Child maltreatment and HPA axis dysregulation: relationship to major depressive disorder and post traumatic stress disorder in females

The association between emotional abuse in childhood and healthcare utilization in adulthood among sami and non-sami: the SAMINOR 2 questionnaire survey

BACKGROUND

Emotional abuse in childhood is the most common type of childhood abuse worldwide and is associated with a variety of somatic and mental health issues. However, globally and in indigenous contexts, research on the associations between emotional abuse in childhood and somatic and mental specialist healthcare utilization in adulthood is sparse.

AIM

The main aim of this study was to investigate the association between emotional abuse in childhood and somatic and mental specialist healthcare utilization in adulthood in Sami and non-Sami populations, and to examine whether this association differs between the two ethnic groups.

METHOD

This study used cross-sectional data from the SAMINOR 2 Questionnaire Survey - a population-based study on health and living conditions in areas with Sami and non-Sami populations in Middle and Northern Norway. In total, 11 600 individuals participated in SAMINOR 2. Logistic regression was used to present the association between emotional abuse in childhood and somatic and mental specialist healthcare utilization.

RESULTS

Emotional abuse in childhood was significantly associated with somatic specialist healthcare utilization in adulthood (fully adjusted odds ratio [OR] 1.31, 95% confidence interval [CI] 1.15-1.49), with no differences observed between ethnic groups. Emotional abuse in childhood was also associated with mental specialist healthcare utilization (fully adjusted OR 3.99, 95% CI 3.09-5.14), however this association was weaker among Sami (crude OR 2.38, 95% CI 1.37-4.13) compared with non-Sami (crude OR 5.40, 95% Cl 4.07-7.15) participants.

CONCLUSIONS

Emotional abuse in childhood is associated with somatic and mental specialist healthcare utilization in adulthood, with a stronger association to mental healthcare utilization. The association between emotional abuse in childhood and mental specialist healthcare utilization was weaker among Sami than non-Sami participants. Future studies should investigate the reason for this ethnic difference. Our results highlight the need to strengthen efforts to prevent childhood abuse and develop strategies to reduce its societal and personal burden.

Early traumatic experiences and the hypothalamus-pituitary-adrenal axis in people with eating disorders: A narrative review

Exposure to trauma during childhood is a non-specific risk factor for psychiatric disorders, including eating disorders (EDs), over the life course. Moreover, an association between stressful life events and the onset/maintenance of EDs has been documented. Therefore, the hypothalamus-pituitary-adrenal (HPA) axis, namely the main component of the endogenous stress response system, has been proposed to be implicated in the pathophysiology of EDs. In this narrative review the current knowledge concerning the effects of early trauma exposure on the HPA axis activity and their putative role in the pathophysiology of EDs will be illustrated. Research findings corroborate the idea that childhood trauma exposure has long-lasting dysregulating effects on the activity of the HPA axis, which may contribute to the biological background of the early trauma-related risk for the development of EDs across the life span. Moreover, literature data support the existence of a "maltreated ecophenotype" in EDs characterized by specific clinic and neuroendocrine features, which may have important implications in treatment programming for such a type of patients.

The association of childhood trauma with depressive and negative symptoms in recent onset psychosis: a sex-specific analysis

BACKGROUND

Childhood trauma may impact the course of schizophrenia spectrum disorders (SSD), specifically in relation to the increased severity of depressive or negative symptoms. The type and impact of trauma may differ between sexes. In a large sample of recent-onset patients, we investigated the associations of depressive and negative symptoms with childhood trauma and whether these are sex-specific.

METHODS

A total of 187 first-episode psychosis patients in remission (Handling Antipsychotic Medication: Long-term Evaluation of Targeted Treatment study) and 115 recent-onset SSD patients (Simvastatin study) were included in this cross-sectional study (men: n = 218; women: n = 84). Total trauma score and trauma subtypes were assessed using the Childhood Trauma Questionnaire Short Form; depressive and negative symptoms were rated using the Positive And Negative Symptoms Scale. Sex-specific regression analyses were performed.

RESULTS

Women reported higher rates of sexual abuse than men (23.5% v. 7.8%). Depressive symptoms were associated with total trauma scores and emotional abuse ratings in men (β: 0.219-0.295; p ≤ 0.001). In women, depressive symptoms were associated with sexual abuse ratings (β: 0.271; p = 0.011). Negative symptoms were associated with total trauma score and emotional neglect ratings in men (β: 0.166-0.232; p ≤ 0.001). Negative symptoms in women were not linked to childhood trauma, potentially due to lack of statistical power.

CONCLUSIONS

Depressive symptom severity was associated with different types of trauma in men and women with recent-onset SSD. Specifically, in women, depressive symptom severity was associated with childhood sexual abuse, which was reported three times as often as in men. Our results emphasize the importance of sex-specific analyses in SSD research.

From Ligands to Behavioral Outcomes: Understanding the Role of Mineralocorticoid Receptors in Brain Function

Stress is a normal response to situational pressures or demands. Exposure to stress activates the hypothalamic-pituitary-adrenal (HPA) axis and leads to the release of corticosteroids, which act in the brain via two distinct receptors: mineralocorticoid receptors (MR) and glucocorticoid receptors (GR). Persistent HPA axis overactivation or dysregulation can disrupt an individual's homeostasis, thereby contributing to an increased risk for mental illness. On the other hand, successful coping with stressful events involves adaptive and cognitive processes in the brain that render individuals more resilient to similar stressors in the future. Here we review the role of the MR in these processes, starting with an overview of the physiological structure, ligand binding, and expression of MR, and further summarizing its role in the brain, its relevance to psychiatric disorders, and related rodent studies. Given the central role of MR in cognitive and emotional functioning, and its importance as a target for promoting resilience, future research should investigate how MR modulation can be used to alleviate disturbances in emotion and behavior, as well as cognitive impairment, in patients with stress-related psychiatric disorders.

Understanding the relationships between physiological and psychosocial stress, cortisol and cognition

Stress is viewed as a state of real or perceived threat to homeostasis, the management of which involves the endocrine, nervous, and immune systems. These systems work independently and interactively as part of the stress response. The scientific stress literature, which spans both animal and human studies, contains heterogeneous findings about the effects of stress on the brain and the body. This review seeks to summarise and integrate literature on the relationships between these systems, examining particularly the roles of physiological and psychosocial stress, the stress hormone cortisol, as controlled by the hypothalamic-pituitary-adrenal (HPA) axis, and the effects of stress on cognitive functioning. Health conditions related to impaired HPA axis functioning and their associated neuropsychiatric symptoms will also be considered. Lastly, this review will provide suggestions of clinical applicability for endocrinologists who are uniquely placed to measure outcomes related to endocrine, nervous and immune system functioning and identify areas of intervention.

A neurostructural biomarker of dissociative amnesia: a hippocampal study in dissociative identity disorder

BACKGROUND

Little is known about the neural correlates of dissociative amnesia, a transdiagnostic symptom mostly present in the dissociative disorders and core characteristic of dissociative identity disorder (DID). Given the vital role of the hippocampus in memory, a prime candidate for investigation is whether total and/or subfield hippocampal volume can serve as biological markers of dissociative amnesia.

METHODS

A total of 75 women, 32 with DID and 43 matched healthy controls (HC), underwent structural magnetic resonance imaging (MRI). Using Freesurfer (version 6.0), volumes were extracted for bilateral global hippocampus, cornu ammonis (CA) 1-4, the granule cell molecular layer of the dentate gyrus (GC-ML-DG), fimbria, hippocampal-amygdaloid transition area (HATA), parasubiculum, presubiculum and subiculum. Analyses of covariance showed volumetric differences between DID and HC. Partial correlations exhibited relationships between the three factors of the dissociative experience scale scores (dissociative amnesia, absorption, depersonalisation/derealisation) and traumatisation measures with hippocampal global and subfield volumes.

