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Sharp TH, Chideya Y, Giuliani A, Hunt X, Tomlinson M, Seedat S, Creswell C, Fearon P, Hamilton-Giachritsis C, Hiller R, Meiser-Stedman R, Du Toit S, Stewart J, Halligan SL. Post-traumatic stress disorder symptoms following exposure to acute psychological trauma in children aged 8-16 years in South Africa: protocol for the Sinethemba longitudinal study. BMJ Open 2024; 14:e085129. [PMID: 38991675 DOI: 10.1136/bmjopen-2024-085129] [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] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Children exposed to trauma are vulnerable to developing post-traumatic stress disorder (PTSD) and other adverse mental health outcomes. In low-and middle-income countries (LMICs), children are at increased risk of exposure to severe trauma and co-occurring adversities. However, relative to high-income countries, there is limited evidence of the factors that predict good versus poor psychological recovery following trauma exposure in LMIC children, and the role of caregiver support in these high-adversity communities. METHODS AND ANALYSIS We will conduct a longitudinal, observational study of 250 children aged 8-16 years and their caregivers in South Africa, following child exposure to acute trauma. Dyads will be recruited from community hospitals following a potentially traumatic event, such as a motor vehicle accident or assault. Potential participants will be identified during their hospital visit, and if they agree, will subsequently be contacted by study researchers. Assessments will take place within 4 weeks of the traumatic event, with 3-month and 6-month follow-up assessments. Participants will provide a narrative description of the traumatic event and complete questionnaires designed to give information about social and psychological risk factors. Child PTSD symptoms will be the primary outcome, and wider trauma-related mental health (depression, anxiety, behavioural problems) will be secondary outcomes. Regression-based methods will be used to examine the association of psychosocial factors in the acute phase following trauma, including caregiver support and responding, with child PTSD and wider mental health outcomes. ETHICS AND DISSEMINATION Ethical approvals have been granted by Stellenbosch University and the University of Bath, with additional approvals to recruit via hospitals and healthcare clinics being granted by the University of Cape Town, the Department of Health and the City of Cape Town. Study findings will be disseminated via publication in journals, workshops for practitioners and policy-makers, and public engagement events.
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Affiliation(s)
| | - Yeukai Chideya
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | | | - Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Pasco Fearon
- University of Cambridge Centre for Family Research, Cambridge, UK
| | | | - Rachel Hiller
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia Norwich Medical School, Norwich, UK
| | - Stefani Du Toit
- Department of Psychiatry, University of Cape Town, Rondebosch, South Africa
| | - Jackie Stewart
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Department of Surgery, University of Cape Town, Rondebosch, South Africa
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Hava D. An Ecological Review of Homicide Bereavement's Risk Factors: Implications for Future Research. TRAUMA, VIOLENCE & ABUSE 2024; 25:413-429. [PMID: 36869782 DOI: 10.1177/15248380231155527] [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: 06/18/2023]
Abstract
This literature review focused on homicide bereavement (HB) risk factors. A content analysis was conducted on 83 empirical papers published in English from January 2000 to December 2021 in peer-reviewed journals. Extracted HB risk factors were synthesized according to six main dimensions: individual level; situational homicide-related factors; and micro, meso, exo, and macro social levels. The review demonstrates that macro-level and situational homicide-related risk factors are in special need of further study. In addition, how HB risk factors interact with one another to influence HB also requires further study. Future research may benefit from examining whether and how individuals experiencing HB influence related factors at various social levels. Last, given that almost all reviewed studies were conducted in Western societies, the sociocultural and ethnic diversity in HB risk factors is in dire need of future study.
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Whitney AJ, Lindeque Z, Kruger R, Steyn SF. Genetically predisposed and resilient animal models of depression reveal divergent responses to early-life adversity. Acta Neuropsychiatr 2023:1-13. [PMID: 37592838 DOI: 10.1017/neu.2023.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Early-life adversity (ELA) is one of the strongest predictors of childhood depression that may be exacerbated by a genetic predisposition to develop depression. We therefore investigated the bio-behavioural effects of an early-life stressor in an accepted rodent model of depression. METHODS The Flinders sensitive line (FSL) and resistant line (FRL) rats were subjected to an early-life stressor, whereafter their bio-behavioural response during pubertal onset was evaluated. Male and female pups were maternally separated for 3 h per day from postnatal day 02 (PND02) to 17, when they were also weaned. Control animals were left undisturbed, until weaning on PND21. Depressive-like behaviour was analysed on PND21 and reassessed on PND36. Hippocampal monoamine levels, markers of oxidative stress and metabolic markers implicating mitochondrial function were also measured. RESULTS On PND21, the non-maternal separation and early weaning (non-MSEW) FSL rats spent 10% more time mobile than their FRL controls in the tail suspension test (TST) yet displayed increased depressive-like behaviour in the forced swim test (FST) on PND36. This depressive-like behaviour coincided with increased hippocampal norepinephrine levels, serotonin turnover and a dysfunctional redox state. Maternal separation and early weaning (MSEW) appeared to initially reduce early-life (PND21) depressive-like behaviour in the TST but then induced depressive-like behaviour on PND36 and increased norepinephrine levels more profoundly in the FRL rats. CONCLUSION These findings highlight the need to further investigate the stress response pathway in these animals and that the absence or presence of genetic susceptibility may influence the presentation of ELA effects.
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Affiliation(s)
- Ashleigh J Whitney
- Centre of Excellence for Pharmaceutical Sciences, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Zander Lindeque
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
| | - Ruan Kruger
- Hypertension in African Research Team (HART), North-West University, Potchefstroom, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Stephan F Steyn
- Centre of Excellence for Pharmaceutical Sciences, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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Andersen E, Prim J, Campbell A, Schiller C, Baresich K, Girdler S. Biobehavioral mechanisms underlying testosterone and mood relationships in peripubertal female adolescents. Dev Psychopathol 2023:1-15. [PMID: 37529837 PMCID: PMC10834847 DOI: 10.1017/s0954579423000937] [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] [Indexed: 08/03/2023]
Abstract
The pubertal transition is characterized by pronounced sex hormone fluctuation, refinement of affective neural circuitry, and an increased risk of depression in female adolescents. Sex hormones, including testosterone, exert modulatory effects on frontal-limbic brain networks and are associated with emotion dysregulation and depressive symptoms. Weekly changes in hormones predict affective symptoms in peripubertal female adolescents, particularly in the context of stress; however, the biobehavioral mechanisms underlying hormone change and mood relationships during the pubertal transition have yet to be determined and was the objective of the present study. Forty-three peripubertal female adolescents (ages 11-14) collected 8-weekly salivary hormone (estrone, testosterone) samples and mood assessments to evaluate hormone-mood relationships, followed by a biobehavioral testing session with psychosocial stress and EEG. Within-person correlations between weekly hormone changes and corresponding mood were performed to determine individual differences in mood sensitivity to weekly hormone change. Increased frontal theta activity indexing emotion reactivity, reduced cortisol reactivity, and reduced vagal efficiency predicted the strength of the relationship between testosterone and mood. Further, testosterone-sensitivity strength was associated with the enhancement of negative affect following stress testing. Results identify divergent frontal theta and stress responses as potential biobehavioral mechanisms underlying mood sensitivity to peripubertal testosterone fluctuation.
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Affiliation(s)
- Elizabeth Andersen
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Julianna Prim
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Alana Campbell
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Crystal Schiller
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Kayla Baresich
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
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Raise-Abdullahi P, Meamar M, Vafaei AA, Alizadeh M, Dadkhah M, Shafia S, Ghalandari-Shamami M, Naderian R, Afshin Samaei S, Rashidy-Pour A. Hypothalamus and Post-Traumatic Stress Disorder: A Review. Brain Sci 2023; 13:1010. [PMID: 37508942 PMCID: PMC10377115 DOI: 10.3390/brainsci13071010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Humans have lived in a dynamic environment fraught with potential dangers for thousands of years. While fear and stress were crucial for the survival of our ancestors, today, they are mostly considered harmful factors, threatening both our physical and mental health. Trauma is a highly stressful, often life-threatening event or a series of events, such as sexual assault, war, natural disasters, burns, and car accidents. Trauma can cause pathological metaplasticity, leading to long-lasting behavioral changes and impairing an individual's ability to cope with future challenges. If an individual is vulnerable, a tremendously traumatic event may result in post-traumatic stress disorder (PTSD). The hypothalamus is critical in initiating hormonal responses to stressful stimuli via the hypothalamic-pituitary-adrenal (HPA) axis. Linked to the prefrontal cortex and limbic structures, especially the amygdala and hippocampus, the hypothalamus acts as a central hub, integrating physiological aspects of the stress response. Consequently, the hypothalamic functions have been attributed to the pathophysiology of PTSD. However, apart from the well-known role of the HPA axis, the hypothalamus may also play different roles in the development of PTSD through other pathways, including the hypothalamic-pituitary-thyroid (HPT) and hypothalamic-pituitary-gonadal (HPG) axes, as well as by secreting growth hormone, prolactin, dopamine, and oxytocin. This review aims to summarize the current evidence regarding the neuroendocrine functions of the hypothalamus, which are correlated with the development of PTSD. A better understanding of the role of the hypothalamus in PTSD could help develop better treatments for this debilitating condition.
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Affiliation(s)
| | - Morvarid Meamar
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
| | - Abbas Ali Vafaei
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
- Department of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Maryam Alizadeh
- Department of Basic Medical Sciences, Faculty of Medicine, Qom Medical Sciences, Islamic Azad University, Qom, Iran
| | - Masoomeh Dadkhah
- Pharmaceutical Sciences Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sakineh Shafia
- Immunogenetics Research Center, Department of Physiology, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Ramtin Naderian
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Seyed Afshin Samaei
- Department of Neurology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Ali Rashidy-Pour
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
- Department of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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Brackbill RM, Butturini E, Cone JE, Ahmadi A, Daniels RD, Farfel MR, Kubale T. Scientific Value of the Sub-Cohort of Children in the World Trade Center Health Registry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12461. [PMID: 36231761 PMCID: PMC9564973 DOI: 10.3390/ijerph191912461] [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: 08/04/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
The World Trade Center Health Registry (WTCHR) was established in 2002 as a public health resource to monitor the health effects from the World Trade Center (WTC) disaster. We evaluated the representativeness of the WTC youth population (<18 years on 11 September 2001) by comparing the distributions of age, gender, race/ethnic groups, and income to 2000 census data for the matched geographic area, including distance from disaster. There were 2379 WTCHR enrolled children living in Lower Manhattan south of Canal Street on 11 September 2001, along with 752 enrolled students who attended school in Lower Manhattan but were not area residents. The WTCHR sub-group of children who were residents was similar to the geographically corresponding census population on age and sex. Black and Hispanic children are moderately overrepresented at 0.9% and 2.4% in the WTCHR compared to 0.8% and 1.7% in census population, respectively, while lower-income households are slightly under-represented, 28.8% in the WTCHR and 30.8% for the corresponding census information. Asian children appear underrepresented at 3.0% participation compared to 6.3% in the census. While the demographics of WTCHR youth are somewhat skewed, the gaps are within expected patterns of under-representation observed in other longitudinal cohorts and can be effectively addressed analytically or through targeted study design.
