Adult Traumatic Events Research Articles

New Evidence for the Role of the Blood-Brain Barrier and Inflammation in Stress-Associated Depression: A Gene-Environment Analysis Covering 19,296 Genes in 109,360 Humans.

Mounting evidence supports the key role of the disrupted integrity of the blood-brain barrier (BBB) in stress- and inflammation-associated depression. We assumed that variations in genes regulating the expression and coding proteins constructing and maintaining this barrier, along with those involved in inflammation, have a predisposing or protecting role in the development of depressive symptoms after experiencing severe stress. To prove this, genome-by-environment (GxE) interaction analyses were conducted on 6.26 M SNPS covering 19,296 genes on PHQ9 depression in interaction with adult traumatic events scores in the UK Biobank (n = 109,360) in a hypothesis-free setup. Among the 63 genes that were significant in stress-connected depression, 17 were associated with BBB, 23 with inflammatory processes, and 4 with neuroticism. Compared to all genes, the enrichment of significant BBB-associated hits was 3.82, and those of inflammation-associated hits were 1.59. Besides some sex differences, CSMD1 and PTPRD, encoding proteins taking part in BBB integrity, were the most significant hits in both males and females. In conclusion, the identified risk genes and their encoded proteins could provide biomarkers or new drug targets to promote BBB integrity and thus prevent or decrease stress- and inflammation-associated depressive symptoms, and possibly infection, e.g., COVID-19-associated mental and neurological symptoms.

Childhood adversities and risk of posttraumatic stress disorder and major depression following a motor vehicle collision in adulthood.

Childhood adversities (CAs) predict heightened risks of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) among people exposed to adult traumatic events. Identifying which CAs put individuals at greatest risk for these adverse posttraumatic neuropsychiatric sequelae (APNS) is important for targeting prevention interventions. Data came from n = 999 patients ages 18-75 presenting to 29 U.S. emergency departments after a motor vehicle collision (MVC) and followed for 3 months, the amount of time traditionally used to define chronic PTSD, in the Advancing Understanding of Recovery After Trauma (AURORA) study. Six CA types were self-reported at baseline: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect and bullying. Both dichotomous measures of ever experiencing each CA type and numeric measures of exposure frequency were included in the analysis. Risk ratios (RRs) of these CA measures as well as complex interactions among these measures were examined as predictors of APNS 3 months post-MVC. APNS was defined as meeting self-reported criteria for either PTSD based on the PTSD Checklist for DSM-5 and/or MDE based on the PROMIS Depression Short-Form 8b. We controlled for pre-MVC lifetime histories of PTSD and MDE. We also examined mediating effects through peritraumatic symptoms assessed in the emergency department and PTSD and MDE assessed in 2-week and 8-week follow-up surveys. Analyses were carried out with robust Poisson regression models. Most participants (90.9%) reported at least rarely having experienced some CA. Ever experiencing each CA other than emotional neglect was univariably associated with 3-month APNS (RRs = 1.31-1.60). Each CA frequency was also univariably associated with 3-month APNS (RRs = 1.65-2.45). In multivariable models, joint associations of CAs with 3-month APNS were additive, with frequency of emotional abuse (RR = 2.03; 95% CI = 1.43-2.87) and bullying (RR = 1.44; 95% CI = 0.99-2.10) being the strongest predictors. Control variable analyses found that these associations were largely explained by pre-MVC histories of PTSD and MDE. Although individuals who experience frequent emotional abuse and bullying in childhood have a heightened risk of experiencing APNS after an adult MVC, these associations are largely mediated by prior histories of PTSD and MDE.

Individuals with Major Depressive Disorder Report High Scores of Insecure-Avoidant and Insecure-Anxious Attachment Styles, Dissociative Identity Symptoms, and Adult Traumatic Events.

