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Bentele UU, Klink ESC, Benz ABE, Meier M, Gaertner RJ, Denk BF, Dimitroff SJ, Unternaehrer E, Pruessner JC. The effect of cognitive reappraisal and early-life maternal care on neuroendocrine stress responses. Sci Rep 2024; 14:6837. [PMID: 38514744 PMCID: PMC10957921 DOI: 10.1038/s41598-024-57106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/14/2024] [Indexed: 03/23/2024] Open
Abstract
Early-life adversity (ELA) is related to profound dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, reflected in both, blunted or exaggerated cortisol stress responses in adulthood. Emotion regulation strategies such as cognitive reappraisal might contribute to this inconsistent finding. Here, we investigate an interaction of early-life maternal care (MC), where low MC represents a form of ELA, and instructed emotion regulation on cortisol responses to acute stress. Ninety-three healthy young women were assigned to a low (n = 33) or high (n = 60) MC group, based on self-reported early-life MC. In the laboratory, participants received regulation instructions, asking to cognitively reappraise (reappraisal group, n = 45) or to focus on senses (control group, n = 48) during subsequent stress exposure, induced by the Trier Social Stress Test. Salivary cortisol and subjective stress levels were measured repeatedly throughout the experiment. Multilevel model analyses confirmed a MC by emotion regulation interaction effect on cortisol trajectories, while controlling for hormonal status. Individuals with low MC in the control compared with the reappraisal group showed increased cortisol responses; individuals with high MC did not differ. These results highlight the significance of emotion regulation for HPA axis stress regulation following ELA exposure. They provide methodological and health implications, indicating emotion regulation as a promising target of treatment interventions for individuals with a history of ELA.
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Affiliation(s)
- Ulrike U Bentele
- Department of Psychology, Division of Neuropsychology, University of Konstanz, Universitaetsstrasse 10, 78464, Constance, Germany.
| | - Elea S C Klink
- Department of Psychology, Division of Neuropsychology, University of Konstanz, Universitaetsstrasse 10, 78464, Constance, Germany
| | - Annika B E Benz
- Department of Psychology, Division of Neuropsychology, University of Konstanz, Universitaetsstrasse 10, 78464, Constance, Germany
| | - Maria Meier
- Department of Psychology, Division of Neuropsychology, University of Konstanz, Universitaetsstrasse 10, 78464, Constance, Germany
- Child- and Adolescent Research Department, University Psychiatric Clinics Basel (UPK), University of Basel, Basel, Switzerland
| | - Raphaela J Gaertner
- Department of Psychology, Division of Neuropsychology, University of Konstanz, Universitaetsstrasse 10, 78464, Constance, Germany
| | - Bernadette F Denk
- Department of Psychology, Division of Neuropsychology, University of Konstanz, Universitaetsstrasse 10, 78464, Constance, Germany
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Constance, Germany
| | | | - Eva Unternaehrer
- Department of Psychology, Division of Neuropsychology, University of Konstanz, Universitaetsstrasse 10, 78464, Constance, Germany
- Child- and Adolescent Research Department, University Psychiatric Clinics Basel (UPK), University of Basel, Basel, Switzerland
| | - Jens C Pruessner
- Department of Psychology, Division of Neuropsychology, University of Konstanz, Universitaetsstrasse 10, 78464, Constance, Germany
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Constance, Germany
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2
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Bérubé A, Pearson J, Blais C, Forget H. Stress and emotion recognition predict the relationship between a history of maltreatment and sensitive parenting behaviors: A moderated-moderation. Dev Psychopathol 2024:1-11. [PMID: 38173233 DOI: 10.1017/s095457942300158x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Our study proposes to examine how stress and emotion recognition interact with a history of maltreatment to influence sensitive parenting behaviors. A sample of 58 mothers and their children aged between 2 and 5 years old were recruited. Parents' history of maltreatment was measured using the Child Trauma Questionnaire. An emotion recognition task was performed. Mothers identified the dominant emotion in morphed facial emotion expressions in children. Mothers and children interacted for 15 minutes. Salivary cortisol levels of mothers were collected before and after the interaction. Maternal sensitive behaviors were coded during the interaction using the Coding Interactive Behavior scheme. Results indicate that the severity of childhood maltreatment is related to less sensitive behaviors for mothers with average to good abilities in emotion recognition and lower to average increases in cortisol levels following an interaction with their children. For mothers with higher cortisol levels, there is no association between a history of maltreatment and sensitive behaviors, indicating that higher stress reactivity could act as a protective factor. Our study highlights the complex interaction between individual characteristics and environmental factors when it comes to parenting. These results argue for targeted interventions that address personal trauma.