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Affiliation(s)
- Robert M. Brackbill
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Emma Butturini
- World Trade Center Health Program Division, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - James E. Cone
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Ayda Ahmadi
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Robert D. Daniels
- World Trade Center Health Program Division, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Mark R. Farfel
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 11101, USA
| | - Travis Kubale
- World Trade Center Health Program Division, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Hayes B, Brent J, Zhong Y, Bazmi S, Porta G, Bovbjerg DH, Tarhini A, Kirkwood JM, Brent DA, Marsland A, Melhem NM. Early Cortisol and Inflammatory Responses to Parental Cancer and Their Impact on Functional Impairment in Youth. J Clin Med 2021; 10:576. [PMID: 33557083 PMCID: PMC7913784 DOI: 10.3390/jcm10040576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Chronic stress is associated with increased risk for maladaptive psychological responses during childhood, adolescence, and young adulthood. Adults exposed to chronic stress during childhood exhibit dysregulation of hypothalamic-pituitary-adrenal (HPA) axis activity and inflammation. There are no studies examining the impact of stress on biological stress responses and functional impairment in adolescents and young adults early after the onset of a stressor. METHODS The sample consisted of 59 offspring, aged 11-25 years, 33 of parents diagnosed with cancer and 26 controls from families with no cancer or severe chronic illness in parents or siblings. Cancer patients and their families were recruited within an average of 62 days (SD = 35.9) and followed at 6 and 9 months later. Functional impairment was assessed and hair cortisol concentrations (HCC), salivary cortisol, and inflammatory markers were measured. Mixed regression analyses were conducted. RESULTS The stress group showed higher functional impairment (β = -5.5, 95% CI (-10.4, -0.06), p = 0.03, d= -0.40) and HCC (β = 10.5, 95% CI (-5.5, -0.50), p < 0.001, d = 1.43). However, HCC were reduced over time in the stress group (β= -0.3, 95% CI (-0.04, -0.01), p < 0.001, d = -1.08). Higher total cortisol output was associated with increased functional impairment over time (β = -3.0, 95% CI (-5.5, -0.5), p = 0.02, d = -0.60). CONCLUSIONS Parental cancer is associated with early increase in cortisol, which was associated with increased functional impairment in offspring. Clinicians need to assess and monitor psychiatric symptoms and functioning in these offspring early on following parental cancer diagnosis.
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Affiliation(s)
- Benjamin Hayes
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA;
| | - Jacob Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA; (J.B.); (D.A.B.)
| | - Yongqi Zhong
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, USA;
| | - Shervin Bazmi
- Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA 15260, USA; (S.B.); (A.M.)
| | - Giovanna Porta
- University of Pittsburgh Medical Center (UPMC), 100 N Bellefield Ave, Pittsburgh, PA 15213, USA;
| | - Dana H. Bovbjerg
- UPMC Hillman Cancer Center, 5150 Centre Ave. Pittsburgh, PA 15232, USA; (D.H.B.); (A.T.); (J.M.K.)
| | - Ahmad Tarhini
- UPMC Hillman Cancer Center, 5150 Centre Ave. Pittsburgh, PA 15232, USA; (D.H.B.); (A.T.); (J.M.K.)
| | - John M. Kirkwood
- UPMC Hillman Cancer Center, 5150 Centre Ave. Pittsburgh, PA 15232, USA; (D.H.B.); (A.T.); (J.M.K.)
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA; (J.B.); (D.A.B.)
| | - Anna Marsland
- Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA 15260, USA; (S.B.); (A.M.)
| | - Nadine M. Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA; (J.B.); (D.A.B.)
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Lopizzo N, Mazzelli M, Zonca V, Begni V, D'Aprile I, Cattane N, Pariante CM, Riva MA, Cattaneo A. Alterations in 'inflammatory' pathways in the rat prefrontal cortex as early biological predictors of the long-term negative consequences of exposure to stress early in life. Psychoneuroendocrinology 2021; 124:104794. [PMID: 33429258 DOI: 10.1016/j.psyneuen.2020.104794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
Early life stress, especially when experienced during the first period of life, affects the brain developmental trajectories leading to an enhanced vulnerability for stress-related psychiatric disorders later in life. Although both clinical and preclinical studies clearly support this association, the biological pathways deregulated by such exposure, and the effects in shaping the neurodevelopmental trajectories, have so far been poorly investigated. By using the prenatal stress (PNS) model, a well-established rat model of early life stress, we performed transcriptomic analyses in the prefrontal cortex of rats exposed or not to PNS and sacrificed at different postnatal days (PNDs 21, 40, 62). We first investigated the long-lasting mechanisms and pathways affected in the PFC. We have decided to focus on the prefrontal cortex because we have previously shown that this brain region is highly sensitive to PNS exposure. We found that adult animals exposed to PNS show alterations in 389 genes, mainly involved in stress and inflammatory signalling. We then wanted to establish whether PNS exposure could also affect the neurodevelopmental trajectories in order to identify the most critical temporal window. We found that PNS rats show the most significant changes during adolescence (between PND 40 versus PND 21), with alterations of several pathways related to stress, inflammation and metabolism, which were maintained until adulthood.
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Affiliation(s)
- Nicola Lopizzo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy
| | - Monica Mazzelli
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy
| | - Valentina Zonca
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Veronica Begni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy
| | - Ilari D'Aprile
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Nadia Cattane
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Carmine M Pariante
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Marco A Riva
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy.
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Pfefferbaum B. Children's Exposure to Single Incidents of Terrorism: Perspectives Over 25 Years Since the Oklahoma City Bombing. Curr Psychiatry Rep 2020; 22:39. [PMID: 32514785 DOI: 10.1007/s11920-020-01163-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This paper traces advances in our knowledge about children's exposure and reactions to terrorist events over the last 25 years, beginning with the 1995 Oklahoma City bombing, and offers observations about cross-cutting issues including implications for services. RECENT FINDINGS Direct and indirect interpersonal exposures have been examined in community samples and in samples of children selected because of their event experiences. Despite its present exclusion from the stressor criterion for a diagnosis of posttraumatic stress disorder, considerable research has documented an association between children's initial subjective reaction and outcomes. Few studies have examined the influence of community or distant effects on outcomes, but contact with media coverage has been well studied. This review confirms the central role of exposure in influencing children's reactions to terrorist incidents and supports recent efforts to distinguish specific experiences that constitute children's event exposures.
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Affiliation(s)
- Betty Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, WP3217, P.O. Box 26901, Oklahoma City, OK, 73126-0901, USA.
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Zantvoord JB, Ensink JBM, Op den Kelder R, Wessel AMA, Lok A, Lindauer RJL. Pretreatment cortisol predicts trauma-focused psychotherapy response in youth with (partial) posttraumatic stress disorder. Psychoneuroendocrinology 2019; 109:104380. [PMID: 31352130 DOI: 10.1016/j.psyneuen.2019.104380] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/01/2019] [Accepted: 07/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite availability of effective trauma-focused psychotherapies, treatment non-response in youth with (partial) posttraumatic stress disorder remains substantial. Studies in adult PTSD have suggested that cortisol is associated with treatment outcome. Furthermore, cortisol prior to treatment could be used to predict treatment success. However, there is a lack of comparable studies in youth with (partial) PTSD. The objective of the current study was therefore to test whether cortisol prior to treatment would differ between treatment responders and non-responders and would positively predict the extent of clinical improvement in youth with (partial) PTSD. METHODS Youth aged 8-18 with PTSD (79.2%) or partial PTSD (20.8%) were treated with 8 sessions of either trauma-focused cognitive behavioral therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR). Prior to treatment initiation, salivary cortisol was measured in treatment responders (n = 23) and treatment non-responders (n = 30) at 10 and 1 min before and 10, 20 and 30 min after personalized trauma script driven imagery (SDI). The cortisol stress response (>1.5 nmol/L increase from baseline) and basal cortisol secretion was assessed during the SDI procedure. We hypothesized that treatment responders would display higher cortisol levels caused by increased cortisol reactivity prior to trauma-focused psychotherapy relative to psychotherapy non-responders and higher cortisol levels would positively predict the extent of clinical improvement. RESULTS Script driven imagery did not induce a cortisol stress response in all but two participants. Prior to treatment responders showed significantly higher basal cortisol secretion during SDI compared to treatment non-responders. This effect remained significant after controlling for gender. Higher pre-treatment basal cortisol secretion further positively predicted the extent of clinical improvement during trauma-focused psychotherapy. CONCLUSION Because SDI failed to provoke a cortisol stress response in our sample, the question if cortisol reactivity differs between treatment responders and non-responders remains inconclusive. However, our results do suggest that higher pretreatment basal cortisol secretion forms a potential indicator of prospective trauma-focused psychotherapy response in youth with (partial) PTSD. Although, the amount of uniquely explained variance in clinical improvement by pre-treatment cortisol secretion is limited and still renders insufficient basis for clinical applicability, these findings do suggest directions for future studies to delineate the mechanisms of treatment success in youth with (partial) PTSD.
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Affiliation(s)
- Jasper B Zantvoord
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Judith B M Ensink
- The Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands; Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Rosanne Op den Kelder
- The Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands; Department of Child Development and Education, University of Amsterdam, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Aimy M A Wessel
- The Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ramon J L Lindauer
- The Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands; Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Shalev A, Porta G, Biernesser C, Zelazny J, Walker-Payne M, Melhem N, Brent D. Cortisol response to stress as a predictor for suicidal ideation in youth. J Affect Disord 2019; 257:10-16. [PMID: 31299399 PMCID: PMC6711816 DOI: 10.1016/j.jad.2019.06.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the association between cortisol response to stress and suicidal ideation (SI) cross-sectionally and longitudinally in our sample of bereaved and non-bereaved youth. METHODS The sample included 114 youth bereaved by sudden parental death and 109 non-bereaved controls, mean age of 12.3 (SD = 3.6), evaluated at four time-points over an average follow-up period of 7 years. The Trier Social Stress Test (TSST) was conducted on average 6 years after bereavement. We used latent class analyses to examine the trajectories of SI over follow-up and up to the time of the TSST and compare them on cortisol measures. We examined whether cortisol measures predicted future SI at 18.5 months on average after the TSST. RESULTS Bereavement was associated with higher cortisol reactivity after controlling for covariates [β = 0.96, 95% CI (0.28, 1.65), p < 0.01, d = 0.41]. Cortisol reactivity to stress was higher in those belonging to the high SI trajectory [β = 1.23, 95% CI (0.41, 2.06), p = 0.004, d = 0.23] compared to the low SI trajectory. Higher baseline cortisol showed small to medium effect size in predicting future SI [β = 2.34, 95% CI (0.17, 4.51), p = 0.03, d = 0.38]. CONCLUSION The persistence of SI is associated with higher cortisol reactivity to stress, and higher baseline cortisol may predict future SI. These results emphasize the importance of HPA-axis activity in youth exposed to major stressors, and those with SI. More research is needed to further clarify biological mechanisms linking SI and behavior, bereavement, and HPA axis response to stress, to better identify at-risk subjects for targeted prevention and intervention efforts.