RESULTS

Hippocampal volumes were found to be smaller in DID as compared with HC in bilateral global hippocampus and bilateral CA1, right CA4, right GC-ML-DG, and left presubiculum. Dissociative amnesia was the only dissociative symptom that correlated uniquely and significantly with reduced bilateral hippocampal CA1 subfield volumes. Regarding traumatisation, only emotional neglect correlated negatively with bilateral global hippocampus, bilateral CA1, CA4 and GC-ML-DG, and right CA3.

CONCLUSION

We propose decreased CA1 volume as a biomarker for dissociative amnesia. We also propose that traumatisation, specifically emotional neglect, is interlinked with dissociative amnesia in having a detrimental effect on hippocampal volume.

Associations between HPA axis reactivity and PTSD and depressive symptoms: Importance of maltreatment type and puberty

The functioning of the hypothalamic-pituitary-adrenal (HPA) axis is implicated in the etiology and maintenance of depressive and posttraumatic stress disorder (PTSD) symptoms. However, different maltreatment experiences as well as the increased sensitivity of the HPA axis during puberty may alter associations between the HPA axis and mental health. To address these gaps, the current study examined the potential bidirectional associations between cortisol reactivity to a stressor, PTSD symptoms, and depressive symptoms among early adolescents across two time points, 1 year apart (n = 454; Mage = 10.98 at Time 1 and Mage = 12.11 at Time 2). Multiple-group path models tested the pathways between cortiol reactivity and mental health prior to and during puberty, for different types of maltreatment . Overall, the results showed that associations between cortisol output and symptoms of PTSD and depression were driven by those in the midst of puberty. Specifically, higher cortisol output at Time 1 was linked with higher levels of subsequent PTSD and depressive symptoms for neglected youth who had reached puberty. However, depressive symptoms predicted subsequent lower cortisol output for the physical abuse and emotional abuse groups. These findings demonstrate longitudinal links between cortisol, depressive symptoms, and PTSD symptoms among youth with different types of maltreatment histories and highlight the need to consider the reorganization of the stress system during puberty in order to advance our understanding of the HPA axis and mental health.

Effects of Early-Life Adversities on Neuropsychiatric and Executive Functions in HIV-Positive Adults

OBJECTIVE

Adverse childhood experiences (ACEs) contribute to elevations in neuropsychiatric and neurocognitive symptoms in HIV+ adults. Emerging data suggest that exposures to threat-related and deprivation-related ACEs may have differential impacts on function, with threat exposure contributing to neuropsychiatric symptoms, and deprivation contributing to executive dysfunction. Yet, it remains unclear how specific types of ACEs impact neuropsychiatric and neurocognitive symptoms in HIV+ adults. Hence, the current study examined whether these two dimensions of adversity contribute differentially to neuropsychiatric symptoms and executive dysfunction in HIV+ adults.

METHODS

We included a sample of demographically matched HIV+ (N = 72) and HIV-negative (N = 85) adults. Standardized self-report measures assessed threat-related (interpersonal violence) and deprivation-related (poverty/neglect) ACEs, as well as neuropsychiatric symptoms (depression, anxiety, apathy). A brief battery of neuropsychological tests assessed executive functions.

RESULTS

Compared to HIV-negative participants, HIV+ participants reported significantly higher rates of threat exposure (51% vs. 67%, p = .04), while rates of deprivation did not differ significantly (8% vs. 13%, p = .38). In the HIV+ sample, threat exposure was associated with neuropsychiatric symptoms (p < .01) but not executive dysfunction (p = .75). By contrast, deprivation was associated with executive dysfunction, at a trend level (p = .09), but not with neuropsychiatric symptoms (p = .70).

CONCLUSIONS

Our data suggest that, relative to HIV-negative samples, HIV+ samples experience higher rates of threat-related ACEs, which contribute to neuropsychiatric symptom elevations. Moreover, our preliminary findings suggest that different types of ACEs could be associated with different profiles of neuropsychiatric and neurocognitive difficulty in HIV+ adults, highlighting the importance of considering dimensions of adversity in future studies.

Time of day influences stress hormone response to ketamine

Over 50% of depressed patients show hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis. Conventional therapy takes weeks to months to improve symptoms. Ketamine has rapid onset antidepressant effects. Yet its action on HPA axis activity is poorly understood. Here, we measured the corticosterone (CORT) response to ketamine administered at different times of day in the Wistar-Kyoto (WKY) rat. In male rats, blood was collected every 10 min for 28 h using an automated blood sampling system. Ketamine (5/10/25 mg · kg) was infused through a subcutaneous cannula at two time points-during the active and inactive period. CORT levels in blood were measured in response to ketamine using a radioimmunoassay. WKY rats displayed robust circadian secretion of corticosterone and was not overly different to Sprague Dawley rats. Ketamine (all doses) significantly increased CORT response at both infusion times. However, a dose dependent effect and marked increase over baseline was observed when ketamine was administered during the inactive phase. Ketamine has a robust and rapid effect on HPA axis function. The timing of ketamine injection may prove crucial for glucocorticoid-mediated action in depression.

Recognizing the importance of childhood maltreatment as a critical factor in psychiatric diagnoses, treatment, research, prevention, and education

Childhood maltreatment is the most important preventable risk factor for psychiatric disorders. Maltreated individuals typically develop psychiatric disorders at an earlier age, have a more pernicious course, more comorbidities, greater symptom severity, and respond less favorably to treatments than non-maltreated individuals with the same primary DSM-5 diagnosis. Furthermore, maltreated individuals have alterations in stress-susceptible brain regions, hypothalamic-pituitary-adrenal response, and inflammatory marker levels not discernible in their non-maltreated counterparts. Hence, maltreated and non-maltreated individuals with the same primary DSM-5 diagnoses appear to be clinically and neurobiologically distinct. The failure to embody this distinction in DSM-5 has interfered with our ability to discover novel treatments, to recommend currently available treatments most likely to be efficacious, and has been a largely unrecognized confound that has thwarted our ability to identify the biological basis for major psychiatric disorders. Incorporating this distinction into DSM will help transform this sign and symptom-based classification system to a more etiologically informed nosology. We discuss several diagnostic alternatives and recommend the inclusion of a Developmental Trauma Disorder diagnosis for severely dysregulated individuals, of all ages, with numerous comorbidities, who experienced interpersonal victimization and disruptions in attachment, such as emotional maltreatment or neglect. For less severely affected maltreated individuals, we suggest using conventional diagnostic categories, such as major depression, but with an essential modifier indicating a history of childhood maltreatment, or early life stress, to delineate the ecophenotypic variant. Implementing this strategy should improve our ability to effectively diagnose and treat individuals with psychiatric disorders and to accelerate discovery.

Therapeutic potential of nociceptin/orphanin FQ peptide (NOP) receptor modulators for treatment of traumatic brain injury, traumatic stress, and their co-morbidities

The nociceptin/orphanin FQ (N/OFQ) peptide (NOP) receptor is a member of the opioid receptor superfamily with N/OFQ as its endogenous agonist. Wide expression of the NOP receptor and N/OFQ, both centrally and peripherally, and their ability to modulate several biological functions has led to development of NOP receptor modulators by pharmaceutical companies as therapeutics, based upon their efficacy in preclinical models of pain, anxiety, depression, Parkinson's disease, and substance abuse. Both posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are debilitating conditions that significantly affect the quality of life of millions of people around the world. PTSD is often a consequence of TBI, and, especially for those deployed to, working and/or living in a war zone or are first responders, they are comorbid. PTSD and TBI share common symptoms, and negatively influence outcomes as comorbidities of the other. Unfortunately, a lack of effective therapies or therapeutic agents limits the long term quality of life for either TBI or PTSD patients. Ours, and other groups, demonstrated that PTSD and TBI preclinical models elicit changes in the N/OFQ-NOP receptor system, and that administration of NOP receptor ligands alleviated some of the neurobiological and behavioral changes induced by brain injury and/or traumatic stress exposure. Here we review the past and most recent progress on understanding the role of the N/OFQ-NOP receptor system in PTSD and TBI neurological and behavioral sequelae. There is still more to understand about this neuropeptide system in both PTSD and TBI, but current findings warrant further examination of the potential utility of NOP modulators as therapeutics for these disorders and their co-morbidities. We advocate the development of standards for common data elements (CDE) reporting for preclinical PTSD studies, similar to current preclinical TBI CDEs. That would provide for more standardized data collection and reporting to improve reproducibility, interpretation and data sharing across studies.

