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Argueta DL, Brice KN, Wu-Chung EL, Chen MA, Lai VD, Paoletti-Hatcher J, Denny BT, Green C, Medina LD, Schulz P, Stinson J, Heijnen C, Fagundes CP. LPS-induced whole-blood cytokine production and depressive symptoms in dementia spousal caregivers: The moderating effect of childhood trauma. Psychoneuroendocrinology 2024; 168:107140. [PMID: 39032477 DOI: 10.1016/j.psyneuen.2024.107140] [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: 02/26/2024] [Revised: 06/09/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
Dementia spousal caregivers are at risk for adverse mental and physical health outcomes. Caregiver burden, anticipatory grief, and proinflammatory cytokine production may contribute to depressive symptoms among caregivers. People who report childhood trauma are more likely to have exaggerated stress responses that may also contribute to depressive symptoms in adulthood. This study aimed to test whether the relationship between whole-blood cytokine production and depressive symptoms is strongest in caregivers who report high levels of childhood trauma. METHODS A sample of 103 dementia spousal caregivers provided self-report data on demographics, health information, caregiver burden, anticipatory grief, and depressive symptoms. We also determined lipopolysaccharide-induced whole-blood cytokine production as the primary measure of immune cell reactivity. We measured interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10) and converted z-scores of each cytokine into a composite panel. We regressed depressive symptoms on proinflammatory cytokine production, caregiver burden, and anticipatory grief, adjusting for demographic and health-related covariates. RESULTS Whole-blood cytokine production and childhood trauma were associated with depressive symptoms. Childhood trauma moderated the relationship between whole-blood cytokine production and depressive symptoms. Whole-blood cytokine production was only associated with depressive symptoms at mean and high levels of childhood trauma, but not at low levels of childhood trauma. The main effects of burden and anticipatory grief on depressive symptoms were strongest for caregivers reporting high levels of childhood trauma. DISCUSSION Childhood trauma has lasting impacts on psychosocial experiences later in life and has effects that may confer susceptibility to inflammation-related depression. Our findings contribute to ongoing efforts to identify risk factors for adverse mental health in dementia spousal caregivers.
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Affiliation(s)
| | - Kelly N Brice
- Department of Psychological Sciences, Rice University, USA
| | | | | | - Vincent D Lai
- Department of Psychological Sciences, Rice University, USA
| | | | - Bryan T Denny
- Department of Psychological Sciences, Rice University, USA
| | - Charles Green
- McGovern Medical School, University of Texas Health Science Center Houston, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, USA
| | - Paul Schulz
- McGovern Medical School, University of Texas Health Science Center Houston, USA
| | | | - Cobi Heijnen
- Department of Psychological Sciences, Rice University, USA; Department of Psychiatry, Baylor College of Medicine, USA
| | - Christopher P Fagundes
- Department of Psychological Sciences, Rice University, USA; Department of Psychology, University of Houston, USA; Department of Psychiatry, Baylor College of Medicine, USA; Department of Behavioral Science, MD Anderson Cancer Center, USA
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Majd M, Chen MA, Chirinos DA, Brown RL, LeRoy AS, Murdock KW, Lydia Wu-Chung E, Thayer JF, Fagundes CP. Trajectories of depressive symptoms early in the course of bereavement: Patterns, psychosocial factors and risk of prolonged grief. Stress Health 2024; 40:e3340. [PMID: 37926770 PMCID: PMC11069593 DOI: 10.1002/smi.3340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/20/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
In the context of bereavement, little is known about the mechanisms that differentiate normative adjustment patterns from those that may indicate potential psychopathology. This study aimed to replicate and extend previous work by (1) characterizing the trajectories of depressive symptoms from 3 to 12 months after the loss of a spouse, (2) examining whether (a) childhood maltreatment and attachment style predicted distinct depression trajectories, and (b) different depression trajectories were associated with the risk of prolonged grief at 12 months post-loss. Recently bereaved individuals (N = 175) completed self-report assessments at 3, 4, 6, and 12-months post-loss. Trajectories of depressive symptoms were estimated using group-based trajectory modelling. Four distinct trajectories of depressive symptoms were identified: (1) resilience (minimal/no depression across time points; 45%), (2) moderate depression-improved (alleviated to 'mild' by 12 months; 31%), (3) severe depression-improved (alleviated to 'moderate' by 12 months; 15%), and (4) chronic depression ('severe' symptoms across time points; 9%). Higher childhood maltreatment predicted a greater likelihood of belonging to the 'severe depression-improved' and 'chronic depression' groups than the 'resilient' and 'moderate depression-improved' groups. Widow(er)s with higher attachment anxiety were more likely to belong to the 'severe depression-improved' and 'chronic depression' groups than the 'resilient' group. The trajectory groups with persistent levels of depressive symptoms up until 6 months were more likely to exhibit prolonged grief at 12 months post-loss. Changes from pre-loss functioning cannot be estimated. Our findings provide insight into the early identification of post-loss prolonged grief.