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Affiliation(s)
- Amit Shalev
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15217, United States; The Herman Dana Division of Child and Adolescent Psychiatry, Department of Psychiatry, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Giovanna Porta
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Candice Biernesser
- Graduate School of Public Health, University of Pittsburgh,Western Psychiatric Hospital, University of Pittsburgh Medical Center
| | | | | | - Nadine Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - David Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine
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12
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Obi IE, McPherson KC, Pollock JS. Childhood adversity and mechanistic links to hypertension risk in adulthood. Br J Pharmacol 2019; 176:1932-1950. [PMID: 30656638 PMCID: PMC6534788 DOI: 10.1111/bph.14576] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/17/2018] [Accepted: 10/29/2018] [Indexed: 02/07/2023] Open
Abstract
Adverse childhood experiences (ACEs), defined as traumatic events in childhood that range from various forms of abuse to household challenges and dysfunction, have devastating consequences on adult health. Epidemiological studies in humans and animal models of early life stress (ELS) have revealed a strong association and insight into the mechanistic link between ACEs and increased risk of cardiovascular disease (CVD). This review focuses on the mechanistic links of ACEs in humans and ELS in mice and rats to vasoactive factors and immune mediators associated with CVD and hypertension risk, as well as sex differences in these phenomena. Major topics of discussion in this review are as follows: (a) epidemiological associations between ACEs and CVD risk focusing on hypertension, (b) evidence for association of ACE exposures to immune-mediated and/or vasoactive pathways, (c) rodent models of ELS-induced hypertension risk, (d) proinflammatory mediators and vasoactive factors as mechanisms of ELS-induced hypertension risk. We also provide some overall conclusions and directions of further research. LINKED ARTICLES: This article is part of a themed section on Immune Targets in Hypertension. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.12/issuetoc.
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Affiliation(s)
- Ijeoma E. Obi
- CardioRenal Physiology and Medicine Section, Division of Nephrology, Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUnited States
| | - Kasi C. McPherson
- CardioRenal Physiology and Medicine Section, Division of Nephrology, Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUnited States
| | - Jennifer S. Pollock
- CardioRenal Physiology and Medicine Section, Division of Nephrology, Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUnited States
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13
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Bhattacharya S, Fontaine A, MacCallum PE, Drover J, Blundell J. Stress Across Generations: DNA Methylation as a Potential Mechanism Underlying Intergenerational Effects of Stress in Both Post-traumatic Stress Disorder and Pre-clinical Predator Stress Rodent Models. Front Behav Neurosci 2019; 13:113. [PMID: 31191267 PMCID: PMC6547031 DOI: 10.3389/fnbeh.2019.00113] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/07/2019] [Indexed: 12/12/2022] Open
Abstract
Although most humans will experience some type of traumatic event in their lifetime only a small set of individuals will go on to develop post-traumatic stress disorder (PTSD). Differences in sex, age, trauma type, and comorbidity, along with many other elements, contribute to the heterogenous manifestation of this disorder. Nonetheless, aberrant hypothalamus-pituitary-adrenal (HPA) axis activity, especially in terms of cortisol and glucocorticoid receptor (GR) alterations, has been postulated as a tenable factor in the etiology and pathophysiology of PTSD. Moreover, emerging data suggests that the harmful effects of traumatic stress to the HPA axis in PTSD can also propagate into future generations, making offspring more prone to psychopathologies. Predator stress models provide an ethical and ethologically relevant way to investigate tentative mechanisms that are thought to underlie this phenomenon. In this review article, we discuss findings from human and laboratory predator stress studies that suggest changes to DNA methylation germane to GRs may underlie the generational effects of trauma transmission. Understanding mechanisms that promote stress-induced psychopathology will represent a major advance in the field and may lead to novel treatments for such devastating, and often treatment-resistant trauma and stress-disorders.
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Affiliation(s)
- Sriya Bhattacharya
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Audrey Fontaine
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada.,Institut des Systèmes Intelligents et de Robotique (ISIR), Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
| | - Phillip E MacCallum
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - James Drover
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jacqueline Blundell
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
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14
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Yirmiya K, Djalovski A, Motsan S, Zagoory-Sharon O, Feldman R. Stress and immune biomarkers interact with parenting behavior to shape anxiety symptoms in trauma-exposed youth. Psychoneuroendocrinology 2018; 98:153-160. [PMID: 30149270 DOI: 10.1016/j.psyneuen.2018.08.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 01/02/2023]
Abstract
The relations between stress, HPA-axis, and the immune system have been extensively studied; however, no study to date addressed the joint contribution of immune and HPA biomarkers to the development of anxiety in youth exposed to chronic trauma as mediated by mother-child interaction patterns. A unique cohort of war-exposed children and their mothers, compared to matched controls, were followed from infancy and the current study reports findings from early adolescence (mean age = 11.66, SD = 1.23; N = 111; exposed = 58 control = 53). Youth and mothers' salivary cortisol (CT) and secretory immunoglobulin (s-IgA) levels were measured three times during a 4-hour lab visit, mother-child interaction patterns were quantified from a joint task, and children's anxiety symptoms diagnosed. Trauma-exposed children had higher levels of CT and s-IgA, exhibited more anxiety symptoms, and showed lower social collaboration with mother during the joint task. Trauma-exposed mothers had higher CT and s-IgA levels and showed less supportive parenting during mother-child interaction. Structural equation modeling defined three bio-behavioral paths by which trauma increases anxiety in youth. While the first path charted a behavioral link from exposure to child anxiety via diminished maternal support, the other two paths described mediated biological paths, one through HPA-axis functioning, the other via the immune system. Paths via the child's HPA and immune system were mediated by the parallel maternal variable. Findings are the first to describe the complex bio-behavioral interplay of stress and immune biomarkers and parenting behavior in shaping to the development of risk and resilience trajectories in youth growing up amidst chronic trauma.
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Affiliation(s)
- Karen Yirmiya
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel; Department of Psychology, Bar-Ilan University, Israel
| | - Amir Djalovski
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel
| | - Shai Motsan
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel
| | - Orna Zagoory-Sharon
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel
| | - Ruth Feldman
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel.
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15
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Eisenlohr-Moul TA, Miller AB, Giletta M, Hastings PD, Rudolph KD, Nock MK, Prinstein MJ. HPA axis response and psychosocial stress as interactive predictors of suicidal ideation and behavior in adolescent females: a multilevel diathesis-stress framework. Neuropsychopharmacology 2018; 43:2564-2571. [PMID: 30267013 PMCID: PMC6224611 DOI: 10.1038/s41386-018-0206-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/25/2018] [Accepted: 08/19/2018] [Indexed: 01/06/2023]
Abstract
Prior studies suggest that hypothalamic-pituitary-adrenal (HPA) axis stress response is a relatively stable risk factor for suicidal behavior in adults, and also that fluctuations in developmentally salient social stress (i.e., peer stress) predict acute suicidal ideation and behavior in adolescent females. Here, we test the hypothesis that periods of high peer stress are prospectively associated with concurrent episodes of suicidal ideation and behavior, but that abnormal cortisol responses to stress at baseline act as a diathesis that strengthens this stressor-suicidality link, using a longitudinal, multi-wave study design. We measured cortisol responses to an adolescent modification of the Trier Social Stress Test in 220 adolescent females recruited for mental health concerns, and measured stress (peer, academic, and mother-child) and suicidal ideation and behaviors repeatedly across 18 months. Logistic multilevel models revealed the predicted interaction between altered cortisol response and elevated periods of peer stress in predicting suicidal behavior, but not ideation. Higher-than-usual peer stress predicted suicidal ideation regardless of HPA function, but predicted suicide attempt only among those with blunted cortisol responses. Results suggest that peer stress serves to trigger suicidal ideation among female youth, but only triggers suicidal behavior among those with blunted cortisol reactivity.
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Affiliation(s)
- Tory A Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood Street, South Tower, Room 335, Chicago, IL, United States.
| | - Adam B Miller
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matteo Giletta
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Paul D Hastings
- Department of Psychology, University of California, Davis, Davis, CA, USA
| | - Karen D Rudolph
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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Asher S, Bhiman V, Gokani N, Jeyarayan K, Bhanot R, Sasitharan A. Is chronic stress in childhood abuse victims linked to structural brain changes? Psychol Med 2018; 48:2624-2625. [PMID: 30058509 DOI: 10.1017/s0033291718001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Shreya Asher
- Barts and The London, School of Medicine and Dentistry,Garrod Building,Turner Street,Whitechapel, E12AD,London,UK
| | - Vaishanjali Bhiman
- Barts and The London, School of Medicine and Dentistry,Garrod Building,Turner Street,Whitechapel, E12AD,London,UK
| | - Nishma Gokani
- Barts and The London, School of Medicine and Dentistry,Garrod Building,Turner Street,Whitechapel, E12AD,London,UK
| | - Kerrthana Jeyarayan
- Barts and The London, School of Medicine and Dentistry,Garrod Building,Turner Street,Whitechapel, E12AD,London,UK
| | - Ravina Bhanot
- Barts and The London, School of Medicine and Dentistry,Garrod Building,Turner Street,Whitechapel, E12AD,London,UK
| | - Archana Sasitharan
- Barts and The London, School of Medicine and Dentistry,Garrod Building,Turner Street,Whitechapel, E12AD,London,UK
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17
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Design, rationale and feasibility of a multidimensional experimental protocol to study early life stress. Contemp Clin Trials Commun 2018; 7:33-43. [PMID: 29696166 PMCID: PMC5898516 DOI: 10.1016/j.conctc.2017.05.003] [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: 11/28/2016] [Revised: 04/06/2017] [Accepted: 05/03/2017] [Indexed: 11/24/2022] Open
Abstract
There is a rapidly accumulating body of evidence regarding the influential role of early life stress (ELS) upon medical and psychiatric conditions. While self-report instruments, with their intrinsic limitations of recall, remain the primary means of detecting ELS in humans, biological measures are generally limited to a single biological system. This paper describes the design, rationale and feasibility of a study to simultaneously measure neuroendocrine, immune and autonomic nervous system (ANS) responses to psychological and physiological stressors in relation to ELS. Five healthy university students were recruited by advertisement. Exclusion criteria included chronic medical conditions, psychotic disorders, needle phobia, inability to tolerate pain, and those using anti-inflammatory medications. They were clinically interviewed and physiological recordings made over a two-hour period pre, during and post two acute stressors: the cold pressor test and recalling a distressing memory. The Childhood Trauma Questionnaire and the Parental Bonding Index were utilised to measure ELS. Other psychological measures of mood and personality were also administered. Measurements of heart rate, blood pressure, respiratory rate, skin conductance, skin blood flow and temporal plasma samples were successfully obtained before, during and after acute stress. Participants reported the extensive psychological and multisystem physiological data collection and stress provocations were tolerable. Most (4/5) participants indicated a willingness to return to repeat the protocol, indicating acceptability. Our protocol is viable and safe in young physically healthy adults and allows us to assess simultaneously neuroendocrine, immune and autonomic nervous system responses to stressors in persons assessed for ELS.
