Longitudinal measurement of cortisol in association with mental health and experience of domestic violence and abuse: study protocol

Consequences of the Lockdown: Domestic Violence During the COVID-19 Pandemic

BACKGROUND

The global pandemic of the coronavirus disease 2019 (COVID-19) has presented many unique challenges to health systems. The hidden impact of COVID-19 and its associated lockdown have been an increased prevalence of domestic violence.

OBJECTIVE

To increase our understanding of the connection between COVID-19 containment measures, domestic violence, and mental health in Germany, we conducted an online self-assessment survey of 98 domestic violence victims and 276 controls. All participants answered questions concerning domestic violence, emotional regulation skills, limitations due to and acceptance of containment measures, and quality of their contact experiences.

RESULTS

There was no significant effect of "gender" x "domestic violence." Among victims of domestic violence, the number of women was considerably higher than the number of men. In addition, the factors "negative contact quality," "emotional regulation," and "resilience" differed significantly between the victims of domestic violence and the control group.

CONCLUSIONS

The COVID-19 outbreak and associated containment and quarantine measures resulted in a "hidden pandemic" of domestic violence for which prevention programs and early victim assistance through the expansion of digital technologies are urgently needed. Prospective studies should expand empirical data to focus on the long-term psychological effects of domestic violence and biomarkers that can serve as warning signs of stress-related disorders.

New Metabolic, Digestive, and Oxidative Stress-Related Manifestations Associated with Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) represents a pressing and generally invalidating syndrome that is triggered by a terrifying or stressful experience, relying on recurrently reliving the traumatic event feelings associated to it, which is subsequently linked to ongoing activations of stress-related neurobiological pathways and is often associated with neurodegeneration. In this paper, we examine what lies beneath this disorder, reviewing evidence that connects PTSD with a wide array of mechanisms and its intertwined pathways that can lead to the decompensation of different pathologies, such as cardiovascular disease, gastrointestinal ailments, autoimmune disorders, and endocrine diseases. Also, the significance of the oxidative stress in this frame of reference is debated. Thus, knowing and identifying the main features of the distressing experience, the circumstances around it, as well as the neuropsychological and emotional characteristics of people prone to develop PTSD after going through disturbing incidents can offer an opportunity to anticipate the development of potential destructive consequences in several psychological dimensions: cognitive, affective, relational, behavioral, and somatic. We can also observe more closely the intricate connections of the disorder to other pathologies and their underlying mechanisms such as inflammation, oxidative stress, bacterial overgrowth syndrome, irritable bowel syndrome, metabolic disorders, oxytocin, and cortisol in order to understand it better and to optimize the course of treatment and its management. The complex foundation PTSD possesses is supported by the existing clinical, preclinical, and experimental data encompassed in the current review. Different biological systems and processes such as the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, oxidative stress, inflammation, and microbiome suffer modifications and changes when it comes to PTSD; that is why targeted therapies exert tremendous alleviations of symptoms in patients diagnosed with this disorder. Therefore, this implies that PTSD is not restricted to the psychiatric domain and should be viewed as a systemic condition.

The coMforT study of a trauma-informed mindfulness intervention for women who have experienced domestic violence and abuse: a protocol for an intervention refinement and individually randomized parallel feasibility trial

Background

Domestic violence and abuse (DVA) is common and destructive to health. Post-traumatic stress disorder (PTSD) is a major mental health consequence of DVA. People who have experienced DVA have specific needs, arising from the repeated and complex nature of the trauma. The National Institute for Health and Care Excellence recommends more research on the effectiveness of psychological interventions for people who have experienced DVA. There is growing evidence that mindfulness-based interventions may help trauma symptoms.

Methods

Intervention refinement and randomized controlled feasibility trial. A prototype trauma-informed mindfulness-based cognitive therapy (TI-MBCT) intervention will be co-produced following qualitative interviews and consensus exercise with stakeholders. Participants in the feasibility trial will be recruited from DVA agencies in two geographical regions and randomized to receive either TI-MBCT or usual care (self-referral to the Improving Access to Psychological Therapies (IAPT) service). TI-MBCT will be delivered as a group-based eight-week program. It will not be possible to blind the participants or the assessors to the study allocation. The following factors will inform the feasibility of progressing to a fully powered trial: recruitment, retention, intervention fidelity, and the acceptability of the intervention and trial design to participants. We will also test the feasibility of measuring the following participant outcomes before and 6 months post-randomization: PTSD, dissociative symptoms, depression, anxiety, DVA re-victimization, self-compassion, and mother-reported child health. Process evaluation and economic analysis will be embedded within the feasibility trial.

