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Dumke L, Schmidt T, Wittmann J, Neldner S, Weitkämper A, Catani C, Neuner F, Wilker S. Low access and inadequate treatment in mental health care for asylum seekers and refugees in Germany-A prospective follow-up study over 12 months and a nationwide cross-sectional study. Appl Psychol Health Well Being 2024. [PMID: 38193582 DOI: 10.1111/aphw.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024]
Abstract
Refugees experience elevated rates of mental health problems, but little is known about mental health service utilization and quality among asylum seekers and refugees in Europe. In a 12-month follow-up study of newly arrived refugees (N = 166, Mage = 32.38 years, 30.7% female) and a nationwide cross-sectional study (N = 579, Mage = 33.89 years, 36.2% female) of refugees who had been living in Germany for an average of 6 years, we examined objective need for mental health treatment, perceived need, access to treatment services, and adequacy of treatment. We defined minimally adequate mental health treatment according to the WHO World Mental Health Survey as ≥8 sessions of psychotherapy (minimally adequate psychotherapy) or pharmacotherapy plus ≥4 medical visits (minimally adequate pharmacotherapy). In both studies, two in three individuals screened for mental health symptoms and additionally perceived a need for professional treatment. Of those, less than half had contact to any service provider, with only 1 in 14 receiving minimally adequate psychotherapy. Overall, no more than one in seven of refugees in need received minimally adequate treatment. Despite a comprehensive mental health-care system, refugees' access to mental health care and the treatment provided are inadequate. Health policies are urgently needed to provide equitable mental health care for all.
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Affiliation(s)
- Lars Dumke
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Telja Schmidt
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Jasmin Wittmann
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sina Neldner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | | | - Claudia Catani
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sarah Wilker
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Dumke L, Wilker S, Kotterba A, Neuner F. The role of psychotherapists' perceived barriers in providing psychotherapy to refugee patients. Clin Psychol Psychother 2023; 30:1071-1082. [PMID: 37114524 DOI: 10.1002/cpp.2859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/22/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
Access to psychotherapy is critical to improving mental health, but only a small proportion of refugees receive treatment in the regular psychotherapeutic care system in high-income countries. In previous research, outpatient psychotherapists reported several barriers to more frequent treatment of refugee patients. However, it is unclear to what extent these perceived barriers contribute to the poor provision of services to refugees. In a survey of N = 2002 outpatient psychotherapists in Germany, we collected data on perceived treatment barriers and on the integration of refugees into regular psychotherapeutic practice. Half of the psychotherapists reported that they do not treat refugee patients. In addition, therapies provided for refugees were, on average, 20% shorter than for other patients. Regression analyses showed direct negative associations between psychotherapists' overall perception of barriers with the number of refugees treated and the number of sessions offered to refugee patients, even when controlling for sociodemographic and workload-related characteristics. Correlation analyses on the level of specific types of barriers further revealed that particularly language-related barriers and lack of contact with the refugee population are negatively correlated with the number of refugees treated and the number of sessions for refugees. Our findings indicate that the integration of refugees into regular psychotherapeutic care could be improved by measures to connect psychotherapists with refugee patients as well as professional interpreters and to ensure coverage of costs for therapy, interpreters and related administrative tasks.
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Affiliation(s)
- Lars Dumke
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Sarah Wilker
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Anna Kotterba
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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Wilker S, Vukojevic V, Schneider A, Pfeiffer A, Inerle S, Pauly M, Elbert T, Papassotiropoulos A, de Quervain D, Kolassa IT. Epigenetics of traumatic stress: The association of NR3C1 methylation and posttraumatic stress disorder symptom changes in response to narrative exposure therapy. Transl Psychiatry 2023; 13:14. [PMID: 36658116 PMCID: PMC9852425 DOI: 10.1038/s41398-023-02316-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
Epigenetic processes allow plasticity in gene regulation in response to significant environmental events. Accumulating evidence suggests that effective psychotherapy is accompanied by epigenetic changes, rendering DNA methylation a potential biomarker of therapy success. Due to the central role of glucocorticoid dynamics in stress regulation and the alteration of aversive memories, glucocorticoid receptors are likely involved in the molecular processes that are required to successfully treat Posttraumatic Stress Disorder (PTSD). This study aimed to investigate the relationship between methylation at the glucocorticoid receptor gene (NR3C1) and PTSD treatment success of evidence-based psychotherapy. A sample of N = 153 conflict survivors from Northern Uganda (98 females and 55 males) with PTSD were treated with Narrative Exposure Therapy (NET). Diagnostic interviews and saliva sampling took place at pretreatment and 4 and 10 months after treatment completion. We investigated potential associations between PTSD symptom development and methylation changes at 38 CpG sites spanning NR3C1 over the three times of measurement using the repeated measures correlation. After accounting for multiple comparisons, DNA methylation at CpG site cg25535999 remained negatively associated with PTSD symptoms. These results were followed up by mixed models as well as structural equation modelling. These analyses revealed that treatment responders had a significant cg25535999 methylation increase after treatment with NET. Furthermore, lower methylation at cg25535999 pretreatment predicted a higher symptom improvement. Our results suggest different epigenetic profile dynamics at NR3C1 cg25535999 in therapy responders compared to non-responders and underscore the central role of glucocorticoid signaling in trauma-focused therapy.
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Affiliation(s)
- Sarah Wilker
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany. .,vivo international e.V., P.O. box 5108, 78430, Konstanz, Germany. .,Clinical and Biological Psychology, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany.
| | - Vanja Vukojevic
- grid.6612.30000 0004 1937 0642Research Platform Molecular and Cognitive Neurosciences (MCN) , Department of Biomedicine, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland ,grid.6612.30000 0004 1937 0642Psychiatric University Clinics, University of Basel, CH-4055 Basel, Switzerland
| | - Anna Schneider
- vivo international e.V., P.O. box 5108, 78430 Konstanz, Germany ,grid.6582.90000 0004 1936 9748Clinical and Biological Psychology, Ulm University, Albert-Einstein-Allee 47, 89081 Ulm, Germany
| | - Anett Pfeiffer
- vivo international e.V., P.O. box 5108, 78430 Konstanz, Germany
| | - Stefan Inerle
- grid.5675.10000 0001 0416 9637Department of Statistics, TU Dortmund University, Joseph-von-Fraunhofer-Straße 2-4, 44227 Dortmund, Germany
| | - Markus Pauly
- grid.5675.10000 0001 0416 9637Department of Statistics, TU Dortmund University, Joseph-von-Fraunhofer-Straße 2-4, 44227 Dortmund, Germany , Research Center Trustworthy Data Science and Security, UA Ruhr, Joseph-von-Fraunhofer-Straße 25, 44227 Dortmund, Germany
| | - Thomas Elbert
- vivo international e.V., P.O. box 5108, 78430 Konstanz, Germany ,grid.9811.10000 0001 0658 7699Clinical Psychology and Neuropsychology, University of Konstanz, Universitätsstr. 10, 78457 Konstanz, Germany
| | - Andreas Papassotiropoulos
- grid.6612.30000 0004 1937 0642Research Platform Molecular and Cognitive Neurosciences (MCN) , Department of Biomedicine, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland ,grid.6612.30000 0004 1937 0642Psychiatric University Clinics, University of Basel, CH-4055 Basel, Switzerland
| | - Dominique de Quervain
- grid.6612.30000 0004 1937 0642Research Platform Molecular and Cognitive Neurosciences (MCN) , Department of Biomedicine, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland ,grid.6612.30000 0004 1937 0642Psychiatric University Clinics, University of Basel, CH-4055 Basel, Switzerland
| | - Iris-Tatjana Kolassa
- vivo international e.V., P.O. box 5108, 78430 Konstanz, Germany ,grid.6582.90000 0004 1936 9748Clinical and Biological Psychology, Ulm University, Albert-Einstein-Allee 47, 89081 Ulm, Germany
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Schmidt TL, Catani C, Dumke L, Groß M, Neldner S, Scharpf F, Weitkämper A, Wilker S, Wittmann J, Stammnitz A, van den Heuvel R, Neuner F. Welcome, how are you doing? - towards a systematic mental health screening and crisis management for newly arriving refugees. Eur J Psychotraumatol 2023; 14:2202053. [PMID: 37097725 PMCID: PMC10132251 DOI: 10.1080/20008066.2023.2202053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Background: Compared to the general German population, refugees in Germany are a high-risk group for trauma spectrum disorders. Currently, many barriers exist for the implementation of a screen-and-treat approach for mental disorders as part of the routine health care provision during the early stage of the immigration process.Objective: The aim of the present study was to develop and test a systematic screening approach to identify individual refugees in need of mental health care during the initial immigration phase.Method: 167 newly arrived refugees underwent a screening interview with the Refugee Health Screener (RHS) carried out by Intercultural Therapy Assistants (ITAs). The ITAs were super-vised by psychologists at a reception centre in Bielefeld, Germany. A subsample of 48 persons partici-pated in clinical validation interviews.Results: Findings demonstrated the need for and feasibility of a systematic screening during the initial immigration phase. However, established cut-off values of the RHS had to be adapted and the screening procedure had to be adjusted due to the needs of a significant number of refugees in severe psychological crises.Conclusion: A systematic screening that is applied shortly after arrival facilitates the early identification of refugees at risk of developing mental disorders and may be helpful to prevent chronic symptom development and an aggravation of psychological crises.
