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Li H, Upreti T, Do V, Dance E, Lewis M, Jacobson R, Goldberg A. Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints. MEDICAL TEACHER 2024; 46:82-101. [PMID: 37405740 DOI: 10.1080/0142159x.2023.2231625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
PURPOSE Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary. METHODS Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed. RESULTS 221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once. CONCLUSIONS Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.
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Affiliation(s)
- Henry Li
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tushar Upreti
- Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
| | - Victor Do
- Department of Pediatrics, Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| | - Erica Dance
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Melanie Lewis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Ryan Jacobson
- Office of Advocacy and Wellbeing, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
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Ballesio A, Zagaria A, Vacca M, Pariante CM, Lombardo C. Comparative efficacy of psychological interventions on immune biomarkers: A systematic review and network meta-analysis (NMA). Brain Behav Immun 2023; 111:424-435. [PMID: 37187256 DOI: 10.1016/j.bbi.2023.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/25/2023] [Accepted: 05/12/2023] [Indexed: 05/17/2023] Open
Abstract
Psychological interventions are viable, cost-effective strategies for improving clinical and psychological impact of inflammation-related conditions. However, their efficacy on immune system function remains controversial. We performed a systematic review and frequentist random-effects network meta-analysis of randomised controlled trials (RCTs) assessing the effects of psychological interventions, against a control condition, on biomarkers of innate and adaptive immunity in adults. PubMed, Scopus, PsycInfo, and Web of Science were searched from inception up to Oct 17, 2022. Cohen's d at 95% confidence interval (CI) was calculated to assess the effect sizes of each class of intervention against active control conditions at post-treatment. The study was registered in PROSPERO (CRD42022325508). Of the 5024 articles retrieved, we included 104 RCTs reporting on 7820 participants. Analyses were based on 13 types of clinical interventions. Compared with the control conditions, cognitive therapy (d = - 0.95, 95% CI: -1.64 to - 0.27), lifestyle (d = - 0.51, 95% CI: -0.99 to - 0.02), and mindfulness-based (d = - 0.38, 95% CI: -0.66 to - 0.09) interventions were associated with post-treatment reduction of proinflammatory cytokines and markers. Mindfulness-based interventions were also significantly associated with post-treatment increase in anti-inflammatory cytokines (d = 0.69, 95% CI: 0.09 to 1.30), while cognitive therapy was associated also with post-treatment increase in white blood cell count (d = 1.89, 95% CI: 0.05 to 3.74). Results on natural killer cells activity were non-significant. Grade of evidence was moderate for mindfulness and low-to-moderate for cognitive therapy and lifestyle interventions; however, substantial overall heterogeneity was detected in most of the analyses.
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Affiliation(s)
- Andrea Ballesio
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
| | - Andrea Zagaria
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Mariacarolina Vacca
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Caterina Lombardo
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Sekhar P, Tee QX, Ashraf G, Trinh D, Shachar J, Jiang A, Hewitt J, Green S, Turner T. Mindfulness-based psychological interventions for improving mental well-being in medical students and junior doctors. Cochrane Database Syst Rev 2021; 12:CD013740. [PMID: 34890044 PMCID: PMC8664003 DOI: 10.1002/14651858.cd013740.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Mindfulness interventions are increasingly popular as an approach to improve mental well-being. To date, no Cochrane Review examines the effectiveness of mindfulness in medical students and junior doctors. Thus, questions remain regarding the efficacy of mindfulness interventions as a preventative mechanism in this population, which is at high risk for poor mental health. OBJECTIVES: To assess the effects of psychological interventions with a primary focus on mindfulness on the mental well-being and academic performance of medical students and junior doctors. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and five other databases (to October 2021) and conducted grey literature searches. SELECTION CRITERIA: We included randomised controlled trials of mindfulness that involved medical students of any year level and junior doctors in postgraduate years one, two or three. We included any psychological intervention with a primary focus on teaching the fundamentals of mindfulness as a preventative intervention. Our primary outcomes were anxiety and depression, and our secondary outcomes included stress, burnout, academic performance, suicidal ideation and quality of life. DATA COLLECTION AND ANALYSIS: We used standard methods as recommended by Cochrane, including Cochrane's risk of bias 2 tool (RoB2). MAIN RESULTS: We included 10 studies involving 731 participants in quantitative analysis. Compared with waiting-list control or no intervention, mindfulness interventions did not result in a substantial difference immediately post-intervention for anxiety (standardised mean difference (SMD) 0.09, 95% CI -0.33 to 0.52; P = 0.67, I2 = 57%; 4 studies, 255 participants; very low-certainty evidence). Converting the SMD back to the Depression, Anxiety and Stress Scale 21-item self-report questionnaire (DASS-21) showed an estimated effect size which is unlikely to be clinically important. Similarly, there was no substantial difference immediately post-intervention for depression (SMD 0.06, 95% CI -0.19 to 0.31; P = 0.62, I2 = 0%; 4 studies, 250 participants; low-certainty evidence). Converting the SMD back to DASS-21 showed an estimated effect size which is unlikely to be clinically important. No studies reported longer-term assessment of the impact of mindfulness interventions on these outcomes. For the secondary outcomes, the meta-analysis showed a small, substantial difference immediately post-intervention for stress, favouring the mindfulness intervention (SMD -0.36, 95% CI -0.60 to -0.13; P < 0.05, I2 = 33%; 8 studies, 474 participants; low-certainty evidence); however, this difference is unlikely to be clinically important. The meta-analysis found no substantial difference immediately post-intervention for burnout (SMD -0.42, 95% CI -0.84 to 0.00; P = 0.05, I² = 0%; 3 studies, 91 participants; very low-certainty evidence). The meta-analysis found a small, substantial difference immediately post-intervention for academic performance (SMD -0.60, 95% CI -1.05 to -0.14; P < 0.05, I² = 0%; 2 studies, 79 participants; very low-certainty evidence); however, this difference is unlikely to be clinically important. Lastly, there was no substantial difference immediately post-intervention for quality of life (mean difference (MD) 0.02, 95% CI -0.28 to 0.32; 1 study, 167 participants; low-certainty evidence). There were no data available for three pre-specified outcomes of this review: deliberate self-harm, suicidal ideation and suicidal behaviour. We assessed the certainty of evidence to range from low to very low across all outcomes. Across most outcomes, we most frequently judged the risk of bias as having 'some concerns'. There were no studies with a low risk of bias across all domains. AUTHORS' CONCLUSIONS: The effectiveness of mindfulness in our target population remains unconfirmed. There have been relatively few studies of mindfulness interventions for junior doctors and medical students. The available studies are small, and we have some concerns about their risk of bias. Thus, there is not much evidence on which to draw conclusions on effects of mindfulness interventions in this population. There was no evidence to determine the effects of mindfulness in the long term.
