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May AK, Smeeth D, McEwen F, Moghames P, Karam E, Rieder MJ, Elzagallaai AA, van Uum S, Pluess M. Hair hormone data from Syrian refugee children: Perspectives from a two-year longitudinal study. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2024; 18:100231. [PMID: 38645423 PMCID: PMC11026725 DOI: 10.1016/j.cpnec.2024.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024] Open
Abstract
For numerous issues of convenience and acceptability, hair hormone data have been increasingly incorporated in the field of war trauma and forced displacement, allowing retrospective examination of several biological metrics thought to covary with refugees' mental health. As a relatively new research method, however, there remain several complexities and uncertainties surrounding the use of hair hormones, from initial hair sampling to final statistical analysis, many of which are underappreciated in the extant literature, and restrict the potential utility of hair hormones. To promote awareness, we provide a narrative overview of our experiences collecting and analyzing hair hormone data in a large cohort of Syrian refugee children (n = 1594), across two sampling waves spaced 12 months apart. We highlight both the challenges faced, and the promising results obtained thus far, and draw comparisons to other prominent studies in this field. Recommendations are provided to future researchers, with emphasis on longitudinal study designs, thorough collection and reporting of hair-related variables, and careful adherence to current laboratory guidelines and practices.
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Affiliation(s)
- Andrew K. May
- Department of Psychological Sciences, School of Psychology, University of Surrey, Guildford, UK
| | - Demelza Smeeth
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Fiona McEwen
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
- Department of War Studies, King's College London, London, UK
| | | | - Elie Karam
- Department of Psychiatry and Clinical Psychology, Balamand University, St Georges Hospital University Medical Center, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Lebanon
| | - Michael J. Rieder
- Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Abdelbaset A. Elzagallaai
- Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Stan van Uum
- Division of Endocrinology and Metabolism, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Michael Pluess
- Department of Psychological Sciences, School of Psychology, University of Surrey, Guildford, UK
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Frost A, Hagaman A, Baranov V, Chung EO, Bhalotra S, Sikander S, Maselko J. Non-linear associations between HPA axis activity during infancy and mental health difficulties during early childhood among children in rural Pakistan. Dev Psychopathol 2023; 35:2086-2095. [PMID: 35959681 PMCID: PMC9922341 DOI: 10.1017/s0954579422000773] [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: 11/06/2022]
Abstract
Hypothalamic pituitary adrenal (HPA) axis activity may be a mechanism linking early adversity to child mental health difficulties. However, there is a dearth of longitudinal evidence for the association between HPA axis activity and mental health among children in low-resource contexts. The goal of this study is to examine linear and curvilinear associations between HPA axis activity during infancy and mental health difficulties in early childhood among children in rural Pakistan. Participants included 104 children (46% male) from the Bachpan study, a longitudinal cohort embedded within a maternal depression trial in Pakistan. We examined the associations between hair-derived cortisol and dehydroepiandosterone (DHEA) at 12 months old and mental health difficulties, measured with the Strengths and Difficulties Questionnaire (SDQ), at 36 months old. There was a significant quadratic association between hair cortisol and SDQ scores, with results showing a U-shaped relationship (i.e., having relatively high or low cortisol predicted increased mental health difficulties). DHEA showed a quadratic association with SDQ scores with an inverted U-shaped relationship (i.e., high and low DHEA was associated with decreased mental health difficulties). Results provide evidence of longitudinal and curvilinear effects of cortisol and DHEA during infancy on mental health difficulties in early childhood.