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Key Words
- ANS, Autonomic nervous system
- Adverse-childhood-events
- CPT, Cold pressor test
- CTQ, Childhood Trauma Questionnaire
- Childhood-stress
- Childhood-trauma questionnaire
- DASS, Depression, Anxiety and Stress Scale
- DS14, Type D Scale
- ECG, lectrocardiogram
- ELS, Early life stress
- EPQRs, Eysenck Personality Questionnaire Revised – short form
- HPA, Hypothalamic-pituitary-adrenal
- PBI, Parental Bonding Instrument
- PTSD, Post-traumatic Stress Disorder
- Parental-bonding-instrument
- RDM, Recall of distressing memory
- Type D scale (DS14)
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18
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Koss KJ, Gunnar MR. Annual Research Review: Early adversity, the hypothalamic-pituitary-adrenocortical axis, and child psychopathology. J Child Psychol Psychiatry 2018; 59:327-346. [PMID: 28714126 PMCID: PMC5771995 DOI: 10.1111/jcpp.12784] [Citation(s) in RCA: 256] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Research on early adversity, stress biology, and child development has grown exponentially in recent years. FINDINGS We review the current evidence for the hypothalamic-pituitary-adrenocortical (HPA) axis as a stress-mediating mechanism between various forms of childhood adversity and psychopathology. We begin with a review of the neurobiology of the axis and evidence for relations between early adversity-HPA axis activity and HPA axis activity-psychopathology, as well as discuss the role of regulatory mechanisms and sensitive periods in development. CONCLUSIONS We call attention to critical gaps in the literature to highlight next steps in this research including focus on developmental timing, sex differences, stress buffering, and epigenetic regulation. A better understanding of individual differences in the adversity-HPA axis-psychopathology associations will require continued work addressing how multiple biological and behavioral systems work in concert to shape development.
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Affiliation(s)
- Kalsea J. Koss
- Center for Research on Child Wellbeing, Office of Population Research, Department of Molecular Biology, Princeton, Princeton University, NJ, USA
| | - Megan R. Gunnar
- Center for Research on Child Wellbeing, Office of Population Research, Department of Molecular Biology, Princeton, Princeton University, NJ, USA
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19
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Persson P, Rossin-Slater M. Family Ruptures, Stress, and the Mental Health of the Next Generation. THE AMERICAN ECONOMIC REVIEW 2018; 108:1214-1252. [PMID: 30091569 DOI: 10.1257/aer.20141406] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper studies how in utero exposure to maternal stress from family ruptures affects later mental health. We find that prenatal exposure to the death of a maternal relative increases take-up of ADHD medications during childhood and anti-anxiety and depression medications in adulthood. Further, family ruptures during pregnancy depress birth outcomes and raise the risk of perinatal complications necessitating hospitalization. Our results suggest large welfare gains from preventing fetal stress from family ruptures and possibly from economically induced stressors such as unemployment. They further suggest that greater stress exposure among the poor may partially explain the intergenerational persistence of poverty.
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Affiliation(s)
- Petra Persson
- Stanford University, 579 Serra Mall, Stanford, CA 94305
| | - Maya Rossin-Slater
- Stanford University School of Medicine, Redwood Building T101C, 259 Campus Drive, Stanford, CA 94305
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20
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Lowell A, Suarez-Jimenez B, Helpman L, Zhu X, Durosky A, Hilburn A, Schneier F, Gross R, Neria Y. 9/11-related PTSD among highly exposed populations: a systematic review 15 years after the attack. Psychol Med 2018; 48:537-553. [PMID: 28805168 PMCID: PMC5805615 DOI: 10.1017/s0033291717002033] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The 11 September 2001 (9/11) attacks were unprecedented in magnitude and mental health impact. While a large body of research has emerged since the attacks, published reviews are few, and are limited by an emphasis on cross-sectional research, short time frame, and exclusion of treatment studies. Additionally, to date, there has been no systematic review of available longitudinal information as a unique data set. Consequently, knowledge regarding long-term trajectories of 9/11-related post-traumatic stress disorder (PTSD) among highly exposed populations, and whether available treatment approaches effectively address PTSD within the context of mass, man-made disaster, remains limited. METHODS The present review aimed to address these gaps using a systematic review of peer-reviewed reports from October 2001 to May 2016. Eligible reports were of longitudinal studies of PTSD among highly exposed populations. We identified 20 reports of 9/11-related PTSD, including 13 longitudinal prevalence studies and seven treatment studies. RESULTS Findings suggest a substantial burden of 9/11-related PTSD among those highly exposed to the attack, associated with a range of sociodemographic and back-ground factors, and characteristics of peri-event exposure. While most longitudinal studies show declining rates of prevalence of PTSD, studies of rescue/recovery workers have documented an increase over time. Treatment studies were few, and generally limited by methodological shortcomings, but support exposure-based therapies. CONCLUSION Future directions for research, treatment, and healthcare policy are discussed.
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Affiliation(s)
- A. Lowell
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - B. Suarez-Jimenez
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - L. Helpman
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - X. Zhu
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - A. Durosky
- New York State Psychiatric Institute, New York, NY, USA
| | - A. Hilburn
- New York State Psychiatric Institute, New York, NY, USA
| | - F. Schneier
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - R. Gross
- Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
- Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Y. Neria
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
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21
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Hagan MJ, Gentry M, Ippen CG, Lieberman AF. PTSD with and without dissociation in young children exposed to interpersonal trauma. J Affect Disord 2018; 227:536-541. [PMID: 29169122 DOI: 10.1016/j.jad.2017.11.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/29/2017] [Accepted: 11/12/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND A Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) was added to the DSM-5, but little is known about this symptom pattern in young children exposed to trauma. Tailoring treatment to traumatized young children requires understanding the different patterns of trauma-related symptomatology and important correlates. The current study tested the hypothesis that type and number of child traumatic events, caregiver trauma exposure, and caregiver symptomatology would predict whether traumatized young children presented with PTSD, PTSD with clinical dissociation, or non-clinical trauma symptoms. METHODS A multinomial regression was conducted using data collected from an ethnically and economically diverse sample of 297 trauma-exposed children between the ages of 3 and 6 and their caregivers. Based on parent-report on a well-validated measure of trauma symptoms, children were categorized into three groups: non-clinical (n = 128), PTSD only (n = 104), or PTSD with dissociation (PTSD-DISS; n = 65). Predictors included trauma exposure, parent trauma symptoms, and child sex. RESULTS Girls were twice more likely than boys to be in the PTSD-DISS group; sexually abused children were almost three times as likely to be in the PTSD-DISS group; and, for every unit increase in parent avoidance symptoms or number of traumatic events, the odds of being in the PTSD-DISS group increased significantly. LIMITATIONS Given the cross-sectional study design, conclusions cannot be drawn regarding causality. Measures were completed by a single reporter. CONCLUSIONS Findings suggest that subgroups of children may be especially vulnerable to comorbid PTSD and dissociation. Implications for treatment are discussed.
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Affiliation(s)
- Melissa J Hagan
- Department of Psychology, San Francisco State University, United States; Department of Psychiatry, University of California, San Francisco, United States.
| | - Miya Gentry
- Department of Psychology, San Francisco State University, United States
| | - Chandra Ghosh Ippen
- Child Trauma Research Program, Department of Psychiatry, University of California, San Francisco, United States
| | - Alicia F Lieberman
- Child Trauma Research Program, Department of Psychiatry, University of California, San Francisco, United States
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22
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Shin S, Pribiag H, Lilascharoen V, Knowland D, Wang XY, Lim BK. Drd3 Signaling in the Lateral Septum Mediates Early Life Stress-Induced Social Dysfunction. Neuron 2017; 97:195-208.e6. [PMID: 29276054 PMCID: PMC5766830 DOI: 10.1016/j.neuron.2017.11.040] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/17/2017] [Accepted: 11/29/2017] [Indexed: 12/30/2022]
Abstract
Early life stress (ELS) in the form of child abuse/neglect is associated with an increased risk of developing social dysfunction in adulthood. Little is known, however, about the neural substrates or the neuromodulatory signaling that govern ELS-induced social dysfunction. Here, we show that ELS-induced downregulation of dopamine receptor 3 (Drd3) signaling and its corresponding effects on neural activity in the lateral septum (LS) are both necessary and sufficient to cause social abnormalities in adulthood. Using in vivo Ca2+ imaging, we found that Drd3-expressing-LS (Drd3LS) neurons in animals exposed to ELS show blunted activity in response to social stimuli. In addition, optogenetic activation of Drd3LS neurons rescues ELS-induced social impairments. Furthermore, pharmacological treatment with a Drd3 agonist, which increases Drd3LS neuronal activity, normalizes the social dysfunctions of ELS mice. Thus, we identify Drd3 in the LS as a critical mediator and potential therapeutic target for the social abnormalities caused by ELS. Early social deprivation (ESD) causes downregulation of Drd3 signaling in the LS Blunted LS Drd3 neuronal activity mediate ESD-induced social dysfunctions Drd3 signaling has corresponding effects on neuronal activity in the LS Activation of Drd3 signaling in the LS normalize social impairments of ESD mice
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Affiliation(s)
- Sora Shin
- Neurobiology Section, Division of Biological Sciences, University of California, San Diego, La Jolla, CA 92093, USA
| | - Horia Pribiag
- Neurobiology Section, Division of Biological Sciences, University of California, San Diego, La Jolla, CA 92093, USA
| | - Varoth Lilascharoen
- Neurobiology Section, Division of Biological Sciences, University of California, San Diego, La Jolla, CA 92093, USA
| | - Daniel Knowland
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA 92093, USA
| | - Xiao-Yun Wang
- Neurobiology Section, Division of Biological Sciences, University of California, San Diego, La Jolla, CA 92093, USA
| | - Byung Kook Lim
- Neurobiology Section, Division of Biological Sciences, University of California, San Diego, La Jolla, CA 92093, USA; Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA 92093, USA; Biomedical Sciences Graduate Program, University of California, San Diego, La Jolla, CA 92093, USA.