Impact of maternal trauma-related psychopathology and life stress on HPA axis stress response

To understand and curb intergenerational transmission of stress-related disorder, it is important to identify how trauma-related psychopathology in mothers impacts their psychophysiological stress regulation, particularly in the context of parenting their infants. In this study we investigated associations between mothers' trauma-related psychopathology and life stress and HPA axis response to a personally relevant stressor (infant separation stress) in a non-clinical sample followed longitudinally postpartum. A community sample of low-income mothers (n = 73) and their infants completed laboratory sessions at 3, 6, 12, and 18 months postnatal, and salivary cortisol samples collected before and after dyadic stress tasks at the latter three sessions. These tasks were used to assess HPA function. A three-level hierarchical linear model of repeated cortisol measures nested within sessions within mother-infant dyads did not reveal significant main effects of trauma-related psychopathology on maternal cortisol response, but there was evidence that both a clinical interviewer-rated diagnosis of PTSD and ongoing self-reported trauma symptoms blunted effects of life events on cortisol reactivity. Region of significance analyses indicated that current life stress predicted more pronounced cortisol reactivity only among mothers without trauma-related psychopathology; for those with trauma-related psychopathology, life stress did not relate to cortisol response. Effects held when controlling for childhood trauma and previous (prenatal) maternal distress symptoms, suggesting they did not reflect ongoing impacts of past trauma exposure and/or psychopathology. Blunting effects of trauma-related psychopathology on maternal life stress responsiveness may help clarify how stress sensitivities and mental health are transmitted from parent to child.

Adverse childhood experiences predict reaction to multiple sclerosis diagnosis

Objective

At the time of multiple sclerosis (MS) diagnosis, identifying those at risk for poorer health-related quality of life and emotional well-being can be a critical consideration for treatment planning. This study aimed to test whether adverse childhood experiences predict MS patients’ health-related quality of life and emotional functioning at time of diagnosis and initial course of disease.

Methods

We recruited patients at the time of new MS diagnosis to complete self-report surveys at baseline and a one-year follow-up. Questionnaires included the Adverse Childhood Experiences (ACEs), as well as the MS Knowledge Questionnaire (MSKQ), the 36-Item Short Form Health Survey (SF-36), and Self-Management Screening (SeMaS).

Results

A total of n = 31 participants recently diagnosed with relapsing remitting MS (median EDSS = 1.0, age M = 33.84 ± 8.4 years) completed the study measures. The ACEs significantly predicted health-related quality of life (SF-36) at baseline (Adjusted R² = 0.18, p = 0.011) and follow-up (Adjusted R² = 0.12, p = 0.03), baseline scores on the SeMaS Depression scale (Adjusted R² = 0.19, p = 0.008), as well as follow-up scores on the SeMaS Anxiety (Adjusted R² = 0.19, p = 0.014) and SeMaS Depression (Adjusted R² = 0.14, p = 0.036) scales. Importantly, increased ACEs scores were predictive of increased anxiety at the one-year follow-up assessment, compared to baseline.

Conclusions

Childhood adversity predicts health-related quality of life and emotional well-being at time of MS diagnosis and over the initial course of the disease. Measured using a brief screening inventory (ACEs), routine administration may be useful for identifying patients in need of increased supportive services.

Child maltreatment and cognitive vulnerabilities: Examining the link to posttraumatic stress symptoms

Research attempting to identify pathways from childhood maltreatment to adulthood posttraumatic stress symptoms (PTSS) implicates cognitive vulnerabilities that may increase risk for mental health concerns. The present study examined two cognitive vulnerabilities and their relation to PTSS amongst individuals with and without childhood maltreatment histories: attentional control and repetitive negative thinking (RNT). This research surveyed college students (N = 376) on constructs of interest. Results revealed that attentional control and RNT demonstrated significant indirect effects on PTSS (95% CI =.0003, .0336 and 95% CI =.0643, .1857, respectively). Findings suggest that childhood maltreatment severity was related to decreased attentional control and increased RNT, which were then both related to increased PTSS. Interventions for increasing attentional control and decreasing RNT should be implemented and evaluated for young adults with early adversity currently experiencing PTSS.

Prenatal exposure to morphine impairs attention and impulsivity in adult rats

RATIONALE

An alarming number of neonates born with prenatal exposure to morphine has resulted from the opioid epidemic; however, the long-term effects of prenatal opioid exposure on offspring behavior remain relatively unknown. In this study, we evaluated whether prenatal exposure to the mu opioid receptor agonist, morphine, has enduring effects on cognitive functions in adult life.

METHODS

On embryonic days 11-18 (E11-E18), female pregnant rats were injected subcutaneously with either morphine or saline twice daily. Adult male offspring that was prenatally exposed to saline or morphine was trained in the 5-choice serial reaction time test (5-CSRTT) to test their cognitive abilities under baseline conditions. Next, these rats were treated with saline (1 ml/kg), naloxone (1 mg/kg), and acute morphine (1, 3, 5 mg/kg), subcutaneously, once daily and following drug challenges rats were tested in the 5-CSRTT. Meanwhile, behavioral performance on training days between opioid drug challenges were analyzed to monitor possible drug-induced shifts in baseline performance. As a final experiment in order to investigate subchronic exposure to morphine, rats were injected with 5 mg/kg morphine for 5 days and then naloxone in the last day of the experiment (day 6).

RESULTS

Firstly, during acquisition of a stable baseline in the training phase, rats prenatally exposed to morphine showed delayed learning of the task demands. Furthermore, under baseline responding the rats prenatally exposed to morphine showed declined inhibitory control demonstrated by increased impulsive and compulsive-like responding compared to rats prenatally exposed to saline. Moreover, acute and subchronic morphine challenges in the rats prenatally exposed to morphine caused a deficit in visuospatial attention in comparison with saline treatment as well as the rats prenatally exposed to saline. These effects were abolished by naloxone.

CONCLUSION

The current findings indicate a direct causal effect of prenatal morphine exposure on inhibitory control and task learning later in life, as well as deficits in attention following morphine exposure in adulthood.

Executive Processes and Emotional and Behavioural Problems in Youths Under Protective Measures

This research studies the executive processes of youths under protective measures between 13 and 18years of age, as well as the emotional problems they have and the presence of behavioural problems, such as difficulties to control and direct attention, to control one’s own behaviour and inhibit inadequate or ineffective responses (hyperactivity-impulsiveness) and problems related to emotional regulation. In addition, we study the presence of significant differences according to the sex of the youths. We also analyse to what extent the difficulties in the executive processes are related to and can predict the emotional and behavioural problems. The instruments used were Stroop’s Colour and Word Test (Stroop), the Paths Test (TESen), and the System of Evaluation for Children and Adolescents (SENA). The results indicated that the youths had difficulties in such executive processes as execution, speed, and accuracy in carrying out tasks. Furthermore, they had emotion problems, amongst which the symptoms of anxiety are worthy of note; whilst attention deficit, hyperactivity-impulsiveness, and problems related to emotional regulation could also be observed. The data indicated greater difficulties in the executive processes for males than for females. There was a greater emotional symptomatology in the females, whilst there were greater deficits in attention and hyperactivity/impulsiveness in the males. Similarly, the deficits in the executive processes were related to and predicted emotional and behavioural problems. This research suggests the design of a structured programme focused on systematic training in real, daily situations, recommending the use of restorative techniques to work on the affected cognitive skills and techniques aimed at improving the youths’ emotion regulation.