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Affiliation(s)
- Praba Sekhar
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Qiao Xin Tee
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Gizem Ashraf
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Darren Trinh
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Jonathan Shachar
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Jiang
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Jack Hewitt
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Sally Green
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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Waechter R, Stahl G, Rabie S, Colak B, Johnson-Rais D, Landon B, Petersen K, Davari S, Zaw T, Mandalaneni K, Punch B. Mitigating medical student stress and anxiety: Should schools mandate participation in wellness intervention programs? MEDICAL TEACHER 2021; 43:945-955. [PMID: 33832384 DOI: 10.1080/0142159x.2021.1902966] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Medical students are at increased risk of poor mental health and need to regularly engage in preventive programs to maintain well-being. However, many do not and it remains an open question whether these programs should be mandatory. We implemented a RCT to examine the effectiveness of assigning medical students to a wellness intervention on adherence to engagement in the assigned intervention and on psychological and academic outcomes. METHOD Medical students participated in a 12-week randomized controlled intervention involving one-hour wellness sessions of either (1) yoga; (2) mindfulness; or (3) walking, held twice-weekly. Students completed standardized psychological assessments at baseline and following the intervention. RESULTS Students randomized to the wellness intervention group engaged in more minutes of assigned activities than students randomized to the control. There was a significant difference in the change from pre- to post- intervention on measures of state anxiety and perceived stress, with better outcomes for the intervention group. CONCLUSIONS The assignment of twice-weekly wellness intervention sessions protects medical students from state anxiety and perceived stress with no negative impact on academic performance. Students adhered to the sessions and reported enjoying the sessions once trying them. Actual engagement is more important than wellness activity type.
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Affiliation(s)
- Randall Waechter
- School of Medicine, St. George's University, St. George, Grenada
| | - Gabriel Stahl
- Emergency Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Sara Rabie
- Department of Educational Services, St. George's University, St. George, Grenada
| | - Bora Colak
- Westchester Medical Center/New York Medical College, Valhalla, NY, USA
| | - Debbi Johnson-Rais
- Division of Student Affairs and Enrollment Management, College of Science, Florida Atlantic University, Boca Raton, FL, USA
| | - Barbara Landon
- Psychological Services Center, School of Medicine, St. George's University, St. George, Grenada
| | | | - Shirin Davari
- School of Medicine, St. George's University, St. George, Grenada
| | - Thinn Zaw
- School of Medicine, St. George's University, St. George, Grenada
| | | | - Bianca Punch
- Windward Islands Research and Education Foundation, St. George, Grenada
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Stability of interleukin-1β, -4, -6, -8, -10, -13, interferon-γ and tumor necrosis factor-α in human sera after repetitive freeze-thaw cycles and long storage. J Pharm Biomed Anal 2021; 196:113900. [PMID: 33535109 DOI: 10.1016/j.jpba.2021.113900] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Cytokines (CKs) are one of the key components of the molecular network modulating multiple immunological interactions. Within such biological systems, CKs functions are associated with several processes, thus quantification of these analytes in serum samples, as well as a faithful determination of its concentration, are crucial for the translational aspect of many studies. AIM This study is focused on the evaluation of the effects of storage duration and multiple freeze-thaw cycles on CKs stability. MATERIALS AND METHODS Serum samples were obtained from 24 healthy participants. Samples were prospectively stored at 4 °C for 1-7 and 30 days, and also underwent multiple freeze-thaw cycles. Afterwards, CK levels were determined by enzyme-linked immunosorbent assay. RESULTS Among the 8 examined CKs all of them showed significant degradation (determined with the two-way ANOVA and post-hoc test) after 4 days of sample storage at 4 °C. Serum were affected by freezing at -20 °C and thawing, and 2 of CKs (IL-1β and IL-8) showed significant concentration decrease after following 2 freeze-thaw cycles. It has been also determineded that CKs in serum samples after multiple freeze-thaw cycles had better stability, when samples were stored at -80 °C (compared to storage at -20 °C). CONCLUSIONS This study demonstrates that long storage at 4 °C, as well as multiple freeze-thaw cycles of serum samples, must be avoided and CK concentrations should be measured immediately after sample collection.