Objective: Individuals with major depressive disorder (MDD) report more issues in social interaction compared to the general population. Moreover, dimensions of dissociation are considered dysfunctional strategies to cope with adverse life events. In this regard, current symptoms of MDD could be associated with traumatic events that occurred in childhood and in adult life. Given this background, the aim of the present study was to explore the associations between attachment styles as a proxy of quality of social interaction, dimensions of dissociation, and childhood and adult traumatic life events among individuals with MDD. Method: A total of 300 individuals with MDD (mean age: 31.31 years; 58.7% female) took part in this study. They completed a series of questionnaires on sociodemographic information, attachment styles, dimensions of dissociation, and childhood and adult traumatic life events. Results: Prevalence rates for attachment styles were as follows: anxious/ambivalent attachment style—71.7%; avoidant/dependent attachment style—13%; secure/close attachment style—15.3%. Compared to the general population, the participants reported higher prevalence rates of insecure attachment styles. Current symptoms of dissociation were associated with adult but not childhood traumatic life events. An anxious attachment style was associated with higher scores of dissociation. Conclusion: Psychotherapeutic treatment of individuals with MDD should consider the individuals’ challenging attachment styles and their risk of dissociation. While it is important to consider both adult and childhood traumatic events, in this research, more recent trauma occurring in adulthood was associated with current symptoms of dissociation.

Models of Trauma Exposure, Depression, and Suicidality in Safety‐Net Primary Care

Suicidality is a major public health concern, particularly for low-income, trauma-exposed patients with limited access to mental health providers. However, limited research has modeled pathways of suicidality in safety-net primary care samples. Patients (N = 207) in a safety-net primary care clinic completed measures of childhood and adult trauma exposure, depression, and suicidality. Participants (M age = 44.8 years, SD = 11.6), were 60.4% male, 63.8% Black/African American, and predominantly low-income (i.e., 69.1% reported an annual income less than $5,000 USD). Half of the sample reported at least four childhood traumatic events (M = 3.9 events, SD = 3.0) and approximately three adult traumatic events (M = 3.0 events, SD = 2.1). Most participants (82.1%) reported significant depressive symptoms, and 43.5% endorsed recent suicidality. Models showing the mediational effect of depression on the association between trauma exposure and suicidality, β = .20, B = 0.23, SE = 0.05, 95% CI [0.16, 0.32], and the moderational effect of trauma exposure on the association between depression and suicidality, β = .16, B = 0.20, SE = 0.08, p = .007, were both supported. These results underscore the high prevalence of trauma exposure, depression, and suicidality in a safety-net primary care sample. They also highlight the pervasiveness and complexity of suicidality in low-income primary care patients, emphasize the importance of trauma-informed suicide assessment, and identify trauma sequelae and depression as potential treatment targets to reduce suicidality.

Cumulative Psychological Trauma, Emotional Regulation, and Orthopedic Injury in a Sample of Pre-Professional and Professional Dancers and College Athletes.

Strong evidence identifies cumulative trauma exposure and a history of childhood adversity as predictive factors for physical and psychological disorders. In this study, dancers and athletes were examined to determine the relationship among childhood adversity, cumulative trauma exposure, stress responses, and injuries (including the need for orthopedic surgery). In this cross-sectional study, 287 pre-professional and professional dancers (n=185) and college athletes (n=102) participated. Seven self-report measures were completed. Descriptive statistical analyses were calculated, followed by a 2 x 2 multivariate analysis (MANCOVA, age and gender were covariates): 1) dancer and athlete groups, and 2) participants who had orthopedic surgery vs no surgery. Stepwise linear regression analyses were calculated to predict cumulative injuries in multiple body regions. The MANCOVA result indicated that dancers and athletes shared similar cumulative injuries to multiple regions of their bodies. Compared to athletes, dancers were exposed to more childhood trauma and experienced more anxiety and emotional difficulties. Participants who underwent orthopedic surgery also had more cumulative trauma and injuries as well as more difficulty with emotional regulation. In both dancers and athletes, increased exposure to childhood and adult traumatic events were significant predictive factors associated with injury. Both dancers and athletes frequently perform within a culture that is pressured and promotes behavior that ignores pain and injury. It is recommended that coaches, educators, and healthcare workers understand the influence of cumulative trauma on risk for orthopedic injury and incorporate trauma-informed care.

