Autonomic nervous system and hypothalamic-pituitary-adrenal axis response to experimentally induced cold pain in adolescent non-suicidal self-injury--study protocol

The relationship between depression severity and heart rate variability in children and adolescents: A meta-analysis

OBJECTIVE

Depression in children and adolescents has gradually attracted social attention. Heart rate variability (HRV) has been found to be influenced by depression severity, but results have not been uniformed in children and adolescents. This study investigated the relationship between depression severity and heart rate variability in children and adolescents, aiming to provide additional evidence for an objective, effective, and convenient depression screening tool in this population.

METHODS

Literature searching was conducted in China National Knowledge Infrastructure (CNKI), Wanfang Data, Web of Science, PubMed, ScienceDirect, and EBSCO. Relevant studies investigating the relationship between depression severity and HRV in children and adolescents were selected for meta-analysis.

RESULTS

31 articles were included in this meta-analysis, involving 4534 participants. Depression severity in children and adolescents was significantly negatively correlated with high frequency (HF) and root mean square of successive differences (RMSSD) in HRV (HF: r = -0.10, 95% CI: -0.17 to -0.04, p = 0.001; RMSSD: r = -0.18, 95% CI: -0.30 to -0.05, p = 0.01). The relationship between HF and depression severity was moderated by age, higher among those aged >12 than among those aged <12 (r = -0.17, -0.02, Q = 7.32, p = 0.007).

CONCLUSION

Heart rate variability is associated with depression severity in children and adolescents.

"Nociplastic Pain": A Challenge to Nosology and to Nociception

The construct of "nociplastic pain" has met with divergent receptions. On the one hand it has been enthusiastically embraced, to the extent of conflation with central sensitization of nociception and the International Classification of Diseases 11th Revision (ICD-11) entity of "primary" pain, and the promulgation of "nociplastic pain syndromes." On the other hand, it has been rejected by those whose skepticism derives from the absence, by definition, of underlying activation of nociceptors. This article seeks to dissect these divergent views and search for reconciliation between them. One line of argument is that "nociplastic" pain, "primary" pain, and "central sensitisation of nociception" reflect different domains of inquiry and should not be conflated. "Nociplastic" pain emerges as a hypothesis that confers clinical legitimacy and utility; while that hypothesis needs a minor but important modification and continues to require testing, discipline in its usage is necessary. The other line of argument discovers an unexpected impasse: the construct of "nociplastic pain" describes a phenomenon that accords with the International Association for the Study of Pain definition of pain but occurs in the absence of nociception-as-currently-defined, thus challenging the definitional link between pain and tissue damage. The article offers a resolution of this impasse by suggesting that nociception-as-currently-defined be replaced by the resurrected concept of a nociceptive apparatus, activation of which is necessary but not sufficient for the experience of pain. One consequence would be to allow the assertions underpinning "nociplastic" to be tested empirically; another would be to relate the phenomenon of pain to a more biologically plausible basis than "actual" or "resemblance to" tissue damage. PERSPECTIVE: This article explores the major challenges posed by "nociplastic pain" to nosology and to nociception. While discipline in the clinical use of the construct is required, it also emerges that the main issue is the International Association for the Study of Pain definition of nociception. A reconceptualization of nociception is proposed for logical, biological, and clinical coherence.

The relationship between salivary Fibroblast Growth Factor-2 and cortisol reactivity and psychological outcomes prior to and during the COVID-19 pandemic

Background

Fibroblast growth factor-2 (FGF2) is a biomarker that is associated with depression, anxiety and stress in rodents. In humans, we have previously demonstrated that salivary FGF2 increased following stress in a similar pattern to cortisol, and FGF2 (but not cortisol) reactivity predicted repetitive negative thinking, a transdiagnostic risk factor for mental illness. The current study assessed the relationship between FGF2, cortisol, and mental health before and during the COVID-19 pandemic.

Methods

We employed a longitudinal correlational design using a convenience sample. We assessed whether FGF2 and cortisol reactivity following the Trier Social Stress Task (TSST) were associated with DASS-21 depression, anxiety and stress, measured at the time of the TSST in 2019-20 (n = 87; time 1), and then again in May 2020 during the first wave of COVID-19 in Sydney (n = 34 of the original sample; time 2).

