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Bilodeau-Houle A, Raymond C, Marin MF. It's all in the hair: Association between changes in hair cortisol concentrations in reaction to the COVID-19 pandemic and post-traumatic stress symptoms in children over time. Psychoneuroendocrinology 2024; 164:107019. [PMID: 38518705 DOI: 10.1016/j.psyneuen.2024.107019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/26/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
After exposure to a stressful/traumatic event, some individuals will develop post-traumatic stress symptoms (PTSS). In adults, low cortisol levels appear to be a risk factor for the development of PTSS. Indeed, both lower pre-trauma cortisol levels and low cortisol levels in the aftermath of a traumatic event have been associated with greater PTSS. In contrast, studies conducted in children showed that elevated cortisol levels shortly after trauma exposure are associated with more severe post-traumatic stress symptomatology. The few studies that have examined how pre-trauma cortisol levels predict PTSS in children have found no effect. Given that a pandemic can induce PTSS in certain individuals, we investigated whether cortisol secretion prior to and in the early stages of the COVID-19 pandemic in Quebec (Canada) predicted PTSS in children. In June 2020, we collected a hair sample from 71 children (8-15 y/o, M = 11.65; 54.93% girls) without a history of psychopathology or exposure to previous traumatic events. Hair samples allowed us to derive cumulative measures of cortisol levels for the months prior to (from mid-December 2019 to mid-March 2020) and at the beginning of the pandemic (from mid-March 2020 to mid-June 2020). PTSS were assessed every 3 months between June 2020 (T1) and March 2021 (T4). The results showed that a greater increase in hair cortisol at the beginning of the pandemic predicted less PTSS at T1, with an increase in these symptoms over time. This study highlights the utility of using hair cortisol during future chronic stressful events to better understand its association with the evolution of distress.
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Affiliation(s)
- Alexe Bilodeau-Houle
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec H2X 3P2, Canada; Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Quebec H1N 3V2, Canada
| | - Catherine Raymond
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec H2X 3P2, Canada; Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Quebec H1N 3V2, Canada
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec H2X 3P2, Canada; Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Quebec H1N 3V2, Canada.
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Schmalbach I, Steudte-Schmiedgen S, Osmers A, Witthöft M, Drees P, Petrowski K. Longitudinal Assessment of Hair Cortisol as a Predictor of Psychological Symptoms During COVID-19. Psychoneuroendocrinology 2024; 163:106991. [PMID: 38412741 DOI: 10.1016/j.psyneuen.2024.106991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND There is a lack of evidence regarding enduring psychoneuroendocrine changes following an initial traumatic event, particular in the presence of an ongoing stressor. The coronavirus pandemic presents an opportunity to explore this matter. Consequently, the purpose of the present study was to investigate the impact of the ongoing pandemic (2021) on individuals, who experienced a first-time motor vehicle crash (MVC) at least 6 years earlier. To this end, we hypothesized that hair cortisol concentrations (HCC) following a first-time traumatic event positively predict symptoms of depression. METHOD We investigated N = 69 individuals (18 - 65 yrs.), who were victims of a MVC during 2010 - 2014. Hair strands were collected 10 days (t1) and 3 months after the MVC (t2), as well during the pandemic in 2021 (t3). To assess symptoms of depression, the participants filled out the Beck Depression Inventory at t1 - t3 and were additionally interviewed (Structured Clinical Interview for DSM-IV Axis I) at t1 and t2. Exclusion criteria conveyed a lifetime or acute mental disorder (incl. past trauma exposure). RESULTS Elevated pre-pandemic HCC following adversity (i.e., MVC) significantly predicted symptoms of depression in adults during the coronavirus pandemic (BDI: ß =.44, p =.010, R2 =.20), even after controlling for confounders. HCC significantly decreased over time, while in average psychological symptoms remained consistent. CONCLUSION Cortisol dysregulation in the past presents an enduring vulnerability to ongoing stress. In this regard, vulnerable groups may benefit from preventive measures. This finding validates the predictive power of HCC and extended past evidence in this regard, at the same time reinforcing the concept of the diathesis-stress model.
