauma exposure on HPA axis activity and highlight the notion of cumulative, retrospective cortisol secretion as a psychobiological indicator of trauma exposure. TRIAL REGISTRATION: Australian Clinical Trials Registry (ACTRN12616000956404).
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Affiliation(s)
- Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Clinical Psychology and Psychotherapy, Faculty of Health, HMU Health and Medical University, Potsdam, Germany.
| | - Sinha Engel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Hannah Klusmann
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Annika Küster
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Sebastian Burchert
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Nadine Skoluda
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - Heinrich Rau
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Berlin, Germany
| | - Urs M Nater
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | | | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Preckel K, Trautmann S, Kanske P. Medication-Enhanced Psychotherapy for Posttraumatic Stress Disorder: Recent Findings on Oxytocin's Involvement in the Neurobiology and Treatment of Posttraumatic Stress Disorder. CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e3645. [PMID: 36398286 PMCID: PMC9667220 DOI: 10.32872/cpe.3645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background Traumatic experiences may result in Posttraumatic Stress Disorder (PTSD), which is characterized as an exaggerated fear response that cannot be extinguished over time or in safe environments. What are beneficial psychotherapeutic treatment options for PTSD patients? Can oxytocin (OXT), which is involved in the stress response, and safety learning, ameliorate PTSD symptomatology and enhance psychotherapeutic effects? Here, we will review recent studies regarding OXT's potential to enhance psychotherapeutic therapies for PTSD treatment. Method We conducted a literature review on the neurobiological underpinnings of PTSD especially focusing on OXT's involvement in the biology and memory formation of PTSD. Furthermore, we researched successful psychotherapeutic treatments for PTSD patients and discuss how OXT may facilitate observed psychotherapeutic effects. Results For a relevant proportion of PTSD patients, existing psychotherapies are not beneficial. OXT may be a promising candidate to enhance psychotherapeutic effects, because it dampens responses to stressful events and allows for a faster recovery after stress. On a neural basis, OXT modulates processes that are involved in stress, arousal and memory. OXT effectively counteracts memory impairments caused by stress and facilitates social support seeking which is a key resilience factor for PTSD and which is beneficial in psychotherapeutic settings. Conclusion OXT has many characteristics that are promising to positively influence psychotherapy for PTSD patients. It potentially reduces intrusions, but preserves memory of the event itself. Introducing OXT into psychotherapeutic settings may result in better treatment outcomes for PTSD patients. Future research should directly investigate OXT's effects on PTSD, especially in psychotherapeutic settings.
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Affiliation(s)
- Katrin Preckel
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sebastian Trautmann
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Medical School Hamburg, Hamburg, Germany
| | - Philipp Kanske
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
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10
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Sopp MR, Michael T, Lass-Hennemann J, Haim-Nachum S, Lommen MJJ. Longitudinal associations between hair cortisol, PTSD symptoms, and sleep disturbances in a sample of firefighters with duty-related trauma exposure. Psychoneuroendocrinology 2021; 134:105449. [PMID: 34687966 DOI: 10.1016/j.psyneuen.2021.105449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/15/2021] [Accepted: 10/11/2021] [Indexed: 01/04/2023]
Abstract
Several studies have found evidence of altered cortisol levels in patients with posttraumatic stress disorder (PTSD). Based on these findings, it is assumed that these patients may show signs of cortisol dysregulation after trauma. Posttrauma cortisol levels are thus considered a potential biomarker of PTSD. However, longitudinal studies using indicators of long-term cortisol secretion such as hair cortisol concentrations (HCC) are scarce. The current study investigated prospective associations between HCC and PTSD symptoms in a sample of Dutch firefighters taking into account varying levels of work-related trauma severity. In addition, we assessed posttraumatic sleep disturbances as a secondary outcome measure to investigate whether effects generalize to this frequent comorbidity of PTSD. Three hundred seventy-one Dutch firefighters with a mean of 14.01 years of work experience were included in the analyses. Baseline assessment included the collection of hair samples and the measurement of work-related trauma severity, PTSD symptoms, and sleep disturbances. PTSD symptoms and sleep disturbance were re-assessed after six and twelve months. Multilevel analyses indicate a significant positive correlation between HCC and baseline PTSD symptoms in those with average or above-average work-related trauma severity. A similar pattern was evident for posttraumatic sleep disturbances at baseline. Moreover, higher HCC predicted more posttraumatic sleep disturbances after 6 months in participants with above-average work-related trauma severity. No other associations emerged for PTSD symptoms or posttraumatic sleep disturbances at six or twelve months. As such, our study supports the existence of a cross-sectional association between HCC and trauma symptoms, which may vary for different levels of subjective trauma severity. The longitudinal stability of this association should be reinvestigated by future research.
