Higher sense of coherence is associated with better mental and physical health in emergency medical services : results from investigations on the revised sense of coherence scale (SOC-R) in rescue workers
2019-05-20, Behnke, Alexander, Conrad, Daniela, Kolassa, Iris-Tatjana, Rojas, Roberto
As rescue workers are regularly confronted with potentially traumatising on-duty events, they have an increased risk to develop trauma-related mental and physical health impairments, including post-traumatic, depressive, and somatic symptoms. For this high-risk group, it could be of particular importance to experience their occupational burden as manageable, meaningful, and coherent. This mindset – called sense of coherence – may be a potential resilience factor against the development of mental and physical health problems. In a cross-sectional cohort of 102 rescue workers (Mdn(QD)age = 26.0 (8.5), age range: 18−61), including 36 women, we investigated whether higher values on the Revised Sense of Coherence Scale (SOC-R) predicted lower post-traumatic, depressive, and somatic symptoms. In addition, we evaluated the factor structure of the SOC-R using confirmatory factor analyses. Linear regressions indicated that higher SOC-R, but particularly manageability scores were associated with less post-traumatic (β = −.31, p = .009), depressive (β = −.44, p < .001), and somatic symptoms (β = −.36, p = .002). Furthermore, we found that all symptom scores significantly increased with occupational and private-life trauma exposure. The SOC-R’s factor structure was replicated, comprising the three subscales manageability, reflection, and balance. However, the SOC-R’s convergent factor validity was rather low in the present sample. Taken together, a high sense of coherence, and in particular a high manageability conviction, was observed as resilience factors for high-risk groups that are frequently exposed to potentially traumatic events. Future studies might investigate whether strengthening the sense of coherence could be one building block in an effective prevention program for maintaining long-term health in risk groups.
Stigmatization Is Associated with Increased PTSD Risk and Symptom Severity After Traumatic Stress and Diminished Likelihood of Spontaneous Remission : A Study with East-African Conflict Survivors
2018-10-10, Schneider, Anna, Conrad, Daniela, Pfeiffer, Anett, Elbert, Thomas, Kolassa, Iris-Tatjana, Wilker, Sarah
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 the survivor’s 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 wanted to investigate 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, symptom severity 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-third of the therapy subsample reported experiences of stigmatization. The main reasons for stigmatization were related to an association with a terrorist 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.
Alterations of hair cortisol and dehydroepiandrosterone in mother-infant-dyads with maternal childhood maltreatment
2017-12, Schury, Katharina, Koenig, Alexandra M., Isele, Dorothea, Hulbert, A. L., Krause, Sabrina, Umlauft, Maria, Kolassa, Stephan, Ziegenhain, Ute, Karabatsiakis, Alexander, Kolassa, Iris-Tatjana
Child maltreatment (CM) has severe effects on psychological and physical health. The hypothalamic-pituitary-adrenal (HPA) axis, the major stress system of the body, is dysregulated after CM. The analysis of cortisol and dehydroepiandrosterone (DHEA) in scalp hair presents a new and promising methodological approach to assess chronic HPA axis activity. This study investigated the effects of CM on HPA axis activity in the last trimester of pregnancy by measuring the two important signaling molecules, cortisol and DHEA in hair, shortly after parturition. In addition, we explored potential effects of maternal CM on her offspring’s endocrine milieu during pregnancy by measuring cortisol and DHEA in newborns’ hair.
CM was assessed with the Childhood Trauma Questionnaire (CTQ). Cortisol and DHEA were measured in hair samples of 94 mothers and 30 newborns, collected within six days after delivery. Associations of maternal CM on her own and her newborn’s cortisol as well as DHEA concentrations in hair were analyzed with heteroscedastic regression models.
Higher CM was associated with significantly higher DHEA levels, but not cortisol concentrations in maternal hair. Moreover, maternal CM was positively, but only as a non-significant trend, associated with higher DHEA levels in the newborns’ hair.
Results suggest that the steroid milieu of the mother, at least on the level of DHEA, is altered after CM, possibly leading to non-genomic transgenerational effects on the developing fetus in utero. Indeed, we observed on an explorative level first hints that the endocrine milieu for the developing child might be altered in CM mothers. These results need extension and replication in future studies. The measurement of hair steroids in mothers and their newborns is promising, but more research is needed to better understand the effects of a maternal history of CM on the developing fetus.