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Ferrer MH, Severin R, Lefort H, Jacob S, Trousselard M. [Improving parasympathetic functioning to contain the inflammatory response of COVID-19 infection]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2020; 65:63-65. [PMID: 33357622 DOI: 10.1016/s0038-0814(20)30248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
COVID-19 infection results in an unrestrained inflammatory reaction in serious cases. The autonomic nervous system (ANS), in particular the parasympathetic branch, helps to regulate the inflammatory response. A dysfunction of this branch, frequent in people at risk of developing COVID-19, favours a pro-inflammatory effect. Reinforcing and stimulating the parasympathetic ANS is possible and accessible to paramedical and medical professionals.
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Affiliation(s)
- Marie-Hélène Ferrer
- Département des neurosciences et sciences cognitives, unité de neurophysiologie du stress, institut de recherche biomédicale des armées, BP 73, 91223 Brétigny-sur-Orge cedex, France.
| | | | - Hugues Lefort
- Hôpital d'instruction des armées Legouest, 27 avenue de Plantières, BP 90001, 57077 Metz cedex 3, France
| | - Sandrine Jacob
- Département des neurosciences et sciences cognitives, unité de neurophysiologie du stress, institut de recherche biomédicale des armées, BP 73, 91223 Brétigny-sur-Orge cedex, France
| | - Marion Trousselard
- Département des neurosciences et sciences cognitives, unité de neurophysiologie du stress, institut de recherche biomédicale des armées, BP 73, 91223 Brétigny-sur-Orge cedex, France
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Schakel L, Veldhuijzen DS, Crompvoets PI, Bosch JA, Cohen S, van Middendorp H, Joosten SA, Ottenhoff TH, Visser LG, Evers AW. Effectiveness of Stress-Reducing Interventions on the Response to Challenges to the Immune System: A Meta-Analytic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 88:274-286. [PMID: 31387109 PMCID: PMC6878733 DOI: 10.1159/000501645] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/21/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is consistent evidence showing an interplay between psychological processes and immune function in health and disease processes. OBJECTIVES The present systematic review and meta-analysis aims to provide a concise overview of the effectiveness of stress-reducing psychological interventions on the activation of immune responses in both healthy subjects and patients. METHODS Included are 3 types of challenges: in vivo, in vitro, and psychophysiological. Such challenges are designed to mimic naturally occurring immune-related threats. RESULTS A systematic literature search was conducted using PubMed, EMBASE, and PsychInfo, resulting in 75 eligible studies. The risk of bias was assessed with the Cochrane risk-of-bias tool. Across all studies, a small-to-medium effect size was found for the effects of psychological interventions on optimization of the immune function (g = 0.33; 95% CI 0.22-0.43). While the largest effects were found for in vivo immune-related challenges (g = 0.61; 95% CI 0.34-0.88; especially on studies that incorporated skin tests and wound healing), studies incorporating psychophysiological challenges and in vitro immune-related stimulations similarly suggest more optimal immune responses among those receiving stress-reducing interventions (g = 0.28; 95% CI 0.15-0.42). CONCLUSION These findings showed substantial heterogeneity depending on the type of challenge, the study populations, and the intervention types. These data demonstrate support for the effectiveness of stress-reducing psychological interventions in improving immunity in studies that tested immune function by means of incorporating an in vivo,in vitro, or psychophysiological challenge. Future research should more consistently incorporate challenges into the study design to gather more insights in the mechanisms underlying the optimized immune function following a psychological intervention. This is also relevant for clinical practice, as psychological interventions can possibly supplement, or at least partially replace, current drug treatments in various somatic conditions to reduce side effects.
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Affiliation(s)
- Lemmy Schakel
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands, .,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands,
| | - Dieuwke S. Veldhuijzen
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Paige I. Crompvoets
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | - Jos A. Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Sheldon Cohen
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Simone A. Joosten
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Tom H.M. Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Leo G. Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Andrea W.M. Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands,Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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Peters EMJ, Müller Y, Snaga W, Fliege H, Reißhauer A, Schmidt-Rose T, Max H, Schweiger D, Rose M, Kruse J. Hair and stress: A pilot study of hair and cytokine balance alteration in healthy young women under major exam stress. PLoS One 2017; 12:e0175904. [PMID: 28423056 PMCID: PMC5397031 DOI: 10.1371/journal.pone.0175904] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 04/02/2017] [Indexed: 12/25/2022] Open
Abstract
Mouse models show that experimental stress mimicking prolonged life-stress exposure enhances neurogenic inflammation, induces adaptive immunity cytokine-imbalance characterized by a shift to Type 1 T-helper cell cytokines and increases apoptosis of epithelial cells. This affects hair growth in otherwise healthy animals. In this study, we investigate whether a prolonged naturalistic life-stress exposure affects cytokine balance and hair parameters in healthy humans. 33 (18 exam, 15 comparison) female medical students with comparable sociobiological status were analyzed during a stressful final examination period, at three points in time (T) 12 weeks apart. T1 was before start of the learning period, T2 between the three-day written exam and an oral examination, and T3 after a 12 week rest and recovery from the stress of the examination period. Assessments included: self-reported distress and coping strategies (Perceived Stress Questionnaire [PSQ], Trier Inventory for the Assessment of Chronic Stress [TICS]), COPE), cytokines in supernatants of stimulated peripheral blood mononucleocytes (PBMCs), and trichogram (hair cycle and pigmentation analysis). Comparison between students participating in the final medical exam at T2 and non-exam students, revealed significantly higher stress perception in exam students. Time-wise comparison revealed that stress level, TH1/TH2 cytokine balance and hair parameters changed significantly from T1 to T2 in the exam group, but not the control. However, no group differences were found for cytokine balance or hair parameters at T2. The study concludes that in humans, naturalistic stress, as perceived during participation in a major medical exam, has the potential to shift the immune response to TH1 and transiently hamper hair growth, but these changes stay within a physiological range. Findings are instructive for patients suffering from hair loss in times of high stress. Replication in larger and more diverse sample populations is required, to assess suitability of trichogram analysis as biological outcome for stress studies.
