Rest After Trauma May Help Decrease PTSD Symptoms

New research suggests a period of rest following a traumatic event can help reduce the subsequent development of involuntary “memory intrusions,” a frequent symptom of post-traumatic stress disorder. Memory intrusions can be both visual or non-visual and are often referred to as flashbacks.

The study, published in Scientific Reports, discovered memory disturbances in PTSD may be mitigated by a process that occurs in the brain that can be facilitated by rest and sleep. Specifically, investigators discovered increased consolidation — storage and contextualization of memories in the brain — helps to alleviate memory intrusions. Experts believe this finding could shed new light on treatment and prevention.

Lead author Dr. Lone Hørlyck, from the Institute of Cognitive Neuroscience at University College London, said, “Over a lifetime, many people experience traumatic events, but most people do not develop persistent trauma symptoms.

“Identifying which mechanisms might contribute to memory intrusions in PTSD is important, as these disturbances comprise an important maintaining factor in the disorder.”

For the study, researchers presented 85 participants with emotionally negative videos, followed by either a period of wakeful rest or a simple control task, where participants were required to pay attention to numbers on a screen.

The videos comprised highly emotional content, such as badly injured people or serious accidents.

Researchers found that participants who had a period of rest following the viewing of negative videos reported fewer memory intrusions related to the videos over the following week.

In contrast, there was no difference between rest and the simple control task on a follow-up memory test assessing how much participants remembered when they wanted to.

Rest and certain phases of sleep are known to increase processing in the hippocampus, a key region of the brain that helps put memory in context.

According to the investigators, the results suggest that a strengthening of this contextual memory system is beneficial in preventing memory intrusions following trauma.

Senior author Professor Neil Burgess, of the Institute of Cognitive Neuroscience, said, “The coherence of memories is often compromised when people are exposed to psychological trauma, resulting in emotional memories popping up involuntarily and out of context.

“However, the binding of an event memory with its context may be partly restored with rest, facilitating deliberate control of the memory.

“The results show that specific brain systems could be targeted to reduce development of PTSD and may explain why treatments that focus on re-exposure and integrating the trauma with other information are beneficial.”

Hørlyck added, “Our findings contribute to a better understanding of the mechanisms that are at play when some people develop memory disturbances following trauma while others do not.”

Source: University College London/EurekAlert

Large Study Shows PTSD Has Strong Genetic Component

In the largest and most diverse genetic study to date of post-traumatic stress disorder (PTSD), scientists reveal that PTSD has a strong genetic component similar to other psychiatric disorders.

The findings are published in the journal Nature Communications.

Despite much research, it has remained unclear why some people go on to develop PTSD after a traumatic event while others do not. Some researchers suggest that the disorder is only a social construct, but other studies point to the fact that genetics may be involved.

In the new study, researchers from the University of California (UC) San Diego School of Medicine and more than 130 additional institutions participating in the Psychiatric Genomics Consortium suggest that genetics may account for between five and 20 percent of the variability in PTSD risk following exposure to a traumatic event.

“Our long-term goal is to develop tools that might help clinicians predict who is at greatest risk for PTSD and personalize their treatment approaches,” said the study’s first and corresponding author Caroline Nievergelt, Ph.D., associate professor of psychiatry at UC San Diego School of Medicine and associate director of neuroscience in the Center of Excellence for Stress and Mental Health at the Veterans Affairs San Diego Healthcare System.

“We can’t always protect people from trauma. But we can treat them in the best ways possible, at the best time.”

The findings show that, like other psychiatric disorders and many other human traits, PTSD is highly polygenic, meaning it is associated with thousands of genetic variants throughout the genome, each making a small contribution to the disorder.

According to the findings, six genomic regions called “loci” contain variants strongly associated with disease risk, providing some clues about the biological pathways involved in PTSD.

“Based on these findings, we can say with certainty that there is just as much of a genetic component to PTSD risk as major depression and other mental illnesses,” said senior author Dr. Karestan Koenen, associate member of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard.

“Our limited ability to study the living human brain and uncover the biological roots of PTSD has contributed to the lack of treatments and the stigma around this debilitating condition. Genetics helps us make new discoveries, find opportunities for new therapies, and counter that stigma,” she said.

Since many behavioral traits and psychiatric disorders have some shared genetic factors, the researchers also looked for genetic correlations between PTSD and 235 other disorders, behaviors and physical traits. They discovered significant overlap with 21, including depression, schizophrenia, neuroticism, insomnia, asthma and coronary artery disease.

“Similar to other mental disorders, the genetic contribution to PTSD correlates with that for many other traits,” said Koenen, who is also professor of psychiatric epidemiology in the Harvard T.H. Chan School of Public Health. “Further research is needed to determine what this means — whether some of the same genes that influence risk for PTSD also influence risk for other diseases like, for example, depression.”