Childhood Adversity and the Creative Experience in Adult Professional Performing Artists.

Childhood adversity is identified as any exposure to abuse, neglect or family dysfunction. Greater exposure to childhood adversity has been strongly identified with increased morbidity and mortality. The aim of this study was to examine differences in creative experiences, fantasy proneness, dispositional flow, exposure to adult traumatic events, and psychopathology (internalized shame, trait anxiety), amongst professional performing artists who experienced no childhood adversity, some adversity, or substantial adversity. This cross-section IRB approved study examined 234 professional performers (dancers, opera singers, actors, directors, musicians). Self-report measurements were included to examine the following psychological factors: adverse childhood experiences (ACEs), experience of creativity questionnaire, dispositional flow, trait anxiety, internalized shame, fantasy, and total adult and childhood traumatic events. The sample was divided into three groups based on ACE scores: 0 ACE (n = 93), 1–3 ACEs (n = 95), ≥4 ACEs (n = 42). The MANCOVA (with age and gender as covariates) results revealed no significant (p = 0.280) differences between all three ACE groups for the nine flow scales (optimal performance measurements). Performing artists with ≥4 ACEs had significantly stronger creative experiences (p = 0.006) related to distinct creative processing, absorption, and a transformational sense of self and the world. They were also more fantasy prone, shame-based, anxious, and experienced more cumulative past traumatic events (p < 0.001). Although the high ACE group experienced greater negative effects, they also endorsed positive creative performance experiences.

Attachment and childhood adversity in athletes, actors, dancers, and healthy controls

An investigation into patterns of childhood adversity and attachment states of mind may provide information that can optimise performance for athletes/performers and their coaches/teachers. This cross-sectional study was designed to examine four groups: athletes (n = 23), actors (n = 39), dancers (n = 30), and healthy control participants (n = 25). The study goals included determining group distribution for attachment classifications and group mean differences for inferred parental caregiving, childhood adversity, adult traumatic events, and degree of resolution for past trauma/loss experiences. The Adult Attachment Interview, Adverse Childhood Experience Questionnaire, and Traumatic Event Questionnaire were administered to participants. The most significant finding in this study was the substantial prevalence rates of unresolved mourning and adverse childhood experiences, especially in the actor group. The athlete group had a greater prevalence of a dismissing attachment classification, suggesting a non-optimal deactivating coping strategy. It is recommended that attachment and trauma-informed care be implemented in the training and treating of athletes and performing artists.

Depersonalization, adversity, emotionality, and coping with stressful situations

ABSTRACTDepersonalization is defined as persistent or recurrent episodes of feeling detached or estranged from a sense of self and the world. This study addressed the primary question: Do nonclinical individuals who endorse high symptomatic depersonalization have inherently more intense emotional responses, along with more childhood adversity and past trauma? In this IRB approved study, participants who met clinical levels of depersonalization (n = 43, 16.3%) were compared to a group without clinical levels of depersonalization (n = 221, 83.7%). Adverse childhood experiences, adult traumatic events, emotional overexcitability, coping strategies under stress, and anxiety were examined in both groups. The variables to assess depersonalization severity included the Dissociative Experience Scale-II, Cambridge Depersonalization Scale, and Multiscale Dissociation Inventory. The results indicated that clinical levels of depersonalization were identified in 16.3% of the sample. The high depersonalization group had significantly more adverse childhood experiences, in particular, emotional abuse and neglect. They also experienced more adult traumatic events, higher levels of anxiety, more emotional overexcitability, and they employed a less adaptive emotion-oriented coping strategy under stress. It is recommended that treating depersonalization symptoms should include examining childhood adversity, especially emotional abuse and neglect. Based on study findings, emotion regulation skills should be promoted to help individuals with elevated depersonalization manage their emotion-oriented coping strategies, anxiety, and emotional overexcitability.