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Affiliation(s)
- Marzieh Majd
- Department of Psychological Sciences, Rice University
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women’s Hospital
- Department of Psychiatry, Harvard Medical School
| | | | - Diana A. Chirinos
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Ryan L. Brown
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Angie S. LeRoy
- Department of Psychology & Neuroscience, Baylor University
| | - Kyle W. Murdock
- Department of Biobehavioral Health, The Pennsylvania State University
| | | | - Julian F. Thayer
- Department of Psychological Sciences, University of California–Irvine
| | - Christopher P. Fagundes
- Department of Psychological Sciences, Rice University
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine
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Ahn J, Lee SW, Kim K, Jin B, Chung US. The Relationship Between Childhood Trauma Experience and Complicated Grief: The Importance of Psychological Support for Individuals Coping With Pet Loss in Korea. J Korean Med Sci 2023; 38:e305. [PMID: 37724498 PMCID: PMC10506898 DOI: 10.3346/jkms.2023.38.e305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/23/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Loss of companion animals can result in various psychological reactions, including complicated grief, depression, anxiety, and insomnia. However, research on the prevalence of patients requiring clinical intervention is limited. Moreover, research examining the relationship between childhood trauma and psychological symptoms after pet loss is lacking. Therefore, this study aimed to investigate the rates of clinically significant psychological distress after pet loss and the impact of childhood trauma on adults who have experienced pet loss. METHODS An online survey was conducted with non-clinical adult participants who had experienced the loss of a companion animal. Psychiatric characteristics were evaluated using standardized assessments, including the Inventory of Complicated Grief (ICG), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the Insomnia Severity Index (ISI). Childhood trauma was evaluated using the Childhood Trauma Questionnaire (CTQ). RESULTS In a sample of 137 individuals who had experienced pet loss, the percentages of those who exceeded the cutoff points were 55% for the ICG, 52% for the PHQ-9, 40% for the GAD-7, and 32% for the ISI. The group that reported childhood trauma exhibited significantly higher scores on the ICG (t = 2.16, P = 0.032), PHQ-9 (t = 3.05, P = 0.003), GAD-7 (t = 2.61, P = 0.010), and ISI (t = 2.11, P = 0.037) than in the group without childhood trauma. For participants who experienced pet loss for less than one year, there was no significant difference in the ICG between the trauma and non-trauma groups, as both had extremely high scores. However, the trauma group had a significantly higher PHQ-9 (t = 2.58, P = 0.012) than the non-trauma group. In contrast, for participants who experienced pet loss for more than one year, the trauma group had a significantly higher ICG (t = 2.22, P = 0.03) than the non-trauma group, while there was no significant difference in the PHQ-9. Additionally, the emotional abuse scores on the CTQ were most significantly correlated with the ICG scores even after controlling for depressive symptoms. CONCLUSION People who experienced pet loss had significant psychological symptoms, ranging from 32% to 55%. Childhood trauma experiences affect complicated grief, depressive symptoms, anxiety symptoms, insomnia and prolonged grief disorder after pet loss. After pet loss, people with childhood trauma may require more psychological help than those without trauma.