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Affiliation(s)
- I Schmalbach
- Department of Medical Psychology and Medical Sociology, Johannes-Gutenberg University Mainz, Mainz, Germany
| | - S Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - A Osmers
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - M Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - P Drees
- University Hospital of the University Johannes-Gutenberg Mainz, Department for Orthopedics and Trauma Surgery, Mainz, Germany
| | - K Petrowski
- Department of Medical Psychology and Medical Sociology, Johannes-Gutenberg University Mainz, Mainz, Germany; Dresden University of Technology, Carl Gustav Carus Medical Faculty, Department of General Medicine/MK3, Dresden, Germany.
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Spaan P, van den Boogert F, Bouman YHA, Hoogendijk WJG, Roza SJ. How are you coping? Stress, coping, burnout, and aggression in forensic mental healthcare workers. Front Psychol 2024; 14:1301878. [PMID: 38274695 PMCID: PMC10808574 DOI: 10.3389/fpsyg.2023.1301878] [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: 09/25/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Perceived stress at work has been linked to several adverse outcomes in workers, including increased risk of burnout and aggression (e.g., anger and irritability). However, much remains unknown about factors that might mitigate the negative influences of perceived stress on workers' well-being. This study focusses on coping as a possible protective factor against perceived stress and its consequences in forensic mental healthcare workers. We aimed to identify which higher-order coping factors were present in this worker sample and to investigate whether these coping factors modify the associations between perceived stress and burnout or aggression. Methods For this observational survey study, 116 forensic mental healthcare workers completed questionnaires assessing changes in work situation since the start of COVID-19, perceived stress, coping, burnout symptoms, and aggression. Results Results from principal component analysis indicated that four higher-order coping factors could be distinguished: social support and emotional coping, positive cognitive restructuring, problem-focused coping, and passive coping. Higher perceived stress levels were associated with higher levels of both burnout and aggression in workers. Problem-focused coping was associated with less burnout symptoms in workers. Furthermore, positive cognitive restructuring was associated with less aggression in workers. Discussion In conclusion, problem-focused coping and positive cognitive restructuring may protect workers against burnout symptoms and aggression and these results may inform future studies on preventive interventions aimed at promoting worker's well-being.
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Affiliation(s)
- Pascalle Spaan
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Research, Transfore, Deventer, Netherlands
| | - Frank van den Boogert
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
- Science and Treatment Innovation, Fivoor, Rotterdam, Netherlands
| | | | | | - Sabine J. Roza
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
- Netherlands Institute for Forensic Psychiatry and Psychology, Utrecht, Netherlands
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Yamaguchi S, Fujita T, Kato S, Yoshimitsu Y, Ito YM, Yano R. Utility of salivary cortisol profile as a predictive biomarker in nurses' turnover risk: a preliminary study. J Physiol Anthropol 2024; 43:1. [PMID: 38167248 PMCID: PMC10759393 DOI: 10.1186/s40101-023-00349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Predicting nurse turnover risk is crucial due to the global nursing shortage; however, existing predictors, such as fatigue and burnout, lack objectivity. Salivary cortisol is a non-invasive marker of stress and fatigue, but its utility in predicting nurse turnover risk is unknown. We examined whether salivary cortisol profiles across three different day shifts in a month are predictors of the extent of nurses' reluctance to stay in their current jobs. METHODS This preliminary longitudinal study followed forty female nurses who engaged in shift work at a university hospital for 3 months. Data at enrollment were collected including demographics, working conditions, chronic fatigue (the Japanese version of the Occupational Fatigue/Exhaustion Recovery Scale), and burnout (Japanese Burnout scale). Salivary cortisol was measured before the three different day shifts (after awakening) during the first month, and the means of these measurements were used as the cortisol profile. The extent of reluctance to stay was assessed using the numerical rating scale at 3 months. RESULTS Among the forty female nurses (mean [SD] age, 28.3 [5.1]), all completed follow-up and were included in the analysis. The cortisol profile was associated with the extent of reluctance to stay (P = 0.017), and this association was significant despite adjustments for chronic fatigue and burnout (P = 0.005). A multiple regression model with chronic fatigue, burnout, and job tenure explained 41.5% of the variation in reluctance to stay. When the cortisol profile was added to this model, the association of the cortisol profile was significant (P = 0.006) with an R2 of 0.529 (ΔR2 = 0.114). CONCLUSIONS This preliminary study conducted in an actual clinical setting indicated the potential of the salivary cortisol profile across three different day shifts in a month to predict nurses' reluctance to stay in their current jobs. The combination of subjective indicators and the cortisol profile would be useful in predicting nurses' turnover risk.