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Affiliation(s)
- Annie Bérubé
- Université du Québec en Outaouais, Gatineau, QC, Canada
- Centre de recherche universitaire pour les jeunes enfants et leur famille, Trois-Rivieres, QC, Canada
| | - Jessica Pearson
- Centre de recherche universitaire pour les jeunes enfants et leur famille, Trois-Rivieres, QC, Canada
- Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada
| | | | - Hélène Forget
- Université du Québec en Outaouais, Gatineau, QC, Canada
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3
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Wen A, Rao U, Kinney KL, Yoon KL, Morris M. Diversity in emotion regulation strategy use: Resilience against posttraumatic stress disorder. Behav Res Ther 2024; 172:104441. [PMID: 38091721 DOI: 10.1016/j.brat.2023.104441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023]
Abstract
Posttraumatic stress disorder (PTSD) is associated with impaired emotion regulation (ER). ER diversity, the variety, prevalence, and relative abundance of ER strategy use, may provide resilience against PTSD. This study examined the prospective relation between ER diversity and PTSD, while accounting for negative and positive life events, in interpersonal violence (IPV) survivors. IPV-exposed women with PTSD onset (PTSD; n = 22), without PTSD onset (IPV; n = 37), and non-traumatized control participants (NTC; n = 41) rated their ER strategy use and experience of negative and positive life events. The ER diversity index differentiated the participant groups. Importantly, group differences in ER diversity depended on the experience of life events. When experiencing fewer positive life events and more negative life events, the IPV and NTC groups, but not the PTSD group, demonstrated higher ER diversity. Thus, greater ER diversity during periods with more negative life events and fewer positive life events may play a protective role against PTSD onset for IPV survivors.
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Affiliation(s)
- Alainna Wen
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA; Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46556, USA.
| | - Uma Rao
- Department of Psychiatry and Human Behavior, University of California Irvine, 5251 California Avenue, Irvine, CA, 92617, USA; Children's Hospital of Orange County, 1201 West La Veta Ave, Orange, CA, 92868, USA.
| | - Kerry L Kinney
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA; Department of Psychological Sciences, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN, 37240, USA.
| | - K Lira Yoon
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA.
| | - Matthew Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA; Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA.
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4
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Tyra AT, Young DA, Ginty AT. Emotion regulation tendencies and cardiovascular responses to repeated acute psychological stress. Int J Psychophysiol 2023; 194:112261. [PMID: 37914039 DOI: 10.1016/j.ijpsycho.2023.112261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023]
Abstract
Poor emotion regulation has been associated with cardiovascular disease (CVD) through maladaptive cardiovascular responses to psychological stress. However, there has been scant research examining the relationship between emotion regulation and habituation of cardiovascular responses to recurrent stress, which may be more directly applicable to the experience of stress in everyday life. The aims of the current study were to examine the associations between emotion regulation tendencies and cardiovascular stress reactivity, as well as habituation of cardiovascular reactivity across repeated stressors. A sample of 453 participants (mean (SD) age = 19.5 (1.3) years; 62 % women) completed a repeated stress paradigm, which consisted of two 10-minute baselines and two identical 4-minute stress tasks, separated by a 10-minute recovery period. Heart rate (HR) was measured continuously; systolic/diastolic blood pressures (SBP/DBP) were measured every 2 min. At the end of the visit, participants completed the Emotion Regulation Questionnaire (ERQ) and Difficulties in Emotion Regulation Scale (DERS). Results indicate that impulse control difficulties when distressed (a DERS subscale) were significantly associated with blunted SBP, DBP, and HR reactivity to both stressors, as well as impaired HR habituation across the stressors. None of the ERQ subscales (cognitive reappraisal, expressive suppression) were found to be associated with cardiovascular stress reactivity or habituation. The outcomes of this study demonstrate a potential underlying physiological pathway through which impulse control difficulties when distressed may contribute to CVD risk. This study also reveals the importance of extending traditional cardiovascular stress reactivity protocols to include multiple exposures of the same stress task.
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Affiliation(s)
- Alexandra T Tyra
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.
| | - Danielle A Young
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Annie T Ginty
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
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5
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Howland MA. Recalibration of the stress response system over adult development: Is there a perinatal recalibration period? Dev Psychopathol 2023; 35:2315-2337. [PMID: 37641984 PMCID: PMC10901284 DOI: 10.1017/s0954579423000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
During early life-sensitive periods (i.e., fetal, infancy), the developing stress response system adaptively calibrates to match environmental conditions, whether harsh or supportive. Recent evidence suggests that puberty is another window when the stress system is open to recalibration if environmental conditions have shifted significantly. Whether additional periods of recalibration exist in adulthood remains to be established. The present paper draws parallels between childhood (re)calibration periods and the perinatal period to hypothesize that this phase may be an additional window of stress recalibration in adult life. Specifically, the perinatal period (defined here to include pregnancy, lactation, and early parenthood) is also a developmental switch point characterized by heightened neural plasticity and marked changes in stress system function. After discussing these similarities, lines of empirical evidence needed to substantiate the perinatal stress recalibration hypothesis are proposed, and existing research support is reviewed. Complexities and challenges related to delineating the boundaries of perinatal stress recalibration and empirically testing this hypothesis are discussed, as well as possibilities for future multidisciplinary research. In the theme of this special issue, perinatal stress recalibration may be a mechanism of multilevel, multisystem risk, and resilience, both intra-individually and intergenerationally, with implications for optimizing interventions.