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23
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Dongling L, Hui C, Ling M, Wenqian B, Zailiang L, Changying C. Post-traumatic stress disorder and its predictors among bereaved Tibetan adolescents four years after the Yushu earthquake: a cross-sectional survey in China. J Clin Nurs 2017; 26:1095-1105. [PMID: 27460126 DOI: 10.1111/jocn.13481] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Liu Dongling
- Department of Nursing; Zhengzhou University; Zhengzhou China
| | - Chen Hui
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine (TCM); Zhengzhou China
| | - Ma Ling
- Department of Nursing; Zhengzhou University; Zhengzhou China
| | - Bie Wenqian
- Department of Nursing; Zhengzhou University; Zhengzhou China
| | - Liu Zailiang
- The Chinese People's Liberation Army 536 Hospital; Xining China
| | - Chen Changying
- Department of Nursing; Zhengzhou University; Zhengzhou China
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Stress hormones and posttraumatic stress symptoms following paediatric critical illness: an exploratory study. Eur Child Adolesc Psychiatry 2017; 26:511-519. [PMID: 27995329 PMCID: PMC5394132 DOI: 10.1007/s00787-016-0933-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 12/07/2016] [Indexed: 12/04/2022]
Abstract
In this exploratory case-control study, we investigated basal cortisol regulation in 5-16-year-old children, 3-6 months following PICU (paediatric intensive care) admission. This was nested within a study of child psychological and cognitive function; 47 children were assessed alongside 56 healthy controls. Saliva samples were collected three times per day (immediately after waking, waking +30 min, and waking +12 h) over two consecutive weekdays. In addition, data on posttraumatic stress symptoms were ascertained from 33 PICU admitted children using the Impact of Events Scale-8 (IES-8). Primary analysis revealed no significant differences in basal cortisol concentrations between PICU discharged children and healthy controls (p > 0.05). Secondary analysis in the PICU group identified a significant positive association between posttraumatic stress symptoms and evening (waking +12 h) cortisol concentrations (p = 0.004). However, when subject to multivariate analysis, evening cortisol was a modest independent predictor of IES-8 scores, relative to the presence of septic illness and poor pre-morbid health. We conclude that paediatric critical illness does not appear to result in marked perturbations to basal cortisol at 3-6 month following discharge. There was evidence of a link between evening cortisol and symptoms of PTSD, but this was not a robust effect and requires further elucidation.
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Helpman L, Penso J, Zagoory-Sharon O, Feldman R, Gilboa-Schechtman E. Endocrine and emotional response to exclusion among women and men; cortisol, salivary alpha amylase, and mood. ANXIETY STRESS AND COPING 2016; 30:253-263. [PMID: 27925794 DOI: 10.1080/10615806.2016.1269323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Social exclusion is ubiquitous and painful. Evolutionary models indicate sex differences in coping with social stress. Recent empirical data suggest different sex patterns in hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal-medullary (SAM) reactivity. The present study sought to test this hypothesis. DESIGN We examined differences in endocrine and emotional response to exclusion by using a virtual ball tossing paradigm (Cyberball). Saliva samples and mood ratings were collected to reflect levels before, and repeatedly following, exclusion. METHODS The sample included 21 women and 23 men. Cortisol and salivary alpha amylase (sAA), biomarkers of the HPA and SAM systems, respectively, were used as indices of two arms of stress response. RESULTS Following exclusion, all participants experienced mood worsening followed by mood improvement, with men reporting less distress than women. Women evinced decline in cortisol following the Cyberball task, whereas men's cortisol levels showed a non-significant rise, and then decline, following exclusion. CONCLUSIONS Our results concur with previous findings showing SAM reactivity to be gender-neutral and HPA reactivity to be gender-divergent. Additional studies are needed to examine sex-specific response to social exclusion. Implications for individual differences in recovery from stress are discussed.
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Affiliation(s)
- Liat Helpman
- a Columbia University Psychiatry , New York , NY , USA.,b New York State Psychiatric Institute , New York , NY , USA
| | - Julia Penso
- c Bar Ilan University , Ramat Gan , Israel.,d Sami Shamoon College of Engineering , Ashdod , Israel
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Laurent HK, Gilliam KS, Wright DB, Fisher PA. Child anxiety symptoms related to longitudinal cortisol trajectories and acute stress responses: evidence of developmental stress sensitization. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 124:68-79. [PMID: 25688433 DOI: 10.1037/abn0000009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cross-sectional research suggests that individuals at risk for internalizing disorders show differential activation levels and/or dynamics of stress-sensitive physiological systems, possibly reflecting a process of stress sensitization. However, there is little longitudinal research to clarify how the development of these systems over time relates to activation during acute stress, and how aspects of such activation map onto internalizing symptoms. We investigated children's (n = 107) diurnal hypothalamic-pituitary-adrenal activity via salivary cortisol (morning and evening levels) across 29 assessments spanning 6+ years, and related longitudinal patterns to acute stress responses at the end of this period (age 9-10). Associations with child psychiatric symptoms at age 10 were also examined to determine internalizing risk profiles. Increasing morning cortisol levels across assessments predicted less of a cortisol decline following interpersonal stress at age 9, and higher cortisol levels during performance stress at age 10. These same profiles of high and/or sustained cortisol elevation during psychosocial stress were associated with child anxiety symptoms. Results suggest developmental sensitization to stress-reflected in rising morning cortisol and eventual hyperactivation during acute stress exposure-may distinguish children at risk for internalizing disorders.
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Ingstrup KG, Wu CS, Olsen J, Nohr EA, Bech BH, Li J. Maternal Antenatal Bereavement and Neural Tube Defect in Live-Born Offspring: A Cohort Study. PLoS One 2016; 11:e0163355. [PMID: 27685943 PMCID: PMC5042438 DOI: 10.1371/journal.pone.0163355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/07/2016] [Indexed: 11/27/2022] Open
Abstract
Background Maternal emotional stress during pregnancy has previously been associated with congenital neural malformations, but most studies are based on data collected retrospectively. The objective of our study was to investigate associations between antenatal maternal bereavement due to death of a close relative and neural tube defects (NTDs) in the offspring. Methods We performed a register-based cohort study including all live-born children (N = 1,734,190) from 1978–2008. Exposure was bereavement due to loss of a close relative from one year before conception to the end of the first trimester of pregnancy. The outcome was NTDs in the offspring according to the International Classification of Disease. We used multivariate logistic regression to estimate prevalence odds ratios (ORs). Results A total of 2% children were born to mothers who lost a close relative prenatally. During 30 years of follow-up, 1,115 children were diagnosed with any NTDs: spina bifida (n = 889), anencephaly (n = 85) and encephalocele (n = 164). And 23 children were diagnosed with two types of NTDs. Overall, when comparing bereaved mothers to non-bereaved mothers, no significant increased prevalence of NTDs in the offspring was seen (OR = 0.84; 95% confidence interval: 0.52–1.33). Conclusion Overall maternal bereavement in the antenatal period was not related to NTDs in liveborn offspring.
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Affiliation(s)
- Katja Glejsted Ingstrup
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
- * E-mail:
| | - Chun Sen Wu
- Research Unit for Obstetrics and Gynecology, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, United States of America
| | - Ellen Aagaard Nohr
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
- Research Unit for Obstetrics and Gynecology, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Bodil Hammer Bech
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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Liu K, Ruggero CJ, Goldstein B, Klein DN, Perlman G, Broderick J, Kotov R. Elevated cortisol in healthy female adolescent offspring of mothers with posttraumatic stress disorder. J Anxiety Disord 2016; 40:37-43. [PMID: 27088877 PMCID: PMC4964788 DOI: 10.1016/j.janxdis.2016.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 04/01/2016] [Accepted: 04/04/2016] [Indexed: 01/04/2023]
Abstract
Offspring with maternal PTSD are at increased risk of developing PTSD themselves. Alterations in the hypothalamic-pituitary-adrenal (HPA) axis may play a role and have been noted in offspring, although evidence is mostly from adult offspring with PTSD symptoms themselves. The present study of adolescent girls (N=472) and their mothers (n=18 with lifetime PTSD versus n=454 with no PTSD) sought to determine whether healthy, non-affected offspring of mothers with PTSD would exhibit altered HPA axis function. Saliva samples were collected from the adolescent girls at waking, 30min after waking, and 8 pm on 3 consecutive days. Offspring whose mothers were diagnosed with PTSD demonstrated higher cortisol awakening response (CAR; Cohen's d=0.58) and greater total cortisol output (Cohen's d=0.62). In this preliminary study, higher cortisol levels during adolescence among offspring of mothers with PTSD may index a vulnerability in these at-risk youth.
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Affiliation(s)
- Keke Liu
- Department of Psychology, University of North Texas, Denton, TX 76203, United States.
| | - Camilo J. Ruggero
- Department of Psychology, University of North Texas, Denton, TX 76203, United States of America
| | - Brandon Goldstein
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, United Sates of America
| | - Daniel N. Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, United Sates of America
| | - Greg Perlman
- Department of Psychiatry, Stony Brook University, Stony Brook, NY 11794, United States of America
| | - Joan Broderick
- Center for Self-Report Science, University of Southern California, Los Angeles, CA 90089, United States of America
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY 11794, United States of America
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Thakur A, Creedon J, Zeanah CH. Trauma- and Stressor-Related Disorders Among Children and Adolescents. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2016; 14:34-45. [PMID: 31975792 PMCID: PMC6524445 DOI: 10.1176/appi.focus.20150026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
DSM-5 introduced a clustering of disorders designated "trauma- and stressor-related disorders." These disorders are unique in that the etiology is specified as part of the diagnostic criteria. In this review, the authors consider how some of these disorders manifest for children and adolescents. In posttraumatic stress disorder and related disorders, the child is exposed to one or more frightening, traumatic events. In attachment disorders, the child experiences severe social neglect. With this framework in mind, the authors consider details of several prominent trauma- and stressor-related disorders that arise in response to either excessive, unwanted input or inadequate, necessary input among children and adolescents.