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Affiliation(s)
- Shinya Yamaguchi
- Department of Nursing, Teine Keijinkai Hospital, Sapporo, Japan
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | | | | | | | - Yoichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
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Schindler-Gmelch L, Capito K, Steudte-Schmiedgen S, Kirschbaum C, Berking M. Hair Cortisol Research in Posttraumatic Stress Disorder - 10 Years of Insights and Open Questions. A Systematic Review. Curr Neuropharmacol 2024; 22:1697-1719. [PMID: 37550910 DOI: 10.2174/1570159x21666230807112425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Cortisol is one of the most extensively studied biomarkers in the context of trauma/posttraumatic stress disorder (PTSD). For more than a decade, hair cortisol concentrations (HCC) have been measured in this context, leading to a two-staged dysregulation model. Specifically, an elevated secretion during/immediately after trauma exposure eventually reverts to hyposecretion with increasing time since trauma exposure has been postulated. OBJECTIVE The aim of our systematic review was to re-evaluate the two-staged secretion model with regard to the accumulated diagnostic, prognostic, and intervention-related evidence of HCC in lifetime trauma exposure and PTSD. Further, we provide an overview of open questions, particularly with respect to reporting standards and quality criteria. METHOD A systematic literature search yielded 5,046 records, of which 31 studies were included. RESULTS For recent/ongoing (traumatic) stress, the predictions of cortisol hypersecretion could be largely confirmed. However, for the assumed hyposecretion temporally more distal to trauma exposure, the results are more ambiguous. As most studies did not report holistic overviews of trauma history and confounding influences, this may largely be attributable to methodological limitations. Data on the prognostic and intervention-related benefits of HCC remain sparse. CONCLUSION Over the last decade, important insights could be gained about long-term cortisol secretion patterns following lifetime trauma exposure and PTSD. This systematic review integrates these insights into an updated secretion model for trauma/PTSD. We conclude with recommendations for improving HCC research in the context of trauma/PTSD in order to answer the remaining open questions.
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Affiliation(s)
- Lena Schindler-Gmelch
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Klara Capito
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Daoust AR, Green H, Vandermeer MRJ, Liu P, Stanton K, Harkness KL, Hayden EP. Total cortisol output during an acute stressor predicts youths' internalizing symptoms during the COVID-19 pandemic. Biol Psychol 2023; 184:108714. [PMID: 37839519 DOI: 10.1016/j.biopsycho.2023.108714] [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] [Received: 12/20/2022] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 10/17/2023]
Abstract
Individual differences in cortisol output may influence adolescents' adjustment to the COVID-19 pandemic; however, boys and girls may differ in terms of associations between cortisol output and internalizing symptoms in the context of COVID-19-related stress. We examined whether pre-pandemic cortisol output during an acute stressor, assessed approximately three years prior to the pandemic, predicted change in adolescents' internalizing symptoms early during the COVID-19 pandemic. Consistent with previous work on other life stressors, girls' cortisol output was positively associated with anxious and somatic symptoms early in the pandemic. Conversely, cortisol output and depressive symptoms were negatively associated for boys; boys with higher cortisol had depressive symptoms which significantly decreased over time. Findings suggest that hypothalamic-pituitary-adrenal axis stress functioning plays a role in shaping differences between adolescent boys' and girls' adjustment during the experience of a ubiquitous chronic stressor.
