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Aizpurua-Perez I, Arregi A, Gonzalez D, Urruticoechea A, Labaka A, Minguez-Alcaide X, Ugartemendia G, Pascual-Sagastizabal E, Echeverria R, Perez-Tejada J. A randomized controlled trial of the effectiveness of a one-to-one peer support intervention on resilience, social support, and salivary cortisol in recently diagnosed women with breast cancer. Eur J Oncol Nurs 2024; 71:102616. [PMID: 38885598 DOI: 10.1016/j.ejon.2024.102616] [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: 10/29/2023] [Revised: 05/11/2024] [Accepted: 05/18/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Peer support has been suggested as a way to help women diagnosed with breast cancer to better cope with their situation, but studies on its effectiveness have conflicting results. This randomized controlled trial aimed to study the effectiveness of a one-to-one peer support intervention on psychological resilience, social support, and salivary cortisol among breast cancer patients. METHODS The sample consisted of 121 newly diagnosed women at Onkologikoa Hospital. Patients who were prescribed chemotherapy were randomly assigned to Intervention Group 1 (IG1) or Control Group 1 (CG1). Similarly, those prescribed adjuvant radiotherapy were assigned to IG2 or CG2. Women in IG1 received 8 biweekly social support sessions from volunteer survivors who had successfully overcome breast cancer, while IG2 received 6 biweekly sessions. CG1 and CG2 only received standard care. Resilience, social support, and salivary cortisol were assessed at baseline (T1) and at the end of the intervention (T2). RESULTS We found a non-significant, yet a small to moderate size increase in resilience from T1 to T2 in IG1 (p = 0.246; dDc = 0.47). Upon regression analysis, we observed that this increase was determined by changes in cortisol (β = -0.658, p = 00.010), affective support (β = -0.997, p = 00.014), and emotional support (β = 0.935, p = 00.008). We also found a significant decrease in resilience levels in CG2 from T1 to T2 (p = 0.003; dDc = 0.88). CONCLUSION The present study suggests that peer support can exert a protective psychological influence on women diagnosed with breast cancer, and further indicates an exciting avenue for future intervention development in the breast cancer care continuum. TRIAL REGISTRATION ClinicalTrials.gov NCT05077371.
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Affiliation(s)
- Ibane Aizpurua-Perez
- Department of Basic Psychological Processes and Their Development, University of the Basque Country, San Sebastian, Spain.
| | - Amaia Arregi
- Department of Basic Psychological Processes and Their Development, University of the Basque Country, San Sebastian, Spain.
| | | | | | - Ainitze Labaka
- Department of Nursing II, University of the Basque Country, San Sebastian, Spain.
| | - Xavier Minguez-Alcaide
- Department of Social Psychology, University of the Basque Country, San Sebastian, Spain.
| | | | - Eider Pascual-Sagastizabal
- Department of Basic Psychological Processes and Their Development, University of the Basque Country, San Sebastian, Spain.
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Girardi D, Dal Corso L, Arcucci E, Yıldırım M, Pividori I, Prandi A, Falco A. Hair dehydroepiandrosterone sulfate as biomarker of employees' well-being? A longitudinal investigation of support, resilience, and work engagement during COVID-19 pandemic. Front Psychol 2024; 15:1337839. [PMID: 38572210 PMCID: PMC10987734 DOI: 10.3389/fpsyg.2024.1337839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/06/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Building on the motivational process of the job demands-resources (JD-R) theory, in the current research we investigated the longitudinal association between supervisor support/resilience as job/personal resources, work engagement (WE) and hair dehydroepiandrosterone sulfate, or DHEA(S), as a possible biomarker of employees' well-being. Methods In the context of the COVID-19 pandemic, 122 workers completed two self-report questionnaires (i.e., psychological data): the former at Time 1 (T1) and the latter three months afterwards, at Time 2 (T2). Participants also collected a strand of hair (i.e., biological data) at T2. Results Results from path analysis showed that both SS and resilience at T1 were positively related to WE at T2, which, in its turn, was positively related to hair DHEA(S) at T2. Both SS and resilience at T1 had a positive indirect effect on hair DHEA(S) at T2 through WE at T2, which fully mediated the association between job/personal resources and hair DHEA(S). Discussion Overall, results are consistent with the motivational process of the JD-R. Furthermore, this study provides preliminary evidence for the role of hair DHEA(S) as a biomarker of WE, a type of work-related subjective well-being that plays a central role in the motivational process of the JD-R, leading to favorable personal and organizational outcomes. Finally, the article outlines practical implications for organizations and professionals to foster WE within the workplace.
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Affiliation(s)
- Damiano Girardi
- FISPPA Section of Applied Psychology, University of Padua, Padua, Italy
| | - Laura Dal Corso
- FISPPA Section of Applied Psychology, University of Padua, Padua, Italy
| | - Elvira Arcucci
- FISPPA Section of Applied Psychology, University of Padua, Padua, Italy
| | - Murat Yıldırım
- Department of Psychology, Agri Ibrahim Cecen University, Ağrı, Türkiye
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
- Department of Social and Educational Sciences, Lebanese American University, Beirut, Lebanon
| | - Isabella Pividori
- Department of Agricultural, Environmental and Animal Sciences, University of Udine, Udine, Italy
| | - Alberto Prandi
- Department of Agricultural, Environmental and Animal Sciences, University of Udine, Udine, Italy
| | - Alessandra Falco
- FISPPA Section of Applied Psychology, University of Padua, Padua, Italy
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Aizpurua-Perez I, Arregi A, Gonzalez D, Macia P, Ugartemendia G, Labaka A, Zabalza N, Perez-Tejada J. Resilience in Newly Diagnosed Breast Cancer Women: The Predictive Role of Diurnal Cortisol and Social Support. Biol Res Nurs 2024; 26:68-77. [PMID: 37477294 DOI: 10.1177/10998004231190074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
BACKGROUND Breast cancer is currently the most prevalent malignancy among women. Psychological resilience is an important factor that diminishes the stress-related emotional and psychosocial disturbances triggered when receiving the diagnosis. Furthermore, resilience appears to be associated with cortisol, the hormonal end-product of the hypothalamic-pituitary-adrenal axis; however, further studies are needed due to the mixed results reported. Thus, we aim to examine the predictive role of social support and cortisol in resilience among breast cancer patients. METHODS A total of 132 women with primary breast cancer completed the Medical Outcomes Study-Social Support Survey (MOS-SSS) and the Resilience Scale (RS-14) and provided four salivary samples for the estimation of participants' total daily cortisol production, for which the formula of the area under the curve with respect to the ground (AUCg) was applied. Moderation analyses were performed to study the influence of social support and AUCg on psychological resilience levels. RESULTS The regression analyses showed a direct significant effect for the emotional support subscale of MOS-SSS on resilience and the interaction between emotional support and AUCg was also found to be statistically significant. Specifically, the conditional effect of emotional support on resilience was found to be significant at middle (M = 3.08; p < .05) and low levels (M = .59; p < .001) of AUCg. CONCLUSIONS Our results suggest that newly diagnosed breast cancer women with middle and low diurnal cortisol profiles may benefit more from emotional support based-interventions while women with high diurnal cortisol may need more individualized therapies.
