Estradiol, stress reactivity, and daily affective experiences in trauma-exposed women.

OBJECTIVE: Women experience higher risk for PTSD following trauma compared with men. Fluctuations in ovarian hormones might contribute to this greater vulnerability, given that estradiol is associated with affect and stress reactivity. Our objective was to test the relations between menstrual cycle-related changes in estradiol, affect, stress reactivity, and trauma-related symptoms. METHOD: We assessed trauma-related symptoms in ethnically diverse naturally cycling women with a history of trauma during a clinical interview. Participants also completed a 10-day ecological momentary assessment (EMA) that included lower- and higher-estradiol phases. We tested associations between estradiol and PTSD symptoms and stress reactivity to a trauma reminder using Spearman correlation and Wilcoxon rank-sum tests. We tested the effect of menstrual cycle day on daily affect using multilevel modeling. RESULTS: Estradiol was negatively associated with symptom severity (rs = -.36), and participants in low- versus high-estradiol cycle phases at interview had higher sympathetic (r = .35) and lower hypothalamic-pituitary-adrenal axis (r = .41) reactivity. Across the EMA period, participants showed a decrease in daily PTSD symptoms (b = -.39), negative (b = -.11) and positive (b = -.24) affect, and variability in daily valence (b = -.07) and arousal (b = -.08), from the low- to high-estradiol phase. CONCLUSIONS: Consistent with prior evidence of more aversive affective experiences in low-estradiol states, lower estradiol was associated with higher trauma-related symptoms. In addition, trauma-exposed women showed a discordant pattern of stress reactivity to a trauma reminder, higher daily symptoms, and greater affective lability in a low-estradiol phase. Given that our sample consisted of high-functioning trauma-exposed women, these results should be replicated in women with PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Trauma Characteristics Moderate the Relation Between Estradiol and Trauma-Related Symptoms.

Women are more likely to develop posttraumatic stress disorder (PTSD) than men, and fluctuations in gonadal hormones might contribute to this vulnerability. Low-estradiol states are associated with aversive affective experiences, including trauma-related symptoms. However, the impact of trauma characteristics on the relation between estradiol and trauma-related symptoms is unknown. We used a clinical interview and 10-day ecological momentary assessment (EMA) that spanned low- and high-estradiol menstrual cycle phases to test trauma type, chronicity, and timing as moderators of the association between estradiol and trauma-related symptoms in 40 naturally cycling young women. We tested interactions between trauma characteristics and (a) estradiol on self-reported symptoms and (b) menstrual cycle-related change in estradiol on change in symptoms. Sexual, chronic, and earlier trauma was associated with more severe symptoms as reported during the interview, rs = .51-.33, but not mean symptoms across the EMA. Estradiol at the time of the interview was inversely associated with symptoms in women with sexual but not nonsexual trauma, interaction: B = -12.62 (SE = 5.28), p = .022. Menstrual cycle-related change in estradiol was inversely associated with change in symptoms in women with chronic trauma, B = -9.65 (SE = 3.49), p = .006, and earlier trauma, B = 0.71 (SE = 0.34), p = .036, but not discrete or later trauma. Sexual, chronic, or early trauma exposure might confer higher symptom vulnerability in low-estradiol states. Clinicians who work with women with particular trauma histories might anticipate menstrual cycle-related variation in symptoms.

Estradiol and Women's Health: Considering the Role of Estradiol as a Marker in Behavioral Medicine.

The sex hormone estradiol, as measured through saliva, represents a non-invasive and cost-effective approach to understanding the influence of hormonal factors on physical and psychological well-being among women. Estradiol levels dramatically change at hormonal transitions, such as puberty, menopause, and postpartum. It is at these transitions where women are at increased risk for psychological and somatic distress. Salivary estradiol also has implications for decision-making and has been broadly associated with engagement in health-compromising behaviors which can influence women's ability to cope with and manage chronic health conditions. This review summarizes the evidence for salivary estradiol as a marker of physical and psychological health, and discusses practical information regarding saliva collection and assay. The overall intent is to expand and clarify knowledge of the relation between changes in salivary estradiol and women's health as well as to provide a means of integrating salivary estradiol into future behavioral medicine research.

Salivary Biomarkers of Parenting Stress in Mothers Under Community Criminal Justice Supervision.

BACKGROUND: Community criminal justice supervised mothers are an underserved population who experience high rates of psychological distress and unique parenting challenges, but little is known about physiological stress system function in this population. OBJECTIVE: We tested the salivary biomarkers of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis function as predictors of subjective maternal stress. METHOD: We recruited 23 mothers (age: M = 35.6 years, SD = 9.3 years; 35% Hispanic, 22% Black, 22% White, 22% multiracial) who were court mandated to a residential treatment center. We measured salivary alpha-amylase (AA) and cortisol, which index SNS and HPA activity, respectively, before and after a naturalistic reminder of a stressful parenting experience. We assessed self-reported parenting stress using the Parenting Stress Index-Short Form (PSI-SF) subscales Parental Distress, Parent-Child Dysfunctional Interactions, and Difficult Child. We used regression to test AA and cortisol mean levels and reactivity as predictors of subscale scores. RESULTS: Mean, but not reactive, salivary stress biomarker levels were associated with parenting stress domains. Mean cortisol levels predicted scores on the Parent-Child Dysfunctional Interaction subscale (adj. R = .48), whereas mean AA predicted Difficult Child subscale scores (adj. R = .28). DISCUSSION: Our results demonstrate the potential predictive utility of AA and cortisol as salivary biomarkers of maternal stress in community-supervised mothers. Given that maternal stress is associated with criminal recidivism and child behavioral health in this population, these biomarkers could potentially inform interventions to improve dyadic health and social outcomes.

Resting amygdala connectivity and basal sympathetic tone as markers of chronic hypervigilance.

BACKGROUND: Chronic hypervigilance, a state of sustained alertness and hyperarousal in the absence of threat, has been shown to predict poorer clinical outcomes post-trauma. An exaggerated and persistent amygdala alerting response to affective information has been proposed as a reactivity-based, and thus indirect, marker of hypervigilance. However, because chronic hypervigilance is a persistent rather than reactive state, it should be directly observable under resting-state conditions without the need for exposure to affectively charged stimuli. OBJECTIVE: We tested resting amygdala connectivity and basal sympathetic and hypothalamic-pituitary-adrenal axis activity as direct neural and neuroendocrine markers of chronic hypervigilance. PARTICIPANTS: 24 trauma-exposed women (age M = 22.9, SD = 5.5) and 20 no-trauma controls (age M = 21.1, SD = 3.2). MEASURES: Amygdala connectivity was measured using functional magnetic resonance imaging at rest and during viewing of novel and familiar affective scenes. Elevated amygdala connectivity during the viewing of novel scenes (exaggerated alerting response) and familiar scenes (persistent alerting response) was used as a reactivity-based index of hypervigilance. Resting amygdala connectivity and basal salivary alpha-amylase (sAA) and cortisol were tested as neural and neuroendocrine markers of hypervigilance, respectively. RESULTS: Compared to no-trauma controls, trauma-exposed women showed greater connectivity between the left amygdala and the ventral anterior cingulate cortex (vACC) both during affective processing and at rest. Exaggerated neural novelty response was associated with greater resting left amygdala-vACC connectivity and higher basal sAA, but not cortisol. CONCLUSIONS: Greater synchronization of threat-detection circuitry in the absence of threat and basal sympathetic tone might serve as complementary resting-state markers of the cognitive and physiological components of chronic hypervigilance, respectively.