To conduct the study, the team collaborated with the Psychiatric Genomics Consortium’s PTSD working group and Cohen Veterans Bioscience, a non-profit organization dedicated to accelerating PTSD and traumatic brain injury research.

The team built an international network of more than 200 researchers, assembling data and DNA samples from more than 60 groups of people with PTSD and control subjects, including the UK Biobank.

The data included more than 200,000 people, which is 10 times larger than the first Psychiatric Genomics Consortium PTSD study, published in 2017. The study group is also the most ancestrally diverse for any psychiatric genetics study to date, with more than 23,000 people with PTSD of European ancestry and more than 4,000 of African ancestry. It also included both civilians and members of the military.

“Our study is distinguished by the fact that it’s international and is highly diverse,” Nievergelt said. “There’s greater representation here than in most studies to date.”

The team used the data to conduct a genome-wide association study (GWAS), using statistical tests to measure the effect of common genetic variants at millions of points across the genome on someone’s likelihood of developing PTSD.

The study uncovered DNA variants at six loci that were significantly tied to PTSD risk. Three of the six loci were specific to certain ancestral backgrounds — two European and one African — and three were only detected in men.

The six loci hint that inflammatory and immune mechanisms may be at play in the disorder, which is consistent with findings from previous research.

Overall, the researchers conclude that PTSD’s heritability — the level of influence genetics has on the variability of PTSD risk in the population — is between five and 20 percent, with some variability by gender. These findings were similar across different ancestral groups.

The research team also developed a polygenic score that could potentially predict one’s risk of developing PTSD following a traumatic event. Polygenic scores take into account the effects of millions of genetic variations and create a measure that can predict a person’s risk of developing a certain trait or disorder.

The team tested their scores on data from men in the UK Biobank dataset, finding that those with the highest scores had 0.4-fold greater odds of developing than those with the lowest scores.

Similarly, when applied to data from the Million Veterans Program — a study of how genes, lifestyle and military exposures impact health and illness — individuals with the highest scores had a significant increase in re-experiencing traumatic memories — a key PTSD symptom.

The researchers assert that polygenic scores are not ready for clinical use. Even larger studies with more diverse datasets are needed to improve the accuracy of PTSD prediction and confirm the genetic findings.

Source: University of California- San Diego

 

Kids Bullied by Siblings May Have Mental Health Issues in Early 20s

UK researchers have discovered that kids bullied at home and at school are more likely to have mental health issues in young adulthood. Investigators found that depression, self-harm and suicidal ideation are more prominent in young adults if they were bullied.

Notably, even sibling bullying can be harmful as it often leads to peer bullying and then issues later in life. Experts stress that education of parents and mental health professionals is necessary to mitigate what may have previously been viewed as harmless banter between siblings.

The new findings are not without precedent as previous studies have identified that sibling bullying has an effect on mental health in adolescence. However, University of Warwick researchers Professor Dieter Wolke and Dr. Slava Dantchev have now found that children who were bullied by siblings and friends are more likely to harm themselves.

The paper appears in the journal Frontiers in Psychiatry. The research shows that sibling bullying can lead to on self-harm, suicide attempts and depression at 24 years of age.

Using the Children of the 90s study, they were able to show that children who were bullied by siblings had more mental health issues in adulthood. If they were also bullied by peers this risk increased further.

The participants were asked to self-report bullying when they were 12 years old; depression, anxiety, suicidal ideation and self-harm were assessed at 24 years old.

Of 3,881 youths studied it was found that 31.2% experienced bullying by a sibling. Of those who both became victims and bullied siblings 15.1% were diagnosed with clinical depression, 35.7% experienced suicidal ideation and 16.1% self-harmed with a further 4.9% with the intent of suicide.

Those who experienced sibling bullying and peer bullying had double the odds of developing clinical depression and consider suicide.

Dantchev said this is the first study to show that being bullied by siblings has adverse effects on mental health into adulthood, when the siblings are not living together anymore. “Those bullied at home are also more likely to be bullied by peers and have no safe space at school or at home. This further increased their torment and affected their mental health.”

Wolke also commented, “As sibling bullying often starts when children are young it will be important to educate and help parents to deal and reduce bullying between siblings in early childhood. This is an area which has been completely overlooked in mental health provision and parent support.”

Source: University of Warwick

Many Patients Hide Life-Threatening Issues From Their Doctors

A new study finds that many patients who have faced domestic violence, sexual assault, depression or thoughts of suicide are likely to hide this information from their healthcare providers.