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Affiliation(s)
- M R Sopp
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Campus A1 3, Saarland University, D-66123 Saarbrücken, Germany
| | - T Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Campus A1 3, Saarland University, D-66123 Saarbrücken, Germany.
| | - J Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Campus A1 3, Saarland University, D-66123 Saarbrücken, Germany
| | - S Haim-Nachum
- School of Education, Bar-Ilan University, Ramat-Gan, Israel
| | - M J J Lommen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
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11
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Hilberdink CE, van Zuiden M, Schrantee A, Korosi A, Kaiser A, Zhutovsky P, Ginty AT, Ensink JBM, Lindauer RJL, Vrijkotte TGM, de Rooij SR. Dysregulated functional brain connectivity in response to acute social-evaluative stress in adolescents with PTSD symptoms. Eur J Psychotraumatol 2021; 12:1880727. [PMID: 33968316 PMCID: PMC8075091 DOI: 10.1080/20008198.2021.1880727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is associated with dysregulated neural, cortisol, and cardiac stress reactivity and recovery. This understanding is predominantly based on studies in adults applying emotional-cognitive and trauma-related stimuli inducing negative emotions or perceived threat. Despite large numbers of adolescents with PTSD, few studies are available on neurobiological stress reactivity in this population. Moreover, no previous studies investigated neural reactivity to social-evaluative stress. Objective: To investigate functional brain connectivity, cortisol and cardiac reactivity to acute social-evaluative stress, and additional cortisol measures in trauma-exposed adolescents with and without high PTSD symptoms. Method: A speech preparation task to induce acute social-evaluative stress elicited by anticipatory threat, was used in a subsample of the Amsterdam Born Child and their Development (ABCD) birth cohort, consisting of trauma-exposed adolescents with (n = 20) and without (n = 29) high PTSD symptoms. Psychophysiological interaction analyses were performed to assess group differences in functional connectivity of the hippocampus, mPFC and amygdala during social-evaluative stress and recovery, measured by fMRI. Additionally, perceived stress, heart rate and cortisol stress reactivity and recovery, cortisol awakening response and day curve were compared. Results: The stressor evoked significant changes in heart rate and perceived stress, but not cortisol. The PTSD symptom and control groups differed in functional connectivity between the hippocampus and cerebellum, middle and inferior frontal gyrus, and the mPFC and inferior frontal gyrus during social-evaluative stress versus baseline. Mostly, the same patterns were found during recovery versus baseline. We observed no significant group differences in amygdala connectivity, and cortisol and cardiac measures. Conclusions: Our findings suggest threat processing in response to social-evaluative stress is disrupted in adolescents with PTSD symptoms. Our findings are mainly but not entirely in line with findings in adults with PTSD, which denotes the importance to investigate adolescents with PTSD as a separate population.
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Affiliation(s)
- Charlotte E Hilberdink
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anouk Schrantee
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Aniko Korosi
- Swammerdam Institute for Life Sciences, Centre for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Antonia Kaiser
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Zhutovsky
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Annie T Ginty
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Judith B M Ensink
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.,Department of Child and Adolescent Psychiatry (JBME, RJLL), Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ramon J L Lindauer
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.,Department of Child and Adolescent Psychiatry (JBME, RJLL), Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Susanne R de Rooij
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Public Health and Occupational Health, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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12
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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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13
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Hair cortisol concentrations in mental disorders: A systematic review. Physiol Behav 2021; 229:113244. [DOI: 10.1016/j.physbeh.2020.113244] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/26/2020] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
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14
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Koumantarou Malisiova E, Mourikis I, Chalimourdas T, Nianiakas N, Michou M, Mantzou A, Darviri C, Vaidakis N, Zervas IM, Chrousos GP, Papageorgiou CC. Low hair cortisol concentrations in obsessive compulsive disorder: A cross-sectional study. J Psychiatr Res 2020; 131:187-193. [PMID: 32979695 DOI: 10.1016/j.jpsychires.2020.09.014] [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: 06/19/2020] [Revised: 08/17/2020] [Accepted: 09/13/2020] [Indexed: 12/16/2022]
Abstract