Exome sequencing of healthy phenotypic extremes links TROVE2 to emotional memory and PTSD
2017-03-27, Heck, Angela, Milnik, Annette, Vukojevic, Vanja, Petrovska, Jana, Egli, Tobias, Singer, Jochen, Escobar, Pablo, Kolassa, Iris-Tatjana, Elbert, Thomas, Papassotiropoulos, Andreas
Many mental disorders represent the extremes of the normal distribution of traits, which are related to multiple cognitive and emotional dimensions. By performing whole-exome sequencing of healthy, young subjects with extremely high versus extremely low aversive memory performance, we identified TROVE2 as a gene implicated in emotional memory in health and disease. TROVE2 encodes Ro60, a broadly expressed RNA-binding protein implicated in the regulation of inflammatory gene expression and autoimmunity. A regulatory TROVE2 variant was linked to higher emotional memory capacity and higher emotional memory-related brain activation in healthy subjects. In addition, TROVE2 was associated with traumatic memory and the frequency of post-traumatic stress disorder in genocide survivors.
Emotion Regulation in Rescue Workers : Differential Relationship With Perceived Work-Related Stress and Stress-Related Symptoms
2019-01-10, Gärtner, Anne, Behnke, Alexander, Conrad, Daniela, Kolassa, Iris-Tatjana, Rojas, Roberto
Rescue workers are exposed to enduring emotional distress, as they are confronted with (potentially) traumatic mission events and chronic work-related stress. Thus, regulating negative emotions seems to be crucial to withstand the work-related strain. This cross-sectional study investigated the influence of six emotion regulation strategies (i.e., rumination, suppression, avoidance, reappraisal, acceptance, and problem solving) on perceived work-related stress and stress-related depressive, post-traumatic, and somatic symptoms in a representative sample of 102 German rescue workers. Multiple regression analyses identified rumination and suppression to be associated with more work-related stress and stress-related symptoms. Acceptance was linked to fewer symptoms and, rather unexpectedly, avoidance was linked to less work-related stress. No effects were observed for reappraisal and problem solving. Our findings confirm the dysfunctional role of rumination and suppression for the mental and physical health of high-risk populations and advance the debate on the context-specific efficacy of emotion regulation strategies.
Alterations of the serum N-glycan profile in female patients with Major Depressive Disorder
2018-02-27, Boeck, Christina, Pfister, Sophia, Bürkle, Alexander, Vanhooren, Valerie, Libert, Claude, Salinas-Manrique, Juan, Dietrich, Detlef E., Kolassa, Iris-Tatjana, Karabatsiakis, Alexander
Glycans are short chains of saccharides linked to glycoproteins that are known to be involved in a wide range of inflammatory processes. As depression has been consistently associated with chronic low-grade inflammation, we asked whether patients with Major Depressive Disorder show alterations in the N-glycosylation pattern of serum proteins that might be linked to associated changes in inflammatory processes.
In a study cohort of 21 female patients with an acute depressive episode and 21 non-depressed female control subjects aged between 50 and 69 years, we analyzed the serum N-glycan profile by DNA Sequencer Adapted-Fluorophore Assisted Carbohydrate Electrophoresis (DSA-FACE) and assessed the serum levels of interleukin (IL)− 6, tumor necrosis factor (TNF)-α and C-reactive protein (CRP) by chemiluminescence immunoassays and nephelometry.
Compared to controls, MDD patients showed significant differences in the serum levels of several N-glycan structures. Alterations in the serum N-glycan profile were associated with depressive symptom severity and exploratory analyses revealed that they were most pronounced in MDD patients with a history of childhood sexual abuse. Furthermore, MDD patients showed higher levels of IL-6 and a trend for higher CRP levels, which were also associated with similar alterations in the serum N-glycan profile as those characteristic for MDD patients.
The relatively small sample size and the presence of potential confounders (e.g., BMI, smoking, medication).
The results offer the first evidence that specific differences in the N-glycosylation pattern of serum proteins constitute a so far unrecognized level of biological alterations that might be involved in the immune changes associated with MDD.