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Affiliation(s)
- Eva M. J. Peters
- Universitätsmedizin Charité, Center 12 for Internal Medicine and Dermatology, Division for General Internal Medicine, Psychosomatics and Psychotherapy: Psycho-Neuro-Immunology Skin Research Group, Berlin, Germany
- Justus-Liebig-University, Department of Psychosomatics and Psychotherapy, Psychoneuroimmunology Laboratory, Gießen, Germany
- * E-mail:
| | - Yvonne Müller
- Justus-Liebig-University, Department of Psychosomatics and Psychotherapy, Psychoneuroimmunology Laboratory, Gießen, Germany
| | - Wenke Snaga
- Universitätsmedizin Charité, Center 12 for Internal Medicine and Dermatology, Division for General Internal Medicine, Psychosomatics and Psychotherapy: Psycho-Neuro-Immunology Skin Research Group, Berlin, Germany
| | - Herbert Fliege
- Foreign Office, Health Service, Psychosocial Counseling, Auswärtiges Amt, Berlin, Germany
| | - Anett Reißhauer
- Universitätsmedizin Charité, Center 12 for Internal Medicine and Dermatology, Division for Physical Medicine and Rehabilitation, Berlin, Germany
| | | | | | | | - Matthias Rose
- Universitätsmedizin Charité, Center 12 for Internal Medicine and Dermatology, Division for General Internal Medicine, Psychosomatics and Psychotherapy: Psycho-Neuro-Immunology Skin Research Group, Berlin, Germany
| | - Johannes Kruse
- Justus-Liebig-University, Department of Psychosomatics and Psychotherapy, Psychoneuroimmunology Laboratory, Gießen, Germany
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Psychoneuroimmunology of Early-Life Stress: The Hidden Wounds of Childhood Trauma? Neuropsychopharmacology 2017; 42:99-114. [PMID: 27629365 PMCID: PMC5143500 DOI: 10.1038/npp.2016.198] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/04/2016] [Accepted: 09/08/2016] [Indexed: 12/15/2022]
Abstract
The brain and the immune system are not fully formed at birth, but rather continue to mature in response to the postnatal environment. The two-way interaction between the brain and the immune system makes it possible for childhood psychosocial stressors to affect immune system development, which in turn can affect brain development and its long-term functioning. Drawing from experimental animal models and observational human studies, we propose that the psychoneuroimmunology of early-life stress can offer an innovative framework to understand and treat psychopathology linked to childhood trauma. Early-life stress predicts later inflammation, and there are striking analogies between the neurobiological correlates of early-life stress and of inflammation. Furthermore, there are overlapping trans-diagnostic patterns of association of childhood trauma and inflammation with clinical outcomes. These findings suggest new strategies to remediate the effect of childhood trauma before the onset of clinical symptoms, such as anti-inflammatory interventions and potentiation of adaptive immunity. Similar strategies might be used to ameliorate the unfavorable treatment response described in psychiatric patients with a history of childhood trauma.
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Wang B, Katsube T, Begum N, Nenoi M. Revisiting the health effects of psychological stress-its influence on susceptibility to ionizing radiation: a mini-review. JOURNAL OF RADIATION RESEARCH 2016; 57:325-35. [PMID: 27242342 PMCID: PMC4973650 DOI: 10.1093/jrr/rrw035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 02/02/2016] [Accepted: 02/25/2016] [Indexed: 05/03/2023]
Abstract
Both psychological stress (PS) and ionizing radiation (IR) cause varied detrimental effects on humans. There has been no direct evidence so far showing PS alone could cause cancer; however, long-lasting PS may affect our overall health and ability to cope with cancer. Due to their living conditions and occupations, some people may encounter concurrent exposure to both PS and IR to a high extent. In addition to possible health effects resulting directly from exposure to IR on these people, fear of IR exposure is also a cause of PS. The question of whether PS would influence susceptibility to IR, radiocarcinogenesis in particular, is of great concern by both the academic world and the public. Recently, investigations using animal PS models demonstrated that PS could modulate susceptibility to IR, causing increased susceptibility to radiocarcinogenesis in Trp53-heterozygous mice, hematological toxicity in peripheral blood and elevated chromosome aberration (dicentrics) frequency in splenocytes of Trp53-wild-type mice. To actively reduce health risk from exposure to IR, further studies are needed to cumulate more evidence and provide insights into the mechanisms underlying the alterations in susceptibility due to PS modulation. This mini-review gives a general overview of the significance of PS effects on humans and experimental animals, with a special focus on summarizing the latest weight-of-evidence approaches to radiobiological studies on PS-induced alterations in susceptibility in experimental animal models. The susceptibility being investigated is mainly in the context of the impact of the modulatory effect of PS on radiocarcinogenesis; we seek to improve understanding of the combined effects of exposure to both PS and IR in order to facilitate, via active intervention, strategies for radiation risk reduction.
