Fish oil for attenuating posttraumatic stress symptoms among rescue workers after the great east Japan earthquake: a randomized controlled trial

Efficacy of Polyunsaturated Fatty Acids as a Treatment for Post-traumatic Stress Disorder: A Systematic Review

INTRODUCTION

Post-traumatic stress disorder (PTSD) is a prevalent health condition among members of the military. Although the efficacy of pharmacological and psychiatric interventions for PTSD has been well studied, there are limited data on the effects of omega-3 (n-3) polyunsaturated fatty acid (PUFA) interventions on PTSD. The use of PUFAs shows promise because of their neuroprotective effects. Thus, this systematic review will synthesize the current state of the evidence regarding the effectiveness of PUFA treatment for PTSD.

MATERIALS AND METHODS

Using the PubMed, PsychINFO, Embase, and CINAHL databases, a search of the literature was conducted using the search terms "posttraumatic-stress-disorder, combat disorders, trauma-related-stress-disorder, omega-3, fatty acid, and polyunsaturated fatty acids" to identify articles published from January 1, 2008, to January 1, 2024, that focused on PUFA interventions for PTSD. A total of 281 articles were identified. Following exclusions and quality assessments using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria proposed by Cochrane, 6 randomized controlled trials (RCTs) and preclinical studies were chosen for inclusion, and data were then extracted into a data matrix for final synthesis and analysis.

RESULTS

The RCTs (n = 3) showed no significant effect of PUFAs in the prevention of PTSD symptom onset. Among preclinical studies (n = 3), PUFAs resulted in a significant decrease in anxiety-like behavior and fear memory and an increase in spatial learning and memory. The quality of evidence among the 6 RCTs and preclinical studies using the Cochrane GRADE criteria ranged from low to high.

CONCLUSIONS

The results from this systematic review suggest that more evidence is needed before making any recommendations for the clinical use of dietary PUFAs in the management of PTSD symptoms.

Early pharmacological interventions for prevention of post-traumatic stress disorder (PTSD) in individuals experiencing acute traumatic stress symptoms

BACKGROUND

Acute traumatic stress symptoms may develop in people who have been exposed to a traumatic event. Although they are usually self-limiting in time, some people develop post-traumatic stress disorder (PTSD), a severe and debilitating condition. Pharmacological interventions have been proposed for acute symptoms to act as an indicated prevention measure for PTSD development. As many individuals will spontaneously remit, these interventions should balance efficacy and tolerability.

OBJECTIVES

To assess the efficacy and acceptability of early pharmacological interventions for prevention of PTSD in adults experiencing acute traumatic stress symptoms.

SEARCH METHODS

We searched the Cochrane Common Mental Disorders Controlled Trial Register (CCMDCTR), CENTRAL, MEDLINE, Embase and two other databases. We checked the reference lists of all included studies and relevant systematic reviews. The search was last updated on 23 January 2023.

SELECTION CRITERIA

We included randomised controlled trials on adults exposed to any kind of traumatic event and presenting acute traumatic stress symptoms, without restriction on their severity. We considered comparisons of any medication with placebo, or with another medication. We excluded trials that investigated medications as an augmentation to psychotherapy.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodological procedures. Using a random-effects model, we analysed dichotomous data as risk ratios (RR) and calculated the number needed to treat for an additional beneficial/harmful outcome (NNTB/NNTH). We analysed continuous data as mean differences (MD) or standardised mean differences (SMD). Our primary outcomes were PTSD severity and dropouts due to adverse events. Secondary outcomes included PTSD rate, functional disability and quality of life.

MAIN RESULTS

We included eight studies that considered four interventions (escitalopram, hydrocortisone, intranasal oxytocin, temazepam) and involved a total of 779 participants. The largest trial contributed 353 participants and the next largest, 120 and 118 participants respectively. The trials enrolled participants admitted to trauma centres or emergency departments. The risk of bias in the included studies was generally low except for attrition rate, which we rated as high-risk. We could meta-analyse data for two comparisons: escitalopram versus placebo (but limited to secondary outcomes) and hydrocortisone versus placebo. One study compared escitalopram to placebo at our primary time point of three months after the traumatic event. There was inconclusive evidence of any difference in terms of PTSD severity (mean difference (MD) on the Clinician-Administered PTSD Scale (CAPS, score range 0 to 136) -11.35, 95% confidence interval (CI) -24.56 to 1.86; 1 study, 23 participants; very low-certainty evidence), dropouts due to adverse events (no participant left the study early due to adverse events; 1 study, 31 participants; very low-certainty evidence) and PTSD rates (RR 0.59, 95% CI 0.03 to 13.08; NNTB 37, 95% CI NNTB 15 to NNTH 1; 1 study, 23 participants; very low-certainty evidence). The study did not assess functional disability or quality of life. Three studies compared hydrocortisone to placebo at our primary time point of three months after the traumatic event. We found inconclusive evidence on whether hydrocortisone was more effective in reducing the severity of PTSD symptoms compared to placebo (MD on CAPS -7.53, 95% CI -25.20 to 10.13; I2 = 85%; 3 studies, 136 participants; very low-certainty evidence) and whether it reduced the risk of developing PTSD (RR 0.47, 95% CI 0.09 to 2.38; NNTB 14, 95% CI NNTB 8 to NNTH 5; I2 = 36%; 3 studies, 136 participants; very low-certainty evidence). Evidence on the risk of dropping out due to adverse events is inconclusive (RR 3.19, 95% CI 0.13 to 75.43; 2 studies, 182 participants; low-certainty evidence) and it is unclear whether hydrocortisone might improve quality of life (MD on the SF-36 (score range 0 to 136, higher is better) 19.70, 95% CI -1.10 to 40.50; 1 study, 43 participants; very low-certainty evidence). No study assessed functional disability.