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Affiliation(s)
- Mariann A Howland
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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6
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Jones EJ, Marsland AL, Gianaros PJ. Do trait-level emotion regulation strategies moderate associations between retrospective reports of childhood trauma and prospective changes in systemic inflammation? Stress Health 2023; 39:525-538. [PMID: 36265175 PMCID: PMC10518806 DOI: 10.1002/smi.3205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/19/2022] [Accepted: 09/01/2022] [Indexed: 11/11/2022]
Abstract
Childhood trauma may confer risk for poorer adult health through changes in systemic inflammation. Emotion regulation may plausibly moderate associations between childhood trauma and adult psychological well-being, but it remains unclear whether moderation effects extend to differences in systemic inflammation. To examine whether childhood trauma and emotion regulation separately and interactively predict prospective changes in C-reactive protein (CRP) and interleukin-6 (IL-6) and whether biopsychosocial factors account for observed associations. Healthy midlife adults (N = 331) retrospectively reported on childhood trauma, current trait-level cognitive reappraisal and expressive suppression, and had their blood drawn. At baseline and then a median of 2.85 years later, 279 of the 331 participants had their blood drawn, body mass index calculated, and reported on health behaviours (smoking, sleep), psychological distress (perceived stress, depressive symptoms), and years of education. Childhood trauma predicted prospective increases in CRP (B = 0.004, p = 0.049), which were partially accounted for by differences in adiposity, psychological distress, and health behaviours. In contrast, cognitive reappraisal predicted prospective decreases in IL-6 (B = -0.007, p = 0.006), which were independent of biopsychosocial influences. Cognitive reappraisal further moderated the association between childhood trauma and prospective changes in IL-6 (B = -0.001, p = 0.012) such that childhood trauma predicted greater IL-6 increases but only among adults lower in cognitive reappraisal (B = 0.006, p = 0.007). There were no main or moderation effects of expressive suppression (ps > 0.05). Cognitive reappraisal may attenuate IL-6 changes over time and may moderate the prospective association between childhood trauma and systemic inflammation in midlife.
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Affiliation(s)
- Emily J. Jones
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anna L. Marsland
- Department of Psychology, Kenneth P. Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peter J. Gianaros
- Department of Psychology, Kenneth P. Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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7
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Doku PN. Child maltreatment and associated sociodemographic factors among children affected by HIV/AIDS in Ghana: a multi-informant perspective. AIDS Care 2023; 35:106-113. [PMID: 35465790 DOI: 10.1080/09540121.2022.2067310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ABSTRACTChild maltreatment is considered a major public health concern among children because they can cause significant physical and psychological problems. Child maltreatment is widespread but often underestimated. Surprisingly, there is hardly any data on child maltreatment and any associated sociodemographic factors children affected by HIV/AIDS in low-income countries. This study employed cross-sectional, quantitative survey that involved 291 children aged 10-17 years and their caregivers in the Lower Manya Krobo District, Ghana and examined their exposure to and experience of child maltreatment. The results show that at least one form of maltreatment was reported by approximately 90% of the children, and it was significantly higher among orphans and vulnerable children (OVC) as compared with comparison children. Older age, frequent changes in residence, non-schooling and living with many siblings are associated with child maltreatment. The results demonstrate that maltreatment among children affected by HIV/AIDS are not rare, and that the dysfunction family conditions that they find themselves bear systemic risks for maltreatment. It is important that culturally appropriate and evidence-based interventions are implemented to address the maltreatment.