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Affiliation(s)
| | - Claudia Catani
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Lars Dumke
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Melissa Groß
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sina Neldner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Florian Scharpf
- Department of Psychology, Bielefeld University, Bielefeld, Germany
- Institute for Interdisciplinary Research on Conflict and Violence, Bielefeld University, Bielefeld, Germany
| | | | - Sarah Wilker
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Jasmin Wittmann
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | | | | | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Catani C, Wittmann J, Schmidt TL, Wilker S, Neldner S, Neuner F. School-based mental health screenings with Ukrainian adolescent refugees in Germany: Results from a pilot study. Front Psychol 2023; 14:1146282. [PMID: 37143592 PMCID: PMC10151552 DOI: 10.3389/fpsyg.2023.1146282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/30/2023] [Indexed: 05/06/2023] Open
Abstract
Since the Russian invasion of Ukraine in February 2022, high numbers of Ukrainians, mostly women and children, have left the country. As of today, Germany has accepted more than one million refugees fleeing from Ukraine including ~200,000 children and adolescents registered in German schools. Since refugee minors are typically affected by high rates of mental health issues, the identification of potential psychological problems at an early stage after arrival is essential in order to make timely referrals for vulnerable youth to diagnostic or treatment services possible. The aim of the present study was to test the feasibility of a classroom-based mental health screening procedure and to assess symptoms of PTSD, depression, and anxiety in a small sample of adolescents who had fled to Germany. Forty-two adolescents (n = 20 girls) took part in the study. Screening results showed that more than half of the sample had elevated ratings in the Refugee Health Screener (RHS) and about 45% reported clinically significant levels of PTSD. Overall, the amount of both mental health problems and current worries related to the war was significantly higher in girls compared to boys. In general, screenings were well received by the adolescents. The findings of this pilot study point to a considerable level of mental health problems and distress in adolescent refugees affected by the recent war in Ukraine. Brief psychological screenings within the school setting might represent a promising approach to identifying potential mental health disorders as early as possible in newly arriving refugee youth.
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Wittmann J, Groß M, Catani C, Schmidt T, Neldner S, Wilker S, May T, Ertl V, Rosner R, Zindler A, Odenwald M, Neuner F. The efficacy of Narrative Exposure Therapy for Children (KIDNET) as a treatment for traumatized young refugees versus treatment as usual: update to the study protocol for the multi-center randomized controlled trial YOURTREAT. Trials 2022; 23:360. [PMID: 35477413 PMCID: PMC9044372 DOI: 10.1186/s13063-022-06288-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background The trial YOURTREAT aims to compare the pragmatic, short-term psychotherapy Narrative Exposure Therapy for Children (KIDNET) with treatment as usual (TAU) for the treatment of young refugees in Germany. This update outlines changes made to the study protocol in response to the current COVID-19 pandemic with the aim of allowing the continuation of the clinical trial while ensuring the safety of the staff and the participants, maintaining methodological quality, and ensuring compliance with legal regulations. Methods The major amendments to the original study protocol include (1) the possibility of using telehealth technology for the conduction of diagnostic and therapy sessions, (2) a reduction of the diagnostic set, and (3) an increased flexibility in the time frame of the study protocol. Discussion The adaptations to the study protocol made it feasible to continue with the trial YOURTREAT during the COVID-19 pandemic. Although the diagnostic set had to be shortened, the primary outcomes and the main secondary outcomes remain unimpaired by the amendment. Therefore, we expect the trial to provide evidence regarding effective treatment options for young refugees in Germany, a population that has received little scientific attention so far and has only very limited access to mental health care in the German health care system. In light of the current pandemic, which globally increases the risk of mental problems, the situation for young refugees is likely to aggravate further. Thus, the clinical and social relevance of the present trial YOURTREAT is even more important in these particular times. Trial registration German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS) DRKS00017222. Registered on May 15, 2019
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Affiliation(s)
- Jasmin Wittmann
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany.
| | - Melissa Groß
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany
| | - Claudia Catani
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany
| | - Telja Schmidt
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany
| | - Sina Neldner
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany
| | - Sarah Wilker
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany
| | - Theodor May
- Independent Biostatistician, Johann-Strauß-Str. 11a, D 33647, Bielefeld, Germany
| | - Verena Ertl
- Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, D 85071, Eichstätt, Germany
| | - Rita Rosner
- Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, D 85071, Eichstätt, Germany
| | - Areej Zindler
- Outpatient Clinic for Refugee Children and Adolescents, Medical Center Hamburg-Eppendorf, Martinistraße 52, D 20246, Hamburg, Germany
| | - Michael Odenwald
- Department of Psychology, Konstanz University, Universitätsstraße 10, D 78464, Konstanz, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany
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Carleial S, Nätt D, Unternährer E, Elbert T, Robjant K, Wilker S, Vukojevic V, Kolassa IT, Zeller AC, Koebach A. DNA methylation changes following narrative exposure therapy in a randomized controlled trial with female former child soldiers. Sci Rep 2021; 11:18493. [PMID: 34531495 PMCID: PMC8445994 DOI: 10.1038/s41598-021-98067-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/02/2021] [Indexed: 02/08/2023] Open
Abstract
The aftermath of traumatization lives on in the neural and epigenetic traces creating a momentum of affliction in the psychological and social realm. Can psychotherapy reorganise these memories through changes in DNA methylation signatures? Using a randomised controlled parallel group design, we examined methylome-wide changes in saliva samples of 84 female former child soldiers from Eastern DR Congo before and six months after Narrative Exposure Therapy. Treatment predicted differentially methylated positions (DMPs) related to ALCAM, RIPOR2, AFAP1 and MOCOS. In addition, treatment associations overlapped at gene level with baseline clinical and social outcomes. Treatment related DMPs are involved in memory formation-the key agent in trauma focused treatments-and enriched for molecular pathways commonly affected by trauma related disorders. Results were partially replicated in an independent sample of 53 female former child soldiers from Northern Uganda. Our results suggest a molecular impact of psychological treatment in women with war-related childhood trauma.Trial registration: Addressing Heightened Levels of Aggression in Traumatized Offenders With Psychotherapeutic Means (ClinicalTrials.gov Identifier: NCT02992561, 14/12/2016).
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Affiliation(s)
- Samuel Carleial
- grid.9811.10000 0001 0658 7699Department of Psychology, Centre for Psychiatry, University of Konstanz, Feuerstein-Strasse. 55, Haus 22, 78479 Konstanz, Germany
| | - Daniel Nätt
- grid.5640.70000 0001 2162 9922Division of Neurobiology, Department of Biomedical and Clinical Sciences, University of Linköping, Building 463, Room 12.023, Linköping, Sweden
| | - Eva Unternährer
- grid.9811.10000 0001 0658 7699Department of Psychology, Centre for Psychiatry, University of Konstanz, Feuerstein-Strasse. 55, Haus 22, 78479 Konstanz, Germany ,grid.6612.30000 0004 1937 0642Child- and Adolescent Research Department, Psychiatric University Hospitals Basel (UPK), University of Basel, Basel, Switzerland
| | - Thomas Elbert
- grid.9811.10000 0001 0658 7699Department of Psychology, Centre for Psychiatry, University of Konstanz, Feuerstein-Strasse. 55, Haus 22, 78479 Konstanz, Germany ,Vivo International E.V., Postbox 5108, 78430 Konstanz, Germany
| | - Katy Robjant
- Vivo International E.V., Postbox 5108, 78430 Konstanz, Germany
| | - Sarah Wilker
- Vivo International E.V., Postbox 5108, 78430 Konstanz, Germany ,grid.7491.b0000 0001 0944 9128Department of Psychology and Sports Science, University of Bielefeld, 33501 Bielefeld, Germany
| | - Vanja Vukojevic
- grid.6612.30000 0004 1937 0642Psychiatric University Clinics, Transfaculty Research Platform, University of Basel, Wilhelm Klein-Strasse 27, CH-4012 Basel, Switzerland
| | - Iris-Tatjana Kolassa
- Vivo International E.V., Postbox 5108, 78430 Konstanz, Germany ,grid.6582.90000 0004 1936 9748Department of Clinical and Biological Psychology, Institute of Psychology & Education, University of Ulm, Ulm University, Ulm, Germany
| | - Anja C. Zeller
- grid.9811.10000 0001 0658 7699Department of Psychology, Centre for Psychiatry, University of Konstanz, Feuerstein-Strasse. 55, Haus 22, 78479 Konstanz, Germany ,Vivo International E.V., Postbox 5108, 78430 Konstanz, Germany
| | - Anke Koebach
- grid.9811.10000 0001 0658 7699Department of Psychology, Centre for Psychiatry, University of Konstanz, Feuerstein-Strasse. 55, Haus 22, 78479 Konstanz, Germany ,Vivo International E.V., Postbox 5108, 78430 Konstanz, Germany
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Wilker S, Kolassa S, Ibrahim H, Rajan V, Pfeiffer A, Catani C, Kolassa IT. Sex differences in PTSD risk: evidence from post-conflict populations challenges the general assumption of increased vulnerability in females. Eur J Psychotraumatol 2021; 12:1930702. [PMID: 34531962 PMCID: PMC8439243 DOI: 10.1080/20008198.2021.1930702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Next to the dose-dependent effect of trauma load, female sex represents a well-established risk factor for PTSD. Exposure to particularly toxic traumatic event types, different coping styles, and biological risk factors are frequently listed as potential causes for the increased PTSD vulnerability in females. Nevertheless, sex differences have not been consistently observed in all study populations. Objective: To investigate sex differences in PTSD risk in post-conflict populations from different countries while considering trauma load. Method: In civilian post-conflict samples from Northern Uganda (N = 1665), Rwanda (N = 433), Syria (N = 974) and Sri Lanka (N = 165), we investigated sex differences in PTSD risk while taking trauma load into account. PTSD and trauma load were assessed using standardized diagnostic interviews. Potential sex differences in PTSD risk were analysed by logistic regression analyses considering trauma load. Results: Across all samples, males reported more traumatic events than females. Both sexes predominantly reported war-related traumatic events. Without considering trauma load, sex effects in PTSD risk were only detected in the Syrian sample. When taking trauma load into account, evidence for an increased PTSD vulnerability in females was found in the Syrian sample, and, to a much lesser extent, in the Northern Ugandan sample. Conclusion: In contrast to the literature, we did not find evidence for a general increased PTSD vulnerability in females. The dose-response effect of trauma load was a much stronger predictor of PTSD risk than sex across all samples.