AUTHORS' CONCLUSIONS

This review provides uncertain evidence regarding the use of escitalopram, hydrocortisone, intranasal oxytocin and temazepam for people with acute stress symptoms. It is therefore unclear whether these pharmacological interventions exert a positive or negative effect in this population. It is important to note that acute traumatic stress symptoms are often limited in time, and that the lack of data prevents the careful assessment of expected benefits against side effects that is therefore required. To yield stronger conclusions regarding both positive and negative outcomes, larger sample sizes are required. A common operational framework of criteria for inclusion and baseline assessment might help in better understanding who, if anyone, benefits from an intervention. As symptom severity alone does not provide the full picture of the impact of exposure to trauma, assessment of quality of life and functional impairment would provide a more comprehensive picture of the effects of the interventions. The assessment and reporting of side effects may facilitate a more comprehensive understanding of tolerability.

Scoping Review of PTSD Treatments for Natural Disaster Survivors

This scoping review explores the current research on PTSD interventions for Natural Disaster survivors. It includes fourteen randomized control trials (RCTs). The included interventions were, pharmaceuticals, nutraceuticals, herbal supplements, CBT, yoga, narrative exposure therapy, acupuncture stimulation, web-based interventions, and a multimodal art and meditation program. CBT is considered the standard of care for general PTSD treatment and was also found to be effective for the treatment of natural disaster-related PTSD symptoms. However, higher-level clinical evidence is needed. There are inconsistencies with the use of pharmaceuticals, nutraceuticals, and herbal supplements, while there is insufficient clinical evidence to effectively determine the efficacy of yoga, acupuncture, art, and narrative exposure therapies. Factors like the availability of resources, cultural sensitivity, and values and preferences impact the effectiveness of interventions used to treat PTSD in natural disaster survivors. Clinical studies in this field need to be further expanded regardless of the study type.

Post-Traumatic Stress Disorder/Developmental Trauma Disorder/Complex Post-Traumatic Stress Disorder and Complementary and Integrative Medicine/Functional Medicine

Response to PTSD treatments differ based on the age the abuse occurred, the type of abuse, and the chronicity of the abuse. Even when modifications to treatment are made based on the developmental age when the abuse occurred, therapies may be insufficient. In addition, when diagnostic criteria are modified to identify more children, some children continue to escape detection. Developmental Trauma Disorder, (akin to the RDoC), may be more suitable to identify epigenetic and inflammatory effects of early abuse that may be responsible for the nonresponsive to treatment. Complementary and Integrative Medicine interventions (meditation, EFT, EMDR, PUFAs, etc.) may reverse these effects.

Early pharmacological interventions for universal prevention of post-traumatic stress disorder (PTSD)

BACKGROUND

Post-traumatic stress disorder (PTSD) is a severe and debilitating condition. Several pharmacological interventions have been proposed with the aim to prevent or mitigate it. These interventions should balance efficacy and tolerability, given that not all individuals exposed to a traumatic event will develop PTSD. There are different possible approaches to preventing PTSD; universal prevention is aimed at individuals at risk of developing PTSD on the basis of having been exposed to a traumatic event, irrespective of whether they are showing signs of psychological difficulties.

OBJECTIVES

To assess the efficacy and acceptability of pharmacological interventions for universal prevention of PTSD in adults exposed to a traumatic event.

SEARCH METHODS

We searched the Cochrane Common Mental Disorders Controlled Trial Register (CCMDCTR), CENTRAL, MEDLINE, Embase, two other databases and two trials registers (November 2020). We checked the reference lists of all included studies and relevant systematic reviews. The search was last updated on 13 November 2020.

SELECTION CRITERIA

We included randomised clinical trials on adults exposed to any kind of traumatic event. We considered comparisons of any medication with placebo or with another medication. We excluded trials that investigated medications as an augmentation to psychotherapy.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodological procedures. In a random-effects model, we analysed dichotomous data as risk ratios (RR) and number needed to treat for an additional beneficial/harmful outcome (NNTB/NNTH). We analysed continuous data as mean differences (MD) or standardised mean differences (SMD).