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Affiliation(s)
- Bing Wang
- Radiation Risk Reduction Research Program, Research Center for Radiation Protection, National Institute of Radiological Sciences, Chiba 263-8555, Japan
| | - Takanori Katsube
- Radiation Risk Reduction Research Program, Research Center for Radiation Protection, National Institute of Radiological Sciences, Chiba 263-8555, Japan
| | - Nasrin Begum
- Center for Nuclear Medicine and Ultrasound, Rajshahi Medical College Hospital Campus, G.P.O. Box No. 35, Rajshahi, Bangladesh
| | - Mitsuru Nenoi
- Radiation Risk Reduction Research Program, Research Center for Radiation Protection, National Institute of Radiological Sciences, Chiba 263-8555, Japan
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Aziz N, Detels R, Quint JJ, Li Q, Gjertson D, Butch AW. Stability of cytokines, chemokines and soluble activation markers in unprocessed blood stored under different conditions. Cytokine 2016; 84:17-24. [PMID: 27208752 DOI: 10.1016/j.cyto.2016.05.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/14/2016] [Accepted: 05/10/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Biomarkers such as cytokines, chemokines, and soluble activation markers can be unstable when processing of blood is delayed. The stability of various biomarkers in serum and plasma was investigated when unprocessed blood samples were stored for up to 24h at room and refrigerator temperature. METHODS Blood was collected from 16 healthy volunteers. Unprocessed serum, EDTA and heparinized blood was stored at room (20-25°C) and refrigerator temperature (4-8°C) for 0.5, 2, 4, 6, 8, and 24h after collection before centrifugation and separation of serum and plasma. Samples were batch tested for various biomarkers using commercially available immunoassays. Statistically significant changes were determined using the generalized estimating equation. RESULTS IFN-γ, sIL-2Rα, sTNF-RII and β2-microglobulin were stable in unprocessed serum, EDTA and heparinized blood samples stored at either room or refrigerator temperature for up to 24h. IL-6, TNF-α, MIP-1β and RANTES were unstable in heparinized blood at room temperature; TNF-α, and MIP-1β were unstable in unprocessed serum at room temperature; IL-12 was unstable in unprocessed serum at refrigerator temperature; and neopterin was unstable in unprocessed EDTA blood at room temperature. IL-1ra was stable only in unprocessed serum at room temperature. CONCLUSION All the biomarkers studied, with the exception of IL-1ra, were stable in unprocessed EDTA blood stored at refrigerator temperature for 24h. This indicates that blood for these biomarkers should be collected in EDTA and if delays in processing are anticipated the unseparated blood should be stored at refrigerator temperature until processing.
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Affiliation(s)
- Najib Aziz
- Department of Epidemiology, UCLA, Los Angeles, CA 90095-1772, United States; Fielding School of Public Health, UCLA, Los Angeles, CA 90095-1772, United States.
| | - Roger Detels
- Department of Epidemiology, UCLA, Los Angeles, CA 90095-1772, United States; Fielding School of Public Health, UCLA, Los Angeles, CA 90095-1772, United States
| | - Joshua J Quint
- Department of Epidemiology, UCLA, Los Angeles, CA 90095-1772, United States; Fielding School of Public Health, UCLA, Los Angeles, CA 90095-1772, United States
| | - Qian Li
- Department of Biostatistics, UCLA, Los Angeles, CA 90095-1772, United States; Fielding School of Public Health, UCLA, Los Angeles, CA 90095-1772, United States
| | - David Gjertson
- Department of Biostatistics, UCLA, Los Angeles, CA 90095-1772, United States; David Geffen School of Medicine, UCLA, Los Angeles, CA 90095-1772, United States
| | - Anthony W Butch
- The Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA 90095-1713, United States; David Geffen School of Medicine, UCLA, Los Angeles, CA 90095-1772, United States
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12
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Duggal NA, Upton J, Phillips AC, Lord JM. Development of depressive symptoms post hip fracture is associated with altered immunosuppressive phenotype in regulatory T and B lymphocytes. Biogerontology 2015; 17:229-39. [PMID: 26112234 PMCID: PMC4723613 DOI: 10.1007/s10522-015-9587-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/13/2015] [Indexed: 12/18/2022]
Abstract
Hip fracture is a common physical trauma in older adults that is also associated with a high incidence of new onset depression. The immune system declines with age and is also compromised by physical and psychological stress. This study examined whether hip fracture and depressive symptoms had additive effects upon the aged immune system that might contribute to poor health outcomes after hip fracture. We assessed the frequency of regulatory T cells, Tregs (CD4+ CD25+ Foxp3+) and IL10 production by CD4 T cells, and the frequency and IL10 production by regulatory B cells, Bregs (CD19+ CD24hi CD38hi) in 101 hip fracture patients (81 female) 6 weeks after injury and 43 healthy age-matched controls (28 female). 38 hip fracture patients (37 %) developed depressive symptoms. Hip fracture did not have an effect on circulating Tregs frequency but a significant reduction in the frequency of Bregs was observed in patients who developed depression compared with non-depressed patients (p = 0.001) or healthy controls (p < 0.001). Bregs also showed a significant decline in IL10 production in depressed hip fracture patients compared with controls (p = 0.04) and non-depressed patients (p = 0.01). In contrast, there was an increase in IL10 production by CD4 T cells in hip fracture patients with new onset depression compared to hip fracture patients without depression (p = .04) and healthy controls (p = .02). We conclude that the reduced immunity associated with new onset depression post hip fracture could include a contribution by heightened Tregs function.
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Affiliation(s)
| | - Jane Upton
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Anna C Phillips
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Janet M Lord
- School of Immunity and Infection, University of Birmingham, Birmingham, B15 2TT, UK.
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK.