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Affiliation(s)
- Paul Narh Doku
- Department of Mental Health Nursing, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
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8
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Schär S, Mürner-Lavanchy I, Schmidt SJ, Koenig J, Kaess M. Child maltreatment and hypothalamic-pituitary-adrenal axis functioning: A systematic review and meta-analysis. Front Neuroendocrinol 2022; 66:100987. [PMID: 35202606 DOI: 10.1016/j.yfrne.2022.100987] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/04/2022]
Abstract
Alterations in hypothalamic-pituitary-adrenal (HPA) axis and its effector hormone cortisol have been proposed as one possible mechanism linking child maltreatment experiences to health disparities. In this series of meta-analyses, we aimed to quantify the existing evidence on the effect of child maltreatment on various measures of HPA axis activity. The systematic literature search yielded 1,858 records, of which 87 studies (k = 132) were included. Using random-effects models, we found evidence for blunted cortisol stress reactivity in individuals exposed to child maltreatment. In contrast, no overall differences were found in any of the other HPA axis activity measures (including measures of daily activity, cortisol assessed in the context of pharmacological challenges and cumulative measures of cortisol secretion). The impact of several moderators (e.g., sex, psychopathology, study quality), the role of methodological shortcomings of existing studies, as well as potential directions for future research are discussed.
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Affiliation(s)
- Selina Schär
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany; Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.
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9
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Gong J, He Y, Wang S, Liu J. Emotion Regulation and Depressive Symptoms Mediate the Association Between Schizotypal Personality Traits and Suicidality in Chinese College Students. Arch Suicide Res 2022; 26:614-625. [PMID: 32924826 DOI: 10.1080/13811118.2020.1818655] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The psychological mechanisms underlying the relationship between schizotypal personality traits and suicidality are not understood. This study investigated the association of schizotypal personality traits with suicidality and explored the mediating role of cognitive appraisal and depression in the relationship between those two variables in a sample of Chinese college students. METHOD Participants (N = 2457) completed the Schizotypal Personality Questionnaire, the Emotional Regulation Questionnaire, the Zung Self-rating Depression Scale, and three questions related to suicidality. RESULTS The cognitive reappraisal score was lower in the students with suicidality than the students without suicidality, whereas scores for depression and schizotypal personality traits were higher in the students with suicidality than the students without suicidality. Schizotypal personality traits and depression were risk factors for suicidality. Depression mediated the association between schizotypal personality traits and suicidality. Cognitive reappraisal negatively affected symptoms of depression and had a significant mediating effect on the association between schizotypal personality traits and suicidality. CONCLUSIONS Schizotypal personality traits and depression are risk factors for suicidality. Cognitive reappraisal and depression mediate the association between schizotypal personality traits and suicidality.
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England-Mason G, MacMillan HL, Atkinson L, Steiner M, Gonzalez A. Emotion regulation moderates between maternal adverse childhood experiences (ACEs) and oxytocin response. Arch Womens Ment Health 2022; 25:421-430. [PMID: 34751819 DOI: 10.1007/s00737-021-01194-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022]
Abstract
Exposure to adverse childhood experiences (ACEs) is associated with oxytocin dysregulation in women, such as decreased peripheral oxytocin concentrations, but little is known about vulnerability markers for oxytocin dysregulation in mothers exposed to ACEs. Identifying vulnerability markers may help inform future targets for prevention and intervention programmes. This study provided a preliminary examination of emotion regulation as a potential moderator of the association between maternal ACEs and peripheral oxytocin levels. The current study included a sample of 38 postpartum women. Women completed questionnaires on exposure to ACEs and difficulties with emotion regulation. At a clinic visit at 9 months postpartum, women provided plasma and salivary oxytocin samples anchored around a mother-infant interaction. Associations between maternal ACEs, three dimensions of difficulties with emotion regulation, and peripheral oxytocin concentrations were examined. Linear regression analyses showed that greater difficulties engaging in goal-directed behaviour (β = - 0.50, p = 0.01) and more limited access to effective emotion regulation strategies (β = - 0.68, p < 0.001) were related to reduced plasma oxytocin concentrations in postpartum women. Furthermore, in postpartum women reporting greater exposure to ACEs, higher levels of nonacceptance of emotional responses (β = - 0.55, p = 0.01) and more limited access to effective emotion regulation strategies (β = - 0.54, p = 0.01) were associated with reduced salivary oxytocin response (i.e. decreased change in oxytocin concentrations from baseline) following mother-infant interaction. Difficulties with emotion regulation may serve as a vulnerability marker for oxytocin dysregulation in postpartum women exposed to ACEs, and this suggests that emotion regulation may be an important target for future clinical interventions. Future research is recommended which replicates these preliminary results and which examines how emotion regulation and peripheral oxytocin levels in mothers exposed to ACEs are associated with parenting and child development outcomes.
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Affiliation(s)
- Gillian England-Mason
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Harriet L MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Offord Centre for Child Studies, McMaster Innovation Park - Suite 201A, Hamilton, ON, Canada
| | - Leslie Atkinson
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Meir Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada. .,Offord Centre for Child Studies, McMaster Innovation Park - Suite 201A, Hamilton, ON, Canada.