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Affiliation(s)
- Ibane Aizpurua-Perez
- Department of Basic Psychological Processes and Their Development, University of the Basque Country, San Sebastian, Spain
| | - Amaia Arregi
- Department of Basic Psychological Processes and Their Development, University of the Basque Country, San Sebastian, Spain
| | | | - Patricia Macia
- Department of Basic Psychological Processes and Their Development, University of the Basque Country, San Sebastian, Spain
| | | | - Ainitze Labaka
- Department of Nursing II, University of the Basque Country, San Sebastian, Spain
| | - Nerea Zabalza
- Oncologic Center (Onkologikoa), San Sebastian, Spain
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Aizpurua-Perez I, Arregi A, Labaka A, Martinez-Villar A, Perez-Tejada J. Psychological resilience and cortisol levels in adults: A systematic review. Am J Hum Biol 2023; 35:e23954. [PMID: 37395446 DOI: 10.1002/ajhb.23954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023] Open
Abstract
Resilience or the capacity to "bend but not break" refers to the ability to maintain or regain psychobiological equilibrium during or after exposure to stressful life events. Specifically, resilience has been proposed as a potential resource for staving off pathological states that often emerge after exposure to repeated stress and that are related to alterations in circulating cortisol. The aim of this systematic review of the literature was to gather evidence related to the relationship between psychological resilience and cortisol levels in adult humans. An extensive systematic search was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method in the PubMed and Web of Science databases. In total, 1256 articles were identified and, of these, 35 peer-reviewed articles were included in the systematic review. We categorized findings according to (1) the short and long-term secretion period covered by the cortisol matrices selected by studies and also according to (2) the differentiated diurnal, phasic (acute), and tonic (basal) components of the HPA output to which they refer and their relationships with resilience. Reported relationships between psychological resilience and distinct cortisol output parameters varied widely across studies, finding positive, negative, and null associations between the two variables. Notably, several of the studies that found no relationship between resilience and cortisol used a single morning saliva or plasma sample as their assessment of HPA axis activity. Despite limitations such as the great variability of the instruments and methods used by the studies to measure both resilience and cortisol, together with their high heterogeneity and small sample sizes, the evidence found in this systematic review points to the potential of resilience as a modifiable key factor to modulate the physiological response to stress. Therefore, further exploration of the interaction between the two variables is necessary for the eventual development of future interventions aimed at promoting resilience as an essential component of health prevention.
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Affiliation(s)
- Ibane Aizpurua-Perez
- Department of Basic Psychological Processes and their Development, University of the Basque Country, San Sebastian, Spain
| | - Amaia Arregi
- Department of Basic Psychological Processes and their Development, University of the Basque Country, San Sebastian, Spain
| | - Ainitze Labaka
- Department of Nursing II, University of the Basque Country, San Sebastian, Spain
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Piarulli FM, Margari A, Margari F, Matera E, Croce F, Furente F, Gabellone A, Petruzzelli MG. Do Cortisol and Dehydroepiandrosterone Influence Motivational Factors for Non-Suicidal Self-Injury in Female Adolescents? J Clin Med 2023; 12:jcm12051924. [PMID: 36902709 PMCID: PMC10003553 DOI: 10.3390/jcm12051924] [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: 02/07/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Non-suicidal self-injury (NSSI) is a significant public health issue that particularly affects female adolescents usually emerging during puberty, with a subsequent reduction and even remission in the phenomenon later in life. The dysregulation of the hormonal stress response, particularly cortisol and dehydroepiandrosterone sulfate (DHEA-S), whose levels increase markedly during pubertal adrenarche, has been associated with the development and maintenance of a wide range of emotional disorders. Our study aims to investigate whether different cortisol-DHEA-S response patterns could be associated with the main motivational moderators to engage NSSI as well as with urgency and motivation to stop NSSI in a sample of female adolescents. We found significant correlations between stress hormones and several factors that support and sustain NSSI, specifically: cortisol levels and distressing/upsetting urge (r = 0.39 and a p = 8.94 × 10-3) and sensation seeking (r = -0.32 and a p = 0.04), as well as cortisol/DHEA-s ratio and external emotion regulation (r = 0.40 and a p = 0.01) and desire to stop NSSI (r = 0.40 and a p = 0.01). Cortisol and DHEA-S may play a role in NSSI through the regulation of stress responses and affective states. Such results could have implications for the development of new and improved treatment and prevention plans for NSSI.
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Affiliation(s)
- Francesco Maria Piarulli
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University “A. Moro”, 7016 Bari, Italy
| | - Anna Margari
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University “A. Moro”, 7016 Bari, Italy
| | - Francesco Margari
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University “A. Moro”, 7016 Bari, Italy
| | - Emilia Matera
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University “A. Moro”, 7016 Bari, Italy
- Correspondence:
| | - Federica Croce
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University “A. Moro”, 7016 Bari, Italy
| | - Flora Furente
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University “A. Moro”, 7016 Bari, Italy
| | - Alessandra Gabellone
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University “A. Moro”, 7016 Bari, Italy
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Gundogmus AG, Sezer Katar K, Orsel S, Ozturk G, Yilmaz KB. The relationship of potential biomarkers with psychological resilience and post-traumatic growth in female patients with breast cancer. PLoS One 2022; 17:e0277119. [PMID: 36525411 PMCID: PMC9757578 DOI: 10.1371/journal.pone.0277119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 10/21/2022] [Indexed: 12/23/2022] Open
Abstract
While investigating psychosocial factors on resilience and post-traumatic growth draws attention, research on biological correlates is limited. We investigated the relationship between post-traumatic growth, resilience, post-traumatic stress, and potential biomarkers in female patients with breast cancer (n = 71) from the general surgery or oncology clinics. They completed the Post-Traumatic Growth Inventory (PTGI), Connor Davidson Psychological Resilience Scale (CD-RISC), Brief Resilience Scale (BRS), PTSD Checklist for DSM-V, and Hospital Anxiety and Depression Scale. Blood samples were collected for NPY, ALLO, DHEA-S, testosterone, cortisol, and hsCRP levels. The relationship between biochemical parameters and the scales was investigated in the whole patient group and in the subgroup of patients who perceived breast cancer as traumatic. When all the patients were evaluated, hsCRP and depression scores were significantly and positively correlated; and hsCRP, BRS score, and PTGI change in self-perception subscale score were significantly and negatively correlated. There was a significant positive correlation between the ALLO level and the psychological resilience (CD-RISC) score in the patient group who perceived breast cancer as traumatic. It was observed that psychological resilience and PTG were positively correlated, and that multiple biomarkers were associated with psychological resilience in female breast cancer patients. Especially findings regarding ALLO levels and psychological resilience could be a new target for future research.