Adolescent oxytocin administration reduces depression-like behaviour induced by early life stress in adult male and female rats

Early life stress (ELS) exposure alters brain development, increasing vulnerability for mental illness in adulthood, including depression. Despite this association, there are no approved pharmacotherapies to protect against the emergence of mental illness resulting from ELS. Recent preclinical work showed that oxytocin (OT) administration in adulthood reduced depressive-like behaviour in male rats with a history of ELS. However, the ability of an OT treatment regime in adolescence, a critical developmental window for the OT system, to prevent the expression of depressive-like behaviours following ELS has not been investigated. Therefore, the present study aimed to determine whether chronic OT administration can ameliorate the enduring effects of ELS on depressive-like behaviours in both male and female rats. Following birth, Long Evans rat pups (N = 107) underwent maternal separation (MS) for either 15 min (MS15) or 6 h (MS360) on postnatal days (PND) 1-21. During adolescence (PND 28-42), rats received a daily injection of either OT (1 mg/kg) or saline. During adulthood (PND 57 onwards), effort-related motivation was measured using a model of effortful choice (EC), while behavioural despair was measured using the forced swim test (FST). Lastly, body and organ weights were measured to examine the physiological impacts of ELS and chronic OT administration. Overall, in both sexes, MS360 increased behavioural despair yet had no impact on effort-related motivation. Importantly, adolescent OT administration prevented the MS360-induced increase in behavioural despair in both males and females. Additionally, MS360 resulted in persistent reductions in body weight in both sexes post-weaning and increased spleen weight in males and adrenal weight in females. OT treatment had no impact on body weight in either sex, but prevented the MS-induced increase in adrenal gland weight in females. Overall, these findings have important implications for using oxytocin as a preventative pharmacotherapy after ELS.

Reduced Oligodendrocyte Precursor Cell Impairs Astrocytic Development in Early Life Stress

Astrocyte maldevelopment is implicated in various neuropsychiatric diseases associated with early life stress. However, the underlying astrocytopathy mechanism, which can result in the psychiatric symptoms, remains unclear. In this study, it is shown that a reduced oligodendrocyte precursor cell (OPC) population accompanies hindered hippocampal astrocytic development in an improved parental isolation mouse model, and that the loss of OPCs suppresses astrocytic network formation and activity. It is further demonstrated that OPC-derived Wnt ligands, in particular Wnt7b, are required for Wnt/β-catenin pathway-mediated astrocytic development and subsequent effects related to neuronal function. In addition, focal replenishment of Wnt7a/b is sufficient to rescue astrocytic maldevelopment. These results elucidate a Wnt-paracrine-dependent but myelin-independent role of OPCs in regulating astrocytic development, which provides a unique insight into the astrocytopathy mechanism in early life stress, and can be implicated in the pathogenesis of human early life stress-related neuropsychiatric disorders.

Epigenetics: A missing link between early life stress and depression

Research has suggested a relationship between early life stress, and depression in particular longer episodes of depression with treatment resistant outcomes. However, the underlying mechanisms for this association remain poorly understood. Molecular studies indicate that, in general, the hereditary character of psychiatric disorders are polygenic, multifactorial and highly complex, with innumerable low-effect genetic variants interacting with each other. In addition, the importance of the environment and its interaction with genes has pointed to a fundamental role of epigenetic mechanisms in psychiatric disorders, such as methylation of deoxyribonucleic acid (DNA), alterations, histone actions and regulation of gene expression by non-coding ribonucleic acids (RNAs). This article provides an overview of the interplay of epigenetics, the HPA axis, early life stress and the development of depression. Advances in our knowledge of epigenetics in the context of early life stress and depression provide a new understanding of the genetic influence on psychopathology and could lead to the identification of new targets for clinical intervention.

Beyond child maltreatment: The incremental value of household dysfunction in the prediction of negative beliefs and internalizing symptoms in women

Child maltreatment is associated with negative mental health outcomes including depression, posttraumatic stress disorder (PTSD), and anxiety. Maltreatment experiences can result in negative beliefs about safety and wellbeing, which may maintain negative mental health symptoms. Household dysfunction (eg, impaired caregiver) is considered less severe than maltreatment but more problematic than well-functioning family environments. Objective: This study investigates the incremental value household dysfunction contributes, above effects of maltreatment, to the prediction of internalizing symptoms (PTSD, depression, anxiety), and the extent to which negative beliefs might maintain these symptoms. Participants/methods: Female college students (N = 252; M_age = 19.2) electronically reported childhood exposure to maltreatment and household dysfunction, current maladaptive beliefs and internalizing symptoms. Results: Structural equation modeling showed household dysfunction significantly predicted internalizing symptoms after controlling for maltreatment experiences; this association was mediated through negative beliefs. Conclusions: Results suggest the additional importance of considering elements of household dysfunction when exploring traumatic histories.

Social vulnerabilities for substance use: Stressors, socially toxic environments, and discrimination and racism

Applying a social determinants of health framework, this review brings attention to evidence from social sciences and neuroscience on the role of selected social factors in individual and population-level vulnerability to substance use and substance use disorders (SUDs). The understanding that social vulnerability to substance use and SUDs is multifaceted and occurs across different levels of influence (individual, interpersonal, community, and societal) is underscored. We propose that socially based stressors play a critical role in creating vulnerability to substance use and SUDs, and as such, deserve greater empirical attention to further understand how they "get under the skin." Current knowledge from social sciences and neuroscience on the relationships among vulnerability to substance use resulting from stressors, exposure to socially toxic childhood environments, and racism and discrimination are summarized and discussed, as are implications for future research, practice, and policy. Specifically, we propose using a top-down approach to the examination of known, yet often unexplored, relationships between vulnerability to substance use and SUDs, related inequities, and potential differential effects across demographic groups. Finally, research gaps and promising areas of research, practice, and policy focused on ameliorating social vulnerabilities associated with substance use and SUDs across the lifespan are presented. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.

Child maltreatment, cognitive functions and the mediating role of mental health problems among maltreated children and adolescents in Uganda

BACKGROUND

Child maltreatment poses high risks to the mental health and cognitive functioning of children not only in childhood but also in later life. However, it remains unclear whether child maltreatment is directly associated with impaired cognitive functioning or whether this link is mediated by mental health problems. Our study aimed at examining this research question among children and adolescents in Uganda.

METHODS

A sample of 232 school-going children and adolescents with a mean age of 14.03 (SD = 3.25) was assessed on multiple forms of maltreatment using the Maltreatment and Abuse Chronology Exposure-Pediatric Version (pediMACE). Executive functions were assessed by the Tower of London task and working memory by the Corsi Block Tapping task, while mental health problems were assessed using the Child PTSD Symptom Scale for PTSD and the Center for Epidemiological Studies Depression Scale for Children (CES-DC).

RESULTS

In total, 232 (100%) of the participant reported to have experienced at least one type of maltreatment in their lifetime including emotional, physical, and sexual violence as well as neglect. We found a negative association between child maltreatment and executive functions (β = - 0.487, p < 0.001) and working memory (β = - 0.242, p = 0.001). Mental health problems did not mediate this relationship.

CONCLUSIONS

Child maltreatment seems to be related to lower working memory and executive functioning of affected children and adolescents even after controlling for potential cofounders. Our study indicates that child maltreatment the affects children's cognitive functionality beyond health and well-being.