MAIN RESULTS

We included 13 studies which considered eight interventions (hydrocortisone, propranolol, dexamethasone, omega-3 fatty acids, gabapentin, paroxetine, PulmoCare enteral formula, Oxepa enteral formula and 5-hydroxytryptophan) and involved 2023 participants, with a single trial contributing 1244 participants. Eight studies enrolled participants from emergency departments or trauma centres or similar settings. Participants were exposed to a range of both intentional and unintentional traumatic events. Five studies considered participants in the context of intensive care units with traumatic events consisting of severe physical illness. Our concerns about risk of bias in the included studies were mostly due to high attrition and possible selective reporting. We could meta-analyse data for two comparisons: hydrocortisone versus placebo, but limited to secondary outcomes; and propranolol versus placebo. No study compared hydrocortisone to placebo at the primary endpoint of three months after the traumatic event. The evidence on whether propranolol was more effective in reducing the severity of PTSD symptoms compared to placebo at three months after the traumatic event is inconclusive, because of serious risk of bias amongst the included studies, serious inconsistency amongst the studies' results, and very serious imprecision of the estimate of effect (SMD -0.51, 95% confidence interval (CI) -1.61 to 0.59; I² = 83%; 3 studies, 86 participants; very low-certainty evidence). No study provided data on dropout rates due to side effects at three months post-traumatic event. The evidence on whether propranolol was more effective than placebo in reducing the probability of experiencing PTSD at three months after the traumatic event is inconclusive, because of serious risk of bias amongst the included studies, and very serious imprecision of the estimate of effect (RR 0.77, 95% CI 0.31 to 1.92; 3 studies, 88 participants; very low-certainty evidence). No study assessed functional disability or quality of life.  Only one study compared gabapentin to placebo at the primary endpoint of three months after the traumatic event, with inconclusive evidence in terms of both PTSD severity and probability of experiencing PTSD, because of imprecision of the effect estimate, serious risk of bias and serious imprecision (very low-certainty evidence). We found no data on dropout rates due to side effects, functional disability or quality of life. For the remaining comparisons, the available data are inconclusive or missing in terms of PTSD severity reduction and dropout rates due to adverse events. No study assessed functional disability.

AUTHORS' CONCLUSIONS

This review provides uncertain evidence only regarding the use of hydrocortisone, propranolol, dexamethasone, omega-3 fatty acids, gabapentin, paroxetine, PulmoCare formula, Oxepa formula, or 5-hydroxytryptophan as universal PTSD prevention strategies. Future research might benefit from larger samples, better reporting of side effects and inclusion of quality of life and functioning measures.

Non-pharmacological therapies for the treatment of post-traumatic stress disorder among emergency responders: a scoping review

OBJECTIVE

Identify non-pharmacological therapies for the treatment of post-traumatic stress disorder in emergency responders.

METHOD

Scope review according to the guidelines of the Joanna Briggs Institute and the PRISMA-ScR protocol. A search was conducted in nine databases, portals of theses and dissertations, and using an electronic search engine.

RESULTS

In total, 23 studies were selected and analyzed, and then categorized into six thematic fields - therapy with omega 3 food supplement, art therapy, physical exercise therapy, mindfulness-based therapy, therapy with elements of nature, and psychotherapy - which were considered non-pharmacological treatments for this psychopathology among emergency responders, as well as the use of psychotherapy via telehealth as an option for treatment.

CONCLUSION

More evidence supporting diet therapy is required, while the other therapeutic options presented positive results, finding support in national and international recommendations of treatment and clinical practice.

Establishing the Effectiveness of Interventions Provided to First Responders to Prevent and/or Treat Mental Health Effects of Response to a Disaster: A Systematic Review

OBJECTIVES

This review systematically explores the current available evidence on the effectiveness of interventions provided to first responders to prevent and/or treat the mental health effects of responding to a disaster.

METHODS

A systematic review of Medline, Scopus, PsycINFO, and gray literature was conducted. Studies describing the effectiveness of interventions provided to first responders to prevent and/or treat the mental health effects of responding to a disaster were included. Quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and the Critical Appraisal Skills Programme (CASP) checklist.

RESULTS

Manuscripts totaling 3869 met the initial search criteria; 25 studies met the criteria for in-depth analysis, including 22 quantitative and 3 qualitative studies; 6 were performed in low- and middle-income countries (LMICs); 18 studies evaluated a psychological intervention; of these, 13 found positive impact, 4 found no impact, and 1 demonstrated worsened symptoms after the intervention. Pre-event trainings decreased psychiatric symptoms in each of the 3 studies evaluating its effectiveness.

