Neurocognitive, emotional and neuroendocrine correlates of exposure to sexual assault in women.

BACKGROUND: Survivors of sexual assault are vulnerable to long-term negative psychological and physical health outcomes, but few studies have investigated changes in cognition, emotional processing and brain function in the early stages after sexual assault. We used a multimodal approach to identify the cognitive and emotional correlates associated with sexual assault in women. METHODS: Twenty-seven female survivors of sexual assault were included within 4 weeks of the traumatic event, and they were compared with 20 age-matched controls. Participants underwent functional MRI while performing cognitive/emotional tasks (n-back, emotional go/no-go, mental imagery). We also measured diurnal salivary cortisol and conducted neuropsychological assessments of attention and memory abilities. RESULTS: Relative to the control group, the survivor group had lower levels of morning cortisol and showed attentional deficits. We observed no between-group differences in brain activation during the n-back or mental imagery tasks. During the emotional go/no-go task, however, the survivor group showed a lack of deactivation in the dorsal anterior cingulate cortex when processing emotional material, relative to neutral material. Exploratory analyses in the survivor group indicated that symptom severity was negatively associated with cerebellar activation when positive emotional (happy) content interfered with response inhibition, and positively associated with cerebellar activation when thinking of positive (happy) memories. LIMITATIONS: The small sample size was the main limitation of this study. CONCLUSION: Dysfunctions in the dorsal anterior cingulate cortex and the cerebellum may represent early functional brain modifications that alter higher cognitive processes when emotional material is involved.

Biological stress indicators as risk markers for increased alcohol use following traumatic experiences.

Alcohol misuse is a common sequela of traumatic event experiences causing considerable morbidity and mortality. Although biological stress indicators have been identified as useful risk markers for the development of trauma-related disorders, no such biological indicators exist for the risk of increased alcohol use after trauma exposure. This is the first study to prospectively investigate the predictive value of long-term cortisol levels and acute stress reactivity for the risk of increased alcohol use following traumatic events. Male soldiers were examined before and 12 months following deployment using a standardized diagnostic interview. We analyzed the moderating role of baseline hair cortisol concentrations (HCCs, n = 153) as well as baseline salivary cortisol and alpha-amylase stress reactivity in response to a laboratory stressor (n = 145) in the association between new-onset traumatic events (according to the DSM-IV A1 criterion) and subsequent daily alcohol use. No main effects of pre-traumatic HCC or salivary stress markers on subsequent change in alcohol use were observed. However, we found that with decreasing HCC, the number of new-onset traumatic events was more strongly associated with subsequent alcohol use independent from changes in posttraumatic stress disorder symptoms. No such relation was seen for the acute stress reactivity data. Taken together, this study provides first evidence suggesting that individual differences in long-term cortisol regulation are involved in the association between traumatic experiences and subsequent alcohol use. HCC may thus serve as a potential target in the early identification of individuals vulnerable for increased alcohol use following traumatic events.

Depressive Symptoms and Salivary Telomere Length in a Probability Sample of Middle-Aged and Older Adults.

OBJECTIVE: To examine the association between depressive symptoms and salivary telomere length in a probability sample of middle-aged and older adults, and to evaluate age and sex as potential moderators of this association and test whether this association was incremental to potential confounds. METHODS: Participants were 3,609 individuals from the 2008 wave of the Health and Retirement Study. Telomere length assays were performed using quantitative real-time polymerase chain reaction on DNA extracted from saliva samples. Depressive symptoms were assessed via interview, and health and lifestyle factors, traumatic life events, and neuroticism were assessed via self-report. Regression analyses were conducted to examine the associations between predictor variables and salivary telomere length. RESULTS: After adjusting for demographics, depressive symptoms were negatively associated with salivary telomere length (b = -.003; p = .014). Furthermore, this association was moderated by sex (b = .005; p = .011), such that depressive symptoms were significantly and negatively associated with salivary telomere length for men (b = - .006; p < .001) but not for women (b = - .001; p = .644). The negative association between depressive symptoms and salivary telomere length in men remained statistically significant after additionally adjusting for cigarette smoking, body mass index, chronic health conditions, childhood and lifetime exposure to traumatic life events, and neuroticism. CONCLUSIONS: Higher levels of depressive symptoms were associated with shorter salivary telomeres in men, and this association was incremental to several potential confounds. Shortened telomeres may help account for the association between depression and poor physical health and mortality.

Age of Trauma Onset and HPA Axis Dysregulation Among Trauma-Exposed Youth.