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Affiliation(s)
- Allison Frost
- Carolina Population Center, University of North Carolina, Chapel Hill
| | - Ashley Hagaman
- Social Behavioral Sciences, Yale School of Public Health, Yale University
| | - Victoria Baranov
- Department of Economics, Faculty of Business and Economics, University of Melbourne
| | - Esther O. Chung
- Carolina Population Center, University of North Carolina, Chapel Hill
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill
| | | | - Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan
- Health Services Academy, Islamabad, Pakistan
| | - Joanna Maselko
- Carolina Population Center, University of North Carolina, Chapel Hill
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill
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Smeeth D, McEwen FS, Popham CM, Karam EG, Fayyad J, Saab D, Rieder MJ, Elzagallaai AA, van Uum S, Pluess M. War exposure, post-traumatic stress symptoms and hair cortisol concentrations in Syrian refugee children. Mol Psychiatry 2023; 28:647-656. [PMID: 36385169 PMCID: PMC9908541 DOI: 10.1038/s41380-022-01859-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022]
Abstract
Altered secretion of cortisol, the primary effector of the hypothalamus-pituitary-adrenal axis, has been proposed as a means by which traumatic experiences compromise later mental health. However, despite the popularity of cortisol as a potential biomarker for stress and adversity, findings are inconsistent, and little is known about the impact of war-related trauma on stress physiology of children and adolescents. Here we aimed to evaluate the relationships between war exposure, current living conditions, hair cortisol concentrations (HCC) and post-traumatic stress disorder (PTSD) symptoms in a large cohort of Syrian refugee children and adolescents (6-18 years) and their caregiver. This longitudinal observational study assessed Syrian refugee children and adolescents in two waves, 1 year apart, within informal tented settlements in Lebanon. The relationships between war exposure, time since leaving Syria, PTSD symptoms and HCC were investigated using linear mixed-model regression utilising both waves of data collected (Y1: N = 1574, Y2: N = 923). Hair cortisol concentration was positively, but weakly associated with the number of war-related events experienced. This was limited to those who were at least 12 years old at the time of war exposure. Conversely, HCC decreased with time since leaving Syria. HCC was also associated with PTSD symptoms but not with the quality of their current living conditions. This study revealed that changes to hypothalamic-pituitary-adrenal axis activity may accompany both earlier war exposure and current PTSD symptoms in children and adolescents. Additionally, early adolescence may be a particularly sensitive time in terms of trauma-related changes to the hypothalamic-pituitary-adrenal axis.
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Affiliation(s)
- Demelza Smeeth
- grid.4868.20000 0001 2171 1133Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Fiona S. McEwen
- grid.4868.20000 0001 2171 1133Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Cassandra M. Popham
- grid.4868.20000 0001 2171 1133Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Elie G. Karam
- grid.429040.bDepartment of Psychiatry and Clinical Psychology, Balamand University, St George Hospital University Medical Center, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - John Fayyad
- grid.429040.bDepartment of Psychiatry and Clinical Psychology, Balamand University, St George Hospital University Medical Center, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Dahlia Saab
- grid.429040.bDepartment of Psychiatry and Clinical Psychology, Balamand University, St George Hospital University Medical Center, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Michael J. Rieder
- grid.39381.300000 0004 1936 8884Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada
| | - Abdelbaset A. Elzagallaai
- grid.39381.300000 0004 1936 8884Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada
| | - Stan van Uum
- grid.39381.300000 0004 1936 8884Division of Endocrinology and Metabolism, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada
| | - Michael Pluess
- Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK.
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Abstract
The effects of glucocorticoids on aggression can be conceptualized based on its mechanisms of action. These hormones can affect cell function non-genomically within minutes, primarily by affecting the cell membrane. Overall, such effects are activating and promote both metabolic preparations for the fight and aggressive behavior per se. Chronic increases in glucocorticoids activate genomic mechanisms and are depressing overall, including the inhibition of aggressive behavior. Finally, excessive stressors trigger epigenetic phenomena that have a large impact on brain programming and may also induce the reprogramming of neural functions. These induce qualitative changes in aggression that are deemed abnormal in animals, and psychopathological and criminal in humans. This review aims at deciphering the roles of glucocorticoids in aggression control by taking in view the three mechanisms of action often categorized as acute, chronic, and toxic stress based on the duration and the consequences of the stress response. It is argued that the tripartite way of influencing aggression can be recognized in all three animal, psychopathological, and criminal aggression and constitute a framework of mechanisms by which aggressive behavior adapts to short-term and log-term changes in the environment.