CONCLUSIONS

This review demonstrates that there are likely effective interventions to both prevent and treat psychiatric symptoms in first responders in high-, medium-, and low-income countries.

Brief mindfulness-based stress management program for a better mental state in working populations - Happy Nurse Project: A randomized controlled trial✰✰

BACKGROUND

The efficacy of the mindfulness-based stress management program for maintaining a better mental state has not been examined among working populations. We aimed to explore the effectiveness of the brief mindfulness-based stress management program for hospital nurses.

METHODS

In a multi-center randomized trial, 80 junior nurses working in hospitals were randomly allocated either to the brief mindfulness-based stress management program or psychoeducation using a leaflet. The program consisted of four 30 min individual sessions conducted by trained senior nurses using a detailed manual. The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) at week 26. Secondary outcomes included presence of a major depressive episode; severity of depression, anxiety, insomnia, burnout, and presenteeism; utility scores; and adverse events up to 52 weeks.

RESULTS

The mean HADS score of all the participants at baseline was 7.2. At 26 weeks, adjusted mean scores on the HADS score were 7.2 (95% confidence intervals: 5.9, 8. 5) in the program group and 6.0 (4.8, 7.2) in the leaflet group, respectively. The coefficient of the group by time interaction was not statistically significant at -1.41 (-3.35, 0.54; P = 0.156). No significant superiority or inferiority was observed on the other outcomes.

LIMITATIONS

We did not manage to recruit the number of participants we initially set out, although our post-hoc analyses showed that this did not lead to changes in our conclusions.

CONCLUSIONS

The additive value of the brief mindfulness-based stress management program was not confirmed in mental state and self-evaluated work efficiency.

Inflammation and post-traumatic stress disorder

While post-traumatic stress disorder (PTSD) is currently diagnosed based solely on classic psychological and behavioral symptoms, a growing body of evidence has highlighted a link between this disorder and alterations in the immune and inflammatory systems. Epidemiological studies have demonstrated that PTSD is associated with significantly increased rates of physical comorbidities in which immune dysregulation is involved, such as metabolic syndrome, atherosclerotic cardiovascular disease, and autoimmune diseases. In line with this, a number of blood biomarker studies have reported that compared to healthy controls, individuals with PTSD exhibit significantly elevated levels of proinflammatory markers, such as interleukin-1β, interleukin-6, tumor necrosis factor-α, and C-reactive protein. Moreover, various lines of animal and human research have suggested that inflammation is not only associated with PTSD but also can play an important role in its pathogenesis and pathophysiology. In this review, we first summarize evidence suggestive of increased inflammation in PTSD. We then examine findings that suggest possible mechanisms of inflammation in this disorder in terms of two different but interrelated perspectives: putative causes of increased proinflammatory activities and potential consequences that inflammation generates. Given that there is currently a dearth of treatment options for PTSD, possibilities of new therapeutic approaches using pharmacological and non-pharmacological treatments/interventions that have anti-inflammatory effects are also discussed. Despite the increasing attention given to the inflammatory pathology of PTSD, there remains much to be elucidated, including more detailed mechanisms of inflammation, potential usefulness of inflammatory biomarkers as diagnostic and prognostic markers, and efficacy of novel treatment strategies targeting inflammation.

Fear of cancer recurrence among breast cancer survivors could be controlled by prudent dietary modification with polyunsaturated fatty acids

BACKGROUND

The pathophysiology of fear of cancer recurrence (FCR), the leading unmet psychological need of cancer survivors, may involve the dysfunctional processing of fear memory. n-3 polyunsaturated fatty acids (PUFAs) have beneficial effects on psychiatric disorders, including depressive disorder and anxiety disorders, and are involved in fear memory processing. We hypothesized that n-3 PUFA composition is associated with FCR in cancer survivors.

METHODS

We conducted a cross-sectional study to examine the relationship between n-3 PUFAs and FCR among breast cancer survivors. Adults who had been diagnosed with invasive breast cancer and were not undergoing chemotherapy were asked to participate. Blood PUFA composition was evaluated by using capillary blood. We directly administered the Concerns About Recurrence Scale (CARS) to assess the grade of FCR.

RESULTS

Among 126 participants used for the analysis, the mean age (SD) was 58 (11) years and 47% had stage I cancer. Multiple regression analysis controlling for possible confounders, depressive symptoms, and post-traumatic stress disorder (PTSD) symptoms revealed that the alpha-linolenic acid (ALA) level was significantly inversely associated with the average score on the CARS overall fear index (beta = -0.165, p = 0.04). No significant associations were found for other PUFAs.

LIMITATIONS

Our findings were obtained from a cross-sectional study in a single institute.

CONCLUSION

These findings provide the first evidence of a beneficial effect of ALA on FCR and indicate the need for prospective study of this association. FCR among breast cancer survivors might be controllable by prudent selection of ALA-containing cooking oil.