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11
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Maternal childhood maltreatment and perinatal outcomes: A systematic review. J Affect Disord 2022; 302:139-159. [PMID: 35041871 DOI: 10.1016/j.jad.2022.01.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maternal childhood maltreatment (MCM) is linked to poor perinatal outcomes but the evidence base lacks cohesion. We explore the impact of MCM on four perinatal outcome domains: pregnancy and obstetric; maternal mental health; infant; and the quality of the care-giving environment. Mechanisms identified in the included studies are discussed in relation to the maternal programming hypothesis and directions for future research. METHOD We completed a comprehensive literature search of eight electronic databases. Independent quality assessments were conducted and PRISMA protocols applied to data extraction. RESULTS Inclusion criteria was met by N = 49 studies. MCM was consistently associated with difficulties in maternal and infant emotional regulation and with disturbances in the mother-infant relationship. Directly observed and maternal-reported difficulties in the mother-infant relationship were often mediated by mothers' current symptoms of psychopathology. Direct and mediated associations between MCM and adverse pregnancy and obstetric outcomes were suggested by a limited number of studies. Emotional and sexual abuse were the most consistent MCM subtype significantly associated with adverse perinatal outcomes. LIMITATIONS A meta-analysis was not possible due to inconsistent reporting and the generally small number of studies for most perinatal outcomes. CONCLUSIONS MCM is associated with adverse perinatal outcomes for mothers' and infants. Evidence suggests these associations are mediated by disruptions to maternal emotional functioning. Future research should explore biological and psychosocial mechanisms underpinning observed associations between specific subtypes of MCM and adverse perinatal outcomes. Services have a unique opportunity to screen for MCM and detect women and infants at risk of adverse outcomes during the perinatal period.
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12
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Ji D, Flouri E, Papachristou E. Social cognition and cortisol in the general population: A systematic review and meta-analysis. Stress Health 2021; 37:415-430. [PMID: 34363741 DOI: 10.1002/smi.3013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/16/2020] [Accepted: 12/05/2020] [Indexed: 11/09/2022]
Abstract
This systematic review examines the evidence on the association between social cognition and cortisol in the general population. Literature was searched in six databases. Of the 401 studies identified, meta-analyses were conducted on 46 effect sizes (Pearson's correlation coefficients) from 19 studies, supplemented by a narrative review. Pooled estimates suggest that better emotion control is associated with increased cortisol concentrations [r = 0.083, 95% CI (0.033, 0.132)]. Emotion recognition or empathy were not significantly associated with cortisol concentrations [r = 0.072, 95% CI (-0.020, 0.165) and r = 0.004, 95% CI (-0.061, 0.068) respectively]. Subgroup analyses showed that the association between emotion control and cortisol concentrations is significant in males, for morning cortisol, when the cortisol data are transformed to correct for skewed distributions, or when participants are instructed to avoid food and drink intake for at least one hour before sample collection. There was no evidence for an association between social cognition with diurnal cortisol slope or cortisol awakening response. More validation work with greater standardization of methodological procedures is required.
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Affiliation(s)
- Dongying Ji
- Department of Psychology and Human Development, UCL Institute of Education, London, UK
| | - Eirini Flouri
- Department of Psychology and Human Development, UCL Institute of Education, London, UK
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13
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Tyra AT, Griffin SM, Fergus TA, Ginty AT. Individual differences in emotion regulation prospectively predict early COVID-19 related acute stress. J Anxiety Disord 2021; 81:102411. [PMID: 33962141 PMCID: PMC9759661 DOI: 10.1016/j.janxdis.2021.102411] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/17/2021] [Accepted: 04/27/2021] [Indexed: 12/18/2022]
Abstract
Preliminary prospective research suggests emotion dysregulation may confer vulnerability to poor stress responses. The present prospective study extends this research by examining both specific emotion regulation strategies and global emotion regulation difficulties in the context of acute stress following onset of the COVID-19 global pandemic in 119 young adults. As part of a larger study, emotion regulation was assessed prior to pandemic onset (January 2019 - February 2020) using two standard measures (Emotion Regulation Questionnaire, ERQ, Gross & John, 2003; Difficulties in Emotion Regulation Scale, DERS, Gratz & Roemer, 2004). A self-report assessment of acute stress was conducted 2-3½ weeks after the COVID-19 pandemic declaration. Results demonstrated cognitive reappraisal and expressive suppression (i.e., ERQ) were not individually predictive of acute stress; however, there was a significant interaction of suppression by reappraisal. Simple effects indicated suppression was negatively associated with acute stress only when reappraisal levels were high. Greater global emotion regulation difficulties (i.e., DERS), particularly nonacceptance of emotions and limited access to emotion regulation strategies, significantly predicted greater acute stress. These results provide further evidence of the temporal relationship between emotion dysregulation and stress reactions, and also suggest the expected effects of emotion regulation strategies may differ across contexts.