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Affiliation(s)
- Sarah Wilker
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany.,Clinical & Biological Psychology, Ulm University, Ulm, Germany
| | - Stephan Kolassa
- SAP S/4HANA CIC & Q2C, SAP Switzerland AG, Tägerwilen, Switzerland
| | - Hawkar Ibrahim
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany.,Department of Clinical Psychology, Koya University, Koya, Iraq
| | - Vathsalan Rajan
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany
| | | | - Claudia Catani
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany
| | - Iris-Tatjana Kolassa
- vivo International e.V, Konstanz, Germany.,Clinical & Biological Psychology, Ulm University, Ulm, Germany
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9
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Zeller AC, Conrad D, Schneider A, Behnke A, Pfeiffer A, Blum GF, Wilker S, Elbert T, Kolassa I. A combination of combat experience, early abduction, and severe traumatization fuels appetitive aggression and violence among abductees of rebel war in Northern Uganda. Aggress Behav 2020; 46:465-475. [PMID: 32643160 DOI: 10.1002/ab.21914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/10/2022]
Abstract
Individuals who perpetrate violence may likely perceive violence as appealing and infliction of violence to derive pleasure is termed as appetitive aggression. Individuals who were abducted as children into an armed group often experience a higher number of traumatic event types, that is traumatic load and are usually socialized in a violence-endorsing environment. This study aims to investigate the interaction between age at initial abduction with that of traumatic load, and their influence on appetitive aggression along with perpetration of violent acts by former members of an armed rebel group of both sexes. Semi-structured interviews were conducted among a target group of formerly abducted rebel-war survivors (including participants with and without combat experience) from Northern Uganda. Participants included 596 women and 570 men with N = 1,166 (Mage = 32.58, SDage = 9.76, range: 18-80 years). We conducted robust linear regression models to investigate the influence of age at initial abduction, traumatic load, combat experience, and biological sex on appetitive aggression as well as their perpetrated violent acts. Our study shows, appetitive aggression and the number of perpetrated violent acts were specifically increased in individuals who were abducted young, experienced several traumatic events in their lifetime, and with previous combat experience. For perpetrated violence men showed increased levels whereas for appetitive aggression the association was independent of biological sex. Therefore, early abducted individuals with a higher traumatic load, who have combat experience, need to be given special intervention to prevent any further violence.
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Affiliation(s)
- Anja C. Zeller
- Clinical Psychology and Neuropsychology, Department of Psychology University of Konstanz Konstanz Germany
- vivo international e.V. Konstanz Germany
| | - Daniela Conrad
- Clinical Psychology and Neuropsychology, Department of Psychology University of Konstanz Konstanz Germany
- Department of Clinical and Biological Psychology, Institute of Psychology and Education Ulm University Ulm Germany
| | - Anna Schneider
- vivo international e.V. Konstanz Germany
- Department of Clinical and Biological Psychology, Institute of Psychology and Education Ulm University Ulm Germany
| | - Alexander Behnke
- Department of Clinical and Biological Psychology, Institute of Psychology and Education Ulm University Ulm Germany
| | | | - Gerrit F. Blum
- Institute of Psychology and Education Ulm University Ulm Germany
| | - Sarah Wilker
- vivo international e.V. Konstanz Germany
- Department of Clinical and Biological Psychology, Institute of Psychology and Education Ulm University Ulm Germany
| | - Thomas Elbert
- Clinical Psychology and Neuropsychology, Department of Psychology University of Konstanz Konstanz Germany
- vivo international e.V. Konstanz Germany
| | - Iris‐Tatjana Kolassa
- vivo international e.V. Konstanz Germany
- Department of Clinical and Biological Psychology, Institute of Psychology and Education Ulm University Ulm Germany
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Schneider A, Pfeiffer A, Conrad D, Elbert T, Kolassa IT, Wilker S. Does cumulative exposure to traumatic stressors predict treatment outcome of community-implemented exposure-based therapy for PTSD? Eur J Psychotraumatol 2020; 11:1789323. [PMID: 33062203 PMCID: PMC7534285 DOI: 10.1080/20008198.2020.1789323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Posttraumatic Stress Disorder (PTSD) is associated with high levels of functional impairments such as difficulties in academic or occupational performance and in social relationships. With an increasing number of traumatic event types experienced (trauma load), PTSD risk increases in a dose-dependent manner. Accordingly, high rates of PTSD can impair the reconstruction process in post-conflict societies. In order to meet these high needs for mental health services in societies with little access to professional care, task shifting approaches and community-based interventions have been suggested. Narrative Exposure Therapy (NET) has been developed as a short and pragmatic exposure-based PTSD treatment that can be easily trained to lay personnel. Yet, it remains unclear whether NET can be effectively provided by trained lay counsellors even at high levels of trauma load. Objective: To investigate whether trauma load influences the treatment effectiveness of NET provided by trained and supervised local lay counsellors. Method: Linear mixed models were calculated to investigate the influence of trauma load on treatment effectiveness in a sample of N = 323 rebel war survivors from Northern Uganda with PTSD. Results: We found a strong reduction of PTSD symptoms following NET, which was not influenced by trauma load. However, individuals with higher levels of trauma load reported higher PTSD symptoms before therapy as well as 4 and 10 months following treatment completion compared to individuals with lower trauma load. Conclusions: Treatment with NET by lay counsellors is effective independent of trauma load. However, individuals with higher trauma load have a higher probability to show residual symptoms, which might require additional time, sessions or treatment modules.
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Affiliation(s)
- Anna Schneider
- Clinical & Biological Psychology, Ulm University, Konstanz, Germany
| | - Anett Pfeiffer
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Daniela Conrad
- Clinical & Biological Psychology, Ulm University, Konstanz, Germany.,Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Thomas Elbert
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | | | - Sarah Wilker
- Clinical & Biological Psychology, Ulm University, Konstanz, Germany.,Clinical Psychology and Psychotherapy, Bielefeld University, Konstanz, Germany
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11
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Vukojevic V, Mastrandreas P, Arnold A, Peter F, Kolassa IT, Wilker S, Elbert T, de Quervain DJF, Papassotiropoulos A, Stetak A. Evolutionary conserved role of neural cell adhesion molecule-1 in memory. Transl Psychiatry 2020; 10:217. [PMID: 32632143 PMCID: PMC7338365 DOI: 10.1038/s41398-020-00899-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 01/17/2023] Open
Abstract
The neural cell adhesion molecule 1 (NCAM-1) has been implicated in several brain-related biological processes, including neuronal migration, axonal branching, fasciculation, and synaptogenesis, with a pivotal role in synaptic plasticity. Here, we investigated the evolutionary conserved role of NCAM-1 in learning and memory. First, we investigated sustained changes in ncam-1 expression following aversive olfactory conditioning in C. elegans using molecular genetic methods. Furthermore, we examined the link between epigenetic signatures of the NCAM1 gene and memory in two human samples of healthy individuals (N = 568 and N = 319) and in two samples of traumatized individuals (N = 350 and N = 463). We found that olfactory conditioning in C. elegans induced ncam-1 expression and that loss of ncam-1 function selectively impaired associative long-term memory, without causing acquisition, sensory, or short-term memory deficits. Reintroduction of the C. elegans or human NCAM1 fully rescued memory impairment, suggesting a conserved role of NCAM1 for memory. In parallel, DNA methylation of the NCAM1 promoter in two independent healthy Swiss cohorts was associated with memory performance. In two independent Sub-Saharan populations of conflict zone survivors who had faced severe trauma, DNA methylation at an alternative promoter of the NCAM1 gene was associated with traumatic memories. Our results support a role of NCAM1 in associative memory in nematodes and humans, and might, ultimately, be helpful in elucidating diagnostic markers or suggest novel therapy targets for memory-related disorders, like PTSD.
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Affiliation(s)
- Vanja Vukojevic
- University of Basel, Department of Psychology, Division of Molecular Neuroscience, Birmannsgasse 8, CH-4055, Basel, Switzerland.
- University of Basel, Department Biozentrum, Life Sciences Training Facility, Klingelbergstrasse 50-70, CH-4056, Basel, Switzerland.
- University of Basel, Psychiatric University Clinics, Wilhelm Klein-Strasse 27, CH-4012, Basel, Switzerland.
- University of Basel, Transfaculty Research Platform, Birmannsgasse 8, CH-4055, Basel, Switzerland.
| | - Pavlina Mastrandreas
- University of Basel, Department of Psychology, Division of Molecular Neuroscience, Birmannsgasse 8, CH-4055, Basel, Switzerland.
- University of Basel, Department Biozentrum, Life Sciences Training Facility, Klingelbergstrasse 50-70, CH-4056, Basel, Switzerland.