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13
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LIU W, WANG X, MEI Z, GONG J, GAO X, ZHAO Y, MA J, XIE F, QIAN L. Chronic Stress Promotes the Progression of Pressure Overload-Induced Cardiac Dysfunction Through Inducing More Apoptosis and Fibrosis. Physiol Res 2015; 64:325-34. [DOI: 10.33549/physiolres.932778] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Stress serves as a risk factor in the etiology of hypertension. The present study was designed to decipher the effect and mechanism of chronic stress on the progression of pressure overload-induced cardiac dysfunction. We used abdominal aortic constriction (AAC) to induce pressure overload with or without chronic restraint stress to establish the animal models. Echocardiographic analysis showed pressure overload-induced cardiac dysfunction was worsened by chronic stress. Compared with the AAC rats, there is a significant increase in cardiac hypertrophy, injury, apoptosis and fibrosis of the AAC + stress rats. Furthermore, we found the secretion of norepinephrine (NE) increased after the AAC operation, while the level of NE was higher in the AAC + stress group. Cardiomyocytes and cardiac fibroblasts isolated from neonatal rats were cultured and separately treated with 1, 10, 100 μM NE. The higher concentration NE induced more cardiomyocytes hypertrophy and apoptosis, cardiac fibroblasts proliferation and collagen expression. These results revealed that high level of NE-induced cardiomyocytes hypertrophy and apoptosis, cardiac fibroblasts proliferation and collagen expression further contributes to the effect of chronic stress on acceleration of pressure overload-induced cardiac dysfunction.
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Affiliation(s)
| | | | | | | | | | | | | | | | - L. QIAN
- Beijing Institute of Basic Medical Sciences, Beijing, China
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14
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Stiegel MA, Pleil JD, Sobus JR, Morgan MK, Madden MC. Analysis of inflammatory cytokines in human blood, breath condensate, and urine using a multiplex immunoassay platform. Biomarkers 2014; 20:35-46. [PMID: 25495125 DOI: 10.3109/1354750x.2014.988646] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A change in the expression of cytokines in human biological media indicates an inflammatory response to external stressors and reflects an early step along the adverse outcome pathway (AOP) for various health endpoints. To characterize and interpret this inflammatory response, methodology was developed for measuring a suite of 10 different cytokines in human blood, exhaled breath condensate (EBC), and urine using an electrochemiluminescent multiplex Th1/Th2 cytokine immunoassay platform. Measurement distributions and correlations for eight interleukins (IL) (1β, 2, 4, 5, 8, 10, 12p70 and 13), interferon-γ (IFN-γ), and tumor necrosis factor-α (TNF-α) were evaluated using 90 blood plasma, 77 EBC, and 400 urine samples collected from nominally healthy adults subjects in North Carolina in 2008-2012. The in vivo results show that there is sufficient sensitivity for characterizing all 10 cytokines at levels of 0.05-0.10 ρg/ml with a dynamic range up to 100 ng/ml across all three of these biological media. The measured in vivo results also show that the duplicate analysis of blood, EBC and urine samples have average estimated fold ranges of 2.21, 3.49, and 2.50, respectively, which are similar to the mean estimated fold range (2.88) for the lowest concentration (0.610 ρg/ml) from a series of spiked control samples; the cytokine method can be used for all three biological media. Nine out of the 10 cytokines measured in EBC were highly correlated within one another with Spearman ρ coefficients ranging from 0.679 to 0.852, while the cytokines measured in blood had a mix of negative and positive correlations, ranging from -0.620 to 0.836. Almost all correlations between EBC and blood were positive. This work also represents the first successful within- and between-person evaluation of ultra trace-level inflammatory markers in blood, EBC, and urine.
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Affiliation(s)
- Matthew A Stiegel
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, NC , USA
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15
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16
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Gill JM, Saligan L, Lee H, Rotolo S, Szanton S. Women in recovery from PTSD have similar inflammation and quality of life as non-traumatized controls. J Psychosom Res 2013; 74:301-6. [PMID: 23497831 DOI: 10.1016/j.jpsychores.2012.10.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/03/2012] [Accepted: 10/29/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) is associated with greater concentrations of inflammatory biomarkers as well as substantial medical burden; however, it is not clear if these morbidity risks change following recovery from PTSD. In this study we compare women who have recovered from PTSD, to those with current PTSD, and healthy controls on their perceived health and inflammatory and metabolic biomarkers. METHODS We studied 3 groups of women: those with current PTSD, those who reported recovery from PTSD, and healthy non-traumatized controls, which were determined using standard diagnostic instruments. We obtained a morning blood sample and examined concentrations of inflammatory biomarkers of: interleukin 6 (IL-6) and c-reactive protein (CRP), and lipid concentrations. Lastly, we evaluated health related quality of life (HRQOL). RESULTS Women who had recovered from PTSD had a similar HRQOL and inflammatory biomarkers as non-traumatized controls. Their concentrations of inflammatory biomarkers were lower than women with current PTSD, and similar to non-traumatized controls. CONCLUSION Health perception as well as biological indicators of health significantly differ in women in recovery from PTSD, compared to those who remain symptomatic. These findings suggest that the psychological recovery is associated with normal levels of inflammatory biomarkers and HRQOL.