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Affiliation(s)
- Ayse Gokcen Gundogmus
- Department of Psychiatry, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
- * E-mail:
| | - Kubra Sezer Katar
- Department of Psychiatry, Islahiye State Hospital, Gaziantep, Turkey
| | - Sibel Orsel
- Department of Psychiatry, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Gulfer Ozturk
- Department of Biochemistry, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Kerim Bora Yilmaz
- Department of Surgery, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
- Department of Medical and Surgical Research, Institute of Health Sciences, Hacettepe University, Ankara, Turkey
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Ang WHD, Chew HSJ, Dong J, Yi H, Mahendren R, Lau Y. Digital training for building resilience: Systematic review, meta-analysis, and meta-regression. Stress Health 2022; 38:848-869. [PMID: 35460533 PMCID: PMC10084366 DOI: 10.1002/smi.3154] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/25/2022] [Accepted: 04/19/2022] [Indexed: 01/01/2023]
Abstract
Resilience is learnable and broadly described as an individual's adaptive coping ability, its potential value for stress reduction must be explored. With a global coronavirus pandemic, innovative ways to deliver resilience training amidst heightened mental health concerns must be urgently examined. This systematic review aimed to (1) evaluate the effectiveness of digital training for building resilience and reducing anxiety, depressive and stress symptoms and (2) to identify essential features for designing future digital training. A three-step search was conducted in eight electronic databases, trial registries and grey literature to locate eligible studies. Randomised controlled trials examining the effects of digital training aimed at enhancing resilience were included. Data analysis was conducted using the Stata version 17. Twenty-two randomised controlled trials involving 2876 participants were included. Meta-analysis revealed that digital training significantly enhanced the participants' resilience with moderate to large effect (g = 0.54-1.09) at post-intervention and follow-up. Subgroup analyses suggested that training delivered via the Internet with a flexible programme schedule was more effective than its counterparts. This review supports the use of digital training in improving resilience. Further high-quality randomised controlled trials with large sample size are needed.
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Affiliation(s)
- Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jie Dong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Rathi Mahendren
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Kent M, Kovalev D, Hart B, Leserve D, Handford G, Vavra D, Lambert K. The emotional impact of disrupted environmental contexts: Enrichment loss and coping profiles influence stress response recovery in Long-Evans rats. J Neuroendocrinol 2022; 34:e13179. [PMID: 35866213 PMCID: PMC9540572 DOI: 10.1111/jne.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
Abstract
With increasing rates of anxiety and mood disorders across the world, there is an unprecedented need for preclinical animal models to generate translational results for humans experiencing disruptive emotional symptoms. Considering that life events resulting in a perception of loss are correlated with depressive symptoms, the enrichment-loss rodent model offers promise as a translational model for stress-initiated psychiatric disorders. Additionally, predisposed temperament characteristics such as coping styles have been found to influence an individual's stress response. Accordingly, male rats were profiled as either consistent or flexible copers and assigned to one of three environments: standard laboratory housing, enriched environment, or enriched environment exposure followed by downsizing to standard laboratory cages (i.e., enrichment-loss group). Throughout the study, several behaviors were assessed to determine stress, social, and reward-processing responses. To assess recovery of the stress response, fecal samples were collected following the swim stress in 3-h increments to determine the recovery trajectory of corticosterone (CORT) and dehydroepiandrosterone (DHEA) metabolite levels. Upon death, neural markers of neuroplasticity including doublecortin, glial fibrillary acidic factor, and brain-derived neurotrophic factor were assessed via immunohistochemistry. Results indicated the flexible coping animals in the continuous enriched group had higher DHEA/CORT ratios (consistent with adaptive responses in past research); furthermore, the enrichment-loss animals exhibited a blunted CORT response throughout the assessments and enriched flexible copers had faster CORT recovery rates than consistent copers. Standard housed animals exhibited less exploratory behavior in the open field task and continuous enriched, flexible rats consumed more food rewards than the other groups. No differences in neuroplasticity neural markers were observed. In sum, the results of the present study support past research indicating the disruptive consequences of enrichment-loss, providing evidence that the model represents a valuable approach for the investigation of neurobiological mechanisms contributing to interindividual variability in responses to changing experiential landscapes.
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Affiliation(s)
- Molly Kent
- Department of BiologyVirginia Military InstituteLexingtonVAUSA
| | - Dmitry Kovalev
- Department of PsychologyUniversity of RichmondRichmondVAUSA
| | - Benjamin Hart
- Department of PsychologyUniversity of RichmondRichmondVAUSA
| | | | | | - Dylan Vavra
- Department of PsychologyUniversity of RichmondRichmondVAUSA
| | - Kelly Lambert
- Department of PsychologyUniversity of RichmondRichmondVAUSA
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de Vries LP, van de Weijer MP, Bartels M. The human physiology of well-being: A systematic review on the association between neurotransmitters, hormones, inflammatory markers, the microbiome and well-being. Neurosci Biobehav Rev 2022; 139:104733. [PMID: 35697161 DOI: 10.1016/j.neubiorev.2022.104733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/09/2022] [Accepted: 06/07/2022] [Indexed: 02/08/2023]
Abstract
To understand the pathways through which well-being contributes to health, we performed a systematic review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines on the association between well-being and physiological markers in four categories, neurotransmitters, hormones, inflammatory markers, and microbiome. We identified 91 studies. Neurotransmitter studies (knumber of studies=9) reported only a possible positive association between serotonin and well-being. For the hormone studies (k = 48), a lower momentary cortisol level was related to higher well-being (meta-analytic r = -0.06), and a steeper diurnal slope of cortisol levels. Inflammatory marker studies (k = 36) reported negative or non-significant relations with well-being, with meta-analytic estimates of respectively r = -0.07 and r = -0.05 for C-reactive protein and interleukin-6. Microbiome studies (k = 4) reported inconsistent associations between different bacteria abundance and well-being. The results indicate possible but small roles of serotonin, cortisol, and inflammatory markers in explaining differences in well-being. The inconsistent and limited results for other markers and microbiome require further research. Future directions for a complete picture of the physiological factors underlying well-being are proposed.
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Affiliation(s)
- Lianne P de Vries
- Department of Biological Psychology, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
| | - Margot P van de Weijer
- Department of Biological Psychology, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Meike Bartels
- Department of Biological Psychology, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, the Netherlands
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Polenick CA, Birditt KS, Turkelson A, Perbix EA, Salwi SM, Zarit SH. Daily Social Interactions and HPA Axis Activity Among Midlife and Older Adults. THE GERONTOLOGIST 2021; 61:897-906. [PMID: 33367791 DOI: 10.1093/geront/gnaa215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Older people experience fewer negative interactions and report less stress in response to interpersonal tensions. Less is known, however, about the implications of daily social interactions for biological stress responses. We evaluated links between daily positive and negative interactions and 2 key biomeasures of the hypothalamic-pituitary-adrenal axis: salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S). We also considered the moderating effects of age. RESEARCH DESIGN AND METHODS Participants included a random sample of 93 individuals aged 40-95 who completed 14 days of daily diary interviews and provided saliva samples during 4 of those days. RESULTS Three-level piecewise models showed that individuals had higher sustained DHEA-S levels on days after reporting more positive interactions. Young-old adults (60-79) had lower overall DHEA-S on days when they had more negative interactions than oldest-old adults (80 and older). Oldest-old adults showed a flatter decline in DHEA-S on days after they reported more negative interactions compared to midlife adults (40-59). Daily social interactions were not significantly associated with cortisol. DISCUSSION AND IMPLICATIONS Strategies to increase positive interactions may help to build physiological resilience to stress, particularly among midlife and young-old adults.