Hydrocortisone administration for reducing post-traumatic stress symptoms: A systematic review and meta-analysis

BACKGROUND

Post-traumatic stress disorder (PTSD) is a debilitating disorder that is often accompanied by alterations in the hypothalamic-pituitary (HPA) axis. While there is abundant evidence for the efficacy of psychological therapies in reducing post-traumatic stress symptoms, barely anything is known about pharmacological interventions. Given the role of the HPA axis in the pathophysiology of PTSD, the aim of this study was to provide the first meta-analysis of Hydrocortisone as a potential treatment for this condition.

METHOD

A systematic review of randomized-controlled trials (RCTs) was conducted to investigate the efficacy of hydrocortisone in the prevention and curative treatment of post-traumatic stress symptoms. This study was pre-registered with the OSF (doi:10.17605/OSF.IO/GJAZF).

FINDINGS

Eight studies (9 effect sizes) covering 362 participants met our inclusion criteria. We found that Hydrocortisone as compared to placebo significantly reduced PTSD symptoms (d = 0.96, 95% Cl 0.22-1.69 p = 0.011) and PTSD incidence (logRR = 0.85, 95% CI 1.12-1.59, p = 0.023). Subgroup analyses revealed a significant effect of Hydrocortisone when it was administered in a preventative context (d = 1.50; 95%CI 0.30-2.69, p = 0.014), but not when it was administered in a curative context (d = 0.28; 95%CI -0.11 to 0.66, p = 0.161).

CONCLUSION

Hydrocortisone appears to be a promising and efficient low-cost medication for the prevention of PTSD. However, the small number of included studies and their limited methodological quality emphasize the need for further rigorous studies in this field.

Current Posttraumatic Stress Symptoms Mediate the Relationship Between Adverse Childhood Experiences and Executive Functions

Adverse childhood experiences (ACEs) and posttraumatic stress disorder (PTSD) are both associated with lower performances on executive function tasks. However, few researchers have evaluated ACEs, posttraumatic stress (PTS) symptoms, and executive function difficulties in conjunction. Using an online micropayment service, the current study assessed whether PTS symptoms mediated the relationship between ACEs and executive functions. In total, 83 participants (54.2% female, age: M = 28.86, SD = 7.71) were administered the ACE questionnaire, PTSD Checklist for DSM-5 (PCL-5), and the Executive Function Index (EFI). A higher number of reported ACEs was related to greater PTS symptom severity (β = .40, p < .001) and worse self-rated executive functions (β = -.32, p = .002). Controlling for the number of reported ACEs, current PTS symptom severity was related to worse executive functions (β = -.45, p < .001). A bootstrapped 95% confidence interval (CI) indicated a significant indirect effect, β = -.18 (95% CI: -.30, -.08), by which current PTS symptoms mediated the relationship between the number of reported ACEs and executive functions. These results suggest that psychological interventions targeting PTS symptoms, in the context of a history of childhood trauma, may concurrently improve executive functions in adult populations.

Integrative Review of Early Life Adversity and Cortisol Regulation in Pregnancy

OBJECTIVE

To synthesize published findings on the relationship between early life adversity and hypothalamic-pituitary-adrenal axis cortisol parameters in pregnant women.

DATA SOURCES

We searched PubMed, CINAHL, and PsycINFO databases using variants and combinations of the keywords early life adversity, pregnancy, hypothalamic-pituitary-adrenal axis, and cortisol.

STUDY SELECTION

We selected articles that included pregnant participants, included measures of cortisol and early life adversity, were published in English in a peer-reviewed journal, and were of sufficient methodologic quality. Date of publication was unrestricted through May 2020.

DATA EXTRACTION

Twenty-five articles met the inclusion criteria and were evaluated for quality and risk of bias. Sources of cortisol included saliva, hair, plasma, and amniotic fluid.

DATA SYNTHESIS

We categorized findings according to four physiologically distinct cortisol output parameters: diurnal (daily pattern), phasic (in response to an acute stressor), tonic (baseline level), and pregnancy-related change. Preliminary evidence suggests that early adversity may be associated with elevated cortisol awakening response (diurnal) and blunted response to acute stressors (phasic), irrespective of other psychosocial symptoms or current stress. For women with high levels of current stress or psychological symptoms, early adversity was associated with higher baseline (tonic) cortisol levels.

CONCLUSION

Early life adversity in women is linked with alterations in cortisol regulation that are apparent during pregnancy. Researchers should examine how variations in each cortisol parameter differentially predict pregnancy health risk behaviors, maternal mental health, and neonatal health outcomes.

Associations Between Experience of Early Childhood Trauma and Impact on Obesity Status, Health, as Well as Perceptions of Obesity-Related Health Care

OBJECTIVE

To evaluate the association between obesity and history of childhood trauma in an effort to define implications for the provider-patient relationship and possible causes of failure of obesity treatment.

METHODS

Multisite survey developed by the Patient-Centered Outcomes Research Institute Learning Health Systems Obesity Cohort Workgroup consisting of 49 questions with 2 questions focusing on history of being a victim of childhood physical and/or sexual abuse was mailed to 19,964 overweight or obese patients. Data collection for this survey occurred from October 27, 2017, through March 1, 2018.

RESULTS

Among the 2211 surveys included in analysis, respondents reporting being a victim of childhood abuse increased significantly with obesity (23.6%, 26.0%, 29.1%, and 36.8% for overweight, class I, class II, and class III obesity, respectively; P<.001). A higher percentage of those who reported being a victim of childhood abuse noted that their weight issues began at an earlier age (P=.002) and were more likely to have weight-related comorbidities (P<.001), even after controlling for body mass index. Impacting physician counseling on weight loss, patients who were childhood victims of abuse reported lower self-esteem (P<.001), were more likely to feel judged by their health care providers (P=.009), and less likely to feel being treated with respect (P=.045).

CONCLUSION

Overall, being a victim of childhood abuse was significantly associated with obesity, lower self-esteem and negative experiences interacting with health care providers. Health care providers should receive training to ensure open and nonjudgmental visits with obese patients and consider the role of trauma survivorship issues in patients' development of obesity and health care experiences.

Regulation of behavioral response to stress by microRNA-690

Psychiatric disorders are affected by genetic susceptibility and environmental adversities. Therefore, the regulation of gene expression under certain environments, such as stress, is a key issue in psychiatric disorders. MicroRNAs (miRNAs) have been implicated as post-transcriptional regulators of several biological processes, which can be differentially controlled through the targeting of multiple mRNAs. However, studies reporting the functions of miRNAs in relation to stress are lacking. In this study, we identified a significant increase in the expression of miRNA-690 (miR-690) in the medial prefrontal cortex (mPFC) of FK506-binding protein 51 knock-out (Fkbp5 KO) mice. In addition, the expression pattern of miR-690 was similar to the sucrose preference of the same group in WT and Fkbp5 KO mice. miR-690 was injected into the mPFC using a recombinant adeno-associated virus mediated gene delivery method. After recovery, miR-690 overexpressing mice were exposed to restraint stress for 2 weeks. In the sucrose preference test and forced swim test, the stressed miR-690 overexpressing mice showed higher sucrose preference and lower immobility time, respectively, than stressed mice injected with the control virus. In the novel object recognition test, the stressed miR-690 overexpressing mice interacted longer with the novel object than those injected with the control virus. These results showed that miR-690 might play a role in stress resilience and could provide new insights into the epigenetic regulation of stress-associated biological functions and diseases, such as depression and post-traumatic stress disorder.