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Affiliation(s)
- Andrew R Daoust
- Department of Psychology, Western University, London, Ontario, Canada.
| | - Haley Green
- Department of Psychology, Western University, London, Ontario, Canada
| | - Matthew R J Vandermeer
- Anxiety Treatment & Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Pan Liu
- Department of Psychology, North Dakota State University, Fargo, ND, USA
| | - Kasey Stanton
- Department of Psychology, University of Wyoming, Laramie, WY, USA
| | - Kate L Harkness
- Department of Psychology, Queens University, Kingston, Ontario, Canada
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Rivest J, Longpré-Poirier C, Desbeaumes Jodoin V, Martineau JT, Chammas M, Aubin F, Caron D, Levenson JA. Biomarkers use in psycho-oncology practice: Are we there yet? Palliat Support Care 2023:1-4. [PMID: 37855133 DOI: 10.1017/s1478951523001438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- Jacynthe Rivest
- Department of Psychiatry, Centre Hospitalier de l'Universite de Montreal (CHUM) and Centre de Recherche du CHUM (CRCHUM), Montreal, QC, Canada
| | - Christophe Longpré-Poirier
- Department of Psychiatry, Centre Hospitalier de l'Universite de Montreal (CHUM) and Centre de Recherche du CHUM (CRCHUM), Montreal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Department of Psychiatry, Centre Hospitalier de l'Universite de Montreal (CHUM) and Centre de Recherche du CHUM (CRCHUM), Montreal, QC, Canada
| | - Joe T Martineau
- Department of Management, HEC Montréal, Montréal, QC, Canada
| | - Marc Chammas
- Department of Psychiatry, St. Mary's Hospital Center, Montreal, QC, Canada
| | - Francine Aubin
- Hemato-oncology Service, Department of Medicine, CHUM and CRCHUM, Montreal, QC, Canada
| | - David Caron
- Department of Psychiatry, CIUSSS de l'Est-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Jon A Levenson
- Department of Psychiatry, Columbia University Medical Center, New York, USA
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Preinbergs JK, Ström JO, Theodorsson E, Ingberg E. Segmental hair analysis as a retrospective testosterone diary: possibilities and pitfalls. Sci Rep 2023; 13:16015. [PMID: 37749110 PMCID: PMC10519998 DOI: 10.1038/s41598-023-41672-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
Testosterone is thought to be incorporated in growing hair strands so that specific hair segments reflect average free hormone concentrations from the corresponding time period. However, the exact mechanisms of hormone integration in scalp hair have not yet been established and it is not known how testosterone is stored in the hair segments over time. The aim of this study was to investigate the stability of testosterone concentrations in hair as it grows and to determine if segmental hair analysis can be used as a retrospective testosterone diary. Thirty men and 40 women provided two hair samples and 16 saliva samples during a period of three months. Hair growth between the two samplings was measured. Hair samples were cut into 10 mm segments resulting in three segments from the first sampling and six segments from the second sampling. Hair samples were pulverised and extracted with methanol. Hair testosterone concentrations were analysed using an in-house radioimmunoassay. Salivary testosterone was analysed using a commercial enzyme-linked immunosorbent assay (Demeditec). The results demonstrated that there is a degree of segmental hormone conservation over time (rho = 0.405-0.461, p < 0.001, n = 66-67), but also highlighted three potential confounders. Firstly, testosterone concentrations were higher in distal hair segments (mean concentration ratio most distal by most scalp-near was 1.55, SD 0.70), which may be due to continuous hormone integration from sebum and changes in hair matrix composition. Secondly, more frequent hair washing stunted the increase in testosterone concentrations in distal segments (rho = -0.404, p = < 0.001, n = 66). And lastly, intra- and inter- individual variability in hair growth rate influenced the temporal resolution along the hair, although mean growth rate was indeed 30.0 mm for three months. In a multiple regression model the biological sex, natural hair colour, and relationship status were significant explanatory variables to hair testosterone concentrations. The current results indicate that repeated hair sampling near the hair roots during a study may be preferable to analysing concentration changes between proximal and distal segments within the same hair sample. Also, hair testosterone analysis needs to be adjusted for sex and the natural hair colour.