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Affiliation(s)
| | - Kira S Birditt
- Aging and Biopsychosocial Innovations Program, Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Angela Turkelson
- Aging and Biopsychosocial Innovations Program, Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Emily A Perbix
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Shreya M Salwi
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Steven H Zarit
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, USA
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Copeland JL, Currie CL, Chief Moon-Riley K. Physical Activity Buffers the Adverse Impacts of Racial Discrimination on Allostatic Load Among Indigenous Adults. Ann Behav Med 2021; 55:520-529. [PMID: 32870255 PMCID: PMC8171801 DOI: 10.1093/abm/kaaa068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Racial discrimination has been associated with biological dysfunction among ethnic minorities. The extent to which regular physical activity (PA) may buffer this association is unknown. Purpose To examine the association between past-year racial discrimination and allostatic load (AL) stratified by PA within a sample of Indigenous adults. Methods Data were collected from Indigenous adults attending university in a city in western Canada between 2015 and 2017. The Experiences of Discrimination Scale was used to assess discrimination and the Godin–Shephard Leisure-Time Physical Activity Questionnaire assessed PA. A composite of seven biomarkers assessing neuroendocrine, cardiovascular, metabolic, and immune system function measured AL. Linear regression models examined associations adjusted for confounders (N = 150). Results In the insufficiently active group, every 1 point increase in racial discrimination (up to a maximum of 9) resulted in approximately one third of a point increase in AL score. In the sufficiently active group, the association between racial discrimination and AL score was not statistically significant. Conclusions A growing body of research suggests racial discrimination is associated with multisystem biological dysregulation and health risks. Increased action to address racism in society is a priority. As that work unfolds, there is a need to identify effective tools that racialized groups can use to buffer the effects of racism on their health. The present findings suggest that engagement in regular PA may attenuate the pernicious effects of discrimination on biological dysfunction.
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Affiliation(s)
- Jennifer L Copeland
- Department of Kinesiology and Physical Education, Faculty of Arts and Science, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Cheryl L Currie
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
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Jenz ST, Goodyear CD, TSgt Graves PR, Goldstein S, Shia MR, Redei EE. Blood and affective markers of stress in Elite Airmen during a preparatory training course: A pilot study. Neurobiol Stress 2021; 14:100323. [PMID: 33912629 PMCID: PMC8066699 DOI: 10.1016/j.ynstr.2021.100323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
In highly stressful environments, individuals with diverging stress-reactivity can perform differently. Identification of blood markers of stress-reactivity is of major significance to help human performance during stress. Candidate transcripts were identified between stressed and non-stressed strains of rats’ blood and brain, and overlapping significant differentially expressed genes were selected. Serum levels of human orthologues of these proteins, in lieu of blood RNA, in addition to classic stress and general clinical markers, were measured in 33 Battlefield Airmen undergoing a 52 day long preparatory training course before their course of initial entry (COIE). Blood samples and factors of affective state, negative valence “Threat” and positive valence “Challenge”, were obtained five times across different days of training which included either routine physical exercise or prolonged and intense physical and mental training. During training, levels of chloride (Cl), dehydroepiandrosterone-sulfate (DHEA-S), creatinine kinase (CK), and total carbon dioxide (TCO2) differed between airmen who subsequently graduated from their COIE and those who did not. Time dependent changes of serum TCO2 and neuropeptide Y (NPY), as well as the affective factor Challenge differed by future graduation status throughout the training. Serum levels of parvin beta (PARVB) correlated with the affective factor Threat, while those of NPY, testosterone, coactosin like F-actin binding protein 1 (COTL1) and C-reactive protein (CRP) correlated with factor Challenge during the extended, intensive periods of training, consistently. These pilot data suggest that the identified panel of blood markers can measure stress responsiveness, which has the potential to advance individualized stress-management strategies. Levels of novel and classical serum markers signal stress severity in men. Biomarker levels reflect stress reactivity of Battlefield Airmen in training. Affective measures correlate with serum biomarkers after extended stress.
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Affiliation(s)
- S T Jenz
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - C D Goodyear
- lnfoscitex Corporation, 4027 Colonel Glenn Highway, Suite 210, Dayton, OH, 45431, USA
| | - P R TSgt Graves
- Air Force Research Laboratory, 711th Human Performance Wing, Airman Systems Directorate, 2510 Fifth Street, Wright Patterson AFB, OH, 45433, USA
| | - S Goldstein
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - M R Shia
- Air Force Research Laboratory, Materials and Manufacturing Directorate, 2977 Hobson Way, Wright-Patterson AFB, OH, 45433, USA
| | - E E Redei
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
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13
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Bürgin D, Kind N, Schröder M, Clemens V, Fegert JM, Eckert A, Buchheim A, O'Donovan A, Boonmann C, Schmid M. The Stress of Caring-Resilience and HPA-Axis Activity in Hair Samples of Youth Residential Caregivers. Front Psychiatry 2020; 11:556486. [PMID: 33408649 PMCID: PMC7779549 DOI: 10.3389/fpsyt.2020.556486] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Professional caregivers in youth residential care institutions experience frequent verbal and physical aggression as well as multiple stressors as part of their everyday work, leading to high levels of burnout and staff turnover. Resilience might buffer against psychophysiological stress response and therefore be crucial for well-being in professional caregivers. Objectives: We aimed to investigate if measures related to resilience [sense of coherence (SoC), self-efficacy and self-care] and attachment security of caregivers were cross-sectionally associated with stress markers in hair samples [cortisol and dehydroepiandrosterone (DHEA)]. Method: Participants (n = 134; 64.2% women) reported on individual resilience measures and provided hair samples for cortisol and DHEA assays. Attachment was assessed in a subsample using the Adult Attachment Projective Picture System (AAP, n = 69). Linear regression models were fitted to estimate the association between resilience measures and the Cortisol:DHEA ratio, cortisol and DHEA, controlling for gender and age. Results: SoC was associated with a lower Cortisol:DHEA ratio (β = -0.36, p < 0.001), driven by a positive association between SoC and DHEA levels (β = 0.28, p = 0.002). Self-care was also associated with lower Cortisol:DHEA ratios (β = -0.24, p = 0.005), due to self-care being associated with higher DHEA (β = 0.21, p = 0.016). HPA-axis measures were not associated with self-efficacy nor with attachment patterns in a subsample. Conclusions: Our findings imply that youth residential care institutions might benefit from programs focusing on enhancing SoC and self-care practices. Fostering a meaningful, comprehensible and manageable professional climate in caregiving environments and implementing self-care in routine practices might enhance not only well-being but also physical health of professional caregivers and in this way buffer adverse health effects of chronic stressors.
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Affiliation(s)
- David Bürgin
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Nina Kind
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Martin Schröder
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Vera Clemens
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Jörg M. Fegert
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Anne Eckert
- Neurobiological Laboratory for Brain Aging and Mental Health, Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Anna Buchheim
- Institute of Psychology, University Innsbruck, Innsbruck, Austria
| | - Aoife O'Donovan
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Mental Health Services, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
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14
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Lai JCL, Leung MOY, Lee DYH, Lam YW, Berning K. Biomarking Trait Resilience With Salivary Cortisol in Chinese Undergraduates. Front Psychol 2020; 11:536510. [PMID: 33192778 PMCID: PMC7649282 DOI: 10.3389/fpsyg.2020.536510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/22/2020] [Indexed: 12/19/2022] Open
Abstract
This study aimed to examine the relationship between trait resilience and salivary cortisol in a group of Chinese undergraduates. The Chinese versions of the Brief Resilience Scale and a measure of optimism, the revised Life Orientation Test were administered to 49 Chinese undergraduates who provided self-collected saliva samples six times per day (immediately after waking; 0.5, 3, 6, and 12 h thereafter; and at bedtime) over 3 consecutive weekdays. The cortisol data were aggregated across the 3 days to examine the association between resilience and components of the diurnal rhythm of cortisol using multiple regression. The results showed that higher resilience was associated with a stronger cortisol response to awakening and a steeper diurnal decline in cortisol from waking to bedtime. Resilience was positively associated with cortisol output over the course of the day but this relationship was not significant (p = 0.065). This pattern of diurnal rhythm is consistent with that typically observed in better adjusted individuals. Generated by an intensive protocol with compliance objectively monitored, these findings clearly indicate the important role of the hypothalamic-pituitary-adrenocortical axis in health and adjustment and contribute to the growing literature on resilience and cortisol in humans.