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Baranov V, Frost A, Hagaman A, Simmons JG, Manzoor MS, Biroli P, Bhalotra S, Rahman A, Sikander S, Maselko J. Effects of a maternal psychosocial intervention on hair derived biomarkers of HPA axis function in mothers and children in rural Pakistan. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Bürgin D, Kind N, Schröder M, Clemens V, Fegert JM, Eckert A, Buchheim A, O'Donovan A, Boonmann C, Schmid M. The Stress of Caring-Resilience and HPA-Axis Activity in Hair Samples of Youth Residential Caregivers. Front Psychiatry 2020; 11:556486. [PMID: 33408649 PMCID: PMC7779549 DOI: 10.3389/fpsyt.2020.556486] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Professional caregivers in youth residential care institutions experience frequent verbal and physical aggression as well as multiple stressors as part of their everyday work, leading to high levels of burnout and staff turnover. Resilience might buffer against psychophysiological stress response and therefore be crucial for well-being in professional caregivers. Objectives: We aimed to investigate if measures related to resilience [sense of coherence (SoC), self-efficacy and self-care] and attachment security of caregivers were cross-sectionally associated with stress markers in hair samples [cortisol and dehydroepiandrosterone (DHEA)]. Method: Participants (n = 134; 64.2% women) reported on individual resilience measures and provided hair samples for cortisol and DHEA assays. Attachment was assessed in a subsample using the Adult Attachment Projective Picture System (AAP, n = 69). Linear regression models were fitted to estimate the association between resilience measures and the Cortisol:DHEA ratio, cortisol and DHEA, controlling for gender and age. Results: SoC was associated with a lower Cortisol:DHEA ratio (β = -0.36, p < 0.001), driven by a positive association between SoC and DHEA levels (β = 0.28, p = 0.002). Self-care was also associated with lower Cortisol:DHEA ratios (β = -0.24, p = 0.005), due to self-care being associated with higher DHEA (β = 0.21, p = 0.016). HPA-axis measures were not associated with self-efficacy nor with attachment patterns in a subsample. Conclusions: Our findings imply that youth residential care institutions might benefit from programs focusing on enhancing SoC and self-care practices. Fostering a meaningful, comprehensible and manageable professional climate in caregiving environments and implementing self-care in routine practices might enhance not only well-being but also physical health of professional caregivers and in this way buffer adverse health effects of chronic stressors.
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Affiliation(s)
- David Bürgin
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Nina Kind
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Martin Schröder
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Vera Clemens
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Jörg M. Fegert
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Anne Eckert
- Neurobiological Laboratory for Brain Aging and Mental Health, Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Anna Buchheim
- Institute of Psychology, University Innsbruck, Innsbruck, Austria
| | - Aoife O'Donovan
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Mental Health Services, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
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Buchmüller T, Lembcke H, Busch J, Kumsta R, Wolf OT, Leyendecker B. Exploring hair steroid concentrations in asylum seekers, internally displaced refugees, and immigrants. Stress 2020; 23:538-545. [PMID: 32116089 DOI: 10.1080/10253890.2020.1737008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The study of physiology in response to war and forced displacement can yield insight into the origin of stress-related mental health disorders. Previous studies found alterations in hair cortisol concentrations (HCC) in refugees. However, the direction of this alteration in HCC, as well as the association between HCC and psychological stress, remain unclear. Mixed findings can potentially be explained by the lack of contextual factors that have been taken into account. In this explorative study, we investigated HCCs in three female refugee samples (N = 89) in different contexts. Samples were i) asylum seekers from Syria, who sought protection in Germany two years ago (n = 37), ii) internally displaced persons (IDPs), who fled a genocide and lived in conditions of onging insecurity in Iraq (n = 14), and iii) Kurdish immigrants and former asylum seekers, who resettled to Germany 18 years ago and were used as reference group (n = 38). HCC was assessed in the scalp-nearest 6 cm of hair (2*3 cm segments). Data on mental and physical health, exposure to traumatic events, and time between immigration and HCC assessments were collected. Syrian asylum seekers had lower HCC than immigrant controls (η2 = .06). PTSD symptoms and perceived stress were associated with elevated cortisol levels in IDPs (r = .66 and r = .56), while time since immigration was associated with cortisol levels only in immigrant controls (r = .38). We discuss our findings with regard to the importance of contextual factors, particularly time since displacement and on-going insecurity, when studying physiological reactions in refugees.Lay summaryFemale Syrian asylum seekers had lower levels of hair cortisol concentration than Kurdish immigrants in Germany. Hair cortisol concentration was associated with post-traumatic stress symptoms only in internally displaced women who were exposed to ongoing stress and insecurity in Iraq.