Adverse childhood experiences (ACE) and adult attachment interview (AAI) in a non-clinical population

Adverse childhood experiences (ACE) tend to be interrelated rather than independently occurring. There is a graded effect associated with ACE exposure and pathology, with an increase when ACE exposure is four or more. This study examined a sample of active individuals (n=129) to determine distribution patterns and relationships between ACEs, attachment classification, unresolved mourning (U), and disclosure difficulty. The results of this study demonstrated a strong relationship between increased ACEs and greater unresolved mourning. Specifically, the group differences for individuals who experienced no ACE (n=42, 33%), those with 1–3 ACEs (n=48, 37.8%), and those with ≥4 ACEs (n=37, 29.1%) revealed a pattern in which increased group ACE exposure was associated with greater lack of resolution for past trauma/loss experiences, more adult traumatic events, and more difficulty disclosing past trauma. Despite ≥4 ACEs, 51.4% of highly exposed individuals were classified as secure in the Adult Attachment Interview. Resilience in this group may be related to a combination of attachment security, college education, and engagement in meaningful activities. Likewise, adversity may actually encourage the cultivation of more social support, goal efficacy, and planning behaviors; factors that augment resilience to adversity.

Type and timing of childhood maltreatment and severity of shutdown dissociation in patients with schizophrenia spectrum disorder.

Dissociation, particularly the shutting down of sensory, motor and speech systems, has been proposed to emerge in susceptible individuals as a defensive response to traumatic stress. In contrast, other individuals show signs of hyperarousal to acute threat. A key question is whether exposure to particular types of stressful events during specific stages of development can program an individual to have a strong dissociative response to subsequent stressors. Vulnerability to ongoing shutdown dissociation was assessed in 75 inpatients (46M/29F, M = 31±10 years old) with schizophrenia spectrum disorder and related to number of traumatic events experienced or witnessed during childhood or adulthood. The Maltreatment and Abuse Chronology of Exposure (MACE) scale was used to collect retrospective recall of exposure to ten types of maltreatment during each year of childhood. Severity of shutdown dissociation was related to number of childhood but not adult traumatic events. Random forest regression with conditional trees indicated that type and timing of childhood maltreatment could predictably account for 31% of the variance (p < 0.003) in shutdown dissociation, with peak vulnerability occurring at 13-14 years of age and with exposure to emotional neglect followed by various forms of emotional abuse. These findings suggest that there may be windows of vulnerability to the development of shutdown dissociation. Results support the hypothesis that experienced events are more important than witnessed events, but challenge the hypothesis that “life-threatening” events are a critical determinant.

Moderation of adult depression by the serotonin transporter promoter variant (5‐HTTLPR), childhood abuse and adult traumatic events in a general population sample

The impact of the promoter polymorphisms of the serotonin transporter (5-HTTLPR) on mood has been studied by two-way interaction models comprising one environmental factor and genotype variants. However, childhood abuse is assumed to be associated with different psychobiological long-term effects than adult traumatic events. Both types of trauma may interact on an individual basis throughout the lifespan moderating the impact of the 5-HTTLPR s allele on depressive disorders. Therefore, the hypothesis of a three-way interaction among the 5-HTTLPR, childhood abuse and adult traumatic experience was tested. Caucasian subjects (1,974) from the general population in Germany (Study of Health in Pomerania (SHIP)) were analyzed. Depressive symptoms were measured with the Beck Depression Inventory (BDI-II). Childhood abuse was assessed with the Childhood Trauma Questionnaire. Adult traumatic events were derived from the SCID interview (DSM-IV) on posttraumatic stress disorder (PTSD). Global three-way interactions among the 5-HTTLPR, adult traumatic experiences and childhood abuse (P = 0.0007) were found. Carriers of the ss or sl genotypes who had been exposed to childhood abuse and to more than two adult traumatic events had higher mean BDI-II scores (16.0 [95% CI 8.4-23.6]) compared to those carrying the ll genotype (7.6 [4.5-10.7]). These results were supported using a second, more severe definition of childhood abuse (P = 0.02). No two-way interactions were observed (P > 0.05). Childhood abuse and adult traumatic events may act synergistically in interaction with the s allele of the 5-HTTLPR to increase the risk for depressive symptoms independently from the lifetime diagnosis of PTSD.