Discussion

This study will lead to the development of a TI-MBCT intervention for DVA survivors with PTSD and inform the feasibility and design of a fully powered randomized controlled trial (RCT). The full trial will aim to determine the effectiveness and cost-effectiveness of a TI-MBCT intervention in improving the clinically important symptoms of PTSD in DVA survivors.

Trial registration

ISRCTN, ISRCTN64458065, Registered 11 January 2019.

Salivary cortisol in post-traumatic stress disorder: a systematic review and meta-analysis

BACKGROUND

Studies investigating salivary cortisol level as susceptibility marker for post-traumatic stress disorder (PTSD) produced inconsistent results. The aim of this study was to compare salivary cortisol concentration levels in PTSD patients with those in controls by synthesizing published data.

METHODS

We did a systematic review, meta-analysis and meta-regression of studies comparing concentrations of salivary cortisol between patients with PTSD and controls. The electronic databases of PubMed, Embase, Web of Science and Psyc-ARTICLES were searched for relevant articles. A random-effects model with restricted maximum-likelihood estimator is used to synthesize the effect size (assessed by standardized mean difference).

RESULTS

A total of 784 articles were identified of which 22 were included in the final analysis. A trend of lower salivary cortisol levels was found in PTSD patients when compared with the controls (SMD = - 0.28, 95% CI-0.53;-0.04, p = 0.022). Subgroup analysis showed that the salivary cortisol levels were lower in patients with PTSD than in controls in studies conducted after 2007 or in studies using saliva samples collected in the morning.

CONCLUSIONS

The evidence from this meta-analysis supports that salivary samples collected in the morning consistently showed a lower salivary cortisol level in patients with PTSD than in controls, although whether salivary cortisol could be used as a diagnostic tool requires further research.

A Review of Selected Studies That Determine the Physical and Chemical Properties of Saliva in the Field of Dental Treatment

Physiological whole saliva is a unique body fluid constantly washing the mucous membranes of the mouth, throat, and larynx. Saliva is a clear, slightly acidic mucinous-serous secretion, composed of various electrolytes, small organic substances, proteins, peptides, and polynucleotides. There are many ways to use saliva as a biological fluid (biofluid). The significant advantages of saliva as a unique diagnostic material are its availability and the noninvasive method of collection. The aim of this review is to emphasize the diagnostic value of saliva as a research material in the configuration of its structure and secretion disorders. The data were obtained using the MEDLINE (PubMed) search engine, as well as an additional manual search. The analysis covered 77 articles selected from a group of 1986 publications and initially qualified for devising. The results were evaluated and checked for the correctness of qualifying in accordance with inclusion and exclusion criteria. The diagnostic use of saliva has attracted the attention of many researchers due to its noninvasive nature and relative simplicity of collection. In addition, it should be noted that the determination of chemical and physical saliva parameters can be effectively performed in the patient's presence in the dental office.

Factors related to the cortisol awakening response of children working on the streets and siblings, before and after 2 years of a psychosocial intervention

The study objective was to observe the cortisol awakening response (CAR) pattern before and after a psychosocial intervention with children from dysfunctional families who had at least one child working on the streets, and to verify factors related to it. Two hundred and eleven children between 7 and 14 years old were selected and 191 were included, 178 were re-evaluated 2 years after, of whom 113 had cortisol measures completed. Besides cortisol, they were evaluated at baseline and at end point regarding: abuse/neglect, mental health symptoms, exposure to urban violence and family environment. There was no significant difference between the CAR area under the curve (AUC) before and after the intervention. Two regression analysis models were built to evaluate factors related to the CAR before and after intervention. Before the intervention, working on the streets (vs. not) was related to a greater cortisol increase after awakening, at follow-up, having suffered physical punishment (vs. not) was related to a flattened cortisol response. The intervention was not associated with changes in the magnitude of the CAR AUC, though the CAR was associated with psychosocial stressors pre- and post-intervention. Effective interventions for children at risk that might shape a physiological cortisol response are still needed.