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Affiliation(s)
- Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
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17
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Glei DA, Goldman N, Lin YH, Weinstein M. Relaxation practice and physiologic regulation in a national sample of older Taiwanese. J Altern Complement Med 2012; 18:653-61. [PMID: 22775201 DOI: 10.1089/acm.2010.0598] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To compare the effects of relaxation practice and other exercise on a multisystem measure of physiologic dysregulation in a national sample of older Taiwanese. DESIGN The study was a cross-sectional survey. SETTINGS/LOCATION The study was conducted in Taiwan. SUBJECTS A population-based sample of 1036 adults aged 53 and older completed an in-home interview and in-hospital physical examination. The final model is based on 934 respondents with complete data. OUTCOME MEASURES The outcome measures were overall dysregulation, based on 26 biomarkers, and subscores for cardiovascular/metabolic risk factors and inflammatory markers. RESULTS After adjustment for age and sex, overall dysregulation is 0.35 of a standard deviation (SD) lower for practitioners of relaxation techniques compared with nonpractitioners. The effect of exercise is smaller: 0.19 SD difference between those who exercise regularly and those who do not exercise. Similar effects of relaxation practice and regular exercise were found on inflammation, but smaller effects for cardiovascular/metabolic risk factors. In the presence of controls for sociodemographic characteristics, medication use, and a wide range of self-reported and interviewer-assessed health indicators, the effect of relaxation practice is attenuated but remains sizable (-0.19 of a SD for overall dysregulation); regular exercise has a comparable effect (-0.16 of a SD). The effects are similar for the inflammation subscore, but not significant for cardiovascular/metabolic risk factors after adjusting for health status. CONCLUSIONS The physiologic benefits of relaxation practice that have been demonstrated in small experimental studies are also evident in the general population of older Taiwanese who practice these techniques in everyday life. Relaxation practice is associated with lower levels of physiologic dysregulation, particularly with respect to inflammation. Among this sample of older adults, the effect appears to be at least as large as that for exercise. Older people with limited ability to engage in vigorous exercise may especially welcome such information.
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Affiliation(s)
- Dana A Glei
- Center for Population and Health, Georgetown University, Washington, DC, USA.
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18
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Zhang W, Li F, Qin S, Luo J. The integrative effects of cognitive reappraisal on negative affect: associated changes in secretory immunoglobulin A, unpleasantness and ERP activity. PLoS One 2012; 7:e30761. [PMID: 22319586 PMCID: PMC3271092 DOI: 10.1371/journal.pone.0030761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 12/20/2011] [Indexed: 12/02/2022] Open
Abstract
Although the regulatory role of cognitive reappraisal in negative emotional responses is widely recognized, this reappraisal's effect on acute saliva secretory immunoglobulin A (SIgA), as well as the relationships among affective, immunological, and event-related potential (ERP) changes, remains unclear. In this study, we selected only people with low positive coping scores (PCSs) as measured by the Trait Coping Style Questionnaire to avoid confounding by intrinsic coping styles. First, we found that the acute stress of viewing unpleasant pictures consistently decreased SIgA concentration and secretion rate, increased perceptions of unpleasantness and amplitude of late positive potentials (LPPs) between 200–300 ms and 400–1000 ms. After participants used cognitive reappraisal, their SIgA concentration and secretion rate significantly increased and their unpleasantness and LPP amplitudes significantly decreased compared with a control condition. Second, we found a significantly positive correlation between the increases in SIgA and the decreases in unpleasantness and a significantly negative correlation between the increases in SIgA and the increases in LPP across the two groups. This study is the first to demonstrate that cognitive reappraisal reverses the decrease of SIgA. In addition, it revealed strong correlations among affective, SIgA and electrophysiological changes with convergent multilevel evidence.
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Affiliation(s)
- Wencai Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Fan Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Shaozheng Qin
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - Jing Luo
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Beijing Key Laboratory of Learning and Cognition, Department of Psychology, Capital Normal University, Beijing, China
- * E-mail:
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19
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Sorenson M, Janusek L, Mathews H. Psychological Stress and Cytokine Production in Multiple Sclerosis. Biol Res Nurs 2011; 15:226-33. [DOI: 10.1177/1099800411425703] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective:Psychological variables such as perceived stress appear to play a role in symptom onset or disease exacerbation in multiple sclerosis (MS). The authors sought to determine if perceived stress is indeed associated with the expression of pro-inflammatory cytokines and disease symptoms in individuals with MS. To do so, the authors examined the relationships among disease symptomatology, perceived stress, and cytokine production from peripheral blood mononuclear cells in 42 outpatients with MS and 36 normative controls.Method:The authors drew peripheral blood from all subjects prior to the completion of a series of psychological instruments. The authors measured stress using the Perceived Stress scale and negative mood with the Profile of Mood States. Disease symptoms were measured using the Multiple Sclerosis Symptom Checklist. Cytokine production was induced separately by lipopolysaccharide and a combination of phytohemagglutinin and phorbol-12-myristate-13-acetate.Results:In MS subjects, the induced production of interleukin (IL)-6 and IL-10 positively correlated with psychological stress, mood disturbance, and disease symptomatology. In contrast, psychological stress in control subjects significantly correlated with level of tumor necrosis factor-alpha (TNF-α), and mood disturbance correlated with levels of TNF-α and interferon-gamma. As well, compared to controls, MS subjects exhibited a significant fourfold increase in the production of IL-12.Conclusion:There is, in those with MS, a pattern of IL-6 and IL-10 production that correlates significantly with perceived stress and disease symptomatology.
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Affiliation(s)
| | - Linda Janusek
- Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Herbert Mathews
- Department of Microbiology and Immunology, Loyola University Chicago, Chicago, IL, USA
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20
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Gill JM, Szanton S. Inflammation and traumatic stress: the society to cells resiliency model to support integrative interventions. J Am Psychiatr Nurses Assoc 2011; 17:404-16. [PMID: 22142977 DOI: 10.1177/1078390311418652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a prevalent psychiatric disorder that develops following a traumatic event and has substantial health implications, including high rates of health morbidity and mortality, as well as significant health-related costs. Medical risks that are associated with PTSD often have an underlying inflammatory pathology, suggesting that inflammation contributes to these health declines. OBJECTIVES AND DESIGN In this critical literature review, the authors examine the medical risks associated with PTSD and the inflammatory mechanisms that likely underlie these risks. RESULTS AND CONCLUSIONS The authors offer a review of their "Cells to Society Resiliency Model" to motivate the development of integrative interventions that include factors of society, community, family, individual, physiological, and cellular factors to thereby reduce the health risks associated with PTSD.