The emerging role of omega-3 fatty acids as a therapeutic option in neuropsychiatric disorders

The prevalence of neurologic and psychiatric diseases has been increasing for decades and, given the moderate therapeutic efficacy and safety profile of existing pharmacological treatments, there is an urgent need for new therapeutic approaches. Nutrition has recently been recognized as an important factor for the prevention and treatment of neuropsychiatric disorders. The omega-3 polyunsaturated fatty acids (n-3 PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) play critical roles in neuronal cell function and neurotransmission as well as inflammatory and immune reactions that are involved in neuropsychiatric disease states. A large number of experimental and epidemiological studies provide a strong basis for interventional clinical trials that assessed the clinical efficacy of n-3 PUFAs in various neurological and psychiatric disorders. Most of these trials found beneficial effects of dietary supplementation with EPA and DHA, and no serious safety concerns have emerged. This review gives an introduction to recent findings on the clinical efficacy of n-3 PUFAs in various neuropsychiatric disorders and the underlying biochemical mechanisms. In addition, the reader will be enabled to identify common methodological weaknesses of clinical studies on n-3 PUFAs, and suggestions for the design of future studies are given.

Omega-3 fatty acids for a better mental state in working populations - Happy Nurse Project: A 52-week randomized controlled trial

The efficacy of omega-3 fatty acids for maintaining a better mental state has not been examined among working populations. We aimed to explore the effectiveness of omega-3 fatty acids for hospital nurses. In a multi-center randomized trial, 80 junior nurses were randomly allocated to either omega-3 fatty acids (1200 mg/day of eicosapentaenoic acid and 600 mg/day of docosahexaenoic acid) or identical placebo pills for 13 weeks. The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS), determined by a blinded rater at week 26 from the study enrolment. Secondary outcomes included the total score of the HADS at 13 and 52 weeks; incidence of a major depressive episode; severity of depression, anxiety, insomnia, burnout, and presenteeism; utility scores; and adverse events at 13, 26 and 52 weeks. The mean HADS score at baseline was 7.2. At 26 weeks, adjusted mean scores on the HADS were 6.32 (95% CIs of standard errors: 5.13, 7.52) in the intervention and 6.81 (5.57, 8.05) in the placebo groups, respectively. The coefficient of the group by time interaction was not statistically significant at 0.58 (-1.35, 2.50; P = 0.557). Although the intervention group showed significant superiority on the HADS score at 52 weeks, depression severity at 52 weeks, insomnia severity at 13 weeks, and absolute presenteeism at 26 weeks, no significant superiority or inferiority was observed on the other outcomes. The additive value of omega-3 fatty acids was not confirmed regarding mental state and self-evaluated work efficiency.

Mechanisms underlying the effects of n-3 polyunsaturated fatty acids on fear memory processing and their hypothetical effects on fear of cancer recurrence in cancer survivors

The relationship of n-3 polyunsaturated fatty acids (PUFAs) and gut microbiota with brain function has been extensively reported. Here, we review how n-3 polyunsaturated fatty acids affect fear memory processing. n-3 PUFAs may improve dysfunctional fear memory processing via immunomodulation/anti-inflammation, increased BDNF, upregulated adult neurogenesis, modulated signal transduction, and microbiota-gut-brain axis normalization. We emphasize how n-3 PUFAs affect this axis and also focus on the hypothetical effects of PUFAs in fear of cancer recurrence (FCR), the primary psychological unmet need of cancer survivors. Its pathophysiology may be similar to that of post-traumatic stress disorder (PTSD), which involves dysfunctional fear memory processing. Due to fewer adverse effects than psychotropic drugs, nutritional interventions involving n-3 PUFAs should be acceptable for physically vulnerable cancer survivors. We are currently studying the relationship of FCR with n-3 PUFAs and gut microbiota in cancer survivors to provide them with a nutritional intervention that protects against FCR.

Mental Health Problems in a Community After the Great East Japan Earthquake in 2011: A Systematic Review

INTRODUCTION

On March 11, 2011, the Great East Japan Earthquake caused a tsunami and led to the collapse of the Fukushima-Daiichi Nuclear Power Plant, thus severely damaging the surrounding area.

METHODS

A systematic review was conducted in March 2015 with the following objectives: (1) to clarify the type, severity, and prevalence of mental health problems in the areas affected by the disaster, (2) to investigate trends in mental health problems over time, (3) to reveal demographic and socio-environmental characteristics associated with the post-disaster risk for developing mental health problems, and (4) to examine the impact of this natural disaster on the mental health of people in Fukushima.

RESULTS

Forty-two papers were included in this review. The reported prevalence of posttraumatic stress reaction exceeded 10% in all studies. While some longitudinal studies observed an improvement in posttraumatic stress reaction over time, none reported a decrease in depression. Most risk factors for mental health problems were related to resettlement of daily lives, preexisting illnesses, and social networks. Overall, the reported prevalence of posttraumatic stress reaction seemed to be higher in Fukushima than in other affected areas.