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Affiliation(s)
- Akanksha Thakur
- The authors are with the Section of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
| | - Jennifer Creedon
- The authors are with the Section of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
| | - Charles H Zeanah
- The authors are with the Section of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
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Liang H, Olsen J, Yuan W, Cnattingus S, Vestergaard M, Obel C, Gissler M, Li J. Early Life Bereavement and Schizophrenia: A Nationwide Cohort Study in Denmark and Sweden. Medicine (Baltimore) 2016; 95:e2434. [PMID: 26817875 PMCID: PMC4998249 DOI: 10.1097/md.0000000000002434] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We aimed to examine whether early life bereavement, as indicator of severe stress, was associated with an increased risk of schizophrenia later in life.Based on population registers, we established a cohort of all children born in Denmark (N = 1 686 416) and Sweden (N = 2 563 659) from 1973 to 1997. Children were categorized as exposed if they lost a first-degree relative during the first 18 years of life. Outcome is the first diagnosis of schizophrenia as either inpatient or outpatient. Log-linear Poisson regression models were used to estimate incidence rate ratios (IRRs).A total of 188,850 children (4.6%) experienced death of a first-degree relative from birth to 18 years of age. Compared with unexposed children, those exposed had overall a 39% higher risk of schizophrenia (= 1.39, 95% CI [confidence interval]: 1.32-1.47). The IRR was particularly high if the family member committed suicide (aIRR = 2.11, 95% CI: 1.90-2.34) or died due to an injury or accident (aIRR = 1.44, 95% CI: 1.27-1.63). The IRR of schizophrenia decreased with increasing child's age at bereavement (P < 0.0001). Children who experienced >1 death during the first 18 years of life (aIRR = 1.79, 95% CI: 1.46-2.19) had a higher risk than those with a single death (aIRR = 1.37, 95% CI: 1.30-1.45).The study suggested that exposure to death of a first-degree relative before 18 years was associated with an increased risk of schizophrenia in later life. The complex mechanisms behind these associations remain to be elucidated.
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Affiliation(s)
- Hong Liang
- From the Department of Reproductive Epidemiology and Social Science (HL, WY), National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices, Shanghai Institute of Planned Parenthood Research, Shanghai, China; Department of Clinical Epidemiology (JO, JL), Aarhus University Hospital, Aarhus, Denmark; Department of Epidemiology (JO), School of Public Health, University of California, Los Angeles, California, USA; Reproduction and Development Institute (WY), Fudan University, Shanghai, China; Department of Medicine (SC), Clinical Epidemiology Unit, Karolinska Institutet, Sweden; Section for General Practice (MV, CO), Department of Public Health, Aarhus University, Denmark; Research Unit of General Practice (MV, CO), Department of Public Health, Aarhus University, Denmark; and National Institute for Health and Welfare (MG), Finland and Nordic School of Public Health, Sweden
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Şimşek Ş, Kaplan İ, Uysal C, Yüksel T, Alaca R. The Levels of Cortisol, Oxidative Stress, and DNA Damage in the Victims of Childhood Sexual Abuse: A Preliminary Study. JOURNAL OF CHILD SEXUAL ABUSE 2016; 25:175-184. [PMID: 26934543 DOI: 10.1080/10538712.2016.1123790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this study we aimed to investigate serum cortisol, oxidative stress, and DNA damage in children who are sexual abuse victims. The study included 38 children who sustained child sexual abuse and 38 age- and gender-matched children who did not have a history of trauma. Cortisol levels reflecting the status of the hypothalamic-pituitary-adrenal axis, anti-oxidant enzymes glutathione peroxidase, superoxide dismutase, natural anti-oxidant coenzyme Q, and 8-hydroxy-2-deoxyguanosine as the indicator of DNA damage were analyzed in serum samples using the enzyme linked immunosorbent assay method. Cortisol levels were significantly higher in the child sexual abuse group compared to the control group. There were no significant differences between the groups in terms of oxidative stress and DNA damage. Cortisol and 8-hydroxy-2-deoxyguanosine levels decreased as the time elapsed since the sexual abuse increased. Coenzyme Q level was lower in victims who sustained multiple assaults than in the victims of a single assault. Cortisol and superoxide dismutase levels were lower in the victims of familial sexual abuse. Decreases in cortisol and 8-hydroxy-2-deoxyguanosine levels as time elapsed may be an adaptation to the toxic effects of high cortisol levels over a prolonged period of time. Child sexual abuse did not result in oxidative stress and DNA damage; however, some features of sexual abuse raised the level of oxidative stress.
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Affiliation(s)
- Şeref Şimşek
- a Department of Child Psychiatry, Dicle University , Diyarbakır , Turkey
| | - İbrahim Kaplan
- b Department of Biochemistry, Dicle University , Diyarbakır , Turkey
| | - Cem Uysal
- c Department of Forensic Medicine, Dicle University , Diyarbakır , Turkey
| | - Tuğba Yüksel
- a Department of Child Psychiatry, Dicle University , Diyarbakır , Turkey
| | - Rümeysa Alaca
- a Department of Child Psychiatry, Dicle University , Diyarbakır , Turkey
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Su X, Liang H, Yuan W, Olsen J, Cnattingius S, Li J. Prenatal and early life stress and risk of eating disorders in adolescent girls and young women. Eur Child Adolesc Psychiatry 2016; 25:1245-1253. [PMID: 27083434 PMCID: PMC5083758 DOI: 10.1007/s00787-016-0848-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 04/06/2016] [Indexed: 12/24/2022]
Abstract
Females are more likely than males to develop eating disorders (EDs) in the adolescence and youth, and the etiology remains unclear. We aimed to estimate the effect of severe early life stress following bereavement, the death of a close relative, on the risk of EDs among females aged 10-26 years. This population-based cohort study included girls born in Denmark (from 1973 to 2000) or Sweden (from 1970 to 1997). Girls were categorized as exposed if they were born to mothers who lost a close relative 1 year prior to or during pregnancy or if the girl herself lost a parent or a sibling within the first 10 years of life. All other girls were included in unexposed group. An ED case was defined by a diagnosis of EDs at ages of 10-26 years, including broadly defined bulimia nervosa, broadly defined anorexia nervosa and mixed EDs. Poisson regression models were used to estimate the incidence rate ratio (IRR) between exposed group and unexposed group.A total of 64453 (3.05 %) girls were included in the exposed group. We identified 9477 girls with a diagnosis of EDs, of whom 307 (3.24 %) were from the exposed group. Both prenatal and postnatal exposure following bereavement by unexpected death was associated with an increased overall risk of EDs (IRRprenatal: 1.49, 95 % CI: 1.01-2.19 and IRRpostnatal: 1.34, 95 % CI: 1.05-1.71). We observed similar results for subtypes of broadly defined bulimia nervosa (IRR: 2.47, 95 % CI: 1.67-3.65) and mixed EDs (IRR: 1.45, 95 % CI: 1.02-2.07).Our findings suggest that prenatal and early postnatal life stress due to unexpected death of a close relative is associated with an increased overall risk of eating disorders in adolescent girls and young women. The increased risk might be driven mainly by differences in broadly defined bulimia nervosa and mixed eating disorders, but not broadly defined anorexia nervosa.
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Affiliation(s)
- Xiujuan Su
- Department of Women's and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China.
| | - Hong Liang
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, 200032 People’s Republic of China
| | - Wei Yuan
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, 8200 N Denmark
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, 8200 N Denmark
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Luecken LJ, Hagan MJ, Sandler IN, Tein JY, Ayers TS, Wolchik SA. Longitudinal mediators of a randomized prevention program effect on cortisol for youth from parentally bereaved families. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 15:224-232. [PMID: 23529870 DOI: 10.1007/s11121-013-0385-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We recently reported that a randomized controlled trial of a family-focused intervention for parentally bereaved youth predicted higher cortisol output 6 years later relative to a control group of bereaved youth (Luecken et al., Psychoneuroendocrinology 35, 785-789, 2010). The current study evaluated longitudinal mediators of the intervention effect on cortisol 6 years later. Parentally bereaved children (N = 139; mean age, 11.4; SD = 2.4; age range = 8-16 years; male; 61% Caucasian, 17% Hispanic, 7% African American, and 15% other ethnicities) were randomly assigned to the 12-week preventive intervention (n = 78) or a self-study control (n = 61) condition. Six years later (mean age, 17.5; SD, 2.4), cortisol was sampled as youth participated in a parent-child conflict interaction task. Using four waves of data across the 6 years, longitudinal mediators of the program impact on cortisol were evaluated. Program-induced increases in positive parenting, decreases in child exposure to negative life events, and lower externalizing symptoms significantly mediated the intervention effect on cortisol 6 years later.
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Affiliation(s)
- Linda J Luecken
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA.
| | - Melissa J Hagan
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA
| | - Irwin N Sandler
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA
| | - Jenn-Yun Tein
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA
| | - Tim S Ayers
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA
| | - Sharlene A Wolchik
- Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA
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Examining the levels of BDNF and cortisol in children and adolescent victims of sexual abuse--a preliminary study. Compr Psychiatry 2015; 61:23-7. [PMID: 25982069 DOI: 10.1016/j.comppsych.2015.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Previous reports have suggested the biological and psychological effects of trauma induced by cortisol and brain-derived neurotrophic factor (BDNF). The present study compared the levels of BDNF, cortisol, and adrenocorticotropic hormone (ACTH) in children and adolescent victims of sexual abuse to those without a trauma history. METHODS The study was conducted in the Department of Child Psychiatry at Dicle University. The study included 44 children (M/F: 12/32) aged between 8 and 17years who experienced sexual abuse with 42 age-and gender-matched children who did not have a history of trauma. Cortisol, ACTH, and BDNF levels were measured using ELISA. RESULTS Cortisol levels were higher and BDNF levels were significantly lower in the victims of sexual abuse compared to the control group. The mean time that elapsed from the initial sexual abuse occurrence until the date of examination was 22.7±21.7months. The evaluation of the relationship between this time span and cortisol levels revealed that cortisol levels decreased with increasing time after trauma. Cortisol and BDNF levels were lower in the victims who experienced multiple sexual assaults. CONCLUSIONS The results of the present study suggest that cortisol and BDNF could be biological molecular mediators of the effects of trauma on biological and psychological systems. This is the first report on the effects of cortisol and BDNF induced trauma in child and adolescent victims of sexual abuse.
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Abstract
BACKGROUND Cryptorchidism (undescended testis) is a common anomaly with largely unexplained etiology. Animal studies have suggested maternal emotional stress as a potential risk factor, but this has not been studied in humans. We aimed to investigate whether maternal bereavement due to the death of a close relative in the antenatal period increases the occurrence of cryptorchidism in the offspring. METHODS In a population-based cohort, we studied death of a close relative as the exposure and cryptorchidism entries in nationwide medical registries as the outcome. Danish national registries included 898,961 (23,609 exposed) boys born from 1978 to 2008 with a maximum of 30 years of follow-up. RESULTS A total of 20,947 boys had cryptorchidism, of whom 13,524 also underwent corrective surgery. We found no increased occurrence of cryptorchidism in the offspring (hazard ratio = 1.02 [95% confidence interval = 0.92-1.14]). Results were similar when the diagnosis was verified with surgery. We adjusted for maternal and paternal age, birth year, and family history of cryptorchidism. CONCLUSION We observed no association between maternal bereavement before and during pregnancy and the occurrence of cryptorchidism in the offspring.