- University of Basel, Transfaculty Research Platform, Birmannsgasse 8, CH-4055, Basel, Switzerland.
| | - Andreas Arnold
- University of Basel, Department of Psychology, Division of Molecular Neuroscience, Birmannsgasse 8, CH-4055, Basel, Switzerland
- University of Basel, Department Biozentrum, Life Sciences Training Facility, Klingelbergstrasse 50-70, CH-4056, Basel, Switzerland
- University of Basel, Transfaculty Research Platform, Birmannsgasse 8, CH-4055, Basel, Switzerland
| | - Fabian Peter
- University of Basel, Department of Psychology, Division of Molecular Neuroscience, Birmannsgasse 8, CH-4055, Basel, Switzerland
- University of Basel, Department Biozentrum, Life Sciences Training Facility, Klingelbergstrasse 50-70, CH-4056, Basel, Switzerland
- University of Basel, Transfaculty Research Platform, Birmannsgasse 8, CH-4055, Basel, Switzerland
| | - Iris-T Kolassa
- Ulm University, Clinical & Biological Psychology, Institute for Psychology & Education, Albert-Einstein-Allee 47, D-89069, Ulm, Germany
| | - Sarah Wilker
- Ulm University, Clinical & Biological Psychology, Institute for Psychology & Education, Albert-Einstein-Allee 47, D-89069, Ulm, Germany
- University Bielefeld, Department for Psychology and Sports Science, P.O. Box 100131, D-33501, Bielefeld, Germany
| | - Thomas Elbert
- University of Konstanz, Clinical Psychology & Behavioural Neuroscience, D-78457, Konstanz, Germany
| | - Dominique J-F de Quervain
- University of Basel, Department of Psychology, Division of Molecular Neuroscience, Birmannsgasse 8, CH-4055, Basel, Switzerland
- University of Basel, Transfaculty Research Platform, Birmannsgasse 8, CH-4055, Basel, Switzerland
- University of Basel, Department of Psychology, Division of Cognitive Neuroscience, Birmannsgasse 8, CH-4055, Basel, Switzerland
| | - Andreas Papassotiropoulos
- University of Basel, Department of Psychology, Division of Molecular Neuroscience, Birmannsgasse 8, CH-4055, Basel, Switzerland.
- University of Basel, Department Biozentrum, Life Sciences Training Facility, Klingelbergstrasse 50-70, CH-4056, Basel, Switzerland.
- University of Basel, Psychiatric University Clinics, Wilhelm Klein-Strasse 27, CH-4012, Basel, Switzerland.
- University of Basel, Transfaculty Research Platform, Birmannsgasse 8, CH-4055, Basel, Switzerland.
| | - Attila Stetak
- University of Basel, Department of Psychology, Division of Molecular Neuroscience, Birmannsgasse 8, CH-4055, Basel, Switzerland
- University of Basel, Department Biozentrum, Life Sciences Training Facility, Klingelbergstrasse 50-70, CH-4056, Basel, Switzerland
- University of Basel, Psychiatric University Clinics, Wilhelm Klein-Strasse 27, CH-4012, Basel, Switzerland
- University of Basel, Transfaculty Research Platform, Birmannsgasse 8, CH-4055, Basel, Switzerland
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12
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Wilker S, Catani C, Wittmann J, Preusse M, Schmidt T, May T, Ertl V, Doering B, Rosner R, Zindler A, Neuner F. The efficacy of Narrative Exposure Therapy for Children (KIDNET) as a treatment for traumatized young refugees versus treatment as usual: study protocol for a multi-center randomized controlled trial (YOURTREAT). Trials 2020; 21:185. [PMID: 32059695 PMCID: PMC7023740 DOI: 10.1186/s13063-020-4127-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Germany hosts a large number of refugees from war-affected countries. The integration of refugees, in particular young refugees from the Middle East, is one of the major current social challenges in Germany. Mental disorders, first of all post-traumatic stress disorder (PTSD) that results from war experiences, are common among young refugees and interfere with quality of life as well as functional integration. Evidence regarding effective treatment options for this population is scarce. In this trial, we aim to evaluate the pragmatic, short-term psychotherapy Narrative Exposure Therapy for Children (KIDNET) for the treatment of young refugees in Germany. METHODS In a rater-blinded, multi-center, randomized-controlled trial, KIDNET is compared to treatment as usual (TAU) within the general health care system. A total number of 80 young refugees who fulfill the diagnostic criteria of PTSD will be randomized to either KIDNET or TAU. Diagnostic interviews will take place at baseline before treatment as well as 6 and 12 months thereafter. They will assess exposure to traumatic events, PTSD and comorbid symptoms, as well as parameters of integration. DISCUSSION The results of this study should provide evidence regarding effective treatment options for young refugees in Germany, a population that has been understudied and received only limited access to mental health care so far. Next to the effects of treatment on mental health outcomes, integration parameters will be investigated. Therefore, this study should provide broad insights into treatment options for young refugees and their potential implications on successful integration. TRIAL REGISTRATION German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS), ID: DRKS00017222. Registered on 15 May 2019.
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Affiliation(s)
- Sarah Wilker
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.
| | - Claudia Catani
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Jasmin Wittmann
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Melissa Preusse
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Telja Schmidt
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Theodor May
- Independent Biostatistician, Johann-Strauß-Str. 11a, 33647, Bielefeld, Germany
| | - Verena Ertl
- Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, 85071, Eichstätt, Germany
| | - Bettina Doering
- Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, 85071, Eichstätt, Germany
| | - Rita Rosner
- Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, 85071, Eichstätt, Germany
| | - Areej Zindler
- Medical Center Hamburg-Eppendorf, Outpatient Clinic for Refugee Children and Adolescents, Martinistraße 52, 20246, Hamburg, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
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13
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Wilker S, Schneider A, Conrad D, Pfeiffer A, Boeck C, Lingenfelder B, Freytag V, Vukojevic V, Vogler C, Milnik A, Papassotiropoulos A, J.-F. de Quervain D, Elbert T, Kolassa S, Kolassa IT. Genetic variation is associated with PTSD risk and aversive memory: Evidence from two trauma-Exposed African samples and one healthy European sample. Transl Psychiatry 2018; 8:251. [PMID: 30467376 PMCID: PMC6250662 DOI: 10.1038/s41398-018-0297-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 09/26/2018] [Accepted: 10/18/2018] [Indexed: 11/11/2022] Open
Abstract
The probability to develop posttraumatic stress disorder (PTSD), characterized by vivid, intrusive emotional memories of the encountered traumatic events, depends - among other factors - on the number of previous traumatic experiences (traumatic load) and individual genetic vulnerability. So far, our knowledge regarding the biological underpinnings of PTSD is relatively sparse. Genome-wide association studies (GWAS) followed by independent replication might help to discover novel, so far unknown biological mechanisms associated with the development of traumatic memories. Here, a GWAS was conducted in N = 924 Northern Ugandan rebel war survivors and identified seven suggestively significant single nucleotide polymorphisms (SNPs; p ≤ 1 × 10-5) for lifetime PTSD risk. Of these seven SNPs, the association of rs3852144 on chromosome 5 was replicated in an independent sample of Rwandan genocide survivors (N = 370, p < .01). While PTSD risk increased with accumulating traumatic experiences, the vulnerability was reduced in carriers of the minor G-allele in an additive manner. Correspondingly, memory for aversive pictures decreased with higher number of the minor G-allele in a sample of N = 2698 healthy Swiss individuals. Finally, investigations on N = 90 PTSD patients treated with Narrative Exposure Therapy indicated an additive effect of genotype on PTSD symptom change from pre-treatment to four months after treatment, but not between pre-treatment and the 10-months follow-up. In conclusion, emotional memory formation seems to decline with increasing number of rs3852144 G-alleles, rendering individuals more resilient to PTSD development. However, the impact on therapy outcome remains preliminary and further research is needed to determine how this intronic marker may affect memory processes in detail.
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Affiliation(s)
- Sarah Wilker
- Clinical & Biological Psychology, Ulm University, Ulm, Germany.
| | - Anna Schneider
- Clinical & Biological Psychology, Ulm University, Ulm, Germany.
| | - Daniela Conrad
- Clinical & Biological Psychology, Ulm University, Ulm, Germany. .,Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany.