CONCLUSION

Given that some mental health problems had not improved even two years after the disaster occurred, long-term mental health support is required for people in the affected area. Our finding that mental health problems seemed to be more severe in residents of Fukushima than among those in other areas suggests that residents in this prefecture require special care.

Polyunsaturated fatty acid composition and childhood adversity: Independent correlates of depressive symptom persistence

Childhood experiences, personality, and polyunsaturated essential fatty acid (PUFA) composition have all been shown to affect the likelihood of depressive symptoms. Few studies have addressed relationships between these factors in their influence on the occurrence or course of depressive symptoms. The following analysis was designed to do so. Subjects, 15-20 years old, had either begun antidepressant treatment within the preceding month (n = 88), or had never taken psychiatric medications (n = 92). Baseline assessments included a structured diagnostic interview, the self-completed Multiphasic Personality Questionnaire, and a determination of plasma PUFA phospholipid composition. Depressive symptom levels were assessed at baseline and again at 4, 8 and 12 months. Omega-3 composition and general childhood trauma scores were unrelated to each other but both correlated, in predicted directions, with negative emotionality. Low omega-3 composition and history of childhood trauma were associated with persistence of depressive symptoms during follow-up, largely through their effects on negative emotionality. Negative emotionality appears to comprise a final common pathway to depressive disorder through which the diverse risk factors of childhood adversity and low omega-3 composition are expressed.

Complementary Therapies for Mental Health Disorders

Approximately 18% of the US adult population has a mental illness, yet only 13% with mental illness receive any treatment. Although pharmacotherapy and psychotherapy are the mainstays of treatment, treatment discontinuation and failure are common. Skepticism toward such treatments has fueled interest in and use of complementary therapies, such as acupuncture, meditation, and natural products. Many medical providers are unaware of the use of these therapies by their patients, and knowledge of the evidence base for these therapies is often lacking. This article presents current evidence-based recommendations for complementary therapies in the treatment of depression, anxiety, and posttraumatic stress disorder.

Fatty acid concentrations in patients with posttraumatic stress disorder compared to healthy controls

BACKGROUND

Although fatty acid (FA)-supplementation studies are currently being implemented, in fact little is known about FA-profiles in posttraumatic stress disorder (PTSD). Therefore, the present study aimed at comparing FA-concentrations between PTSD-patients and healthy controls.

METHODS

A cross-sectional study comparing a mixed-gender sample of 49 patients with PTSD due to civilian trauma to 46 healthy controls regarding erythrocyte FAs including docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), arachidonic acid (AA), and nervonic acid (NA).

RESULTS

DHA was found to be significantly lower in PTSD-patients compared to controls after adjusting for sociodemographic and dietary factors (p =0.043). Additionally, exploratory analyses showed lower vaccenic acid (p =0.035) and eicosatrienoic acid (p =0.006), but higher erucic acid (p =0.032) in PTSD-patients. The effect of erucic acid remained after adjustment for sociodemographic factors (p =0.047); with the additional adjustment for dietary factors none of these FAs were found to be significant.

LIMITATIONS

Statistical power for differences with small effect sizes was limited, and dietary assessment could be optimized.

CONCLUSIONS

We found little evidence for a considerable role of FA-metabolism in PTSD. Apart from lower DHA after adjusting for confounders, no differences were observed in the hypothesized long-chained polyunsaturated FA-concentrations. Additionally, we found few alterations in the long-chained monounsaturated FAs, which may be explained by dietary factors. Nevertheless, the observed small effect sizes and limited extent of the alterations emphasize the importance of further investigating the assumed role of FA-metabolism and its underlying mechanisms in PTSD, before implementing further FA-supplementation studies.

Mental health and psychological impacts from the 2011 Great East Japan Earthquake Disaster: a systematic literature review

Background

On March 11, 2011, Japan experienced an unprecedented combination of earthquake/tsunami/nuclear accidents (the Great East Japan Earthquake; GEJE). We sought to identify mental health and psychosocial consequences of this compound disaster.

Method

A systematic literature review was conducted of quantitative research articles addressing mental health of survivors and the psychological impact of the GEJE. For articles between March 2011 and December 2014, PubMed, PsychINFO, and EMBASE databases were searched with guidance on literature review method.

Results

Forty-nine studies met the inclusion criteria. A substantial proportion of the affected individuals experienced considerable psychological distress. Mental health outcomes included, but were not limited to, posttraumatic stress disorder, depression, and anxiety symptoms. Physical health changes, such as sleeping and eating disturbances, also occurred. In Fukushima, radioactive release induced massive fear and uncertainty in a large number of people, causing massive distress among the affected residents, especially among mothers of young children and nuclear plant workers. Stigma was additional challenge to the Fukushima residents. The review identified several groups with vulnerabilities, such as disaster workers, children, internally displaced people, patients with psychiatric disorders, and the bereaved.