The hypothalamic-pituitary-adrenal axis (HPA axis) is a pathway through which childhood trauma may increase risk for negative health outcomes. The HPA axis is sensitive to stress throughout development; however, few studies have examined whether timing of exposure to childhood trauma is related to differences in later HPA axis functioning. Therefore, we examined the association between age of first trauma and HPA axis functioning among adolescents, and whether these associations varied by sex. Parents of 97 youth (aged 9-16 years) completed the Early Trauma Inventory (ETI), and youth completed the Socially-Evaluated Cold-Pressor Task (SECPT). We measured salivary cortisol response to the SECPT, the cortisol awakening response, and diurnal regulation at home across 2 consecutive weekdays. Exposure to trauma during infancy related to delayed cortisol recovery from peak responses to acute stress, d = 0.23 to 0.42. Timing of trauma exposure related to diverging patterns of diurnal cortisol regulation for males, d = 0.55, and females, d = 0.57. Therefore, the HPA axis may be susceptible to developing acute stress dysregulation when exposed to trauma during infancy, whereas the consequences within circadian cortisol regulation may occur in the context of later trauma exposure and vary by sex. Further investigations are warranted to characterize HPA axis sensitivity to exposure to childhood trauma across child development.

Salivary oxytocin after oxytocin administration: Examining the moderating role of childhood trauma.

Although oxytocin administration influences behavior, its effects on peripheral oxytocin concentrations are mixed and derived from studies on healthy subjects. Additionally, trauma attenuates the behavioral effects of oxytocin, but it is unknown whether it also influences its effect on peripheral circulation. This study examined whether salivary oxytocin increased after oxytocin administration and whether trauma attenuated this effect. We conducted a randomized, double-blind, placebo-controlled, within-subjects study in 100 male adolescents living in residential youth care facilities. Participants self-administered intranasally 24 IU of oxytocin and placebo (one week later) and provided a saliva sample before and 15 min after administration. Salivary oxytocin increased significantly after oxytocin administration, but this effect might be inflated by exogenous oxytocin reaching the throat. Trauma did not moderate this effect. Our findings suggest that trauma did not attenuate the effect of oxytocin administration on salivary oxytocin, but more robust methodologies are recommended to draw more solid conclusions.

Early traumatic experiences impair the functioning of both components of the endogenous stress response system in adult people with eating disorders.

Childhood trauma is a non-specific risk factor for eating disorders (EDs). It has been suggested that this risk is exerted through trauma-induced long-lasting changes in the body stress response system. Therefore, we explored the activity of the hypothalamus-pituitary-adrenal axis and of the sympathetic nervous system in adult ED patients with or without a history of childhood trauma exposure. Salivary cortisol and alpha-amylase, a marker of the sympathetic nervous system activity, were measured at awakening and after 15, 30 and 60 min in 35 women with EDs. The Childhood Trauma Questionnaire (CTQ) was employed to assess exposure to childhood trauma and, according to the CTQ cut-off scores, 21 ED women were classified as maltreated (Mal) participants and 14 women as no-maltreated (noMal) ED participants. Compared to noMal ED women, Mal ED participants showed significantly decreased cortisol awakening response (between group difference: p = 0.0003) and morning salivary alpha-amylase secretion (between group difference: p = 0.02). Present results confirm that the cortisol awakening response of adult ED patients with childhood trauma exposure is lower than that of adult ED patients without childhood trauma experiences and show for the first time that also the morning secretion of salivary alpha-amylase is decreased in adult ED patients who have been exposed to early traumatic experiences. These results point for the first time to a dampening in the basal activity of both components of the endogenous stress response system in childhood maltreated adult ED women.

Effects of childhood trauma on cortisol levels in suicide attempters and ideators.

OBJECTIVES: Suicide is a global health issue. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, has been identified as one potential risk factor for suicide. Recent evidence has indicated that blunted cortisol reactivity to stress is associated with suicidal behavior. The current study investigated whether childhood trauma was associated with blunted cortisol reactivity to a laboratory stressor and resting cortisol levels in suicide attempters and ideators. METHODS: 160 Participants were recruited and grouped according to history of previous suicidal attempt, suicidal ideation or as control participants. Participants completed background questionnaires, including the Childhood Trauma Questionnaire, before completing a laboratory stress task. Cortisol levels were assessed at rest and during the stress task. RESULTS: The highest levels of childhood trauma were reported in those who had attempted suicide (78.7%), followed by those who thought about suicide (37.7%) and then those with no suicidal history (17.8%). Moreover, regression analyses showed that childhood trauma was a significant predictor of blunted cortisol reactivity to stress and resting cortisol levels, such that higher levels of trauma were associated with lower cortisol levels in those with a suicidal history. Family history of suicide did not interact with the effects of childhood trauma on cortisol levels. CONCLUSIONS: These results indicate that childhood trauma is associated with blunted HPA axis activity in vulnerable populations in adulthood. The challenge for researchers is to elucidate the precise causal mechanisms linking trauma, cortisol and suicide risk and to investigate whether the effects of childhood trauma on cortisol levels are amendable to psychological intervention.