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Affiliation(s)
- Jisung Ahn
- Department of Psychiatry, Kyungpook National University, Daegu, Korea
| | - Sang Won Lee
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, Daegu, Korea
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyungmin Kim
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, Daegu, Korea
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bohyun Jin
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Psychiatry, Kyungpook National University Children's Hospital, Daegu, Korea
| | - Un Sun Chung
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Psychiatry, Kyungpook National University Children's Hospital, Daegu, Korea.
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Chen MA, Suchting R, Thayer JF, Fagundes CP. Resilience to stress across the lifespan: Childhood maltreatment, heart rate variability, and bereavement. Psychol Aging 2023; 38:247-262. [PMID: 36951695 PMCID: PMC10192121 DOI: 10.1037/pag0000738] [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] [Indexed: 03/24/2023]
Abstract
Following a stressful life event, there is considerable variation in how individuals respond and adapt. Multiple models of risk and resilience show that adverse childhood experiences may be associated with an individual's response to stress later in life. While there is considerable support that early adversity can sensitize the stress response system and lead to adverse outcomes later in life, there is mounting evidence that in adolescence and young adulthood, certain biological predispositions to stress may be associated with resilience in the context of subsequent stressors. In this study, we evaluated how individual differences in vagally mediated heart rate variability moderated the relationship between childhood maltreatment and grief among a sample of individuals experiencing a stressful life event (i.e., spousal bereavement) over time. Data were collected at approximately 3, 4.5, and 6.5 months after the death of a spouse (n = 130). Heart rate variability moderated the relationship between childhood maltreatment and grief symptoms over time (b = -0.03, p < .001), such that among individuals with more severe experiences of childhood maltreatment, those with higher heart rate variability had a faster recovery from grief than those with low heart rate variability. This research highlights an overall pattern of resilience among older adult's following spousal bereavement, as well as the relationships between childhood maltreatment, heart rate variability, and differential responses to grief following the loss of a spouse. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Michelle A. Chen
- Institute of Policy Research, Northwestern University, Evanston, IL
| | - Robert Suchting
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX
| | - Julian F. Thayer
- Department of Psychological Science, University of California, Irvine, Irvine, CA
- Department of Psychology, The Ohio State University, Columbus, OH
| | - Christopher P. Fagundes
- Department of Psychological Sciences, Rice University, Houston, TX
- Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX
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Chen MA, Fagundes CP. Childhood maltreatment, emotion regulation strategies and depressive symptoms during spousal bereavement. CHILD ABUSE & NEGLECT 2022; 128:105618. [PMID: 35344805 DOI: 10.1016/j.chiabu.2022.105618] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 02/18/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Childhood maltreatment increases the risk of depression, especially after experiencing a stressful life event, such as bereavement. Employing emotion regulation strategies can mitigate the impact childhood maltreatment has on depression later in life following the loss of a spouse. OBJECTIVE We evaluated how cognitive reappraisal and expressive suppression moderated the impact of childhood maltreatment and depressive symptoms following spousal bereavement. PARTICIPANTS AND SETTING We examined 130 bereaved individuals 3 months after the death of a spouse, 4 months after the death of a spouse, and 6 months after the death of a spouse. METHODS We utilized a mixed model approach to test the interaction between childhood maltreatment and cognitive reappraisal and between childhood maltreatment and expressive suppression to predict depressive symptoms across 3 time points. RESULTS Cognitive reappraisal moderated the relationship between childhood maltreatment and depressive symptoms (b = - 0.17,p = .003); expressive suppression did not (b = 0.06,p = .452). Participants who used less cognitive reappraisal had a positive relationship between childhood maltreatment and depressive symptoms (b = 3.27,p < .001);participants who used more cognitive reappraisal did not (b = 1.09,p = .065). CONCLUSIONS Childhood maltreatment interacted with cognitive reappraisal, but not expressive suppression, to predict depressive symptoms following spousal bereavement. This study reveals how emotion regulation strategies can be utilized as a tool to buffer the impact of childhood maltreatment on mental health following a stressor later in life, which can serve as a target for future interventions for individuals experiencing a stressful life event.