| | - Anett Pfeiffer
- 0000 0001 0658 7699grid.9811.1Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Christina Boeck
- 0000 0004 1936 9748grid.6582.9Clinical & Biological Psychology, Ulm University, Ulm, Germany
| | - Birke Lingenfelder
- 0000 0001 0658 7699grid.9811.1Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Virginie Freytag
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Vanja Vukojevic
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Department Biozentrum, Life Sciences Training Facility, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Christian Vogler
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Annette Milnik
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Andreas Papassotiropoulos
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Department Biozentrum, Life Sciences Training Facility, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Dominique J.-F. de Quervain
- 0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Thomas Elbert
- 0000 0001 0658 7699grid.9811.1Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
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14
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Conrad D, Wilker S, Schneider A, Karabatsiakis A, Pfeiffer A, Kolassa S, Freytag V, Vukojevic V, Vogler C, Milnik A, Papassotiropoulos A, J-F de Quervain D, Elbert T, Kolassa IT. Integrated genetic, epigenetic, and gene set enrichment analyses identify NOTCH as a potential mediator for PTSD risk after trauma: Results from two independent African cohorts. Psychophysiology 2018; 57:e13288. [PMID: 30328613 PMCID: PMC7379258 DOI: 10.1111/psyp.13288] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 12/17/2022]
Abstract
The risk of developing posttraumatic stress disorder (PTSD) increases with the number of traumatic event types experienced (trauma load) in interaction with other psychobiological risk factors. The NOTCH (neurogenic locus notch homolog proteins) signaling pathway, consisting of four different trans‐membrane receptor proteins (NOTCH1–4), constitutes an evolutionarily well‐conserved intercellular communication pathway (involved, e.g., in cell–cell interaction, inflammatory signaling, and learning processes). Its association with fear memory consolidation makes it an interesting candidate for PTSD research. We tested for significant associations of common genetic variants of NOTCH1–4 (investigated by microarray) and genomic methylation of saliva‐derived DNA with lifetime PTSD risk in independent cohorts from Northern Uganda (N1 = 924) and Rwanda (N2 = 371), and investigated whether NOTCH‐related gene sets were enriched for associations with lifetime PTSD risk. We found associations of lifetime PTSD risk with single nucleotide polymorphism (SNP) rs2074621 (NOTCH3) (puncorrected = 0.04) in both cohorts, and with methylation of CpG site cg17519949 (NOTCH3) (puncorrected = 0.05) in Rwandans. Yet, none of the (epi‐)genetic associations survived multiple testing correction. Gene set enrichment analyses revealed enrichment for associations of two NOTCH pathways with lifetime PTSD risk in Ugandans: NOTCH binding (pcorrected = 0.003) and NOTCH receptor processing (pcorrected = 0.01). The environmental factor trauma load was significant in all analyses (all p < 0.001). Our integrated methodological approach suggests NOTCH as a possible mediator of PTSD risk after trauma. The results require replication, and the precise underlying pathophysiological mechanisms should be illuminated in future studies. Integrating genetic, epigenetic, and gene set enrichment analyses, while accounting for the environmental factor traumatic load, we identified stress‐ and memory‐associated neurogenic locus notch homolog protein (NOTCH) genes and related gene sets as potential risk mediators for the development of posttraumatic stress disorder (PTSD) after trauma. Thus, our results strengthen the presumed role of memory‐ and inflammation‐associated genes in PTSD development, and revealed a promising target for future treatment studies. Furthermore, we demonstrated the importance of traumatic load in PTSD etiology, and of an integrated approach in order to obtain a more comprehensive understanding of the functionality of PTSD‐associated markers.
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Affiliation(s)
- Daniela Conrad
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany.,Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Sarah Wilker
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Anna Schneider
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Alexander Karabatsiakis
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Anett Pfeiffer
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | | | - Virginie Freytag
- Division of Molecular Neuroscience, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Vanja Vukojevic
- Division of Molecular Neuroscience, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.,Department Biozentrum, Life Sciences Training Facility, University of Basel, Basel, Switzerland.,Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Christian Vogler
- Division of Molecular Neuroscience, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.,Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Annette Milnik
- Division of Molecular Neuroscience, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.,Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Andreas Papassotiropoulos
- Division of Molecular Neuroscience, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.,Department Biozentrum, Life Sciences Training Facility, University of Basel, Basel, Switzerland.,Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Dominique J-F de Quervain
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.,Psychiatric University Clinics, University of Basel, Basel, Switzerland.,Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Thomas Elbert
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
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15
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Schneider A, Conrad D, Pfeiffer A, Elbert T, Kolassa IT, Wilker S. Stigmatization Is Associated With Increased PTSD Risk After Traumatic Stress and Diminished Likelihood of Spontaneous Remission-A Study With East-African Conflict Survivors. Front Psychiatry 2018; 9:423. [PMID: 30364089 PMCID: PMC6191513 DOI: 10.3389/fpsyt.2018.00423] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/17/2018] [Indexed: 12/25/2022] Open
Abstract
Studies in conflict population have repeatedly documented that the number of traumatic event types experienced (trauma load) increases the risk to develop posttraumatic stress disorder (PTSD) in a dose-dependent manner. Misconceptions about survivors' experiences and actions during the war, as well as mental health symptoms frequently lead to stigmatization by their own families and the community, which might render them even more vulnerable for PTSD development and prevent successful recovery. We therefore investigated whether stigmatization affects trauma-related psychopathology beyond the well-known effect of trauma load. The study sample comprised N = 1131 survivors of the rebel war led by the Lord's Resistance Army (LRA) in Northern Uganda, including a large proportion of formerly abducted individuals and child soldiers. We investigated how the experience of stigmatization affects PTSD risk and the likelihood of spontaneous remission, taking trauma load into account. Further, the association of stigmatization with treatment outcome was determined in a subsample of N = 284 individuals with PTSD who received trauma-focused psychotherapy. More than one third of the total sample, and almost two-thirds of the therapy subsample, reported experiences of stigmatization. The main reasons for stigmatization were related to an association with a rebel group (e.g., being called a rebel), followed by mental health problems/PTSD symptoms and HIV/AIDS. Stigmatization was strongly associated with a higher prevalence of lifetime and current PTSD, a diminished probability of spontaneous remission and higher PTSD symptoms before and after trauma-focused psychotherapy, beyond the effect of trauma load. In sum, our results support the assumption that stigmatization aggravates trauma-related psychopathology and impede symptom improvement. In post-conflict regions, community and family interventions which aim at reducing stigmatization and discrimination might therefore complement individual psychotherapy in order to allow survivors to recover and reintegrate into society.
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Affiliation(s)
- Anna Schneider
- Department of Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.,Vivo International e.V., Konstanz, Germany
| | - Daniela Conrad
- Department of Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.,Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Anett Pfeiffer
- Vivo International e.V., Konstanz, Germany.,Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Thomas Elbert
- Vivo International e.V., Konstanz, Germany.,Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Iris-Tatjana Kolassa
- Department of Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.,Vivo International e.V., Konstanz, Germany
| | - Sarah Wilker
- Department of Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.,Vivo International e.V., Konstanz, Germany
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16
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Heck A, Milnik A, Vukojevic V, Petrovska J, Egli T, Singer J, Escobar P, Sengstag T, Coynel D, Freytag V, Fastenrath M, Demougin P, Loos E, Hartmann F, Schicktanz N, Delarue Bizzini B, Vogler C, Kolassa IT, Wilker S, Elbert T, Schwede T, Beisel C, Beerenwinkel N, de Quervain DJF, Papassotiropoulos A. Exome sequencing of healthy phenotypic extremes links TROVE2 to emotional memory and PTSD. Nat Hum Behav 2017. [DOI: 10.1038/s41562-017-0081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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17
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Conrad D, Wilker S, Pfeiffer A, Lingenfelder B, Ebalu T, Lanzinger H, Elbert T, Kolassa IT, Kolassa S. Does trauma event type matter in the assessment of traumatic load? Eur J Psychotraumatol 2017; 8:1344079. [PMID: 28804594 PMCID: PMC5533143 DOI: 10.1080/20008198.2017.1344079] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/05/2017] [Indexed: 11/05/2022] Open
Abstract
Background: The likelihood of developing Posttraumatic Stress Disorder (PTSD) depends on the interaction of individual risk factors and cumulative traumatic experiences. Hence, the identification of individual susceptibility factors warrants precise quantification of trauma exposure. Previous research indicated that some traumatic events may have more severe influences on mental health than others; thus, the assessment of traumatic load may be improved by weighting event list items rather than calculating the simple sum score. Objective: We compared two statistical methods, Random Forests using Conditional Interference (RF-CI) and Least Absolute Shrinkage and Selection Operator (LASSO), based on their ability to rank traumatic experiences according to their importance for predicting lifetime PTSD. Methods: Statistical models were initially fitted in a sample of N1 = 441 survivors of the Northern Ugandan rebel war. The ability to correctly predict lifetime PTSD was then tested in an independent sample of N2 = 211, and subsequently compared with predictions by the simple sum score of different traumatic event types experienced. Results: Results indicate that RF-CI and LASSO allow for a ranking of traumatic events according to their predictive importance for lifetime PTSD. Moreover, RF-CI showed slightly better prediction accuracy than the simple sum score, followed by LASSO when comparing prediction results in the validation sample. Conclusion: Given the expense in time and calculation effort by RF-CI and LASSO, and the relatively low increase in prediction accuracy by RF-CI, we recommend using the simple sum score to measure the environmental factor traumatic load, e.g., in analyses of gene × environment interactions.