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Weems CF. Biological correlates of child and adolescent responses to disaster exposure: a bio-ecological model. Curr Psychiatry Rep 2015; 17:51. [PMID: 25980506 DOI: 10.1007/s11920-015-0588-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Exposure to both human-caused and natural disasters is associated with a number of postevent reactions in youth including the experience of symptoms of several mental disorders. There is wide variability in these responses, with some youth having very intense exposure to the disaster and yet showing resilience or even personal growth, while others with low exposure sometimes show intensely negative reactions. Research findings are reviewed in this article to identify biological correlates of risk and resilience focusing on potential genetic, neurobiological, and physiological factors linked to the reactions of children exposed to disasters. A bio-ecological model is presented to couch this review of biological correlates of disaster exposure. The model predicts susceptibility to negative reactions after disaster exposure, and the biological correlates of disaster reactions can be understood in terms of this susceptibility as it relates to biological markers of the fear system.
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Affiliation(s)
- Carl F Weems
- Department of Human Development and Family Studies, Iowa State University, 4380 Palmer, Ames, IA, 50011-4380, USA,
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Adolescent Survivors of Hurricane Katrina: A Pilot Study of Hypothalamic–Pituitary–Adrenal Axis Functioning. CHILD & YOUTH CARE FORUM 2015. [DOI: 10.1007/s10566-014-9297-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Trauma in childhood is a psychosocial, medical, and public policy problem with serious consequences for its victims and for society. Chronic interpersonal violence in children is common worldwide. Developmental traumatology, the systemic investigation of the psychiatric and psychobiological effects of chronic overwhelming stress on the developing child, provides a framework and principles when empirically examining the neurobiological effects of pediatric trauma. This article focuses on peer-reviewed literature on the neurobiological sequelae of childhood trauma in children and in adults with histories of childhood trauma.
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Affiliation(s)
- Michael D De Bellis
- Healthy Childhood Brain Development and Developmental Traumatology Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 104360, Durham, NC 27710, USA.
| | - Abigail Zisk
- Healthy Childhood Brain Development and Developmental Traumatology Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 104360, Durham, NC 27710, USA
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Gao W, Zhong P, Xie Q, Wang H, Jin J, Deng H, Lu Z. Temporal features of elevated hair cortisol among earthquake survivors. Psychophysiology 2014; 51:319-26. [DOI: 10.1111/psyp.12179] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/25/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Wei Gao
- Research Center for Learning Science; Southeast University; Nanjing China
| | - Ping Zhong
- Research Center for Learning Science; Southeast University; Nanjing China
| | - Qiaozhen Xie
- Research Center for Learning Science; Southeast University; Nanjing China
| | - Haiyang Wang
- Research Center for Learning Science; Southeast University; Nanjing China
| | - Jing Jin
- Research Center for Learning Science; Southeast University; Nanjing China
| | - Huihua Deng
- Research Center for Learning Science; Southeast University; Nanjing China
| | - Zuhong Lu
- Research Center for Learning Science; Southeast University; Nanjing China
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Abstract
AbstractAlthough considerable research has examined the relations between parental behavior and a range of child developmental outcomes, much of this work has been conducted at a very broad level of behavioral analysis. A developmental psychopathology framework and recent research conducted within this framework point to the need for models of parenting and child psychopathology that offer greater specificity regarding processes that may be implicated in the effects of these relationships. In addition, recent animal work and some human work has focused more on theproximalbiological and social mechanisms through which parenting affects child outcomes. Our conceptualization of parenting effects acknowledges that family and child factors are embedded in a dynamic biological and social context that is key to understanding developmental trajectories of child adjustment. In this paper, we review two areas of research that are illuminating the biological processes underlying links between parenting and child psychopathology: molecular genetics and psychophysiology. We adopt a biopsychosocial perspective on developmental psychopathology that implies that a set of hierarchically organized, but reciprocally interacting, processes, from the genetic to the environmental, provide the essential elements of both normative and nonnormative development (Gottlieb, 2007). New directions stimulated by this general approach are discussed, with an emphasis on the contextual and developmental issues and applications implied by such a perspective.
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Stress reactivity in war-exposed young children with and without posttraumatic stress disorder: Relations to maternal stress hormones, parenting, and child emotionality and regulation. Dev Psychopathol 2013; 25:943-55. [DOI: 10.1017/s0954579413000291] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe current study examined biomarkers of stress in war-exposed young children and addressed maternal and child factors that may correlate with children's stress response. Participants were 232 Israeli children aged 1.5–5 years, including 148 children exposed to continuous war. Similarly, 56 were diagnosed with posttraumatic stress disorder (PTSD) and 92 were defined as exposed-no-PTSD. Child cortisol (CT) and salivary alpha amylase (sAA), biomarkers of the hypothalamic–pituitary–adrenal and sympathetic–adrenal–medullary arms of the stress response, were measured at baseline, following challenge, and at recovery. Maternal CT and sAA, PTSD symptoms, and reciprocal parenting, and child negative emotionality and regulatory strategies were assessed. Differences between war-exposed children and controls emerged, but these were related to child PTSD status. Children with PTSD exhibited consistently low CT and sAA, exposed-no-PTSD displayed consistently high CT and sAA, and controls showed increase in CT following challenge and decrease at recovery and low sAA. Exposed children showed higher negative emotionality; however, whereas exposed-no-PTSD children employed comfort-seeking strategies, children with PTSD used withdrawal. Predictors of child CT included maternal CT, PTSD symptoms, low reciprocity, and negative emotionality. Findings suggest that high physiological arousal combined with approach strategies may be associated with greater resilience in the context of early trauma.
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Finsterwald C, Alberini CM. Stress and glucocorticoid receptor-dependent mechanisms in long-term memory: from adaptive responses to psychopathologies. Neurobiol Learn Mem 2013; 112:17-29. [PMID: 24113652 DOI: 10.1016/j.nlm.2013.09.017] [Citation(s) in RCA: 210] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/20/2013] [Accepted: 09/25/2013] [Indexed: 12/17/2022]
Abstract
A proper response against stressors is critical for survival. In mammals, the stress response is primarily mediated by secretion of glucocorticoids via the hypothalamic-pituitary-adrenocortical (HPA) axis and release of catecholamines through adrenergic neurotransmission. Activation of these pathways results in a quick physical response to the stress and, in adaptive conditions, mediates long-term changes in the brain that lead to the formation of long-term memories of the experience. These long-term memories are an essential adaptive mechanism that allows an animal to effectively face similar demands again. Indeed, a moderate stress level has a strong positive effect on memory and cognition, as a single arousing or moderately stressful event can be remembered for up to a lifetime. Conversely, exposure to extreme, traumatic, or chronic stress can have the opposite effect and cause memory loss, cognitive impairments, and stress-related psychopathologies such as anxiety disorders, depression and post-traumatic stress disorder (PTSD). While more effort has been devoted to the understanding of the negative effects of chronic stress, much less has been done thus far on the identification of the mechanisms engaged in the brain when stress promotes long-term memory formation. Understanding these mechanisms will provide critical information for use in ameliorating memory processes in both normal and pathological conditions. Here, we will review the role of glucocorticoids and glucocorticoid receptors (GRs) in memory formation and modulation. Furthermore, we will discuss recent findings on the molecular cascade of events underlying the effect of GR activation in adaptive levels of stress that leads to strong, long-lasting memories. Our recent data indicate that the positive effects of GR activation on memory consolidation critically engage the brain-derived neurotrophic factor (BDNF) pathway. We propose and will discuss the hypothesis that stress promotes the formation of strong long-term memories because the activation of hippocampal GRs after learning is coupled to the recruitment of the growth and pro-survival BDNF/cAMP response element-binding protein (CREB) pathway, which is well-know to be a general mechanism required for long-term memory formation. We will then speculate about how these results may explain the negative effects of traumatic or chronic stress on memory and cognitive functions.
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Pfefferbaum B, Weems CF, Scott BG, Nitiéma P, Noffsinger MA, Pfefferbaum RL, Varma V, Chakraburtty A. Research Methods in Child Disaster Studies: A Review of Studies Generated by the September 11, 2001, Terrorist Attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina. CHILD & YOUTH CARE FORUM 2013; 42:285-337. [PMID: 24443635 PMCID: PMC3892998 DOI: 10.1007/s10566-013-9211-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND A comprehensive review of the design principles and methodological approaches that have been used to make inferences from the research on disasters in children is needed. OBJECTIVE To identify the methodological approaches used to study children's reactions to three recent major disasters-the September 11, 2001, attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina. METHODS This review was guided by a systematic literature search. RESULTS A total of 165 unduplicated empirical reports were generated by the search and examined for this review. This included 83 references on September 11, 29 on the 2004 Tsunami, and 53 on Hurricane Katrina. CONCLUSIONS A diversity of methods has been brought to bear in understanding children's reactions to disasters. While cross-sectional studies predominate, pre-event data for some investigations emerged from archival data and data from studies examining non-disaster topics. The nature and extent of the influence of risk and protective variables beyond disaster exposure are not fully understood due, in part, to limitations in the study designs used in the extant research. Advancing an understanding of the roles of exposure and various individual, family, and social factors depends upon the extent to which measures and assessment techniques are valid and reliable, as well as on data sources and data collection designs. Comprehensive assessments that extend beyond questionnaires and checklists to include interviews and cognitive and biological measures to elucidate the negative and positive effects of disasters on children also may improve the knowledge base.
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Affiliation(s)
- Betty Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, WP 3470, P.O. Box 26901, Oklahoma City, OK 73126-0901, USA. Terrorism and Disaster Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Carl F. Weems
- Department of Psychology, University of New Orleans, New Orleans, LA, USA
| | - Brandon G. Scott
- Department of Psychology, University of New Orleans, New Orleans, LA, USA
| | - Pascal Nitiéma
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Health Sciences Center, Oklahoma City, OK, USA. Terrorism and Disaster Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mary A. Noffsinger
- Courtroom Sciences, Inc., Irving, TX, USA. Terrorism and Disaster Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rose L. Pfefferbaum
- Liberal Arts Department, Phoenix Community College, Phoenix, AZ, USA. Terrorism and Disaster Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Vandana Varma
- Terrorism and Disaster Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Amarsha Chakraburtty
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Ulrike S, Reinhold L, Dirk H. Major depression in young girls is related to altered cortisol awakening response. Eur Child Adolesc Psychiatry 2013; 22:379-84. [PMID: 23292185 DOI: 10.1007/s00787-012-0371-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 12/24/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is evidence that clinical depression is associated with elevated basal cortisol levels in adult patients. OBJECTIVE The present investigation tries to find out, whether this relationship also holds true in adolescents with major depression. METHODS For 131 female subjects (63 MDD, 68 controls) the cortisol awakening response (CAR) was measured at 0, 30, 45, and 60 min after awakening. All subjects provided saliva cortisol. RESULTS A significantly higher CAR was found in patients. The global mean difference was due to differences 60 and 45 min after awakening. LIMITATIONS A causal interpretation of the data is restricted, because of its cross-sectional nature. The effect size of the mean differences is rather small. CONCLUSION The observed HPA hyperactivity may be a cause as well as a consequence of depression in childhood.