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Affiliation(s)
- Thimo Buchmüller
- Center for Child and Family Research, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Hanna Lembcke
- Department for Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Julian Busch
- Center for Child and Family Research, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Robert Kumsta
- Department for Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Oliver T Wolf
- Department for Cognitive Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Birgit Leyendecker
- Center for Child and Family Research, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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Viljoen M, Benecke RM, Martin L, Adams RCM, Seedat S, Smith C. Anxiety: An overlooked confounder in the characterisation of chronic stress-related conditions? PLoS One 2020; 15:e0230053. [PMID: 32298279 PMCID: PMC7162495 DOI: 10.1371/journal.pone.0230053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 02/20/2020] [Indexed: 12/25/2022] Open
Abstract
Although anxiety disorders are among the most prevalent of psychiatric disorders, childhood trauma-related studies seldom consider anxiety proneness as distinct aetiological contributor. We aimed to distinguish between trauma- and anxiety-associated physiological profiles. South African adolescent volunteers were categorised for trauma exposure (CTQ, mean score 39±11) and anxiety proneness (AP)(CASI, mean score 37±7, STAI-T, mean score 41±8). Circulating hormone and leukocyte glucocorticoid receptor levels, as well as leukocyte functional capacity, were assessed. AP was associated with lower DHEAs (P<0.05) and higher leukocyte GR expression (P<0.05). DHEAs was also negatively correlated with anxiety sensitivity (CASI, P<0.05). In conclusion, AP may have more predictive power than trauma in terms of health profile. Increased glucocorticoid sensitivity previously reported after trauma, may be a unique function of anxiety and not trauma exposure per se. DHEAs concentration was identified as potentially useful marker for monitoring progressive changes in HPA-axis sensitivity and correlated with psychological measures of anxiety.
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Affiliation(s)
- Monet Viljoen
- Department of Physiological Sciences, Science Faculty, Stellenbosch University, Stellenbosch, South Africa
| | - Rohan M. Benecke
- Department of Physiological Sciences, Science Faculty, Stellenbosch University, Stellenbosch, South Africa
| | - Lindi Martin
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Bellville, Cape Town, South Africa
| | - Rozanne C. M. Adams
- Department of Physiological Sciences, Science Faculty, Stellenbosch University, Stellenbosch, South Africa
- Flow Cytometry and Imaging Unit, Central Analytical Facility, Stellenbosch University, Stellenbosch, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Bellville, Cape Town, South Africa
| | - Carine Smith
- Department of Physiological Sciences, Science Faculty, Stellenbosch University, Stellenbosch, South Africa
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Micol VJ, Roberts AG, Taylor-Cavelier SJ, Geiss EG, Lopez-Duran N. Early trauma moderates the link between familial risk for depression and post-stress DHEA/cortisol ratios in adolescents. Psychoneuroendocrinology 2019; 110:104424. [PMID: 31536943 DOI: 10.1016/j.psyneuen.2019.104424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND One proposed mechanism for familial transmission of depression risk is impaired ability to regulate stress. While much of this work has focused on the stress hormone cortisol, there is evidence that the neuroprotective hormone dehydroepiandrosterone (DHEA) may play a critical role in stress regulation and that the ratios of DHEA to cortisol may provide meaningful information about individual differences in stress processing. In this study, we examined DHEA and DHEA/cortisol ratios among teens at low and high risk for depression. METHODS Participants included 101 youth (12-16-year-old; 50 female) including 53 with a family history of depression (High Risk for depression). Adolescents and their parents completed diagnostic interviews, the Childhood Trauma Questionnaire and the Childhood Depression Inventory. Saliva samples were collected at multiple time points before and after adolescents underwent the Trier Social Stress Test. Cortisol and DHEA ratios were examined at baseline and 35 min post-stress initiation. RESULTS High risk (HR) and low risk (LR) participants did not differ on DHEA/cortisol ratios. However, childhood trauma moderated the relationship between risk group and DHEA/cortisol ratios, where at high levels of trauma, HR participants had significantly higher ratios than LR participants. CONCLUSION Our findings suggest that higher DHEA/cortisol ratios may not be indicative of greater protection against risk for depression as previously conceptualized. In the context of early trauma, higher DHEA/cortisol ratios may reflect a blunting of the HPA-axis that is not observed when examining cortisol levels alone. This study has implications for our conceptualization of DHEA/cortisol ratios as an indicator of risk for psychopathology.
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Affiliation(s)
- Valerie J Micol
- University of Michigan, Department of Psychology, United States.
| | | | | | - Elisa G Geiss
- University of Michigan, Department of Psychology, United States
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