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Affiliation(s)
- Alexandra T. Tyra
- Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798, USA,Corresponding author
| | - Siobhán M. Griffin
- SASHLab, Centre for Social Issues in Research, Department of Psychology, University of Limerick, V94T9PX, Ireland,Health Research Institute, University of Limerick, V94T9PX, Ireland
| | - Thomas A. Fergus
- Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798, USA
| | - Annie T. Ginty
- Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798, USA
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Sandoz V, Stuijfzand S, Lacroix A, Deforges C, Quillet Diop M, Ehlert U, Rubo M, Messerli-Bürgy N, Horsch A. The Lausanne Infant Crying Stress Paradigm: Validation of an Early Postpartum Stress Paradigm with Women at Low vs. High Risk of Childbirth-Related Posttraumatic Stress Disorder. J Pers Med 2021; 11:472. [PMID: 34073240 PMCID: PMC8228424 DOI: 10.3390/jpm11060472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 12/27/2022] Open
Abstract
Stress reactivity is typically investigated in laboratory settings, which is inadequate for mothers in maternity settings. This study aimed at validating the Lausanne Infant Crying Stress Paradigm (LICSP) as a new psychosocial stress paradigm eliciting psychophysiological stress reactivity in early postpartum mothers (n = 52) and to compare stress reactivity in women at low (n = 28) vs. high risk (n = 24) of childbirth-related posttraumatic stress disorder (CB-PTSD). Stress reactivity was assessed at pre-, peri-, and post-stress levels through salivary cortisol, heart rate variability (high-frequency (HF) power, low-frequency (LF) power, and LF/HF ratio), and perceived stress via a visual analog scale. Significant time effects were observed for all stress reactivity outcomes in the total sample (all p < 0.01). When adjusting for perceived life threat for the infant during childbirth, high-risk mothers reported higher perceived stress (p < 0.001, d = 0.91) and had lower salivary cortisol release (p = 0.023, d = 0.53), lower LF/HF ratio (p < 0.001, d = 0.93), and marginally higher HF power (p = 0.07, d = 0.53) than low-risk women. In conclusion, the LICSP induces subjective stress and autonomic nervous system (ANS) reactivity in maternity settings. High-risk mothers showed higher perceived stress and altered ANS and hypothalamic-pituitary-adrenal reactivity when adjusting for infant life threat. Ultimately, the LICSP could stimulate (CB-)PTSD research.
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Affiliation(s)
- Vania Sandoz
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (S.S.); (A.L.); (C.D.); (M.Q.D.)
| | - Suzannah Stuijfzand
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (S.S.); (A.L.); (C.D.); (M.Q.D.)
| | - Alain Lacroix
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (S.S.); (A.L.); (C.D.); (M.Q.D.)
| | - Camille Deforges
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (S.S.); (A.L.); (C.D.); (M.Q.D.)
| | - Magali Quillet Diop
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (S.S.); (A.L.); (C.D.); (M.Q.D.)
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland;
| | - Marius Rubo
- Clinical Child Psychology & Biological Psychology, University of Fribourg, 1701 Fribourg, Switzerland; (M.R.); (N.M.-B.)
| | - Nadine Messerli-Bürgy
- Clinical Child Psychology & Biological Psychology, University of Fribourg, 1701 Fribourg, Switzerland; (M.R.); (N.M.-B.)
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (S.S.); (A.L.); (C.D.); (M.Q.D.)
- Neonatology Service, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
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15
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The differential calibration of the HPA axis as a function of trauma versus adversity: A systematic review and p-curve meta-analyses. Neurosci Biobehav Rev 2021; 127:54-135. [PMID: 33857580 DOI: 10.1016/j.neubiorev.2021.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/22/2022]
Abstract
Although there is an abundance of evidence linking the function of the hypothalamic-pituitary-adrenal (HPA) axis to adverse early-life experiences, the precise nature of the association remains unclear. Some evidence suggests early-life adversity leads to cortisol hyper-reactivity, while other evidence suggests adversity leads to cortisol hypo-reactivity. Here, we distinguish between trauma and adversity, and use p-curves to interrogate the conflicting literature. In Study 1, trauma was operationalized according to DSM-5 criteria; the p-curve analysis included 68 articles and revealed that the literature reporting associations between trauma and blunted cortisol reactivity contains evidential value. Study 2 examined the relationship between adversity and cortisol reactivity. Thirty articles were included in the analysis, and p-curve demonstrated that adversity is related to heightened cortisol reactivity. These results support an inverted U-shaped function relating severity of adversity and cortisol reactivity, and underscore the importance of distinguishing between "trauma" and "adversity".