The role of childhood trauma and stress reactivity for increased alcohol craving after induced psychological trauma: an experimental analogue study.

BACKGROUND: Traumatic events are associated with alcohol use problems with increased alcohol craving as a potential mediator. There is still a lack of knowledge regarding the causal nature of this association and its underlying mechanisms. This study investigated the effects of acute trauma exposure on alcohol craving in healthy individuals considering the role of stress reactivity and childhood trauma (CT) using a laboratory randomized controlled design. METHODS: Ninety-five healthy participants were randomly exposed to a trauma or a neutral film. History of CT, and pre- to post-film changes in craving (craving reactivity, CR), anxiety, skin conductance, heart rate, and saliva cortisol levels were assessed. Moreover, associations between trauma film exposure and CR, the moderating role of CT, and associations between CT, stress reactivity, and trauma-induced CR were analyzed. RESULTS: Relative to the neutral film, the trauma film elicited an increase in CR in females but not in males. In males but not in females, the association between trauma film exposure and CR was moderated by CT, with trauma-induced CR increasing with the number of CT. In males, CT was related to decreased cortisol reactivity and increased heart rate and skin conductance response of which skin conductance was also associated with CR. DISCUSSION: These findings provide further evidence for a causal link between traumatic experiences and CR. While this association seems to be stronger in females, males might still be at risk in case of other vulnerability factors such as CT, with altered sympathetic stress reactivity as a potential contributing mechanism.

Utilization of machine learning for prediction of post-traumatic stress: a re-examination of cortisol in the prediction and pathways to non-remitting PTSD.

To date, studies of biological risk factors have revealed inconsistent relationships with subsequent post-traumatic stress disorder (PTSD). The inconsistent signal may reflect the use of data analytic tools that are ill equipped for modeling the complex interactions between biological and environmental factors that underlay post-traumatic psychopathology. Further, using symptom-based diagnostic status as the group outcome overlooks the inherent heterogeneity of PTSD, potentially contributing to failures to replicate. To examine the potential yield of novel analytic tools, we reanalyzed data from a large longitudinal study of individuals identified following trauma in the general emergency room (ER) that failed to find a linear association between cortisol response to traumatic events and subsequent PTSD. First, latent growth mixture modeling empirically identified trajectories of post-traumatic symptoms, which then were used as the study outcome. Next, support vector machines with feature selection identified sets of features with stable predictive accuracy and built robust classifiers of trajectory membership (area under the receiver operator characteristic curve (AUC)=0.82 (95% confidence interval (CI)=0.80-0.85)) that combined clinical, neuroendocrine, psychophysiological and demographic information. Finally, graph induction algorithms revealed a unique path from childhood trauma via lower cortisol during ER admission, to non-remitting PTSD. Traditional general linear modeling methods then confirmed the newly revealed association, thereby delineating a specific target population for early endocrine interventions. Advanced computational approaches offer innovative ways for uncovering clinically significant, non-shared biological signals in heterogeneous samples.

Salivary biomarkers of neural hypervigilance in trauma-exposed women.

OBJECTIVES: More than half of all adults will be exposed to a traumatic event at some point in their lives, yet we do not yet have reliable biomarkers to help predict who experiences trauma-related symptoms in response to exposure. We tested the utility of salivary cortisol and salivary alpha amylase as markers of (1) neural reactivity to negative affective information and (2) neural hypervigilance in the absence of threat. PARTICIPANTS: 20 women (mean age 23.6 +/- 5.8 years) with a history of trauma exposure. MEASURES: Salivary cortisol and alpha amylase reactivity were measured in response to a trauma reminder during a clinical interview. Neural reactivity to novel and familiar affective scenes was measured in a later session using functional magnetic resonance imaging. RESULTS: Salivary alpha amylase, but not cortisol, increased in response to the trauma reminder. Salivary alpha amylase reactivity was associated with neural reactivity in the salience network in response to novel negative scenes and neural hypervigilance as indexed by reactivity to novel neutral scenes. CONCLUSIONS: Salivary alpha amylase might serve as a more reliable marker of trauma-related reactivity to negative affective information, and also as a marker of hypervigilance in the absence of threatening information.