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Affiliation(s)
- Michelle A Chen
- Department of Psychological Sciences, Rice University, Houston, TX, USA.
| | - Christopher P Fagundes
- Department of Psychological Sciences, Rice University, Houston, TX, USA; Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Chen MA, Brown RL, Chen JY, de Dios MA, Green CE, Heijnen CJ, Fagundes CP. Childhood maltreatment, subjective social status, and health disparities in bereavement. Psychoneuroendocrinology 2022; 135:105595. [PMID: 34837775 PMCID: PMC8702370 DOI: 10.1016/j.psyneuen.2021.105595] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/21/2021] [Accepted: 11/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Spousal bereavement can lead to adverse health outcomes; however, not all widow(er)s experience the same degree of health problems. Thus, it is important to understand the contribution of disparities (e.g., childhood maltreatment and subjective social status) that may underlie adverse health outcomes that arise following bereavement. METHODS We collected data from 130 spousally bereaved individuals at 3-time points (3 months post-loss, 4 months post-loss, and 6 months post-loss). Using mixed models, we assessed the interaction of childhood maltreatment, subjective social status, and time to predict changes in proinflammatory cytokine production, depressive symptoms, grief symptoms. RESULTS We found a significant interaction between childhood maltreatment, subjective social status, and time predicting proinflammatory cytokine production (beta > -0.01, p = 0.048), depressive symptoms (beta = 0.008, p = .010), and grief symptoms (beta = 0.001 p = .001). CONCLUSION This study highlights the role of disparities related to childhood maltreatment and subjective social status on adverse health outcomes following spousal bereavement.
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Affiliation(s)
- Michelle A. Chen
- Department of Psychological Sciences, Rice University, 6100 Main St, Houston, TX 77005, USA
| | - Ryan L. Brown
- Department of Psychological Sciences, Rice University, 6100 Main St, Houston, TX 77005, USA
| | - Jonathan Y. Chen
- McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX 77030, USA,School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA
| | - Marcel A. de Dios
- Department of Psychological, Health, and Learning Sciences, University of Houston, 4800 Calhoun Rd, Houston, TX 77004, USA
| | - Charles E. Green
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Cobi J. Heijnen
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX 77030
| | - Christopher P. Fagundes
- Department of Psychological Sciences, Rice University, 6100 Main St, Houston, TX 77005, USA,Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, 1515 Holcome Blvd, Houston, TX 77030, USA,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
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Seiler A, von Känel R, Slavich GM. The Psychobiology of Bereavement and Health: A Conceptual Review From the Perspective of Social Signal Transduction Theory of Depression. Front Psychiatry 2020; 11:565239. [PMID: 33343412 PMCID: PMC7744468 DOI: 10.3389/fpsyt.2020.565239] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022] Open
Abstract
Losing a spouse is considered one of the most stressful life events a person can experience. Particularly in the immediate weeks and months after the loss, bereavement is associated with a significantly increased risk of morbidity and mortality. Despite an abundance of research aimed at identifying risk factors for adverse health outcomes following marital death, the mechanisms through which mental and physical health problems emerge following bereavement remain poorly understood. To address this issue, the present review examines several pathways that may link bereavement and health, including inflammation and immune dysregulation, genetic and epigenetic changes, gut microbiota activity, and biological aging. We then describe how these processes may be viewed from the perspective of the Social Signal Transduction Theory of Depression to provide a novel framework for understanding individual differences in long-term trajectories of adjustment to interpersonal loss. Finally, we discuss several avenues for future research on psychobiological mechanisms linking bereavement with mental and physical health outcomes.
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Affiliation(s)
- Annina Seiler
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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