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Affiliation(s)
- Julian C L Lai
- Psychophysiology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Monique O Y Leung
- Psychophysiology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Daryl Y H Lee
- Psychophysiology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Yun Wah Lam
- Department of Chemistry, City University of Hong Kong, Kowloon, Hong Kong
| | - Karsten Berning
- Department of Chemistry, City University of Hong Kong, Kowloon, Hong Kong
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15
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Nishimi K, Choi KW, Davis KA, Powers A, Bradley B, Dunn EC. Features of Childhood Maltreatment and Resilience Capacity in Adulthood: Results from a Large Community-Based Sample. J Trauma Stress 2020; 33:665-676. [PMID: 32537815 PMCID: PMC7828462 DOI: 10.1002/jts.22543] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 10/16/2019] [Accepted: 12/10/2019] [Indexed: 11/11/2022]
Abstract
Childhood maltreatment is consistently associated with poor outcomes. However, few epidemiological studies have examined the association between childhood maltreatment and adult resilience capacity, defined as one's perceived ability to cope successfully with challenges. This study aimed to determine associations between adult resilience capacity and specific types and features of childhood maltreatment. Participants were African American adults recruited from a public urban hospital in Atlanta, GA (N = 1,962) between 2005 and 2013. Childhood maltreatment, including witnessing domestic violence or physical, emotional, and sexual abuse, was assessed retrospectively using the Traumatic Events Inventory. Perceived resilience capacity was assessed using the Connor-Davidson Resilience Scale. Linear regressions were performed assessing the association between resilience capacity and childhood maltreatment exposure in general, as well as specific dimensions of exposure, including type, co-occurrence, and developmental timing, adjusting for covariates. Participants exposed to any maltreatment reported lower resilience capacity than unexposed peers, B = -0.38, SE = 0.04, p < .001. All maltreatment types were negatively associated with resilience capacity, even after adjusting for other lifetime trauma exposure. Only emotional abuse remained significantly associated with resilience capacity after accounting for current psychological distress, B = -0.11, SE = 0.05, p = .022. Maltreatment co-occurrence followed an inverse dose-response relationship with resilience capacity: For each additional maltreatment type, scores decreased by 0.18 units (SD = 0.02), p < .001. Finally, the developmental timing of maltreatment did not reveal any differential influences on resilience capacity. The results suggest that childhood emotional abuse and co-occurrence of maltreatment types may be particularly deleterious to adult resilience capacity.
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Affiliation(s)
- Kristen Nishimi
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Karmel W. Choi
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA
| | - Kathryn A. Davis
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA,Atlanta VA Medical Center, Atlanta, GA
| | - Erin C. Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA,Center on the Developing Child at Harvard University, Cambridge, MA
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16
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Scarola S, Kent M, Neal S, Trejo JP, Bardi M, Lambert K. Postpartum environmental challenges alter maternal responsiveness and offspring development. Horm Behav 2020; 122:104761. [PMID: 32330549 DOI: 10.1016/j.yhbeh.2020.104761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 04/11/2020] [Accepted: 04/17/2020] [Indexed: 12/21/2022]
Abstract
Because many threats exist in an animal's natural habitat, it is important to understand the impact of environmental challenges on maternal-offspring interactions and outcomes. In the current study, a rodent model incorporating the presence of restricted resources and an environmental threat (e.g. predator-related odors and sounds) was investigated. Specifically, pregnant females were assigned to one of four treatments: standard resources, without threat (SR; n = 7); standard resources plus threat (SR-T; n = 8); restricted resources, without threat (RR; n = 7); and restricted resources plus threat (RR-T; n = 6). Maternal rats were moved into the assigned conditions on postnatal day 2 and remained until pups were weaned. Following a standard pup retrieval task on postnatal days 2 and 6, maternal rats were exposed to a retrieval challenge task on postnatal day 8 in which each rat had to traverse a novel barrier to retrieve pups. For neurobiological measures of stress/resilience responsiveness, fecal samples were collected for detection of corticosterone and DHEA metabolites; additionally, immunohistochemistry was conducted on the maternal brains to indicate the presence of Neuropeptide Y (NPY) and Brain Derived Neurotrophic Factor (BDNF) immunoreactivity in the hippocampus, amygdala and hypothalamus. Pup development measures, including body weight and tail length, were also collected. Results suggest that maternal rats with restricted resources exhibited diminished maternal responsiveness that resulted in altered pup development measures; further, restricted resource rats exhibited endocrine markers of compromised emotional resilience (lower DHEA) and decreased neural markers of neuroplasticity (BDNF) and emotional resilience (NPY). Interestingly, predator threat affected various aspects of maternal-pup interactions but had no effect on neurobiological variables, suggesting that restricted resources had a more negative impact on maternal-related outcomes than the presence of predator threat.
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Affiliation(s)
- Samantha Scarola
- Department of Psychology, Behavioral Neuroscience Program, Randolph Macon College, Ashland, VA 23005, USA
| | - Molly Kent
- Department of Biology, Virginia Military Institute, Lexington, VA 25440, USA
| | - Steven Neal
- Department of Psychology, Behavioral Neuroscience Program, Randolph Macon College, Ashland, VA 23005, USA
| | - Jose Perdomo Trejo
- Department of Psychology, Behavioral Neuroscience Program, Randolph Macon College, Ashland, VA 23005, USA
| | - Massimo Bardi
- Department of Psychology, Behavioral Neuroscience Program, Randolph Macon College, Ashland, VA 23005, USA
| | - Kelly Lambert
- Department of Psychology, University of Richmond, Richmond, VA 23173, USA.
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17
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Laliberté Durish C, Yeates KO, Brooks BL. Convergent and divergent validity of the Connor-Davidson Resilience Scale in children with concussion and orthopaedic injury. Brain Inj 2018; 32:1525-1533. [PMID: 30047782 DOI: 10.1080/02699052.2018.1502471] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Psychological resilience is an important predictor of outcome in concussion; however, there is no published evidence of psychometric support for use of a measure of psychological resilience in children with concussion. This study examined construct validity of the Connor-Davidson Resilience Scale (CD-RISC) in a paediatric concussion and orthopaedic injury sample. METHODS Seventy-five children with a history of concussion or orthopaedic injury were recruited from a children's hospital. Total sample and within-group correlations between the CD-RISC (25- and 10-item versions) and measures presumed to be related or unrelated to the construct of psychological resilience were analysed. RESULTS In the total sample, both versions of the CD-RISC were negatively correlated with self-reported depressive symptoms and general behaviour problems. The 10-item version was also negatively correlated with parent-reported general behaviour problems and self-reported anxiety, and was positively correlated with self-reported quality of life. The injury groups did not exhibit significantly different correlations. CONCLUSIONS The construct validity of the CD-RISC is satisfactory when used with children with concussion. The 10-item version may provide a more efficient measure of resiliency with better construct validity in this population.