Recent findings have highlighted the association between changes in the activity of the HPA axis, primarily its end-hormone, cortisol and OCD. However, to date, cortisol levels of OCD patients have been assessed mainly in body fluids, such as serum, saliva or urine, frequently leading to ambiguous results because of their inherent lack of stability. The aim of this study was to investigate time-integrated levels of stress exposure in 32 OCD patients and 32 sex and age-matched healthy controls by measuring endogenous cortisol in hair segments reflecting the last 3 months preceding hair collection. Psychometric parameters, including BDI, FQ, STAI, PSS and ECQ-R, were obtained in all participants; Y-BOCS was performed in the OCD patients. The OCD patients exhibited significantly higher scores in all psychometric instruments administered and lower hair cortisol concentrations than the healthy controls (p = 0.001, r = 0.41). No significant correlations were found between the HCC and the Y-BOCS total scores. After having sorted OCD patients into subtypes, according to the nature of their symptomatology, the "washers/cleaners" category showed the lowest HCC (compared to the "checking/harming", "ordering/symmetry" and "sexual/religious obsessions" categories). The novel finding of chronic low cortisol secretion in OCD patients could be attributed to a possible down-regulation of the HPA axis, as an adaptive response to chronic stress exposure. Given that the OCD subtypes reflect the great heterogeneity in the OCD spectrum, studies with larger samples should extend the investigation of HCC in patients with distinctive symptomatology, so as to develop a basis for better neuroendocrine profiling and understanding of the pathophysiology of OCD. Further work is needed in exploring HPA axis' activity over the natural course and treatments of the disorder.
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Affiliation(s)
- Elli Koumantarou Malisiova
- Postgraduate Course on the Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; First Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, Outpatient Specialty Clinic for Obsessive Compulsive Disorder and Behavioral Therapy, Eginition Hospital, 72-74 Vas. Sofias Ave, 11528, Athens, Greece.
| | - Iraklis Mourikis
- First Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, Outpatient Specialty Clinic for Obsessive Compulsive Disorder and Behavioral Therapy, Eginition Hospital, 72-74 Vas. Sofias Ave, 11528, Athens, Greece
| | - Thodoris Chalimourdas
- First Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, Outpatient Specialty Clinic for Obsessive Compulsive Disorder and Behavioral Therapy, Eginition Hospital, 72-74 Vas. Sofias Ave, 11528, Athens, Greece
| | - Nikolaos Nianiakas
- EPAPSY (Nongovernmental, Non-Profit Organization), 36 Salaminos Str., 15124, Athens, Greece
| | - Maria Michou
- Postgraduate Course on the Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aimilia Mantzou
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, Aghia Sophia Children's Hospital, Athens, Greece
| | - Christina Darviri
- Postgraduate Course on the Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Vaidakis
- First Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Medical School, 72-74 Vas. Sophias Ave., 11528, Athens, Greece
| | - Iannis M Zervas
- First Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Medical School, 72-74 Vas. Sophias Ave., 11528, Athens, Greece
| | - George P Chrousos
- Postgraduate Course on the Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, Aghia Sophia Children's Hospital, Athens, Greece; Division of Endocrinology and Metabolism, Center of Clinical Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece; University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527, Athens, Greece
| | - Charalambos C Papageorgiou
- First Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Medical School, 72-74 Vas. Sophias Ave., 11528, Athens, Greece
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15
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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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16
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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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17
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Lifetime PTSD is associated with impaired emotion recognition in veterans and their offspring. Psychiatry Res 2020; 284:112666. [PMID: 31727441 DOI: 10.1016/j.psychres.2019.112666] [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] [Received: 05/11/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 01/03/2023]
Abstract
PTSD is associated with emotion dysregulation. Studies have found inconsistent impaired facial emotion recognition ability (ERA) in patients with PTSD and intergenerational transmission of PTSD has been reported, although no studies exist regarding ERA. Our objective was to characterise the facial ERA of a group of traumatised war veterans with, and without lifetime PTSD, and also of their respective adult offspring. Sixty-one veterans with, and without lifetime PTSD and 73 offspring were tested for ERA of seven basic facial emotions expressions, 40 years after veterans had been exposed to war-related trauma. Veterans with lifetime PTSD showed impairment of recognition of all emotions, irrespective of the type, when compared with veterans without PTSD. This result was maintained after adjusting for potential confounders-including depressive symptoms. Offspring of veterans with lifetime PTSD also showed impaired recognition of all emotions, including after adjustment for the same variables. Offspring of veterans with lifetime PTSD also showed specific impairment in recognising the emotions of happiness and disgust. These results confirm that PTSD has negative effects with regards to emotion regulation and also on the next generation. This could result in this population being at increased risk of suffering from relationship problems and psychopathology.
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18
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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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