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Affiliation(s)
- Julia K Preinbergs
- Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden.
| | - Jakob O Ström
- Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden
- Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Elvar Theodorsson
- Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden
| | - Edvin Ingberg
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Bärtl C, Kreuzpointner L, Wüst S, Kudielka BM. Investigation of cross-sectional and longitudinal associations between work-related burnout and hair cortisol: The Regensburg Burnout Project. Psychoneuroendocrinology 2023; 149:106026. [PMID: 36657345 DOI: 10.1016/j.psyneuen.2023.106026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Burnout is characterized by feelings of exhaustion, depersonalization as well as reduced personal accomplishment and is linked to various negative health effects. Previous studies on biological correlates of burnout have focused on the hypothalamic-pituitary-adrenal (HPA) axis. However, especially studies on hair cortisol concentrations (HCC) were often based on cross-sectional data and yielded inconsistent results, probably due to the heterogeneity of the selected samples. Accordingly, the aim of the present study was to investigate cross-sectional as well as longitudinal associations between burnout and HCC within a sample consisting of a strictly specified group of individuals suffering from burnout (BO group) and a healthy comparison group (HC group). METHODS After a multi-stage recruitment procedure based on burnout symptoms and pathogenesis, eligible subjects (out of an initial sample of 1022 volunteers) were assigned either to a BO (n = 55) or HC group (n = 59), as described in detail in Bärtl et al. (2022). Burnout symptoms as well as HCC (1 cm hair samples) were measured repeatedly at two sampling time points t1 (n = 114) and t2 (n = 100) with an interval of M = 7.20 months (SD = 1.16) between assessments. RESULTS In the total study sample, no cross-sectional associations between burnout and HCC were found either at t1 or at t2. When the analysis was restricted to the BO group, HCC was positively related to burnout symptomatology at t1 but not t2. In the longitudinal analysis, burnout symptoms at t1 were significant negative predictors of HCC at t2. However, the change in HCC from t1 to t2 was not associated with the change in burnout symptoms. CONCLUSIONS In the present study, we investigated the association between HCC and burnout in a strictly defined sample of subjects suffering from burnout and healthy controls. Our findings mainly do not support our hypotheses. At least, the positive association between HCC and burnout symptoms only within the BO group supports the idea that HPA axis alterations in burnout might only become apparent once a certain threshold of burnout symptomatology has been exceeded, while the longitudinal data provide some empirical evidence for the potential long-term development of hypocortisolism in burnout. However, respective results remain relatively inconclusive.
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Affiliation(s)
- Christoph Bärtl
- Institute of Psychology, University of Regensburg, Regensburg, Germany.
| | | | - Stefan Wüst
- Institute of Psychology, University of Regensburg, Regensburg, Germany
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Elder GJ, Altena E, Palagini L, Ellis JG. Stress and the hypothalamic-pituitary-adrenal axis: How can the COVID-19 pandemic inform our understanding and treatment of acute insomnia? J Sleep Res 2023:e13842. [PMID: 36748346 DOI: 10.1111/jsr.13842] [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: 07/14/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
Stress and sleep are very closely linked, and stressful life events can trigger acute insomnia. The ongoing COVID-19 pandemic is highly likely to represent one such stressful life event. Indeed, a wide range of cross-sectional studies demonstrate that the pandemic is associated with poor sleep and sleep disturbances. Given the high economic and health burden of insomnia disorder, strategies that can prevent and treat acute insomnia, and also prevent the transition from acute insomnia to insomnia disorder, are necessary. This narrative review outlines why the COVID-19 pandemic is a stressful life event, and why activation of the hypothalamic-pituitary-adrenal axis, as a biological marker of psychological stress, is likely to result in acute insomnia. Further, this review outlines how sleep disturbances might arise as a result of the COVID-19 pandemic, and why simultaneous hypothalamic-pituitary-adrenal axis measurement can inform the pathogenesis of acute insomnia. In particular, we focus on the cortisol awakening response as a marker of hypothalamic-pituitary-adrenal axis function, as cortisol is the end-product of the hypothalamic-pituitary-adrenal axis. From a research perspective, future opportunities include identifying individuals, or particular occupational or societal groups (e.g. frontline health staff), who are at high risk of developing acute insomnia, and intervening. From an acute insomnia treatment perspective, priorities include testing large-scale online behavioural interventions; examining if reducing the impact of stress is effective and, finally, assessing whether "sleep vaccination" can maintain good sleep health by preventing the occurrence of acute insomnia, by preventing the transition from acute insomnia to insomnia disorder.