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Affiliation(s)
- Christianne Laliberté Durish
- a Department of Psychology , University of Calgary , Calgary , AB, Canada.,b Alberta Children's Hospital Research Institute , University of Calgary , Calgary , AB, Canada
| | - Keith Owen Yeates
- a Department of Psychology , University of Calgary , Calgary , AB, Canada.,b Alberta Children's Hospital Research Institute , University of Calgary , Calgary , AB, Canada.,c Hotchkiss Brain Institute , University of Calgary , Calgary , AB, Canada.,d Departments of Paediatrics and Clinical Neurosciences , University of Calgary , Calgary , AB, Canada
| | - Brian L Brooks
- a Department of Psychology , University of Calgary , Calgary , AB, Canada.,b Alberta Children's Hospital Research Institute , University of Calgary , Calgary , AB, Canada.,d Departments of Paediatrics and Clinical Neurosciences , University of Calgary , Calgary , AB, Canada.,e Neurosciences program , Alberta Children's Hospital , Calgary , AB, Canada
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18
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Savic D, Knezevic G, Matic G, Damjanovic S. PTSD and depressive symptoms are linked to DHEAS via personality. Psychoneuroendocrinology 2018; 92:29-33. [PMID: 29621722 DOI: 10.1016/j.psyneuen.2018.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/19/2018] [Accepted: 03/25/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research results on dehydroepiandrosterone sulfate ester (DHEAS) in post-traumatic stress disorder (PTSD) are inconsistent. We hypothesized that personality traits could be the confounders of DHEAS levels and disease symptoms, which could in part explain the discrepancy in findings. METHOD This study was a part of a broader project in which simultaneous psychological and biological investigations were carried out in hospital conditions. 380 male subjects were categorized in four groups: A) current PTSD (n = 132), B) lifetime PTSD (n = 66), C) trauma controls (n = 101), and D) healthy controls (n = 81), matched by age. RESULTS The level of DHEAS is significantly lower in the current PTSD group than in trauma controls. All groups significantly differ in personality traits Disintegration and Neuroticism (current PTSD group having the highest scores). DHEAS is related to both PTSD and depressive symptoms; however, Structural Equation Model (SEM) shows that the relations are indirect, realized via their confounder - personality trait Disintegration. CONCLUSIONS According to our project results, DHEAS is the second putative biomarker for trauma-related disorders that fails to fulfil this expectation. It appears to be more directly related to personality than to the disease symptoms (the first one being basal cortisol). Our data promote personality as a biologically based construct with seemingly important role in understanding the mental health status.
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Affiliation(s)
- Danka Savic
- University of Belgrade, Vinca Institute, Laboratory of Theoretical and Condensed Matter Physics 020/2, Mike Petrovica Alasa 12-14, 11001 Belgrade, Serbia.
| | - Goran Knezevic
- University of Belgrade, School of Psychology, Cika Ljubina 18-20, 11000 Belgrade, Serbia.
| | - Gordana Matic
- University of Belgrade, Institute for Biological Research "Sinisa Stankovic", Bulevar despota Stefana 142, 11060 Belgrade, Serbia
| | - Svetozar Damjanovic
- University of Belgrade, Clinic of Endocrinology, Diabetes and Metabolic Diseases, Doktora Subotica 13, 11000 Belgrade, Serbia.
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19
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Pretreatment biomarkers predicting PTSD psychotherapy outcomes: A systematic review. Neurosci Biobehav Rev 2017; 75:140-156. [DOI: 10.1016/j.neubiorev.2017.01.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/13/2017] [Accepted: 01/23/2017] [Indexed: 11/19/2022]
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20
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Kamin HS, Kertes DA. Cortisol and DHEA in development and psychopathology. Horm Behav 2017; 89:69-85. [PMID: 27979632 DOI: 10.1016/j.yhbeh.2016.11.018] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 11/19/2016] [Accepted: 11/30/2016] [Indexed: 01/01/2023]
Abstract
Dehydroepiandrosterone (DHEA) and cortisol are the most abundant hormones of the human fetal and adult adrenals released as end products of a tightly coordinated endocrine response to stress. Together, they mediate short- and long-term stress responses and enable physiological and behavioral adjustments necessary for maintaining homeostasis. Detrimental effects of chronic or repeated elevations in cortisol on behavioral and emotional health are well documented. Evidence for actions of DHEA that offset or oppose those of cortisol has stimulated interest in examining their levels as a ratio, as an alternate index of adrenocortical activity and the net effects of cortisol. Such research necessitates a thorough understanding of the co-actions of these hormones on physiological functioning and in association with developmental outcomes. This review addresses the state of the science in understanding the role of DHEA, cortisol, and their ratio in typical development and developmental psychopathology. A rationale for studying DHEA and cortisol in concert is supported by physiological data on the coordinated synthesis and release of these hormones in the adrenal and by their opposing physiological actions. We then present evidence that researching cortisol and DHEA necessitates a developmental perspective. Age-related changes in DHEA and cortisol are described from the perinatal period through adolescence, along with observed associations of these hormones with developmental psychopathology. Along the way, we identify several major knowledge gaps in the role of DHEA in modulating cortisol in typical development and developmental psychopathology with implications for future research.
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Affiliation(s)
- Hayley S Kamin
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA
| | - Darlene A Kertes
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA; University of Florida Genetics Institute, University of Florida, Gainesville, FL 32611, USA.
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21
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Walker FR, Pfingst K, Carnevali L, Sgoifo A, Nalivaiko E. In the search for integrative biomarker of resilience to psychological stress. Neurosci Biobehav Rev 2017; 74:310-320. [DOI: 10.1016/j.neubiorev.2016.05.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/26/2016] [Accepted: 05/06/2016] [Indexed: 12/20/2022]
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22
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Mizuno Y, Hofer A, Suzuki T, Frajo-Apor B, Wartelsteiner F, Kemmler G, Saruta J, Tsukinoki K, Mimura M, Fleischhacker WW, Uchida H. Clinical and biological correlates of resilience in patients with schizophrenia and bipolar disorder: A cross-sectional study. Schizophr Res 2016; 175:148-153. [PMID: 27185483 DOI: 10.1016/j.schres.2016.04.047] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 04/29/2016] [Accepted: 04/29/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The concept of resilience is relevant in understanding the heterogeneous outcomes noted in schizophrenia and bipolar disorder. However, clinical and biological correlates of resilience in these populations have rarely been investigated. We aimed to identify key correlates of subjective resilience in such patients using comprehensive assessments and to explore associations between resilience levels and peripheral biomarkers. METHOD 180 subjects with DSM-IV schizophrenia, bipolar disorder, and healthy controls (60 per group) were included. Demographic and clinical variables were assessed by means of interview and various psychometric scales. Furthermore, blood and saliva samples were obtained for the assessment of brain-derived neurotrophic factor, adrenocorticotropic hormone, cortisol, high sensitivity C-reactive protein, and alpha-amylase levels. Cross-sectional associations with resilience, as assessed by the 25-item Resilience Scale were sought. RESULTS Resilience Scale total scores were significantly higher in healthy individuals (130.1, 95% confidence intervals (CI): 124.8-135.4) compared to subjects with schizophrenia (109.9, 95% CI: 104.6-115.2, p<0.001) and bipolar disorder (119.0, 95% CI: 113.8-124.3, p=0.012), while the difference between patient groups was non-significant (p=0.055). Self-esteem, spirituality, quality of life, and hopelessness were correlated with resilience in all three groups. In addition, internalized stigma and depression were relevant factors in the schizophrenia and bipolar disorder group, respectively. Correlations between resilience levels and peripheral biomarkers did not reach significance. CONCLUSION Although causal relationships must be confirmed in prospective studies, our results have implications in developing psychological interventions to enhance resilience in patients with schizophrenia and bipolar disorder. The biological correlates of resilience in these populations warrant further investigations.