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16
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Raymond C, Marin MF, Wolosianski V, Journault AA, Longpré C, Leclaire S, Cernik R, Juster RP, Lupien SJ. Early childhood adversity and HPA axis activity in adulthood:The importance of considering minimal age at exposure. Psychoneuroendocrinology 2021; 124:105042. [PMID: 33249330 DOI: 10.1016/j.psyneuen.2020.105042] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/11/2020] [Accepted: 10/28/2020] [Indexed: 12/22/2022]
Abstract
Early adversity (EA) modulates stress hormone secretion in mixed directions. The Accumulation Model suggests that the number of EA predicts patterns of cortisol dysregulations, while the Life Cycle Model of Stress highlights the importance of considering the timing at which EA began, given that brain regions sensitive to stress hormones follow distinct developmental trajectories. We aimed to test these two models in 85 healthy men and women, aged 21-40 years old who reported having been exposed to EA during childhood. Participants were grouped based on the number of EA events to which they were exposed during their lifespan (Accumulation Model) and the age of first exposure to EA (Life Cycle Model). Diurnal and stress-induced reactive cortisol secretion were measured in all participants. Results showed that although the number of EA was not associated with patterns of basal or reactive cortisol secretion, adults first exposed to EA between the ages of 3 and 7 - an important time window for amygdala development - showed greater cortisol awakening response and lower cortisol reactivity relative to those first exposed to EA before 3 or after 7. These results provide support for the Life Cycle Model of Stress and highlight the importance of considering minimal age at exposure to EA when assessing the effects of early adversity on patterns of cortisol secretion.
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Affiliation(s)
- Catherine Raymond
- Center for Studies on Human Stress, Institut Universitaire en santé mentale de Montréal, Research Center, CIUSSS Est-de-l'Île-de-Montréal, Montréal, Québec, Canada; Department of Neurosciences, Université de Montréal, Montréal, Québec, Canada.
| | - Marie-France Marin
- Center for Studies on Human Stress, Institut Universitaire en santé mentale de Montréal, Research Center, CIUSSS Est-de-l'Île-de-Montréal, Montréal, Québec, Canada; Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Victoria Wolosianski
- Center for Studies on Human Stress, Institut Universitaire en santé mentale de Montréal, Research Center, CIUSSS Est-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Audrey-Ann Journault
- Center for Studies on Human Stress, Institut Universitaire en santé mentale de Montréal, Research Center, CIUSSS Est-de-l'Île-de-Montréal, Montréal, Québec, Canada; Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Charlotte Longpré
- Center for Studies on Human Stress, Institut Universitaire en santé mentale de Montréal, Research Center, CIUSSS Est-de-l'Île-de-Montréal, Montréal, Québec, Canada; Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sarah Leclaire
- Center for Studies on Human Stress, Institut Universitaire en santé mentale de Montréal, Research Center, CIUSSS Est-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Rebecca Cernik
- Center for Studies on Human Stress, Institut Universitaire en santé mentale de Montréal, Research Center, CIUSSS Est-de-l'Île-de-Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada
| | - Robert-Paul Juster
- Center for Studies on Human Stress, Institut Universitaire en santé mentale de Montréal, Research Center, CIUSSS Est-de-l'Île-de-Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada
| | - Sonia J Lupien
- Center for Studies on Human Stress, Institut Universitaire en santé mentale de Montréal, Research Center, CIUSSS Est-de-l'Île-de-Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, Montréal, Québec, Canada
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17
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Perinatal depression: Data-driven subtypes derived from life history and mindfulness and personality. J Affect Disord 2020; 276:335-344. [PMID: 32871664 DOI: 10.1016/j.jad.2020.07.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 05/19/2020] [Accepted: 07/05/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Perinatal depression is the most prevalent mental disorder during the perinatal period, and research suggests that it presents heterogeneously. We aimed to explore how subtypes of perinatal depression present in terms of multivariate patterns of stable characteristics. METHODS A cohort study was conducted from March 2016 to March 2018 with Chinese women in the prenatal period (n = 3186). Of the participants, 682 (21.41%) women with Edinburgh Postnatal Depression Scale scores ≥10, indicating probable depression, were included, with the remaining 2504 (78.59%) representing the control group. We assessed mood distress, cognition, life history, emotional regulation, and personality, and used latent class analysis and latent transition analysis to identify perinatal depression subtypes. Of the 682 women with probable depression, only 598 were included in the full analyses, as they completed at least 10 questionnaires. A second, non-overlapping sample and a follow-up cohort were used. RESULTS We identified four subtypes: 1) a highly distressed type characterized by distress across all domains, high levels of rumination and neuroticism, and reduced trait mindfulness; 2) two moderately distressed types: one with high trauma and low perceived social support, and another with low trauma, high perceived social support, and expressive suppression; and 3) a slightly distressed subtype. LIMITATIONS We only collected cost and time spent in hospital from medical records. We only had a small follow-up sample. CONCLUSIONS This multidimensional subtyping of women with perinatal depression could help reduce the apparent heterogeneity of perinatal depression. Distinguishing the subtype characteristics facilitates identifying underlying causes of perinatal depression.