The findings, published online in JAMA Network Open, show that up to 47.5 percent of patients who have experienced one or more of these four threats do not disclose this critical information to care providers out of embarrassment, fear of judgment or the possible long-term implications of sharing such information.

Understanding how to make patients feel more comfortable with clinicians is key to helping patients address such life-threatening risks, says the study’s senior author Angela Fagerlin, PhD, chair of the department of Population Health Sciences at the University of Utah Health.

“For primary care providers to help patients achieve their best health, they need to know what the patient is struggling with,” says Fagerlin. For example, patients who withhold they have been sexually assaulted are potentially at risk for post-traumatic stress disorder and sexually-transmitted diseases, she explains.

“There are numerous ways providers can help patients, such as getting resources, therapy and treatment.”

The study involved more than 4,500 people in two national online surveys from 2015. Participants in one survey averaged 36 years old, while participants from the second had a median age of 61.

The respondents reviewed a list of medically relevant information and were asked to indicate whether they had ever withheld this information from a clinician. They were also asked the reasons why they withheld the information.

The surveys show that 40 to 47.5 percent of participants chose not to tell their provider that they had experienced at least one of the four threats. Over 70 percent said the reason why was embarrassment or fear of being judged or lectured.

If the patient was female or younger, the odds were higher they would keep this information to themselves. What compounds this issue is that several recent studies have shown how health care providers downplay or fail to take seriously women’s medical complaints.

One limitation noted by the study’s first author, Andrea Gurmankin Levy, PhD, MBe, a professor in social sciences at Middlesex Community College in Middletown, Connecticut, is that study participants may have not shared in their survey responses all the information they withheld, meaning that this phenomenon may be even more prevalent than the study reveals.

Levy says the survey reinforces that there is discomfort and a lack of trust between patients and providers. If patients filled out a questionnaire about sensitive information when they arrive at the provider’s office, might that improve the information flow? For example, is it easier to tell a piece of paper something sensitive than to look into your clinician’s eyes and say it?

This is the team’s second article based on the 2015 surveys. The first, published in November 2018, revealed that 60 to 80 percent of those surveyed did not share pertinent information with their provider regarding daily issues like diet and exercise. One third did not speak up when they disagreed with their provider’s recommendations.

Both surveys raise concerns about communication and trust between patients and their caregivers. Improving this relationship falls both on providers’ and patients’ shoulders, the authors say.

Providers need to establish an atmosphere where the patient feels neither judged nor rushed, but rather are able to share concerns fundamental to their well-being. In addition, patients will benefit by sharing sensitive information with their providers.

Researchers from University of Utah Health, Middlesex Community College, University of Michigan and University of Iowa collaborated on the study.

Source: University of Utah Health

Traumatized Adults May Find Touch, Closeness Less Appealing

Adults who were traumatized as children may be more likely to keep a greater physical distance between themselves and strangers, and may also find touch stimuli less comforting than people without a history of trauma, according to a team of researchers from Bonn University Hospital (UKB) and Ruhr University Bochum in Germany.

Research has shown that people who have been humiliated, beaten or sexually abused in childhood are more likely to suffer from mental illnesses such as depression or anxiety attacks in adulthood than those without a history of abuse.

But according to controlled analyses, these mental disorders are not responsible for the stronger aversion to touch and closeness — but rather the traumatization itself.

The findings, published in the American Journal of Psychiatry, suggest that experiences of violence as a child may lead to a permanently changed perception of social stimuli.

The study involved 92 adults (64 women) who were interviewed about their experiences with violence and accompanying illnesses.

The researchers tested sensory perception by stroking the bare skin of the shins with one hand with either a fast or a slower movement.

“Touch is of central importance because it influences brain development, provides a feeling for one’s own body and serves as a stress regulator,” said Dr. Dirk Scheele of the UKB’s Division of Medical Psychology.

Interpersonal contact is mediated via two different nerve fibers in the skin: Aß fibers transmit sensory information and respond primarily to faster touches, while C tactile fibers transmit emotional well-being and are activated primarily by slow touches, said  lead author and doctoral student Ayline Maier.

The participants lay in the brain scanner during the experiments and could not see the experimenter who performed the movements. His hands were in cotton gloves to avoid direct skin contact. The functional magnetic resonance imaging system recorded the activity of the brain areas. After each measurement, the subjects were asked how comforting the touches were.

The more pronounced the maltreatment experiences during childhood, the more strongly two brain regions reacted to rapid touches. The somatosensory cortex is located in the brain approximately above the ear and registers where a touch occurs.

“This area encodes haptic sensations and is involved in the preparation and initiation of body movement — for example, pulling away the leg that has been touched,” Maier said.