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Affiliation(s)
- Yuya Mizuno
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Alex Hofer
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria
| | - Takefumi Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, Inokashira Hospital, Tokyo, Japan
| | - Beatrice Frajo-Apor
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria
| | - Fabienne Wartelsteiner
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria
| | - Juri Saruta
- Division of Environmental Pathology, Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Kanagawa, Japan
| | - Keiichi Tsukinoki
- Division of Environmental Pathology, Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Kanagawa, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Gallagher S, Sumner RC, Muldoon OT, Creaven AM, Hannigan A. Unemployment is associated with lower cortisol awakening and blunted dehydroepiandrosterone responses. Psychoneuroendocrinology 2016; 69:41-9. [PMID: 27018925 DOI: 10.1016/j.psyneuen.2016.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 11/26/2022]
Abstract
Previous research has investigated the endocrinological consequences of unemployment as a likely pathway behind chronic stress and negative health outcomes. Despite these early attempts at delineating the neuroendocrine consequences of the chronic stress experienced by the unemployed, identifying a consistent and stable effect has remained elusive. Here we sought to strengthen existing knowledge into the effect of the stress of employment status on cortisol by improving on the methodological weaknesses of earlier studies and extend this line of enquiry by measuring the steroid hormone Dehydroepiandrosterone-Sulfate (DHEAS). Saliva samples were collected from unemployed and employed participants at four time points across two days. As expected, unemployed people reported higher stress, lower social support and lower self-esteem. Unexpectedly, the unemployed showed lower overall cortisol output, a likely consequence of a higher cortisol awakening response (CAR) in the employed. However, they also had a higher DHEA output across the day, albeit the diurnal pattern across the day was more dysregulated compared to that seen in those employed with a blunted response evident in the evening; the cortisol:DHEAS ratio was also lower in the unemployed group. Further, these hormone differences were correlated with self-esteem and stress. Taken together these results suggest that the relationship between employment status and endocrine responses is far more complicated than previously thought. We have shown for the first time that unemployed people have a lower CAR, but also show a blunted DHEA response relative to those employed and we suggest that this may be a feature of chronic stress exposure or perhaps dependent on the prevailing socio-economic context.
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Affiliation(s)
- Stephen Gallagher
- Laboratory for the Study of Anxiety, Stress & Health (SASHLab), Department of Psychology, University of Limerick, Castletroy, County Limerick, Ireland; Health Research Institute, University of Limerick, Castletroy, County Limerick, Ireland.
| | - Rachel C Sumner
- Laboratory for the Study of Anxiety, Stress & Health (SASHLab), Department of Psychology, University of Limerick, Castletroy, County Limerick, Ireland
| | - Orla T Muldoon
- Health Research Institute, University of Limerick, Castletroy, County Limerick, Ireland; Centre for Social Issues Research (CSI-R), University of Limerick, Castletroy, County Limerick, Ireland
| | - Ann-Marie Creaven
- Laboratory for the Study of Anxiety, Stress & Health (SASHLab), Department of Psychology, University of Limerick, Castletroy, County Limerick, Ireland; Centre for Social Issues Research (CSI-R), University of Limerick, Castletroy, County Limerick, Ireland
| | - Ailish Hannigan
- Health Research Institute, University of Limerick, Castletroy, County Limerick, Ireland; Graduate Entry Medical School, University of Limerick, Castletroy, County Limerick, Ireland
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Lambert KG, Nelson RJ, Jovanovic T, Cerdá M. Brains in the city: Neurobiological effects of urbanization. Neurosci Biobehav Rev 2015; 58:107-22. [PMID: 25936504 PMCID: PMC4774049 DOI: 10.1016/j.neubiorev.2015.04.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 03/27/2015] [Accepted: 04/22/2015] [Indexed: 12/11/2022]
Abstract
With a majority of humans now living in cities, strategic research is necessary to elucidate the impact of this evolutionarily unfamiliar habitat on neural functions and well-being. In this review, both rodent and human models are considered in the evaluation of the changing physical and social landscapes associated with urban dwellings. Animal models assessing increased exposure to artificial physical elements characteristic of urban settings, as well as exposure to unnatural sources of light for extended durations, are reviewed. In both cases, increased biomarkers of mental illnesses such as major depression have been observed. Additionally, applied human research emphasizing the emotional impact of environmental threats associated with urban habitats is considered. Subjects evaluated in an inner-city hospital reveal the impact of combined specific genetic vulnerabilities and heightened stress responses in the expression of posttraumatic stress disorder. Finally, algorithm-based models of cities have been developed utilizing population-level analyses to identify risk factors for psychiatric illness. Although complex, the use of multiple research approaches, as described herein, results in an enhanced understanding of urbanization and its far-reaching effects--confirming the importance of continued research directed toward the identification of putative risk factors associated with psychiatric illness in urban settings.
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Affiliation(s)
- Kelly G Lambert
- Department of Psychology, Randolph-Macon College, Ashland, VA 23005, USA.
| | - Randy J Nelson
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Tanja Jovanovic
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30303, USA
| | - Magdalena Cerdá
- Department of Epidemiology, Columbia University, New York, NY 10032, USA
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Govender M, Bowen RC, German ML, Bulaj G, Bruggers CS. Clinical and Neurobiological Perspectives of Empowering Pediatric Cancer Patients Using Videogames. Games Health J 2015; 4:362-74. [PMID: 26287927 PMCID: PMC4545566 DOI: 10.1089/g4h.2015.0014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Pediatric oncology patients often experience fatigue and physical and mental deconditioning during and following chemotherapy treatments, contributing to diminished quality of life. Patient empowerment is a core principle of patient-centered care and reflects one's ability to positively affect his or her own health behavior and health status. Empowerment interventions may enhance patients' internal locus of control, resilience, coping skills, and self-management of symptoms related to disease and therapy. Clinical and technological advancements in therapeutic videogames and mobile medical applications (mobile health) can facilitate delivery of the empowerment interventions for medical purposes. This review summarizes clinical strategies for empowering pediatric cancer patients, as well as their relationship with developing a “fighting spirit” in physical and mental health. To better understand physiological aspects of empowerment and to elucidate videogame-based intervention strategies, brain neuronal circuits and neurotransmitters during stress, fear, and resilience are also discussed. Neuroimaging studies point to the role of the reward system pathways in resilience and empowerment in patients. Taken together, videogames and mobile health applications open translational research opportunities to develop and deliver empowerment interventions to pediatric cancer patients and also to those with other chronic diseases.