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Affiliation(s)
- Jessica M Gill
- National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA.
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21
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Khabour OF, Barnawi JM. Association of longevity with IL-10 -1082 G/A and TNF-alpha-308 G/A polymorphisms. Int J Immunogenet 2010; 37:293-8. [PMID: 20518833 DOI: 10.1111/j.1744-313x.2010.00925.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cytokines are crucial for the regulation of inflammation development in humans. Many studies have shown that variations in cytokine genes might play a role in determining human longevity. This study examined the changes in the gene pool relevant to the -308 G/A polymorphism in the promoter region of the proinflammatory cytokine tumour necrosis factor (TNF)-alpha gene and the -1082 G/A polymorphism in the promoter region of anti-inflammatory cytokine interleukin (IL)-10 gene with aging and survival selection occurs in the Jordanian population. IL-10 -1028 G/A and TNF-alpha-308 G/A were genotyped in 119 randomly selected elderly subjects (41 women and 78 men) with a mean age of 90.2 years and young control subjects of 118 (46 women and 72 men) with a mean age of 31.9 years. No significant differences were found in the genotype and allele frequencies of TNF-alpha gene variants between the two groups (P > 0.05) while the IL-10 genotype and allele frequencies were significantly associated with longevity in men (P < 0.05) but not in women (P < 0.05). Thus, IL-10 -1028 G/A polymorphism seems to play a role in the pathway to longevity in Jordanian men.
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Affiliation(s)
- O F Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan.
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22
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Gill JM, Saligan L, Woods S, Page G. PTSD is associated with an excess of inflammatory immune activities. Perspect Psychiatr Care 2009; 45:262-77. [PMID: 19780999 DOI: 10.1111/j.1744-6163.2009.00229.x] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE. Post-traumatic stress disorder (PTSD) is associated with inflammatory-related medical conditions. This review examines studies of immune function in individuals with PTSD to determine if excessive inflammation is associated with PTSD. CONCLUSIONS. Current studies suggest an excess of inflammatory actions of the immune system in individuals with chronic PTSD. High levels of inflammatory cytokines have also been linked to PTSD vulnerability in traumatized individuals. There is also evidence that excessive inflammation is in part due to insufficient regulation by cortisol. PRACTICE IMPLICATIONS. An excess of inflammatory immune activity may contribute to health declines in individuals with PTSD, and treating PTSD symptoms may reduce these risks.
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Affiliation(s)
- Jessica M Gill
- National Institutes of Health, National Institutes of Nursing Research, Bethesda, MD, USA.
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23
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Curtin NM, Mills KHG, Connor TJ. Psychological stress increases expression of IL-10 and its homolog IL-19 via beta-adrenoceptor activation: reversal by the anxiolytic chlordiazepoxide. Brain Behav Immun 2009; 23:371-9. [PMID: 19159673 DOI: 10.1016/j.bbi.2008.12.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 12/08/2008] [Accepted: 12/08/2008] [Indexed: 10/21/2022] Open
Abstract
Recent studies from our laboratory indicate that psychological stress is a potent inducer of the anti-inflammatory cytokine interleukin (IL)-10, raising the possibility that the IL-10 family of cytokines may be key mediators of stress-induced immunosuppression. In this study we examined the impact of psychological stress (restraint stress) on expression of IL-10, and the novel IL-10 family members IL-19, IL-20 and IL-24 in mouse spleen following an in vivo challenge with lipopolysaccharide (LPS). We found that stressor exposure significantly augmented LPS-induced IL-10 expression. Similarly, IL-19 expression was induced by LPS, and this was significantly enhanced by restraint stress. In contrast, expression of IL-24 was not significantly altered by LPS or stress, and expression of IL-20 was largely not detectable in vivo in either saline or LPS-treated animals. Consistent with a role for sympathetic nervous system (SNS) activation in stress-induced immune regulation, the sympathetic neurotransmitter noradrenaline increased LPS-induced IL-10 and IL-19 expression in splenocytes and dendritic cells, and the ability of noradrenaline to induce expression of these cytokines was blocked by pre-treatment with the beta-adrenoceptor antagonist propranolol. Similarly, pre-treatment of mice with the peripherally acting beta-adrenoceptor antagonist nadolol completely blocked the stress-induced increase in IL-10 and IL-19 mRNA expression. Finally, pre-treatment with the benzodiazepine anxiolytic chlordiazepoxide prevented the stress-induced increase in IL-10 and IL-19 expression. Taken together, these data demonstrate that psychological stress induces expression of the IL-10 and its homolog IL-19 via activation of beta-adrenoceptors, and the ability of stress to induce these cytokines is prevented by treatment with the anxiolytic chlordiazepoxide. The findings suggest that stress enhances the production of immunosuppressive cytokines, which may impact on stress-related disease processes.
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Affiliation(s)
- Niamh M Curtin
- Neuroimmunology Research Group, Department of Physiology, School of Medicine & Trinity College Institute of Neuroscience, Trinity College, Dublin 2, Ireland
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24
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Connor TJ. Don't stress out your immune system - just relax. Brain Behav Immun 2008; 22:1128-9. [PMID: 18708135 DOI: 10.1016/j.bbi.2008.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022] Open
Affiliation(s)
- Thomas J Connor
- Neuroimmunology Research Group, Department of Physiology, School of Medicine & Trinity College Institute of Neuroscience, Trinity College, Dublin 2, Ireland
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