Traumatic Histories and Stressful Life Events of Incarcerated Parents II: Gender and Ethnic Differences in Substance Abuse and Service Needs

Substance abuse is increasingly common in prison inmates. This article presents findings on substance abuse and service needs of male and female inmate parents in Arizona, with a particular focus on gender and ethnic differences across inmates. A sample of 838 incarcerated fathers and 1,441 mothers completed anonymous questionnaires regarding traumatic and stressful events experienced as children and/or adults, including addiction. Exposure to childhood and adult traumatic events, especially child abuse, was related to self-reported alcohol and drug problems for both males and females. Mothers reported significantly more postrelease service needs than fathers. Implications for practice and policy are discussed.

Traumatic Histories and Stressful Life Events of Incarcerated Parents: Childhood and Adult Trauma Histories

Abuse and trauma are common in the histories of prison inmates. This article presents the results of research on the trauma histories and stressful life events experienced by 2,279 male and female inmate parents in Arizona, with a particular focus on gender and ethnic differences across inmates. A sample of 838 incarcerated fathers and 1,441 mothers completed anonymous questionnaires regarding traumatic and stressful events experienced as children and/or adults. High rates of exposure to childhood and adult traumatic events, especially child abuse, were found for both males and females and across ethnic groups.

Interactive Effect of Stressful Life Events and the Serotonin Transporter 5-HTTLPR Genotype on Posttraumatic Stress Disorder Diagnosis in 2 Independent Populations

The 5-HTTLPR polymorphism in the promoter region of the serotonin transporter gene (SLC6A4) has been found to moderate several categories of emotional response after stressful life events. Previous studies generally focused on its effect on depressive symptoms; little is known about its moderation of the development of posttraumatic stress disorder (PTSD). To examine the effects of childhood adversity, adult traumatic events, 5-HTTLPR genotypes, and gene x environment interactions on the etiology of PTSD. A cross-sectional study in which participants in several studies investigating the genetics of substance dependence were also screened for lifetime PTSD. The triallelic system of 5-HTTLPR was genotyped. Logistic regression modeling was used in the analyses. General community. Five hundred eighty-two European American and 670 African American individuals who reported experiences of childhood adversity, adult traumatic events, or both. Main Outcome Measure Diagnosis of PTSD, defined by DSM-IV diagnostic criteria and assessed through the Semi-Structured Assessment for Drug Dependence and Alcoholism interview. Childhood adversity and adult traumatic events both predicted PTSD. Although the 5-HTTLPR genotype alone did not predict the onset of PTSD, it interacted with adult traumatic events and childhood adversity to increase the risk for PTSD, especially for those with high rates of both types of trauma exposure (European American: odds ratio [OR], 2.86; 95% confidence interval [CI], 1.50-5.45; P = .002; African American: OR, 1.88; 95% CI, 1.04-3.40; P = .04; pooled: OR, 2.31; 95% CI, 1.50-3.56; P < .001). Participants who had both childhood adversity and adult traumatic events were more likely to develop lifetime PTSD compared with those who experienced either type of adverse event. The risk was increased in individuals with 1 or 2 copies of the S' (S) allele compared with the L' (L) homozygotes. Our study provides additional direct evidence that PTSD is influenced by the interactive effect of environmental and genetic factors.