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Affiliation(s)
- Meveshni Govender
- 1 Division of Hematology-Oncology, University of Utah School of Medicine , Salt Lake City, Utah
| | - Randy C Bowen
- 2 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah
| | - Massiell L German
- 2 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah
| | - Grzegorz Bulaj
- 3 Department of Medicinal Chemistry, College of Pharmacy, University of Utah , Salt Lake City, Utah
| | - Carol S Bruggers
- 1 Division of Hematology-Oncology, University of Utah School of Medicine , Salt Lake City, Utah.,2 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah.,4 Huntsman Cancer Institute, University of Utah School of Medicine , Salt Lake City, Utah.,5 Primary Children's Hospital , Salt Lake City, Utah
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Rusch HL, Shvil E, Szanton SL, Neria Y, Gill JM. Determinants of psychological resistance and recovery among women exposed to assaultive trauma. Brain Behav 2015; 5:e00322. [PMID: 25798336 PMCID: PMC4356866 DOI: 10.1002/brb3.322] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/19/2015] [Accepted: 01/24/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Women exposed to potentially traumatic events (PTEs) are at high risk for developing psychiatric disorders, including posttraumatic stress disorder (PTSD), general anxiety disorder (GAD), major depressive disorder (MDD), and substance-related disorders. However, this risk is not universal. Most women are resistant (i.e., remain asymptomatic), or recover following a brief symptomatic period. This study examined the psychological factors associated with resistant and recovered outcomes in a sample of high-risk women exposed to assault-related PTEs. METHOD One hundred and fifty-nine women completed the Life Events Checklist and were administered the Structured Clinical Interview for DSM-IV Axis I Disorders. This resulted in three groups: (1) no diagnosis (no past or current psychiatric disorder diagnosis; n = 56), (2) past diagnosis (a past psychiatric disorder diagnosis, but none currently; n = 31), and (3) current diagnosis (a current diagnosis of one or more psychiatric disorders; n = 72). Groups were compared on sociodemographics, PTE exposure, psychopathology, health-related quality of life (HRQOL), and psychological resilience-related factors. RESULTS The majority of respondents (79%) did not develop chronic PTSD following assault exposure, and the most common psychiatric outcome was MDD (30%). High endorsement of mastery and social support were associated with the no diagnosis group; and greater reports of mastery and posttraumatic growth were associated with recovery from a past psychiatric disorder. Furthermore, both resilient groups (i.e., no diagnosis and past diagnosis) scored higher on HRQOL measures compared with the current diagnosis group (P < 0.001). CONCLUSION Psychological resilience has ramifications to health and well-being, and identifying these factors has potential to inform preventive strategies and treatment interventions for assault exposed women.
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Affiliation(s)
- Heather L Rusch
- National Institute of Nursing Research, National Institutes of Health Bethesda, Maryland, 20892 ; Henry M Jackson Foundation for the Advancement of Military Medicine Maryland, 20817
| | - Erel Shvil
- New York State Psychiatric Institute New York, New York, 10032 ; Department of Psychiatry, Columbia University Medical Center New York, New York, 10032
| | - Sarah L Szanton
- School of Nursing, Johns Hopkins University Baltimore, Maryland, 21205
| | - Yuval Neria
- New York State Psychiatric Institute New York, New York, 10032 ; Department of Psychiatry, Columbia University Medical Center New York, New York, 10032
| | - Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health Bethesda, Maryland, 20892
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Hou WK, Ng SM. Emotion-focused positive rumination and relationship satisfaction as the underlying mechanisms between resilience and psychiatric symptoms. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014. [DOI: 10.1016/j.paid.2014.07.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yehuda R, Pratchett LC, Elmes MW, Lehrner A, Daskalakis NP, Koch E, Makotkine I, Flory JD, Bierer LM. Glucocorticoid-related predictors and correlates of post-traumatic stress disorder treatment response in combat veterans. Interface Focus 2014; 4:20140048. [PMID: 25285201 DOI: 10.1098/rsfs.2014.0048] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The identification of biomarkers for post-traumatic stress disorder (PTSD) and resilience/recovery is critical for advancing knowledge about pathophysiology and treatment in trauma-exposed persons. This study examined a series of glucocorticoid-related biomarkers prior to and in response to psychotherapy. Fifty-two male and female veterans with PTSD were randomized 2 : 1 to receive either prolonged exposure (PE) therapy or a weekly minimal attention (MA) intervention for 12 consecutive weeks. Psychological and biological assessments were obtained prior to and following treatment and after a 12-week naturalistic follow-up. Response was defined dichotomously as no longer meeting criteria for PTSD at post-treatment based on the Clinician Administered PTSD Scale for DSM-IV (CAPS). Clinical improvement on the CAPS was apparent for both PE and MA, with no significant difference according to treatment condition. Biomarkers predictive of treatment gains included the BCLI polymorphism of the glucocorticoid receptor gene. Additional predictors of treatment response were higher bedtime salivary cortisol and 24 h urinary cortisol excretion. Pre-treatment plasma dehydroepiandrosterone/cortisol ratio and neuropetide Y (NPY) levels were predictors of reductions in PTSD symptoms, and, for NPY only, of other secondary outcomes as well, including anxiety and depression ratings. Glucocorticoid sensitivity changed in association with symptom change, reflecting clinical state. It is possible to distinguish prognostic and state biomarkers of PTSD using a longitudinal approach in the context of treatment. Identified markers may also be relevant to understanding mechanisms of action of symptom reduction.
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Affiliation(s)
- Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, New York, NY , USA ; Department of Psychiatry and Neuroscience , Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Laura C Pratchett
- James J. Peters Veterans Affairs Medical Center, New York, NY , USA ; Department of Psychiatry and Neuroscience , Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Matthew W Elmes
- Department of Biochemistry and Cell Biology , Stony Brook University , Stony Brook , NY, USA
| | - Amy Lehrner
- James J. Peters Veterans Affairs Medical Center, New York, NY , USA ; Department of Psychiatry and Neuroscience , Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Nikolaos P Daskalakis
- James J. Peters Veterans Affairs Medical Center, New York, NY , USA ; Department of Psychiatry and Neuroscience , Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Erin Koch
- James J. Peters Veterans Affairs Medical Center, New York, NY , USA ; Department of Psychiatry and Neuroscience , Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Iouri Makotkine
- James J. Peters Veterans Affairs Medical Center, New York, NY , USA ; Department of Psychiatry and Neuroscience , Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Janine D Flory
- James J. Peters Veterans Affairs Medical Center, New York, NY , USA ; Department of Psychiatry and Neuroscience , Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Linda M Bierer
- James J. Peters Veterans Affairs Medical Center, New York, NY , USA ; Department of Psychiatry and Neuroscience , Icahn School of Medicine at Mount Sinai , New York, NY , USA
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Brewer-Smyth K, Koenig HG. Could spirituality and religion promote stress resilience in survivors of childhood trauma? Issues Ment Health Nurs 2014; 35:251-6. [PMID: 24702209 DOI: 10.3109/01612840.2013.873101] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Trauma is a precursor to many mental health conditions that greatly impact victims, their loved ones, and society. Studies indicate that neurobiological associations with adverse childhood experiences are mediated by interpersonal relationships and play a role in adult behavior, often leading to cycles of intergenerational trauma. There is a critical need to identify cost effective community resources that optimize stress resilience. Faith-based communities may promote forgiveness rather than retaliation, opportunities for cathartic emotional release, and social support, all of which have been related to neurobiology, behavior, and health outcomes. While spirituality and religion can be related to guilt, neurotic, and psychotic disorders, they also can be powerful sources of hope, meaning, peace, comfort, and forgiveness for the self and others. This article provides an overview of religion and spirituality as they relate to the neurobiology of resilience in victims of childhood trauma.
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