Conclusions

Following the GEJE, a considerable proportion of the population was mentally affected to a significant degree. The affected individuals showed a wide array of mental and physical consequences. In Fukushima, the impact of nuclear disaster was immense and complex, leading to fear of radiation, safety issues, and stigma issues.

Omega-3 Polyunsaturated Fatty Acids in Prevention of Mood and Anxiety Disorders

Psychiatric disorders in general, and major depression and anxiety disorders in particular, account for a large burden of disability, morbidity and premature mortality worldwide. Omega-3 polyunsaturated fatty acids (PUFAs) have a range of neurobiological activities in modulation of neurotransmitters, anti-inflammation, anti-oxidation and neuroplasticity, which could contribute to psychotropic effects. Here we reviewed recent research on the benefits of omega-3 PUFA supplements in prevention against major depression, bipolar disorders, interferon-α-induced depression patients with chronic hepatitis C viral infection, and posttraumatic stress disorder. The biological mechanisms underlying omega-3 PUFAs'psychotropic effects are proposed and reviewed. Nutrition is a modifiable environmental factor that might be important in prevention medicine, which have been applied for many years in the secondary prevention of heart disease with omega-3 PUFAs. This review extends the notion that nutrition in psychiatry is a modifiable environmental factor and calls for more researches on prospective clinical studies to justify the preventive application of omega-3 PUFAs in daily practice.

Fish consumption and resilience to depression in Japanese company workers: a cross-sectional study

BACKGROUND

Depression is a common disorder that is influenced by psychosocial factors in the workplace. Increasing resilience, the ability to cope with stress in the face of adversity, is considered an important strategy to prevent depression. It has been suggested that consumption of fish, which is a major source of long chain n-3 polyunsaturated fatty acids (LC n-3 PUFA), may prevent depression. However, associations between depression, resilience, and fish consumption have not been documented. The aim of the study is to investigate the association between fish consumption and resilience to depression.

METHODS

Participants were 527 Japanese employees at three worksites of a large company. The Center for Epidemiologic Studies Depression (CES-D) Scale was administered to assess depressive symptoms, and the 14-item Resilience Scale (RS-14) was administered to assess resilience. A self-report questionnaire extracted from the Food Frequency Questionnaire was used to measure fish consumption frequency. Regression analyses were conducted to assess a mediation model based on a statistical analysis framework defined by Baron and Kenny. The indirect association of resilience was calculated with the bootstrapping method. Each analysis was adjusted by age, sex, marital status, work position, and educational background.

RESULTS

The association between fish consumption frequency and total CES-D score was significant (B=-0.94; p=0.011). The association between fish consumption frequency and total RS-14 score was significant (B=1.4; p=0.010), as was association total RS-14 score and the total CES-D score (B=-0.34; p<0.001). When controlling for total RS-14 score, there was no longer a significant association between fish consumption frequency and total CES-D score. The bootstrapping results revealed that significant indirect association though fish consumption frequency and total CES-D score (bias corrected and accelerated confidence interval=-0.83 to -0.13; 95% confidence interval) through total RS-14 score.

CONCLUSIONS

Fish consumption might be associated with resilience to depression. Further studies are needed, particularly double blind randomized placebo controlled intervention trials on the potential preventative effect of LC n-3 PUFA on resilience to depression.

A mindfulness-based stress management program and treatment with omega-3 fatty acids to maintain a healthy mental state in hospital nurses (Happy Nurse Project): study protocol for a randomized controlled trial

BACKGROUND

It is reported that nursing is one of the most vulnerable jobs for developing depression. While they may not be clinically diagnosed as depressed, nurses often suffer from depression and anxiety symptoms, which can lead to a low level of patient care. However, there is no rigorous evidence base for determining an effective prevention strategy for these symptoms in nurses. After reviewing previous literature, we chose a strategy of treatment with omega-3 fatty acids and a mindfulness-based stress management program for this purpose. We aim to explore the effectiveness of these intervention options for junior nurses working in hospital wards in Japan.

METHODS/DESIGN

A factorial-design multi-center randomized trial is currently being conducted. A total of 120 nurses without a managerial position, who work for general hospitals and gave informed consent, have been randomly allocated to a stress management program or psychoeducation using a leaflet, and to omega-3 fatty acids or identical placebo pills. The stress management program has been developed according to mindfulness cognitive therapy and consists of four 30-minute individual sessions conducted using a detailed manual. These sessions are conducted by nurses with a managerial position. Participants allocated to the omega-3 fatty acid groups are provided with 1,200 mg/day of eicosapentaenoic acid and 600 mg/day of docosahexaenoic acid for 90 days. The primary outcome is the change in the total score of the Hospital Anxiety and Depression Scale (HADS), determined by a blinded rater via the telephone at week 26. Secondary outcomes include the change in HADS score at 13 and 52 weeks; presence of a major depressive episode; severity of depression, anxiety, insomnia, burnout, and presenteeism; utility scores and adverse events at 13, 26 and 52 weeks.