Mental Defeat and Cumulative Trauma Experiences Predict Trauma-Related Psychopathology : Evidence From a Postconflict Population in Northern Uganda
2017-11, Wilker, Sarah, Kleim, Birgit, Geiling, Angelika, Pfeiffer, Anett, Elbert, Thomas, Kolassa, Iris-Tatjana
The peritraumatic cognitive process of mental defeat, the complete loss of inner resistance, has been identified as a key predictor of PTSD. Yet, most evidence on cognitive risk factors stems from industrialized countries where survivors typically report few traumata. Research from postconflict settings indicates that individual differences decrease with accumulating traumatic experiences, as almost everybody develops PTSD at extreme levels of trauma load. Would this leave less room for the impact of cognitive processes? In a sample of 227 Ugandan rebel war survivors, we investigated whether mental defeat influences trauma-related psychopathology in regression models accounting for cumulative trauma exposure. We found strong main effects of mental defeat on lifetime PTSD risk, current PTSD severity and dissociative symptoms, but no mental defeat × trauma load interaction effects. Our results indicate that peritraumatic mental defeat is central to understand individual differences in psychological reactions after single traumatic events as well as multiple traumatization.
Genetic variation is associated with PTSD risk and aversive memory : Evidence from two trauma-Exposed African samples and one healthy European sample
2018-11-22, Wilker, Sarah, Schneider, Anna, Conrad, Daniela, Pfeiffer, Anett, Boeck, Christina, Lingenfelder, Birke, Freytag, Virginie, Vukojevic, Vanja, Elbert, Thomas, Kolassa, Iris-Tatjana
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.
Auditory Memory Decay as Reflected by a New Mismatch Negativity Score Is Associated with Episodic Memory in Older Adults at Risk of Dementia
2018, Laptinskaya, Daria, Thurm, Franka, Küster, Olivia C., Fissler, Patrick, Schlee, Winfried, Kolassa, Stephan, von Arnim, Christine A. F., Kolassa, Iris-Tatjana
The auditory mismatch negativity (MMN) is an event-related potential (ERP) peaking about 100-250 ms after the onset of a deviant tone in a sequence of identical (standard) tones. Depending on the interstimulus interval (ISI) between standard and deviant tones, the MMN is suitable to investigate the pre-attentive auditory discrimination ability (short ISIs, ≤ 2 s) as well as the pre-attentive auditory memory trace (long ISIs, >2 s). However, current results regarding the MMN as an index for mild cognitive impairment (MCI) and dementia are mixed, especially after short ISIs: while the majority of studies report positive associations between the MMN and cognition, others fail to find such relationships. To elucidate these so far inconsistent results, we investigated the validity of the MMN as an index for cognitive impairment exploring the associations between different MMN indices and cognitive performance, more specifically with episodic memory performance which is among the most affected cognitive domains in the course of Alzheimer's dementia (AD), at baseline and at a 5-year-follow-up. We assessed the amplitude of the MMN for short ISI (stimulus onset asynchrony, SOA = 0.05 s) and for long ISI (3 s) in a neuropsychologically well-characterized cohort of older adults at risk of dementia (subjective memory impairment, amnestic and non-amnestic MCI;n= 57). Furthermore, we created a novel difference score (ΔMMN), defined as the difference between MMNs to short and to long ISI, as a measure to assess the decay of the auditory memory trace, higher values indicating less decay. ΔMMN and MMN amplitude after long ISI, but not the MMN amplitude after short ISI, was associated with episodic memory at baseline (β= 0.38,p= 0.003;β= -0.27,p= 0.047, respectively). ΔMMN, but not the MMN for long ISIs, was positively associated with episodic memory performance at the 5-year-follow-up (β= 0.57,p= 0.013). The results suggest that the MMN after long ISI might be suitable as an indicator for the decline in episodic memory and indicate ΔMMN as a potential biomarker for memory impairment in older adults at risk of dementia.
Does trauma event type matter in the assessment of traumatic load?
2017-07-06, Conrad, Daniela, Wilker, Sarah, Pfeiffer, Anett, Lingenfelder, Birke, Ebalu, Tracie, Lanzinger, Hartmut, Elbert, Thomas, Kolassa, Iris-Tatjana, Kolassa, Stephan
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.
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.
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 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.
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.