The posterior insula cortex is an area deep in the brain behind the temple that is responsible for all body perceptions such as touch, hunger, thirst and pain.

“In traumatized people, the activity in these two areas in response to rapid touches is significantly increased,” Scheele said.

On the other hand, activation in the hippocampus was much weaker during slow touches in those with a history of abuse. The hippocampus serves the formation of memory and thus also stores negative and positive associations of stimuli.

“Specifically, the activity of the hippocampus could reflect how rewarding a touch was in the experiment,” said Maier. More traumatized participants might find a slow and thus more emotionally charged touch less pleasant.

The researchers also investigated social distance. The participants were asked to walk up to a person they did not know and to stop when the distance was just about perceived as pleasant. It was significantly larger in more severely traumatized people —  on average by twelve centimeters.

“The results show that the perception and sensory processing of people with traumatic childhood experiences have changed,” Scheele said, summarizing the results. Touching is less comforting in those with a trauma history compared to those without maltreatment experience.

Maier said, “This result may also open up opportunities for new therapies: Supplementary body-based therapies in a safe environment could make it possible to retrain this stimulus processing.” However, this potential would first have to be investigated in more detail in further studies.

Source: University of Bonn

Study: Trans College Students Far More Likely to Have Mental Health Issues

A new study has found that gender minority students, whose gender identity differs from the sex assigned them at birth, are between two and four times more likely to experience mental health problems than their peers.

“There has never been a more important time for colleges and universities to take action to protect and support trans, genderqueer, and nonbinary students on campus,” said study lead author Dr. Sarah Ketchen Lipson, a Boston University School of Public Health assistant professor of health law, policy & management.

For the study, the researchers looked at rates of depression, anxiety, eating disorders, self-injury, and suicidality in a sample of more than 1,200 gender minority students from 71 colleges and universities.

About 78 percent of the gender minority students included in the study met the criteria for one or more mental health problems, with nearly 60 percent screening positive for clinically significant depression, compared to 28 percent of cisgender students, whose sex assigned at birth aligns with their current gender identity.

The findings stem from an analysis of two waves of data collected between fall 2015 and spring 2017 through the Healthy Minds Study, a national, annual survey about campus mental health that Lipson co-leads with University of Michigan colleague Daniel Eisenberg.

The Healthy Minds Study, which more than 300,000 US college students have voluntarily taken since its launch in 2007, uses clinically validated methods of screening for symptoms of depression, anxiety, eating disorders, and other mental health concerns.

The survey includes space for participants to fill in their assigned gender at birth as well as their current gender identity, which allowed the researchers to filter their analysis and focus on the collective mental health of gender minority students.

“Reports that more than 40 percent of transgender people have attempted suicide in their lifetimes suggested, to me, that there is a large and disproportionate burden of disease among [people in the gender minority] that public health research can contribute to addressing,” said Dr. Julia Raifman, BU School of Public Health assistant professor of health law, policy & management.

According to the researchers, the findings from the Healthy Minds Study reinforce the disparities facing gender minority students revealed by other research, which has shown that college dropout rates are higher among transgender students, and that they experience near-constant discrimination and harassment.

Bathrooms and housing are some of the most stressful areas on college campuses for transgender students, with research showing that transgender college students are at significantly higher risk for suicide and attempted suicide when denied access to gender-appropriate bathrooms and housing on college campuses.

“Mental health outcomes, as well as negative educational outcomes like dropping out, are preventable,” says Lipson. “The most effective way to prevent them would be, from my perspective, through policy changes. Inclusive policies are necessary to advance equity. And that’s what I really want these data to speak to.”

The researchers add they hope that officials in higher education will use the study’s results as a springboard for more urgent action, such as addressing gender minority needs in housing policies, creating or revising policies that allow students to change their name in campus records, improving mental health resources on campuses, and raising awareness of gender minority issues.

The researchers plan to continue using data from the Healthy Minds Study with the eventual goal of recording longitudinal data that follows gender minority students throughout their college experience, examining mental health alongside individual, institutional, and societal factors. They say additional research is also needed to explore the intersectionality of gender identities with other identities, such as race or religious beliefs.

“We are in a time when transgender people are being denied equal rights to jobs, to housing, to healthcare, and to participation in the military. These data suggest that new policies eliminating equal rights for transgender people are affecting a population that already experiences a disproportionate burden of disease,” said Raifman, referring to recent actions initiated by the Trump administration, such as banning transgender individuals from serving in the military and rolling back Obama-era rules intended to protect transgender individuals from discrimination.

“As next steps, it will be important to evaluate whether equal rights or the elimination of equal rights for transgender people affects mental health disparities,” she concluded.

The study was published in the American Journal of Preventive Medicine.

Source: Boston University