Implications of Severe Polyvictimization for Cardiovascular Disease Risk Among Female Survivors of Violence

In this study, we examined the impact of severe polyvictimization on 30-year cardiovascular disease (CVD) risk among female survivors of intimate partner violence (IPV). Data were collected from 34 participants in the "Leave it on the Mat" pilot study. The study was conducted in an urban city in a Midwestern state from August 2012 to April 2014. Severe polyvictimization was considered present if participants reported a history of three or more forms of victimization (childhood exposure to domestic violence, being psychologically or physically abused in childhood, and lifetime sexual assault) in addition to IPV. CVD risk factors included smoking, body mass index (BMI), and systolic blood pressure (SBP). A Framingham-based prediction model was used to estimate 30-year CVD risk. A linear regression model, adjusted for age, education, race/ethnicity, and family history of CVD, was calculated. Fifty percent (n = 17) of the study participants reported severe polyvictimization and the average 30-year risk of CVD in the full sample was 22.3. Participants who experienced severe polyvictimization had higher 30-year CVD risk scores when compared to participants who experienced two or fewer forms of victimization. The findings revealed that severe polyvictimization was prevalent among survivors of IPV and was associated with increased scores on the 30-year CVD risk model. Screening for abuse history could aid identification of individuals at high CVD risk.

Early life maltreatment and depression: Mediating effect of maternal hair cortisol concentration on child abuse potential

INTRODUCTION

Maternal early life maltreatment (ELM) and history of depression can bear a risk for adverse development in the child. One neurobiological pathway for the transmission of both maternal ELM and remitted depression (MDD) might be altered maternal cortisol levels. In the present study, we examine (1) main and interacting effects of maternal ELM and remitted MDD on hair cortisol concentration (HCC) in mothers, whether (2) maternal HCC explains the association between maternal ELM or remitted MDD and maternal child abuse potential, and (3) whether maternal child abuse potential as well as maternal HCC are associated with maternal report of child well-being.

METHODS

The current study involved 127 mother-child dyads. Maternal history of ELM and psychopathology were assessed via the Mini International Neuropsychiatric Interview (M.I.N.I.) and Childhood Experience and Care (CECA) interview. The Child Abuse Potential Inventory (CAPI) was used to assess maternal child abuse and neglect potential. We applied the Kidscreen-27 parent report to study child well-being. To assess HCC, hair strands were taken from the mothers. To test the research questions, a two-factorial analysis of covariance, mediation analysis using ordinary least squares regressions with bootstrapping, and Pearson correlations were calculated.

RESULTS

Mothers with ELM had significantly increased HCC. There was no effect of remitted MDD on HCC, nor an interaction effect of both factors. HCC was a significant mediator of the association between maternal ELM and maternal child abuse potential. Maternal child abuse potential as well as HCC were significantly associated with reduced child well-being.

DISCUSSION

Our data suggest that adverse experiences in childhood are associated with altered HPA-axis functioning reflected in increased levels of HCC. HPA-axis activity is not altered in mothers with remitted MDD. From a clinical point of view, one might speculate that the partially mediating effect of maternal HCC could indicate a starting point in the prevention of the intergenerational cycle of abuse.

Epigenetic alterations associated with childhood trauma and adult mental health outcomes: A systematic review

Objectives: Multiple, chronic and repeated trauma exposure in childhood is associated with adverse mental health outcomes in adulthood. In this paper we synthesise the literature on epigenetic modifications in childhood trauma (CT) and the mediating effects of differential epigenetic mechanisms on the association between CT and the later onset of psychiatric disorders.Methods: We reviewed the literature up to March 2018 in four databases: PubMed, Web of Science, EBSCOhost and SCOPUS. Non-human studies were excluded. All studies investigating CT exposure both in healthy adults (18 years and older) and adults with psychiatric disorders were included.Results: Thirty-six publications were included. For mood disorders, methylation of the glucocorticoid receptor NR3C1 gene, specifically at the NGFI-A binding site in exon 1F, and correlation with CT was a robust finding. Several studies documented differential methylation of SLC6A4, BDNF, OXTR and FKBP5 in association with CT. Common pathways identified include neuronal functioning and maintenance, immune and inflammatory processes, chromatin and histone modification, and transcription factor binding.Conclusions: A variety of epigenetic mediators that lie on a common pathway between CT and psychiatric disorders have been identified, although longitudinal studies and consistency in methodological approach are needed to disentangle cause and effect associations.

How Does Childhood Trauma Impact Women's Sexual Desire? Role of Depression, Stress, and Cortisol

The relationship between childhood trauma and adult sexual dysfunction is well documented; however, there is a paucity of research that examines the physiological and psychological mechanisms that may potentiate this relationship. As depression, perceived stress, and hypothalamic pituitary adrenal (HPA) axis dysregulation are correlates of childhood trauma and sexual dysfunction, the current study sought to examine the association of each of these domains with low sexual desire in a sample of (N = 275 [n = 137 women with low sexual desire; n = 138 sexually healthy women]) non-clinically depressed women. First, we assessed the relative contributions of HPA axis dysregulation (as indexed by the diurnal cortisol slope), childhood trauma, depression symptoms and perceived daily stress on low sexual desire. Next, we examined the degree to which HPA axis dysregulation, perceived stress, and depressive symptoms, respectively, mediated the relationship between childhood trauma and sexual desire. Results indicate that diurnal cortisol slope and depression symptoms contribute to low desire over and above perceived stress and childhood trauma and that childhood trauma is associated with low sexual desire predominantly through depressive symptomatology. Theoretical and clinical implications of the findings are discussed.

GABAergic System in Stress: Implications of GABAergic Neuron Subpopulations and the Gut-Vagus-Brain Pathway

Stress can cause a variety of central nervous system disorders, which are critically mediated by the γ-aminobutyric acid (GABA) system in various brain structures. GABAergic neurons have different subsets, some of which coexpress certain neuropeptides that can be found in the digestive system. Accumulating evidence demonstrates that the gut-brain axis, which is primarily regulated by the vagus nerve, is involved in stress, suggesting a communication between the "gut-vagus-brain" pathway and the GABAergic neuronal system. Here, we first summarize the evidence that the GABAergic system plays an essential role in stress responses. In addition, we review the effects of stress on different brain regions and GABAergic neuron subpopulations, including somatostatin, parvalbumin, ionotropic serotonin receptor 5-HT3a, cholecystokinin, neuropeptide Y, and vasoactive intestinal peptide, with regard to signaling events, behavioral changes, and pathobiology of neuropsychiatric diseases. Finally, we discuss the gut-brain bidirectional communications and the connection of the GABAergic system and the gut-vagus-brain pathway.

The Association Between Adverse Childhood Experiences (ACEs) and Postoperative Bariatric Surgery Weight Loss Outcomes

PURPOSE

Previous research demonstrates that exposure to adverse childhood experiences (ACEs) is associated with development of obesity. The same mechanisms mediating this relationship could theoretically affect attempts to lose weight in adulthood. However, it is unclear whether or not exposure to ACEs impacts the effectiveness of bariatric surgery. The present study aimed to examine the association of exposure to ACEs to postoperative weight loss outcomes.

MATERIALS AND METHODS

One hundred ninety-eight patients undergoing bariatric surgery were evaluated for their exposure to ACEs, determined by a presurgical questionnaire and recorded as an ACEs score. Percent total weight loss (%TWL) was calculated to evaluate postoperative weight loss at 1-, 3-, and 6-month intervals postoperatively. One hundred forty-two participants were available for follow-up at the 6-month postoperative interval.

RESULTS

The sample consisted of 167 women and 31 men with a mean age of 47.7. Twenty-five percent of participants experienced high exposure to ACEs, defined as experiencing ≥ 4 ACEs. The average %TWL at 6 months was 16.52%. Multilevel modeling found no significant relationship between ACEs score and %TWL at any of the postoperative time intervals, both before and after adjusting for age, sex, and race.

CONCLUSION

High exposure to ACEs was not associated with poorer weight loss outcomes, and participants with a large number of ACEs generally lost the anticipated amount of weight.