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Affiliation(s)
- Greg J Elder
- Northumbria Sleep Research, Northumbria University, Newcastle upon Tyne, UK
| | - Ellemarije Altena
- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine-UMR 5287 CNRS, Team Neuroimaging and Human Cognition, Université de Bordeaux, Bordeaux, France
| | - Laura Palagini
- Department of Neuroscience and Rehabilitation, Psychiatric Section University of Ferrara, Ferrara, Italy.,Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy
| | - Jason G Ellis
- Northumbria Sleep Research, Northumbria University, Newcastle upon Tyne, UK
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Jia R, Ayling K, Coupland C, Chalder T, Massey A, Nater U, Broadbent E, Gasteiger N, Gao W, Kirschbaum C, Vedhara K. Increases in stress hormone levels in a UK population during the COVID-19 pandemic: A prospective cohort study. Psychoneuroendocrinology 2023; 148:105992. [PMID: 36495625 PMCID: PMC9705007 DOI: 10.1016/j.psyneuen.2022.105992] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/26/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research suggests that psychological factors may influence vulnerability to SARS-CoV-2 infection, although the mechanisms are unclear. PURPOSE We examined whether the hypothalamic-pituitary-adrenal axis may be a possible mechanism, by measuring the relationship between indices of psychological distress and cortisone in hair (hairE) in a UK cohort during the COVID-19 pandemic. METHODS Participants (N = 827) provided two 3 cm hair samples over a 6-month period between April-September 2020. Samples reflected hairE in the 3 months prior to the collection date. RESULTS HairE in the first samples (T1: commenced April 2020) did not differ significantly from pre-pandemic population norms. However, hairE in the second samples (T2: commenced July 2020) were significantly higher than T1 and pre-pandemic population norms, with a 23% increase between T1 and T2. Linear regressions, controlling for age and gender, demonstrated that at both timepoints, hairE levels were greatest in people with a history of mental health difficulties. In addition, stress reported at T1 predicted greater hairE at T2 and a greater change in hairE between T1 and T2. CONCLUSIONS These findings demonstrate that during the COVID-19 pandemic hairE was substantially elevated across a large community cohort, with greatest levels in those with a history of mental health difficulties and greatest changes in those reporting greatest levels of stress early in the pandemic. Further research is required with verified SARS-CoV-2 outcomes to determine whether the HPA axis is among the mechanisms by which a history of mental health difficulties and stress influence SARS-CoV-2 outcomes.
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Affiliation(s)
- Ru Jia
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Kieran Ayling
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Carol Coupland
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London SE5 8AF, UK
| | - Adam Massey
- Cortigenix, Cortigenix Laboratory, 6 Westhill Court, Walcott, Lincoln LN4 3BU, UK
| | - Urs Nater
- Department of Clinical and Health Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria
| | - Elizabeth Broadbent
- Department of Psychological Medicine, University of Auckland, Private bag 92019, Auckland, New Zealand
| | - Norina Gasteiger
- Department of Psychological Medicine, University of Auckland, Private bag 92019, Auckland, New Zealand; School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Wei Gao
- Faculty of Psychology, TU Dresden, 01062 Dresden, Germany
| | | | - Kavita Vedhara
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
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