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Affiliation(s)
- Daniela Conrad
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany.,Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Sarah Wilker
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Anett Pfeiffer
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Birke Lingenfelder
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | | | - Hartmut Lanzinger
- Institute of Number Theory and Probability Theory, Ulm University, Ulm, Germany
| | - Thomas Elbert
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Hinsberger M, Holtzhausen L, Sommer J, Kaminer D, Elbert T, Seedat S, Wilker S, Crombach A, Weierstall R. Feasibility and effectiveness of narrative exposure therapy and cognitive behavioral therapy in a context of ongoing violence in South Africa. Psychol Trauma 2016; 9:282-291. [PMID: 27710003 DOI: 10.1037/tra0000197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In an observer-blinded intervention trial, we tested the reduction of posttraumatic stress symptoms, aggressive attitude, and behavior in young males living in a context of ongoing community and gang violence by means of (a) forensic offender rehabilitation narrative exposure therapy (FORNET), and (b) the cognitive-behavioral intervention "Thinking for a Change" (TFAC). A waiting list served as the control condition. METHOD A total of 39 young men were included in the data analysis: 15 completed FORNET, 11 underwent cognitive-behavioral therapy (CBT), and 13 were on a waiting list for later treatment. The primary efficacy endpoints were the PTSD Symptom Scale-Interview (PSS-I) severity score, the Appetitive Aggression Scale (AAS) score, and the number of perpetrated violent event types 8 months (on average) after treatment. RESULTS Only in the sample receiving FORNET were posttraumatic stress disorder (PTSD) scores significantly reduced at the first follow-up (Cohen's d = -0.97) and significantly different from those of the control group (Cohen's d = -1.03). The changes in scores for appetitive aggression and perpetrated events were not significant for any of the treatment conditions. CONCLUSIONS The study shows that trauma-focused treatment can reduce the psychological symptoms of posttraumatic stress even for individuals living under unsafe conditions in low-income urban communities. However, achieving changes in violent behavior within a context of ongoing violence may require more than the treatment of trauma-related suffering, confrontation with one's offenses, or cognitive-behavioral interventions. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | | | | | - Sarah Wilker
- Department of Clinical and Biological Psychology, University of Ulm
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Boeck C, Koenig AM, Schury K, Geiger ML, Karabatsiakis A, Wilker S, Waller C, Gündel H, Fegert JM, Calzia E, Kolassa IT. Inflammation in adult women with a history of child maltreatment: The involvement of mitochondrial alterations and oxidative stress. Mitochondrion 2016; 30:197-207. [DOI: 10.1016/j.mito.2016.08.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/15/2016] [Accepted: 08/12/2016] [Indexed: 12/24/2022]
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20
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Zakrzewicz A, Wilker S, Stumpf S, Petrie K, Padberg W, Janciauskiene S, Grau V. Potential protective role of secretory leukocyte protease inhibitor (SLPI) in transplanted organs. Pneumologie 2016. [DOI: 10.1055/s-0036-1584625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Siebers R, Fink B, Richter K, Wilker S, Küllmar M, Zukunft S, Aggarwal N, Zakrzewicz A, Padberg W, Janciauskiene S, Grau V. A soluble factor mediates alpha-1 antitrypsin-induced inhibition of ATP-induced IL-1β release by monocytic cells. Pneumologie 2016. [DOI: 10.1055/s-0036-1584659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Wilker S, Pfeiffer A, Elbert T, Ovuga E, Karabatsiakis A, Krumbholz A, Thieme D, Schelling G, Kolassa IT. Endocannabinoid concentrations in hair are associated with PTSD symptom severity. Psychoneuroendocrinology 2016; 67:198-206. [PMID: 26923850 DOI: 10.1016/j.psyneuen.2016.02.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 12/26/2022]
Abstract
The endocannabinoid system has been implicated in the regulation of the stress response, fear memory formation, and inflammatory processes. Posttraumatic stress disorder (PTSD) can result from exposure to extreme stress and is characterized by strong, associative memories for the traumatic events experienced. Furthermore, an elevated physical disease risk has been observed in PTSD, likely to be mediated by inflammatory processes. Therefore, altered endocannabinoid regulation can be expected in individuals with PTSD. However, attempts to assess PTSD-associated differences in the endocannabinoid system from human blood samples have provided inconsistent results, possibly due to fluctuating levels of endocannabinoids. In hair, these neuromodulators are accumulated over time and thus give access to a more stable and reliable assessment. We therefore investigated PTSD-associated differences in hair concentrations of endocannabinoids (N-acyl-ethanolamides palmitoylethanolamide [PEA], oleoylethanolamide [OEA] and stearoylethanolamide [SEA]) in 38 rebel war survivors from Northern Uganda suffering from PTSD and N=38 healthy rebel war survivors without current and lifetime PTSD. PTSD diagnosis and symptom severity were assessed in structured clinical interviews employing the Posttraumatic Diagnostic Scale (PDS). A significant group difference was observed for OEA, with PTSD patients showing reduced hair concentrations. Regression analyses further revealed strong negative relationships between all investigated N-acyl-ethanolamides and symptom severity of PTSD. The observed reductions in endocannabinoids might account for the increased inflammatory state as well as for the failure to extinguish fear memories observed in PTSD. Our findings add to the accumulating evidence suggesting the endocannabinoid system as a target for pharmacological enhancement of exposure-based psychotherapy for PTSD.
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Affiliation(s)
- Sarah Wilker
- Clinical & Biological Psychology, Institute of Psychology & Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany.
| | - Anett Pfeiffer
- Clinical Psychology, University of Konstanz, Universitätsstr. 10, 78457 Konstanz, Germany
| | - Thomas Elbert
- Clinical Psychology, University of Konstanz, Universitätsstr. 10, 78457 Konstanz, Germany
| | - Emilio Ovuga
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Alexander Karabatsiakis
- Clinical & Biological Psychology, Institute of Psychology & Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany
| | - Aniko Krumbholz
- Institute of Doping Analysis and Sports Biochemistry Dresden, 01731 Kreischa, Germany
| | - Detlef Thieme
- Institute of Doping Analysis and Sports Biochemistry Dresden, 01731 Kreischa, Germany
| | - Gustav Schelling
- Department of Anaesthesiology, Ludwig-Maximilians University, 82131 Munich, Germany
| | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Institute of Psychology & Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany
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Thomaes K, de Kloet C, Wilker S, El-Hage W, Schäfer I, Kleim B, Schmahl C, van Zuiden M. Investigating biological traces of traumatic stress in changing societies: challenges and directions from the ESTSS Task Force on Neurobiology. Eur J Psychotraumatol 2016; 7:29453. [PMID: 26996535 PMCID: PMC4800281 DOI: 10.3402/ejpt.v7.29453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 11/14/2022] Open
Abstract
Traumatic stress can have severe consequences for both mental and physical health. Furthermore, both psychological and biological traces of trauma increase as a function of accumulating traumatic experiences. Neurobiological research may aid in limiting the impact of traumatic stress, by leading to advances in preventive and treatment interventions. To promote the possibility for clinical implementation of novel research findings, this brief review describes timely conceptual and methodological challenges and directions in neurobiological trauma research on behalf of the Task Force "Neurobiology of Traumatic Stress" of the European Society for Traumatic Stress Studies (ESTSS). The most important conceptual challenges are the heterogeneity of disorders and existence of subtypes across diagnostic categories: differential latent profiles and trajectories regarding symptom expression and neural correlates are being unraveled; however, similar latent classes' approaches for treatment response and neurobiological data remain scarce thus far. The key to improving the efficacy of currently available preventive interventions and treatments for trauma-related disorders lies in a better understanding and characterization of individual differences in response to trauma and interventions. This could lead to personalized treatment strategies for trauma-related disorders, based on objective information indicating whether individuals are expected to benefit from them. The most important methodological challenge identified here is the need for large consortia and meta-analyses or, rather, mega-analyses on existent data as a first step. In addition, large multicenter studies, combining novel methods for repeated sampling with more advanced statistical modeling techniques, such as machine learning, should aim to translate identified disease mechanisms into molecular blood-based biomarker combinations to predict disorder vulnerability and treatment responses.
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Affiliation(s)
- Kathleen Thomaes
- GGZ inGeest/Department of Psychiatry & Anatomy and neurosciences, VU University Medical Center, Amsterdam, The Netherlands;
| | - Carien de Kloet
- Arq Psychotrauma Expert Group, Foundation Centrum '45, Oegstgeest, The Netherlands
| | - Sarah Wilker
- Department of Clinical and Biological Psychology, Ulm University, Ulm, Germany
| | - Wissam El-Hage
- Department of Psychiatry, CHRU de Tours, Inserm U930, University of Tours, Tours, France
| | - Ingo Schäfer
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zürich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Mirjam van Zuiden
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Ramo-Fernández L, Schneider A, Wilker S, Kolassa IT. Epigenetic Alterations Associated with War Trauma and Childhood Maltreatment. Behav Sci Law 2015; 33:701-721. [PMID: 26358541 DOI: 10.1002/bsl.2200] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Survivors of war trauma or childhood maltreatment are at increased risk for trauma-spectrum disorders such as post-traumatic stress disorder (PTSD). In addition, traumatic stress has been associated with alterations in the neuroendocrine and the immune system, enhancing the risk for physical diseases. Traumatic experiences might even affect psychological as well as biological parameters in the next generation, i.e. traumatic stress might have transgenerational effects. This article outlines how epigenetic processes, which represent a pivotal biological mechanism for dynamic adaptation to environmental challenges, might contribute to the explanation of the long-lasting and transgenerational effects of trauma. In particular, epigenetic alterations in genes regulating the hypothalamus-pituitary-adrenal axis as well as the immune system have been observed in survivors of childhood and adult trauma. These changes could result in enduring alterations of the stress response as well as the physical health risk. Furthermore, the effects of parental trauma could be transmitted to the next generation by parental distress and the pre- and postnatal environment, as well as by epigenetic marks transmitted via the germline. While epigenetic research has a high potential of advancing our understanding of the consequences of trauma, the findings have to be interpreted with caution, as epigenetics only represent one piece of a complex puzzle of interacting biological and environmental factors. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Anna Schneider
- Clinical and Biological Psychology, Ulm University, Germany
| | - Sarah Wilker
- Clinical and Biological Psychology, Ulm University, Germany
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25
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Siebers R, Wilker S, Küllmar M, Aggarwal N, Zakrzewicz A, Padberg W, Janciauskiene S, Grau V. Alpha-1 antitrypsin inhibits ATP-induced release of IL-1β in human monocytes via a cholinergic pathway. Pneumologie 2015. [DOI: 10.1055/s-0035-1556630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Hiller S, Zakrzewicz A, Wilker S, Jurastow I, Hecker A, Kummer W, Padberg W, Grau V. β-NAD inhibits ATP-mediated interleukin-1β release. Pneumologie 2015. [DOI: 10.1055/s-0035-1556629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Zakrzewicz A, Wilker S, Janciauskiene S, Tikkanen R, Padberg W, Grau V. SLPI suppresses ATP-mediated release of IL-1β from human monocytes – evidence for a novel anti-inflammatory mechanism. Pneumologie 2015. [DOI: 10.1055/s-0035-1556628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Backhaus S, Wilker S, Zakrzewicz A, Küllmar M, Padberg W, Ruppert C, Grau V. Surfactant inhibits ATP-induced release of interleukin-1β in human monocytes. Pneumologie 2015. [DOI: 10.1055/s-0035-1556631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Karabatsiakis A, Hamuni G, Wilker S, Kolassa S, Renu D, Kadereit S, Schauer M, Hennessy T, Kolassa IT. Metabolite profiling in posttraumatic stress disorder. J Mol Psychiatry 2015; 3:2. [PMID: 25848535 PMCID: PMC4367823 DOI: 10.1186/s40303-015-0007-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic stress does not only increase the risk for posttraumatic stress disorder (PTSD), but is also associated with adverse secondary physical health outcomes. Despite increasing efforts, we only begin to understand the underlying biomolecular processes. The hypothesis-free assessment of a wide range of metabolites (termed metabolite profiling) might contribute to the discovery of biological pathways underlying PTSD. METHODS Here, we present the results of the first metabolite profiling study in PTSD, which investigated peripheral blood serum samples of 20 PTSD patients and 18 controls. We performed liquid chromatography (LC) coupled to Quadrupole/Time-Of-Flight (QTOF) mass spectrometry. Two complementary statistical approaches were used to identify metabolites associated with PTSD status including univariate analyses and Partial Least Squares Discriminant Analysis (PLS-DA). RESULTS Thirteen metabolites displayed significant changes in PTSD, including four glycerophospholipids, and one metabolite involved in endocannabinoid signaling. A biomarker panel of 19 metabolites classifies PTSD with 85% accuracy, while classification accuracy from the glycerophospholipid with the highest differentiating ability already reached 82%. CONCLUSIONS This study illustrates the feasibility and utility of metabolite profiling for PTSD and suggests lipid-derived and endocannabinoid signaling as potential biological pathways involved in trauma-associated pathophysiology.