Circulating PACAP peptide and PAC1R genotype as possible transdiagnostic biomarkers for anxiety disorders in women: a preliminary study

Pituitary adenylate cyclase activating polypeptide (PACAP, gene Adcyap1) is a neuropeptide and hormone thought to play a critical role in stress response (Stroth et al., Ann NY Acad Sci 1220:49-59, 2011; Hashimoto et al., Curr Pharm Des 17:985-989, 2011). Research in humans implicates PACAP as a useful biomarker for the severity of psychiatric symptoms in response to psychological stressors, and work in rodent models suggests that PACAP manipulation exerts downstream effects on peripheral hormones and behaviors linked to the stress response, providing a potential therapeutic target. Prior work has also suggested a potential sex difference in PACAP effects due to differential estrogen regulation of this pathway. Therefore, we examined serum PACAP and associated PAC1R genotype in a cohort of males and females with a primary diagnosis of generalized anxiety disorder (GAD) and nonpsychiatric controls. We found that, while circulating hormone levels were not associated with a GAD diagnosis overall (p = 0.19, g = 0.25), PACAP may be associated with GAD in females (p = 0.04, g = 0.33). Additionally, among patients with GAD, the risk genotype identified in the PTSD literature (rs2267735, CC genotype) was associated with higher somatic anxiety symptom severity in females but lower somatic anxiety symptom severity in males (-3.27, 95%CI [-5.76, -0.77], adjusted p = 0.03). Taken together, the associations between the risk genotype, circulating PACAP, and somatic anxiety severity were stronger among females than males. These results indicate a potential underlying biological etiology for sex differences in stress-related anxiety disorders that warrants further study.

Post-traumatic Stress Disorder and Suicidal Behaviors in American Adolescents: Analysis of 159,500 Psychiatric Hospitalizations

Objectives Our main goal is to understand the demographics and psychiatric comorbidities and to evaluate the risk of suicidal behaviors in post-traumatic stress disorder (PTSD) adolescents. Methods We included 159,500 adolescents (age, 12 to 18 years) with a primary psychiatric diagnosis from the Nationwide Inpatient Sample from January to December 2014 and grouped them by a diagnosis of PTSD (N = 21,230 [13.3%]). A logistic regression model was used to measure the odds ratio (OR) for suicidal behaviors in PTSD versus non-PTSD cohorts. Results A higher proportion of PTSD adolescents were females (75.7%) and whites (63.6%). The most prevalent psychiatric comorbidities in PTSD inpatients (vs. non-PTSD) were anxiety disorders (100% vs. 31.9%) and mood disorders (89.4% vs. 84.7%). About 48.7% of PTSD inpatients had suicidal behaviors and had a higher risk (OR 1.23; 95% CI: 1.19-1.26; P < 0.001) compared to that seen in 43.6% of the non-PTSD cohort. Conclusions Diagnosis of PTSD is prevalent in adolescents, especially females and whites, with anxiety and mood disorders being the most prevalent comorbidities. There exists a significant association between PTSD and suicidal behaviors, with an increased risk of 23% in adolescents.

Perinatal exposure to bisphenol A at the intersection of stress, anxiety, and depression

Endocrine-disrupting compounds (EDCs) are common contaminants in our environment that interfere with typical endocrine function. EDCs can act on steroid and nuclear receptors or alter hormone production. One particular EDC of critical concern is bisphenol A (BPA) due to its potential harm during the perinatal period of development. Previous studies suggest that perinatal exposure to BPA alters several neurotransmitter systems and disrupts behaviors associated with depression and anxiety in the rodent offspring later in life. Thus, dysregulation in neurotransmission may translate to behavioral phenotypes observed in mood and arousal. Many of the systems disrupted by BPA also overlap with the stress system, although little evidence exists on the effects of perinatal BPA exposure in relation to stress and behavior. The purpose of this review is to explore studies involved in perinatal BPA exposure and the stress response at neurochemical and behavioral endpoints. Although more research is needed, we suggest that perinatal BPA exposure is likely inducing variations in behavioral phenotypes that modulate their action through dysregulation of neurotransmitter systems sensitive to stress and endocrine disruption.

Hair cortisol concentration mediates the association between parent and child psychopathology

Parent and child mental health are strongly associated and this association may be transmitted via disruption to the hypothalamic-pituitary-adrenal axis in children. This study examined the potential mediating role of hair cortisol concentration (HCC) in the association between parent psychopathology and child mental disorder. Data come from 100 children diagnosed with a mental disorder [major depression (66 %), generalized anxiety (58 %), attention-deficit hyperactivity (33 %), oppositional defiant (35 %)] and their parents. Parent psychopathology was measured using the Center for Epidemiological Studies Depression Scale and State-Trait Anxiety Inventory. Child mental disorder was measured using the Mini International Neuropsychiatric Interview and hair samples were assayed using high-sensitivity ELISA for cortisol extraction. Sex-specific path models were specified to estimate mediating effects (αβ). Children were, on average, 14.4 (SD 2.3) years of age and 70 % were girls. Adjusting for child age, parent sex, and family income, HCC mediated the association between symptoms of parent psychopathology and major depression and attention-deficit hyperactivity in all children (αβ ranging -0.07 to 0.19; 38-46 % effect mediated). Mediating effects for generalized anxiety and opposition defiant were evident for boys only (αβ ranging -0.26 to 0.14; 31-38 % effect mediated). Evidence suggests HCC partially mediates the association between parent psychopathology and child mental disorder, and for generalized anxiety and oppositional defiant, this effect is specific to boys. Family inventions to reduce child stress may be effective in buffering the consequences of parent psychopathology. Further research that considers sex effects is needed to clarify how HCC conditions risk for mental disorder in children.

Gender differences in the associations between types of childhood maltreatment and sleep disturbance among Chinese adolescents

BACKGROUND

To explore the association between different types of childhood maltreatment and sleep disturbance among Chinese adolescents, with a particular focus on gender differences.

METHODS

A cross-sectional study was conducted in 7 randomly selected provinces of China via the 2015 School-Based Chinese Adolescents Health Survey. Questionnaires from 153,547 students were completed and were eligible for this study. The Chinese Version of the Pittsburgh Sleep Quality Index (CPSQI) and Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to assess sleep disturbance and childhood maltreatment, respectively.

RESULTS

The prevalence of sleep disturbance among adolescents in China was 21.6%. A significantly increased risk of sleep disturbance was associated with physical abuse (aOR=1.22, 95% CI=1.21-1.24), emotional abuse (aOR=1.15, 95% CI=1.14-1.15), sexual abuse (aOR=1.16, 95% CI=1.15-1.18), physical neglect (aOR=1.04, 95% CI=1.03-1.05), and emotional neglect (aOR=1.03, 95% CI=1.02-1.03). A significant dose-response relationship was found between cumulative childhood maltreatment experiences and sleep disturbance. The interaction terms (between physical abuse/emotional abuse/sexual abuse/physical neglect/emotional neglect/number of childhood traumas and gender) were significantly associated with sleep disturbance. Further stratification analyses by gender showed that girls who reported experiencing one or more of these five types of childhood maltreatment had a higher risk of sleep disturbance than boys.

LIMITATIONS

The study only included school students, and the cross-sectional design limited our ability to make causal inferences.

CONCLUSIONS

The study findings suggest that childhood maltreatment increases the risk of sleep disturbance in adolescents. Furthermore, exposure to single and multiple types of childhood maltreatment predicts lower sleep quality in girls.

Autonomic nervous system activity and callous-unemotional traits in physically maltreated youth

BACKGROUND

Research into callous-unemotional (CU) traits often focuses exclusively on biological risk factors without integrating social factors. This gap exists despite a growing body of research showing that the social environment may actually impact physiological functioning, which could in turn affect behavior.