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Affiliation(s)
- Schmidt Ulrike
- Department of Clinical and Physiological Psychology, University of Trier, 54286 Trier, Germany
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Kaplow JB, Shapiro DN, Wardecker BM, Howell KH, Abelson JL, Worthman CM, Prossin AR. Psychological and environmental correlates of HPA axis functioning in parentally bereaved children: preliminary findings. J Trauma Stress 2013; 26:233-40. [PMID: 23526635 PMCID: PMC5790317 DOI: 10.1002/jts.21788] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined bereaved children's HPA-axis functioning (cortisol awakening response; CAR) in relation to psychological distress, coping, and surviving parents' grief reactions. Participants included 38 children (20 girls) with recent parental loss (previous 6 months) and 28 of their surviving caregivers (23 women) who were assessed using self-report instruments and in-person, semistructured interviews. Interviews involved discussions about the child's thoughts and feelings related to the loss. Participants provided 3 saliva samples at home (awakening, 30 minutes later, and evening) over 3 successive days, beginning on the day following the interview. Results show a significant relation between dampening of the child's Day 1 CAR and more symptoms of anxiety (r = -.45), depression (r = -.40), posttraumatic stress (r = -.45), and maladaptive grief (r = -.43), as well as higher levels of avoidant coping (r = -.53). Higher levels of parental maladaptive grief were also associated (r = -.47) with a dampening of the child's Day 1 CAR. Our results raise the possibility that blunted CAR may be a result of accumulating allostatic load and/or a result of emotionally challenging events (discussions regarding the deceased) and their subsequent processing (or lack thereof) within the family, which may be particularly stressful for those bereaved children experiencing high levels of psychological distress, avoidant coping, and parental maladaptive grief.
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Affiliation(s)
- Julie B. Kaplow
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | | | - Kathryn H. Howell
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - James L. Abelson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Alan R. Prossin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Kumari M, Head J, Bartley M, Stansfeld S, Kivimaki M. Maternal separation in childhood and diurnal cortisol patterns in mid-life: findings from the Whitehall II study. Psychol Med 2013; 43:633-643. [PMID: 22785027 DOI: 10.1017/s0033291712001353] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Animal studies suggest that maternal separation is associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis through effects that occur in a critical period following birth. Evidence for an association of the diurnal cortisol rhythm with maternal separation in humans is equivocal. METHOD We examined whether maternal separation in childhood is associated with diurnal cortisol pattern in 3712 middle-aged men and women. Two aspects of cortisol release were examined: the cortisol awakening response (CAR) and the diurnal slope in cortisol throughout the day. RESULTS Maternal separation in childhood was reported by 12% of participants. Those participants who reported maternal separation had a larger CAR and flatter slopes in cortisol levels compared to those who did not report maternal separation [adjusted mean CAR in those reporting no separation versus separation: 7.1, 95% confidence interval (CI) 6.7-7.5 v. 8.4, 95% CI 7.3-9.5, p = 0.02, corresponding to adjusted mean diurnal slope: -0.129 (95% CI -0.130 to -0.128) v. -0.126 (95% CI -0.128 to -0.124), p = 0.01]. In participants who reported maternal separation, the age of separation was not associated with either cortisol measure (p = 0.11). The association between maternal separation and slope in cortisol secretion was largely explained by smoking behaviour and marital status at the time of sample collection whereas that of the CAR was explained by childhood psychosocial, material factors and adult health behaviours. CONCLUSIONS Our findings suggest that maternal separation in childhood is associated with alterations in the diurnal cortisol pattern in middle age. These associations are predominantly accounted for by adult circumstances and behaviours.
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Affiliation(s)
- M Kumari
- Department of Epidemiology and Public Health, University College London, UK.
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Fryers T, Brugha T. Childhood determinants of adult psychiatric disorder. Clin Pract Epidemiol Ment Health 2013; 9:1-50. [PMID: 23539489 PMCID: PMC3606947 DOI: 10.2174/1745017901309010001] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/22/2012] [Accepted: 07/07/2012] [Indexed: 02/06/2023]
Abstract
The aim of this project was to assess the current evidence from longitudinal studies for childhood determinants of adult mental illness. Because of the variable and often prolonged period between factors in childhood and the identification of mental illness in adults, prospective studies, particularly birth cohorts, offer the best chance of demonstrating associations in individuals. A review was undertaken in 2006 of the published literature from longitudinal studies, together with some large-scale retrospective studies and relevant reviews which provided supplementary evidence. The main focus was upon potentially ameliorable characteristics, experiences or situations of childhood; however, other factors, not determinants but pre-cursors, associated with later mental illness could not be left out. Seven major electronic data-bases of published research were interrogated with a range of key-words and the results supplemented from personal searches, enquiries and reference trails. In excess of 1,500 abstracts were read to select 250 papers for full review. The material was assessed in relation to ten factors: Psychological disturbance; Genetic Influences; Neurological Deviance; Neuroticism; Behaviour; School Performance; Adversity; Child Abuse or Neglect; Parenting and parent-child relationships; Disrupted and Disfunctional Families. In 2011 the search was repeated for the period 2006 to mid-2011, using the same search terms and supplemented in the same manner. Over 1,800 abstracts emerged and almost 200 papers selected for more detailed review. These were then integrated into the original text with modifications where necessary. The whole text was then revised and edited in January / February 2012. There is continuing evidence for the association with later mental ill-health for each of these ten factors, but with different degrees of conviction. The evidence for each is discussed in detail and weighed both separately and in relation to others. These are then summarised, and the research implications are considered. Finally, the implications for prevention are discussed together with the practical potential for preventive and health-promoting programmes.
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Affiliation(s)
- Tom Fryers
- International and Public Health, School of Health Sciences, New York Medical College, USA ; Department of Health Sciences, University of Leicester, UK
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Dietz LJ, Stoyak S, Melhem N, Porta G, Matthews KA, Payne MW, Brent DA. Cortisol response to social stress in parentally bereaved youth. Biol Psychiatry 2013; 73:379-87. [PMID: 23021533 PMCID: PMC3789373 DOI: 10.1016/j.biopsych.2012.08.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 07/23/2012] [Accepted: 08/13/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND Parental bereavement is associated with increased risk for psychiatric illness and functional impairment in youth. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis functioning may be one pathway through which bereaved children experience increased risk for poor outcomes. However, few studies have prospectively examined the association between parental bereavement and cortisol response while accounting for psychiatric disorders in both youth and their caregivers. METHODS One-hundred and eighty-one bereaved and nonbereaved offspring and their caregivers were assessed at multiple time points over a 5-year period after parental death. Offspring participated in an adaptation of the Trier Social Stress Task (TSST), and salivary cortisol samples were collected before and after exposure to social stressors. Mixed models for repeated measures were used to analyze the effects of bereavement status, psychiatric disorder in both offspring and caregiver, and demographic indices on trajectories of cortisol response. RESULTS After controlling for demographic variables and offspring depression, bereaved offspring demonstrated significantly different trajectories of cortisol response compared with nonbereaved offspring, characterized by higher total cortisol output and an absence of cortisol reactivity to acute social stress. Within the bereaved group, offspring of parents who died by sudden natural death demonstrated significant cortisol reactivity to social stress compared with offspring whose parents died by suicide, who demonstrated more blunted trajectory of cortisol response. CONCLUSIONS Parentally bereaved youth demonstrate higher cortisol output than nonbereaved youth but are less able to mount an acute response in the face of social stressors.
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Affiliation(s)
- Laura J. Dietz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Samuel Stoyak
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nadine Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Giovanna Porta
- Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - Karen A. Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Monica Walker Payne
- Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA,Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
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Ingstrup K, Liang H, Olsen J, Nohr E, Bech B, Wu C, Christensen K, Li J. Maternal bereavement in the antenatal period and oral cleft in the offspring. Hum Reprod 2013; 28:1092-9. [DOI: 10.1093/humrep/des434] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Pfefferbaum B, Tucker P, North CS, Jeon-Slaughter H. Autonomic reactivity and hypothalamic pituitary adrenal axis dysregulation in spouses of Oklahoma City bombing survivors 7 years after the attack. Compr Psychiatry 2012; 53:901-6. [PMID: 22520087 PMCID: PMC3526068 DOI: 10.1016/j.comppsych.2012.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/24/2012] [Accepted: 03/12/2012] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The objective of this exploratory pilot study was to examine autonomic reactivity and hypothalamic pituitary adrenal axis dysregulation in spouses of highly exposed survivors of the 1995 Oklahoma City bombing. METHODS This study compared psychiatric diagnoses and biological stress markers (physiological reactivity and cortisol measures) in spouses of bombing survivors and matched community participants. Spouses were recruited through bombing survivors who participated in prior studies. Individuals with medical illnesses and those taking psychotropic medications that would confound biological stress measures were excluded. The final sample included 15 spouses and 15 community participants. The primary outcome measures were psychiatric diagnoses assessed with the Diagnostic Interview Schedule for DSM-IV (DIS-IV). Biological stress markers were physiological reactivity and recovery in heart rate and blood pressure responses to a trauma interview and cortisol (morning, afternoon, and diurnal variation). RESULTS Compared to the community participants, spouses evidenced greater reactivity in heart rate, systolic blood pressure, and diastolic blood pressure; delayed recovery in systolic blood pressure; and higher afternoon salivary cortisol. CONCLUSIONS The results support the need for further research in this area to clarify post-disaster effects on biological stress measures in the spouses of survivors and the potential significance of these effects and to address the needs of this important population which may be overlooked in recovery efforts.
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Affiliation(s)
- Betty Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, PO Box 26901, WP 3470 Oklahoma City, OK 73126-0901, USA.
| | - Phebe Tucker
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, P.O. Box 26901, WP 3470, Oklahoma City, OK 73126-0901, USA
| | - Carol S. North
- The North Texas VA Health Care System and the Departments of Psychiatry and Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Haekyung Jeon-Slaughter
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, P.O. Box 26901, WP 3470, Oklahoma City, OK 73126-0901, USA
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