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Affiliation(s)
- Alexander Karabatsiakis
- Clinical & Biological Psychology, Ulm University, Albert-Einstein Allee 47, 89081 Ulm, Germany
| | - Gilava Hamuni
- Clinical & Biological Psychology, Ulm University, Albert-Einstein Allee 47, 89081 Ulm, Germany
| | - Sarah Wilker
- Clinical & Biological Psychology, Ulm University, Albert-Einstein Allee 47, 89081 Ulm, Germany
| | | | | | - Suzanne Kadereit
- Department of Biology, University of Konstanz, Konstanz, Germany
| | - Maggie Schauer
- Clinical Psychology & Neuropsychology, University of Konstanz, Konstanz, Germany
| | | | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Ulm University, Albert-Einstein Allee 47, 89081 Ulm, Germany
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30
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Wilker S, Pfeiffer A, Kolassa S, Koslowski D, Elbert T, Kolassa IT. How to quantify exposure to traumatic stress? Reliability and predictive validity of measures for cumulative trauma exposure in a post-conflict population. Eur J Psychotraumatol 2015; 6:28306. [PMID: 26589255 PMCID: PMC4654773 DOI: 10.3402/ejpt.v6.28306] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/10/2015] [Accepted: 07/21/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND While studies with survivors of single traumatic experiences highlight individual response variation following trauma, research from conflict regions shows that almost everyone develops posttraumatic stress disorder (PTSD) if trauma exposure reaches extreme levels. Therefore, evaluating the effects of cumulative trauma exposure is of utmost importance in studies investigating risk factors for PTSD. Yet, little research has been devoted to evaluate how this important environmental risk factor can be best quantified. METHODS We investigated the retest reliability and predictive validity of different trauma measures in a sample of 227 Ugandan rebel war survivors. Trauma exposure was modeled as the number of traumatic event types experienced or as a score considering traumatic event frequencies. In addition, we investigated whether age at trauma exposure can be reliably measured and improves PTSD risk prediction. RESULTS All trauma measures showed good reliability. While prediction of lifetime PTSD was most accurate from the number of different traumatic event types experienced, inclusion of event frequencies slightly improved the prediction of current PTSD. CONCLUSIONS As assessing the number of traumatic events experienced is the least stressful and time-consuming assessment and leads to the best prediction of lifetime PTSD, we recommend this measure for research on PTSD etiology.
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Affiliation(s)
- Sarah Wilker
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.,Vivo International, Allensbach, Germany;
| | - Anett Pfeiffer
- Vivo International, Allensbach, Germany.,Clinical Psychology, University of Konstanz, Konstanz, Germany
| | | | - Daniela Koslowski
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Thomas Elbert
- Vivo International, Allensbach, Germany.,Clinical Psychology, University of Konstanz, Konstanz, Germany
| | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Wilker S, Elbert T, Papassotiropoulos A, de Quervain DJF, Kolassa IT. Response to: further support for an association between the memory-related gene WWC1 and posttraumatic stress disorder: results from the Detroit Neighborhood Health Study. Biol Psychiatry 2014; 76:e27-8. [PMID: 24947540 DOI: 10.1016/j.biopsych.2014.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/01/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Sarah Wilker
- Clinical & Biological Psychology, Institute for Psychology & Education, University of Ulm, Ulm, Germany.
| | - Thomas Elbert
- Clinical Psychology & Behavioural Neuroscience, University of Konstanz, Konstanz, Germany
| | | | | | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Institute for Psychology & Education, University of Ulm, Ulm, Germany
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Wilker S, Pfeiffer A, Kolassa S, Elbert T, Lingenfelder B, Ovuga E, Papassotiropoulos A, de Quervain D, Kolassa IT. The role of FKBP5 genotype in moderating long-term effectiveness of exposure-based psychotherapy for posttraumatic stress disorder. Transl Psychiatry 2014; 4:e403. [PMID: 24959896 PMCID: PMC4080328 DOI: 10.1038/tp.2014.49] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/29/2014] [Accepted: 05/22/2014] [Indexed: 12/16/2022] Open
Abstract
Exposure-based therapies are considered the state-of-the-art treatment for Posttraumatic Stress Disorder (PTSD). Yet, a substantial number of PTSD patients do not recover after therapy. In the light of the well-known gene × environment interactions on the risk for PTSD, research on individual genetic factors that influence treatment success is warranted. The gene encoding FK506-binding protein 51 (FKBP5), a co-chaperone of the glucocorticoid receptor (GR), has been associated with stress reactivity and PTSD risk. As FKBP5 single-nucleotide polymorphism rs1360780 has a putative functional role in the regulation of FKBP5 expression and GR sensitivity, we hypothesized that this polymorphism influences PTSD treatment success. We investigated the effects of FKBP5 rs1360780 genotype on Narrative Exposure Therapy (NET) outcome, an exposure-based short-term therapy, in a sample of 43 survivors of the rebel war in Northern Uganda. PTSD symptom severity was assessed before and 4 and 10 months after treatment completion. At the 4-month follow-up, there were no genotype-dependent differences in therapy outcome. However, the FKBP5 genotype significantly moderated the long-term effectiveness of exposure-based psychotherapy. At the 10-month follow-up, carriers of the rs1360780 risk (T) allele were at increased risk of symptom relapse, whereas non-carriers showed continuous symptom reduction. This effect was reflected in a weaker treatment effect size (Cohen's D=1.23) in risk allele carriers compared with non-carriers (Cohen's D=3.72). Genetic factors involved in stress response regulation seem to not only influence PTSD risk but also responsiveness to psychotherapy and could hence represent valuable targets for accompanying medication.
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Affiliation(s)
- S Wilker
- Clinical and Biological Psychology, Institute for Psychology and Education, University of Ulm, Ulm, Germany,Clinical and Biological Psychology, Institute for Psychology and Education, University of Ulm, Albert-Einstein Allee 47, Ulm 89069, Germany. E-mail:
| | - A Pfeiffer
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - S Kolassa
- SAP Switzerland AG, Tägerwilen, Switzerland
| | - T Elbert
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - B Lingenfelder
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - E Ovuga
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | - D de Quervain
- Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - I-T Kolassa
- Clinical and Biological Psychology, Institute for Psychology and Education, University of Ulm, Ulm, Germany
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Wilker S, Kolassa S, Vogler C, Lingenfelder B, Elbert T, Papassotiropoulos A, de Quervain DJF, Kolassa IT. The role of memory-related gene WWC1 (KIBRA) in lifetime posttraumatic stress disorder: evidence from two independent samples from African conflict regions. Biol Psychiatry 2013; 74:664-71. [PMID: 23582269 DOI: 10.1016/j.biopsych.2013.02.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/13/2013] [Accepted: 02/28/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) results from the formation of a strong memory for the sensory-perceptual and affective representations of traumatic experiences, which is detached from the corresponding autobiographical context information. Because WWC1, the gene encoding protein KIBRA, is associated with long-term memory performance, we hypothesized that common WWC1 alleles influence the risk for a lifetime diagnosis of PTSD. METHODS Traumatic load and diagnosis of current and lifetime PTSD were assessed in two independent African samples of survivors from conflict zones who had faced severe trauma (n = 392, Rwanda, and n = 399, Northern Uganda, respectively). Array-based single nucleotide polymorphism (SNP) genotyping was performed. The influence of WWC1 tagging SNPs and traumatic load on lifetime PTSD was estimated by means of logistic regression models with correction for multiple comparisons in the Rwandan sample. Replication analysis was performed in the independent Ugandan sample. RESULTS An association of two neighboring SNPs in almost complete linkage disequilibrium, rs10038727 and rs4576167, with lifetime PTSD was discovered in the Rwandan sample. Although each traumatic event added to the probability of lifetime PTSD in a dose-dependent manner in both genotype groups, carriers of the minor allele of both SNPs displayed a diminished risk (p = .007, odds ratio = .29 [95% confidence interval = .15-.54]). This effect was confirmed in the independent Ugandan sample. CONCLUSIONS This study reveals an association between two WWC1 SNPs and the likelihood of PTSD development, indicating that this memory-related gene might be involved in processes that occur in response to traumatic stress and influence the strengthening of fear memories.