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18
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Almanza-Sepulveda ML, Fleming AS, Jonas W. Mothering revisited: A role for cortisol? Horm Behav 2020; 121:104679. [PMID: 31927022 DOI: 10.1016/j.yhbeh.2020.104679] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/26/2022]
Abstract
This selective review first describes the involvement of the maternal hypothalamic-pituitary-adrenal (HPA) axis during pregnancy and the postpartum period, and the relation between peripartum HPA axis function and maternal behavior, stress reactivity and emotional dysregulation in human mothers. To provide experimental background to this correlational work, where helpful, animal studies are also described. It then explores the association between HPA axis function in mothers and their infants, under ongoing non-stressful conditions and during stressful challenges, the moderating role of mothers' sensitivity and behavior in the mother-child co-regulation and the effects of more traumatic risk factors on these relations. The overarching theme being explored is that the HPA axis - albeit a system designed to function during periods of high stress and challenge - also functions to promote adaptation to more normative processes, shown in the new mother who experiences both high cortisol and enhanced attraction and attention to and recognition of, their infants and their cues. Hence the same HPA system shows positive relations with behavior at some time points and inverse ones at others. However, the literature is not uniform and results vary widely depending on the number, timing, place, and type of samplings and assessments, and, of course, the population being studied and, in the present context, the state, the stage, and the stress levels of mother and infant.
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Affiliation(s)
- Mayra L Almanza-Sepulveda
- Department of Psychology, University of Toronto at Mississauga, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
| | - Alison S Fleming
- Department of Psychology, University of Toronto at Mississauga, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada.
| | - Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18a, 171 77 Stockholm, Sweden.
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19
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Humphreys KL, LeMoult J, Wear JG, Piersiak HA, Lee A, Gotlib IH. Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire. CHILD ABUSE & NEGLECT 2020; 102:104361. [PMID: 32062423 PMCID: PMC7081433 DOI: 10.1016/j.chiabu.2020.104361] [Citation(s) in RCA: 215] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 05/18/2023]
Abstract
BACKGROUND Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature. OBJECTIVE We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores. PARTICIPANTS AND SETTING 192 unique samples consisting of 68,830 individuals. METHODS We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis. RESULTS We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95-1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32-.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations. CONCLUSIONS These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.
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Affiliation(s)
| | | | - John G Wear
- Western University of Health Sciences, United States
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20
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Neglect, HPA axis reactivity, and development. Int J Dev Neurosci 2019; 78:100-108. [DOI: 10.1016/j.ijdevneu.2019.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/27/2019] [Accepted: 07/29/2019] [Indexed: 11/22/2022] Open
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21
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Stickel S, Eickhoff S, Goecke TW, Schneider F, Quinete NS, Lang J, Habel U, Chechko N. Cumulative cortisol exposure in the third trimester correlates with postpartum mothers' neural response to emotional interference. Biol Psychol 2019; 143:53-61. [PMID: 30797948 DOI: 10.1016/j.biopsycho.2019.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 02/09/2019] [Accepted: 02/15/2019] [Indexed: 12/23/2022]
Abstract
Prolonged stress affects the central nervous system, rendering individuals vulnerable to a wide range of mental health disorders. 76 healthy postpartum mothers were studied by means of functional magnetic resonance imaging within 6 days of childbirth. The subjects were required to perform the emotional Stroop task involving happy and anxious word-face combinations. Hair samples were collected to determine cumulative hair cortisol concentration (HCC) in the third trimester. HCC was found to be negatively correlated with the recruitment of the dorsal anterior cingulate cortex (ACC) and the midcingulate cortex (MCC). In response to the emotional interference of only anxious target faces, a negative correlation was seen between HCC and the bilateral orbitofrontal cortex, extending to the rostral ACC and the MCC. Women with lower HCC recruited brain areas relevant to emotional cognitive control, indicating that lower HCC helps preserve conflict monitoring and resolution capacities and thus benefits mental health in pregnancy.
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Affiliation(s)
- S Stickel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany.
| | - S Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - T W Goecke
- RoMed Hospital Rosenheim, Department of Obstetrics, Rosenheim, Germany
| | - F Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Aachen, Germany; University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - N S Quinete
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty, Uniklinik RWTH Aachen University, Aachen, Germany; Southeast Environmental Research Center, Florida International University, FL, USA
| | - J Lang
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty, Uniklinik RWTH Aachen University, Aachen, Germany
| | - U Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - N Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
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