DISCUSSION

An effective preventive intervention may not only lead to the maintenance of a healthy mental state in nurses, but also to better quality of care for inpatients. This paper outlines the background and methods of a randomized trial that evaluates the possible additive value of omega-3 fatty acids and a mindfulness-based stress management program for reducing depression in nurses.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT02151162 (registered on 27 May 2014).

Modulation of fear memory by dietary polyunsaturated fatty acids via cannabinoid receptors

Although the underlying mechanism remains unknown, several studies have suggested benefits of n-3 long-chain polyunsaturated fatty acid (PUFA) for patients with anxiety disorders. Elevated fear is thought to contribute to the pathogenesis of particular anxiety disorders. The aim of the present study was to evaluate whether the dietary n-3 to n-6 PUFA (3:6) ratio influences fear memory. For this purpose, the effects of various dietary 3:6 ratios on fear memory were examined in mice using contextual fear conditioning, and the effects of these diets on central synaptic transmission were examined to elucidate the mechanism of action of PUFA. We found that fear memory correlated negatively with dietary, serum, and brain 3:6 ratios in mice. The low fear memory in mice fed a high 3:6 ratio diet was increased by the cannabinoid CB1 receptor antagonist rimonabant, reaching a level seen in mice fed a low 3:6 ratio diet. The agonist sensitivity of CB1 receptor was enhanced in the basolateral nucleus of the amygdala (BLA) of mice fed a high 3:6 ratio diet, compared with that of mice fed a low 3:6 ratio diet. Similar enhancement was induced by pharmacological expulsion of cholesterol in the neuronal membrane of brain slices from mice fed a low 3:6 ratio diet. CB1 receptor-mediated short-term synaptic plasticity was facilitated in pyramidal neurons of the BLA in mice fed a high 3:6 ratio diet. These results suggest that the ratio of n-3 to n-6 PUFA is a factor regulating fear memory via cannabinoid CB1 receptors.

Possibility of polyunsaturated fatty acids for the prevention and treatment of neuropsychiatric illnesses

Increasing evidence from the fields of neurophysiology and neuropathology has uncovered the role of polyunsaturated fatty acids (PUFA) in protecting neuronal cells from oxidative damage, controlling inflammation, regulating neurogenesis, and preserving neuronal function. Numerous epidemiological studies have shown that deficits in the dietary PUFA docosahexaenoic acid and eicosapentaenoic acid are associated with the onset and progression of neuropsychiatric illnesses such as dementia, schizophrenia, depression, and posttraumatic stress disorder (PTSD). Recent clinical trials have offered compelling evidence that suggests that n-3 PUFA could reduce depressive, psychotic, and suicidal symptoms, as well as aggression. Although many studies have had the validity of their results questioned because of small sample size, several studies have indicated that n-3 PUFA are useful therapeutic tools for the treatment of dementia, major depression, bipolar disorder, and PTSD. These findings suggest that the pharmacological and nutritional actions of n-3 PUFA may be beneficial in certain neuropsychiatric illnesses. This review article outlines the role of PUFA in neurodevelopment and the regulatory mechanisms in neuronal stem cell differentiation and also the possible use of PUFA as a prescription medicine for the prophylaxis or treatment of neuropsychiatric illnesses such as dementia, mood disorder, and PTSD.

Impact of lipid nutrition on neural stem/progenitor cells

The neural system originates from neural stem/progenitor cells (NSPCs). Embryonic NSPCs first proliferate to increase their numbers and then produce neurons and glial cells that compose the complex neural circuits in the brain. New neurons are continually produced even after birth from adult NSPCs in the inner wall of the lateral ventricle and in the hippocampal dentate gyrus. These adult-born neurons are involved in various brain functions, including olfaction-related functions, learning and memory, pattern separation, and mood control. NSPCs are regulated by various intrinsic and extrinsic factors. Diet is one of such important extrinsic factors. Of dietary nutrients, lipids are important because they constitute the cell membrane, are a source of energy, and function as signaling molecules. Metabolites of some lipids can be strong lipid mediators that also regulate various biological activities. Recent findings have revealed that lipids are important regulators of both embryonic and adult NSPCs. We and other groups have shown that lipid signals including fat, fatty acids, their metabolites and intracellular carriers, cholesterol, and vitamins affect proliferation and differentiation of embryonic and adult NSPCs. A better understanding of the NSPCs regulation by lipids may provide important insight into the neural development and brain function.