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Affiliation(s)
- Sarah Wilker
- Clinical and Biological Psychology, Institute for Psychology and Education, University of Ulm, Ulm, Germany.
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Wilker S, Kolassa IT. Genetic influences on posttraumatic stress disorder (PTSD): inspirations from a memory-centered approach. Psychiatr Danub 2012; 24:278-279. [PMID: 23013632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Sarah Wilker
- Institute of Psychology & Education University of Ulm, Ulm, Germany
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Schmitz J, Zakrzewicz A, Wilker S, Kuncová J, Padberg W, Grau V, Holler J. Differential expression of Neuropeptide Y (NPY) and NPY receptors 1/2 between rat lung and kidney allografts. Pneumologie 2012. [DOI: 10.1055/s-0032-1315548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
It is still disputed in which anatomical compartments of allograft recipients T-cells proliferate. After experimental renal transplantation, host monocytes and lymphocytes accumulate in the lumina of graft blood vessels. In this study, we test the hypothesis that T lymphocytes proliferate in the vascular bed of the graft. Kidneys were transplanted in the Dark Agouti to Lewis rat strain combination, an established experimental model for acute rejection. Isogeneic transplantation was performed as a control. Cells in the S-phase of mitosis were detected in situ three days posttransplantation by pulse-labeling with BrdU and by immunohistochemical detection of the proliferating cell nuclear antigen (PCNA). More than 20% of all T-cells in the lumina of allograft blood vessels incorporated BrdU and approximately 30% of them expressed PCNA. In the blood vessels of isografts as well as in other organs of allograft recipients, only few BrdU(+) cells were detected. A majority of the BrdU(+) cells in graft blood vessels expressed CD8. In conclusion, we demonstrate that CD8(+) T lymphocytes proliferate in the lumina of the blood vessels of renal allografts during the onset of acute rejection.
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Affiliation(s)
- V Grau
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University Giessen, Germany.
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Affiliation(s)
- F Jung
- Department of General and Thoracic Surgery, Justus Liebig University, Giessen, Germany
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Korom S, De Meester I, Maas E, Stein A, Wilker S, Jung F, Weimer R, Brendel MD, Ernst W, Friemann S, Linder R, Grimm H, Padberg W, Scharpé S, Kupiec-Weglinski JW, Schwemmle K. CD26 expression and enzymatic activity in recipients of kidney allografts. Transplant Proc 2002; 34:1753-4. [PMID: 12176563 DOI: 10.1016/s0041-1345(02)03054-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S Korom
- Department of General and Thoracic Surgery, University Hospital, Justus Liebig University, Giessen, Germany.
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Mazurek S, Grimm H, Wilker S, Leib S, Eigenbrodt E. Metabolic characteristics of different malignant cancer cell lines. Anticancer Res 1998; 18:3275-82. [PMID: 9858895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Extracellular AMP inhibits cell proliferation of MCF-7 and MDA-MB-453 whereas cell proliferation of the highly malignant Novikoff cell line is not affected. In medium with low glucose supply MDA-MB-453 cells grow well, Novikoff cells are slightly inhibited and MCF-7 cells are totally unable to grow. Isoelectric focusing revealed that a glyclytic enzyme complex exists in all three cell lines. In addition to the glycolytic enzymes, c-Raf-kinase, adenylate kinase, and nucleoside diphosphate kinase are also found within the complex. The differences in glucose in dependence of the three cell lines can be explained by the different constitutions of shuttle enzymes. MDA-MB-453 and Novikoff cells contain cytsolic glycerol 3-phosphate dehydrogenase which is associated with glyceraldehyde 3-phosphate dehydrogenase within the glycolytic enzyme complex and which is responsible for the transport of cytoslic hydrogen in the mitochondria. MCF-7 and Novikoff cells contain the pI 7.8 form of malate dehydrogenase which couples glycolysis with glutaminolysis.
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Affiliation(s)
- S Mazurek
- Institute of Biochemistry and Endocrinology, Veterinary Faculty, University of Giessen, Germany.
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Mogul HR, Marshall M, Frey M, Burke HB, Wynn PS, Wilker S, Southern AL, Gambert SR. Insulin like growth factor-binding protein-1 as a marker for hyperinsulinemia in obese menopausal women. J Clin Endocrinol Metab 1996; 81:4492-5. [PMID: 8954066 DOI: 10.1210/jcem.81.12.8954066] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hyperinsulinemia, a manifestation of insulin resistance, precursor of non-insulin dependent diabetes mellitus (NIDDM) and the hallmark of Syndrome X was assessed in 27 obese post-menopausal women. Insulin-like growth factor binding protein-1 (IGFBP-1), which had been shown previously to correlate inversely with insulin in animal and human studies, was evaluated as a diagnostic marker for abnormal glucose stimulated area under the curve (AUC) insulin (defined a priori as > or = 100 microU/ml). We performed analysis of variance and logistic regression to assess IGFBP-1 and other study covariates, including body mass index, blood pressure, lipids and measures of glucose and insulin in hyperinsulinemic vs. normal women and evaluated performance characteristics (sensitivity, specificity, positive and negative predictive values and accuracy rates). The mean IGFBP-1 was 6.1 ng/ml (95% confidence interval (CI) 3.1 to 8.9) for the hyper-insulinemic women compared to 33.5 ng/ml (CI 15.8 to 51.2) for normal women (P = .0027). At a cutoff point of 15ng/ml, which was selected to correspond to the lower 95% confidence limit for the normal study population, IGFBP-1 was abnormal in all 13 women with hyperinsulinemia and 4 women with normal insulin levels (sensitivity 100%, specificity 69%; positive predictive value 76%, negative predictive value 100%, diagnostic accuracy rate 85%). Logistic regression models indicated that, of all study covariates, IGFBP-1 was the best predictor variable for AUC-insulin as a binary dependent variable. These results suggest that IGFBP-1 may be a simple serum marker for hyperinsulinemia in a subpopulation of obese menopausal women.
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Affiliation(s)
- H R Mogul
- Division of Endocrinology and Metabolism, New York Medical College, Valhalla 10595, USA.
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Grimm H, Tibell A, Norrlind B, Blecher C, Wilker S, Schwemmle K. Immunoregulation by parenteral lipids: impact of the n-3 to n-6 fatty acid ratio. JPEN J Parenter Enteral Nutr 1994; 18:417-21. [PMID: 7815672 DOI: 10.1177/0148607194018005417] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The immune system is reported to be influenced by polyunsaturated fatty acids. Therefore, immunoregulation caused by intravenous fat emulsions with different n-3 to n-6 fatty acid ratios was studied in an in vivo model. METHODS Experimental rat heart allotransplantation served as a defined immunologic challenge. Twenty percent emulsions of safflower oil (n-3 to n-6 = 1:370), fish oil (n-3 to n-6 = 7.6:1), and soybean oil (n-3 to n-6 = 1:6.5), and a 1:1 mixture of safflower oil and fish oil (n-3 to n-6 = 1:2.1) were continuously infused (9 g of fat per kg of body weight per day) after transplantation until complete rejection. The prolongation of graft survival, an accepted parameter of immunosuppression, was assessed. Beyond that, cytokine release by mitogen-stimulated peripheral-blood mononuclear cells (PBMCs) from animals exsanguinated on day 4 after transplantation was evaluated. RESULTS The mean rejection time was 7.8 days in the sham-infused saline control group and 6.7 days in the safflower- and fish-oil-mixture group (oil control group). Continuous infusion of soybean oil prolonged the graft survival time to 10.4 days, fish oil to 12.3 days, and safflower oil to 13.3 days. PBMC alpha-tumor necrosis factor release was significantly reduced in the fish-oil group (51.9 +/- 13.0 pg/10(6) PBMCs vs 70.8 +/- 10.9 pg/10(6) PBMCs [controls], p < .004). Interleukin-6 release was diminished in both the fish-oil group (22.2 +/- 13.6 pg/10(6) PBMCs vs 40.7 +/- 8.3 pg/10(6) PBMCs [controls], p < .002) and the safflower-oil group (28.4 +/- 6.9 pg/10(6) PBMCs, p < .002). CONCLUSIONS The n-3 to n-6 fatty acid ratio determined the immunoregulatory potential of intravenous fat emulsions in vivo. Both n-3 and n-6 fatty acids were immunosuppressive when applied as the main polyunsaturated fatty acid sources. PBMC cytokine release was significantly reduced in these groups. The more balanced the n-3 to n-6 ratios, the less immunosuppressive the fat emulsion. There was no immunosuppressive effect at an n-3 to n-6 ratio of 1:2.1.
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Affiliation(s)
- H Grimm
- Department of General and Thoracic Surgery, University of Giessen, Germany
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