Results

FGF2 reactivity (but not absolute FGF2 levels) at time 1 predicted depression, anxiety, and stress across timepoints. Cortisol reactivity at time 1 was associated with stress over timepoints, and absolute cortisol levels were associated with depression across timepoints.

Limitations

The sample was comprised of mostly healthy participants from a student population, and there was high attrition between timepoints. The outcomes need to be replicated in larger, more diverse, samples.

Conclusions

FGF2 and cortisol may be uniquely predictive of mental health outcomes in healthy samples, potentially allowing for early identification of at-risk individuals.

Do Cortisol and Dehydroepiandrosterone Influence Motivational Factors for Non-Suicidal Self-Injury in Female Adolescents?

Non-suicidal self-injury (NSSI) is a significant public health issue that particularly affects female adolescents usually emerging during puberty, with a subsequent reduction and even remission in the phenomenon later in life. The dysregulation of the hormonal stress response, particularly cortisol and dehydroepiandrosterone sulfate (DHEA-S), whose levels increase markedly during pubertal adrenarche, has been associated with the development and maintenance of a wide range of emotional disorders. Our study aims to investigate whether different cortisol-DHEA-S response patterns could be associated with the main motivational moderators to engage NSSI as well as with urgency and motivation to stop NSSI in a sample of female adolescents. We found significant correlations between stress hormones and several factors that support and sustain NSSI, specifically: cortisol levels and distressing/upsetting urge (r = 0.39 and a p = 8.94 × 10^-3) and sensation seeking (r = -0.32 and a p = 0.04), as well as cortisol/DHEA-s ratio and external emotion regulation (r = 0.40 and a p = 0.01) and desire to stop NSSI (r = 0.40 and a p = 0.01). Cortisol and DHEA-S may play a role in NSSI through the regulation of stress responses and affective states. Such results could have implications for the development of new and improved treatment and prevention plans for NSSI.

Childhood Maltreatment, Low Serum Cortisol Levels, and Non-Suicidal Self-Injury in Young Adults With Major Depressive Disorders

BACKGROUND

Non-suicidal self-injury (NSSI) is a serious public health problem widely present among young adults and adolescents. While finding risk factors associated with NSSI among young patients with major depressive disorder (MDD) is challenging, the current study aims to measure childhood adversity and serum cortisol levels and elucidate their relationship in MDD patients with NSSI.

METHODS

In this cross-sectional study, 126 young patients with MDD (aged 16 to 35 years) were recruited. The depressive symptoms were assessed by the Beck Depression Inventory (BDI-II), and the childhood adversity was evaluated by the Chinese version of the Childhood Trauma Questionnaire (CTQ) scale. Serum cortisol levels were determined by the kits in patients.

RESULTS

Relative to MDD patients without NSSI, MDD patients with NSSI had a higher CTQ total score and its four subscores. Moreover, the cortisol levels in patients with MDD/NSSI were significantly decreased than in MDD patients without NSSI. For patients with MDD/NSSI, there is a negative association between cortisol levels and emotional neglect, but not for MDD patients without NSSI. Further regression analysis showed that low cortisol levels, BDI-II, and emotional neglect were risk factors for NSSI in young patients with MDD.

CONCLUSION

Our findings suggest that young MDD patients with NSSI experience more childhood adversity and have lower cortisol levels. Also, lower cortisol levels were associated with childhood adversity but not with depressive symptoms. Further, lower cortisol levels, depressive symptoms, and emotional neglect were risk factors for NSSI in young patients with MDD.

Longitudinal covariance of resting-state cardiac function and borderline personality disorder symptoms in adolescent non-suicidal self-injury

OBJECTIVES

Cardiac function is altered in borderline personality disorder (BPD). In adolescents with non-suicidal self-injury (NSSI) resting heart rate (HR) and vagally mediated heart rate variability (vmHRV) are associated with BPD symptoms. The study aimed to investigate longitudinal covariance of BPD symptoms and cardiac function in adolescent NSSI.

METHODS

HR and vmHRV were recorded in female adolescents with NSSI (n = 17) completing a baseline and 1-year follow-up assessment. Physiological data, structured clinical interviews and self-reports were obtained at both time points. Predictors of change in clinical outcomes and cardiac function were assessed.