OBJECTIVE

The current study addresses this limitation by examining physical maltreatment and heart rate stress reactivity as potential risk factors for CU traits.

PARTICIPANTS AND SETTING

This research was conducted in a community sample of Chinese youth (mean age = 11.83 years, 44.3 % female).

METHODS

Each child separately reported frequency of physical maltreatment experiences by his or her mother and father over the past 12 months. Children completed a self-report measure of CU traits.

RESULTS

Frequency of maternal physical maltreatment was associated with uncaring traits in females, but not in males. Paternal physical maltreatment was associated with uncaring traits in both males and females and with callous traits in females only. While paternal physical maltreatment was associated with lower heart rate reactivity in females, maternal physical maltreatment was associated with higher heart rate reactivity in females.

CONCLUSION

Findings provide mixed support for a potential physiological pathway through which child maltreatment may impact callous traits and provide a multilevel, biosocial lens through which to understand CU traits.

The role of childhood maltreatment in cortisol in the hypothalamic-pituitary-adrenal (HPA) axis in methamphetamine-dependent individuals with and without depression comorbidity and suicide attempts

BACKGROUND

The hypothalamic-pituitary-adrenal (HPA) axis dysregulation which was found to have an important role in the pathophysiology of depression, suicide, and substance dependence, may be influenced by childhood maltreatment (CM). The present study aimed to investigate the relationship between CM and cortisol changes in methamphetamine-dependent individuals.

METHODS

In a cross-sectional study, methamphetamine-dependent individuals (n = =195) with or without both comorbid major depressive disorder (MDD) and a history of suicide attempts were selected and completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Beck Scale for Suicide Ideation (BSSI), and the Beck Depression Inventory-II (BDI-II). To assess cortisol levels, saliva samples were collected at six time intervals for two consecutive days.

RESULTS

A history of CM significantly predicted wake-up cortisol level, cortisol awakening response (CAR), and diurnal cortisol slope. Methamphetamine-dependent individuals with both MDD and lifetime suicide attempts had higher CM and higher cortisol levels with a blunted diurnal cortisol slope than individuals who were merely methamphetamine-dependent. Individuals with high CM showed higher cortisol levels with a blunted diurnal slope than those with low or without CM.

LIMITATIONS

Cross-sectional data and use of self-report scales, especially retrospective measurements (e.g., the CTQ-SF), were important limitations of this study.

CONCLUSION

Findings suggest that methamphetamine-dependent individuals with adverse psychological factors such as CM, MDD, and suicide attempts may show dysregulation in biological factors including cortisol level. In addition, CM and its effects on cortisol in the HPA axis may emerge as important factors regarding psychopathological use of methamphetamine.

Sensitive Periods for the Association Between Childhood Maltreatment and BMI

INTRODUCTION

Although previous research has suggested a positive association between child maltreatment and BMI over the life course, it is unclear when this develops.

METHODS

The authors used time-varying effect models and data from a nationally representative, longitudinal, cohort study (Add Health), to test how childhood physical, sexual, and emotional abuse uniquely varied in associations with BMI from age 13 to 28 years, and whether different patterns existed for male and female participants. Add Health collected data from 1994 to 2008, and the present analyses took place in 2018.

RESULTS

Age 18 years was the earliest that a relationship between maltreatment and BMI emerged for either sex. Child sexual abuse was negatively associated with BMI among male participants from 18.5 to 20 years, but positively associated with BMI among female participants from 19 to 24.5 years, and childhood emotional abuse was positively associated with BMI among female participants from 18 to 28 years.

CONCLUSIONS

The relationship between child maltreatment and BMI varies as a function of type of maltreatment, sex, and time. Notably, associations between maltreatment and BMI did not emerge until young adulthood. Future research should investigate mechanisms by which the association between maltreatment and BMI changes over time to identify trauma-informed intervention targets for improving weight outcomes.

Female pups receive more maltreatment from stressed dams

The effects of exposure to developmental stress often diverge for males and females. Using the scarcity-adversity model of low nesting resources outside the home cage, our lab has discovered sex differences in both behavioral and epigenetic consequences of repeated exposure to caregiver maltreatment. For the measures we have performed to date, we have found more consequences for females. The reasons underlying this sex disparity are unknown. In the current experiment, we aimed to discern the quality of maternal care received by male and female pups in our model. As we have previously found more behavioral and epigenetic consequences in females, we hypothesized that females receive more adverse care compared to their male littermates. Our hypothesis was supported; in our maltreatment condition, we found that female pups received more adverse care than males. This sex difference in adverse care was not present in our two control conditions (cross-foster and normal maternal care). These data lend support to the notion that one reason females in our model incur more behavioral and epigenetic consequences is a result of greater mistreatment by the dam.

Differential activation of the renin-angiotensin-aldosterone-system in response to childhood and adulthood trauma

OBJECTIVE

Previous evidence suggested lasting and cumulative effects of traumatization on the renin-angiotensin-aldosterone-system (RAAS). However, it is unclear whether traumas during childhood and those experienced in adulthood differentially impact the RAAS. In this study, we sought to investigate main and putative interactive effects of childhood and adulthood trauma on RAAS functioning.

METHODS

Plasma concentrations of renin and aldosterone were measured in a general population sample (n = 2016). Childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ), adulthood trauma was measured using the PTSD module of the Structured Clinical Interview of the DSM-IV. Linear regression models were calculated to assess the relations between childhood or adulthood traumatization with renin and aldosterone concentrations.

RESULTS

Exposure to (ß = 0.094; p = 0.01), severity of childhood trauma (ß = 0.004; p = 0.01) were associated with increased aldosterone, but not renin levels. Results were carried by all dimensions of abuse, while childhood neglect was not associated with altered RAAS activity. In contrast, adulthood traumas (ß = 0.113; p < 0.01) were significantly associated with increased renin concentrations. Subjects with PTSD (renin: ß = 0.345; p = 0.01; aldosterone: ß = 0.232; p = 0.04) and those who had been exposed to both childhood and adulthood trauma showed increases in renin (ß = 0.180; p < 0.01) and aldosterone (ß = 0.340; p < 0.01) levels.

DISCUSSION

These findings indicate that trauma is associated with differential alterations of the RAAS depending on the time of traumatization. Moreover, exposure to childhood or adulthood trauma may act synergistically on the RAAS, resulting in severe dysregulation of the RAAS. The results contribute to explain associations between trauma and enhanced risk for physical disease.

Childhood abuse predicts affective symptoms via HPA reactivity during mother-infant stress

Despite extensive literature positing the hypothalamic-pituitary-adrenal (HPA) axis as a mechanism in the association between early childhood maltreatment and later adult psychopathology, empirical support for this full pathway is lacking. We tested indirect effects of childhood maltreatment on women's later affective symptomatology via HPA axis responding to a stressor involving their own infant. Women (n = 47) in a larger longitudinal study were assessed following the birth of their infant from 3 to 18 months postnatal. They reported childhood maltreatment history at 3 months and participated in a dyadic stress task with their infant at 12 months, at which time four salivary cortisol samples were collected to assess HPA response. Depression and anxiety symptoms at 18 months (controlling for symptom levels reported at 12 months) served as the primary outcome. Multilevel modeling was used to estimate both levels and dynamics of women's cortisol response trajectories. Tests of indirect effects revealed a significant effect of total Childhood Trauma Questionnaire (CTQ) scores on anxiety symptoms and a marginally significant effect on depression symptoms. Follow-up analyses with CTQ subscales revealed significant indirect effects of emotional and physical abuse on women's ongoing anxiety symptoms via more pronounced cortisol reactivity curves during the mother-infant stressor. We discuss methodological choices that may have allowed these effects to be detected in the present study and implications for stress-related risk and intervention.