RESULTS

Patients showed a reduction of NSSI (z_(34;17) = -3.79, P < 0.0001), depressive symptoms (z_(34;17) = -3.74, P < 0.0001), and increases in the level of functioning (z_(34;17) = 2.87, P = 0.004). Symptoms of BPD and frequency of BPD diagnosis did not significantly change. No significant differences on HR or vmHRV were observed. Changes in BPD symptoms were associated with changes in HR (r₍₁₇₎= 0.532, P = 0.028) and vmHRV (r₍₁₇₎ = -0.516, P = 0.033).

CONCLUSIONS

Longitudinal changes in BPD symptomatology in adolescents engaging in NSSI are associated with changes in resting cardiac function. Clinical studies are needed to investigate the utility of cardiac markers to track treatment outcome in adolescents with BPD.

Longitudinal development of pain sensitivity in adolescent non-suicidal self-injury

Nonsuicidal self-injury (NSSI) is associated with reduced pain sensitivity (PS). Existing theories posit that altered PS is a risk factor for NSSI. Cross-sectional data suggest that PS normalizes in those terminating self-injury. However, previously no study addressed the longitudinal course of PS in patients engaging in NSSI. We addressed changes in PS and clinical symptomatology in adolescents with NSSI (n = 18) and matched controls (n = 19) over one year. Despite significant clinical improvements, PS did not change in the NSSI group but decreased in controls. Greater NSSI reduction was associated with increased pain tolerance. Findings are discussed in the light of current theories on PS in NSSI.

Psychobiological response to pain in female adolescents with nonsuicidal self-injury

BACKGROUND

Nonsuicidal self-injury (NSSI) is associated with reduced pain sensitivity and alterations in top-down processing of nociceptive information. The experience of acute pain is characterized by reactivity of the autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis, which to our knowledge has not been systematically investigated in the context of NSSI.

METHODS

Adolescents fulfilling DSM-5 diagnostic criteria for NSSI and matched healthy controls received cold pain stimulation. We obtained self-reports on psychological distress and measured blood pressure, heart rate variability (HRV) and saliva cortisol. Regression analyses were used to investigate group differences on observed difference scores, adjusting for confounding variables.

RESULTS

We included 30 adolescents engaging in NSSI and 30 controls in our study. Adolescents in the NSSI group showed a greater pain threshold. Groups significantly differed in their psychological response to pain. In patients with NSSI, mood and body awareness increased after painful stimulation; in controls it decreased. Tension increased in controls only. The HPA axis response to painful stimulation was increased in the NSSI compared with the control group. Analysis of ultra-short-term recordings of HRV revealed significant group differences during the anticipation of pain and recovery.

LIMITATIONS

Future studies should incorporate multiple measures of saliva cortisol and replicate the present findings in a naturalistic setting.

CONCLUSION

Compared with controls, individuals engaging in NSSI show psychological benefits in response to pain. Biological findings highlight decreased physiologic arousal before and prolonged arousal (ANS and HPA axis response) after painful stimulation in adolescents engaging in NSSI. Greater pain-inflicted autonomic arousal and cortisol secretion may counteract dissociative states, reduce negative affect and increase body awareness in adolescents engaging in NSSI, lending support for a neurobiological pathomechanism underlying the intraindividual and antisuicide functions of NSSI.

Resting cardiac function in adolescent non-suicidal self-injury: The impact of borderline personality disorder symptoms and psychosocial functioning

Vagally mediated heart rate variability (vmHRV) is reduced in borderline personality disorder (BPD). Non-suicidal self-injury (NSSI) is associated with comorbid psychopathology, in particular BPD. We aimed to examine differences in cardiac function (vmHRV and heart rate [HR]) comparing adolescents (12-17 years) engaging in NSSI (n=30) and healthy controls (n=30). Further, we aimed to determine clinical concomitants of cardiac function in patients with NSSI. Analyses showed no significant group differences on cardiac function. Controlling for a host of confounding variables resting state HR and vmHRV in adolescents with NSSI were significantly correlated with BPD symptoms and the current level of functioning.