Stress, vulnerability and resilience, a developmental approach

Implementing Core Genes and an Omnigenic Model for Behaviour Traits Prediction in Genomics

A high number of genome variants are associated with complex traits, mainly due to genome-wide association studies (GWAS). Using polygenic risk scores (PRSs) is a widely accepted method for calculating an individual's complex trait prognosis using such data. Unlike monogenic traits, the practical implementation of complex traits by applying this method still falls behind. Calculating PRSs from all GWAS data has limited practical usability in behaviour traits due to statistical noise and the small effect size from a high number of genome variants involved. From a behaviour traits perspective, complex traits are explored using the concept of core genes from an omnigenic model, aiming to employ a simplified calculation version. Simplification may reduce the accuracy compared to a complete PRS encompassing all trait-associated variants. Integrating genome data with datasets from various disciplines, such as IT and psychology, could lead to better complex trait prediction. This review elucidates the significance of clear biological pathways in understanding behaviour traits. Specifically, it highlights the essential role of genes related to hormones, enzymes, and neurotransmitters as robust core genes in shaping these traits. Significant variations in core genes are prominently observed in behaviour traits such as stress response, impulsivity, and substance use.

Efficacy of a transdiagnostic, prevention-focused program for at-risk young adults: a waitlist-controlled trial

BACKGROUND

Prevention programs that are 'transdiagnostic' may be more cost-effective and beneficial, in terms of reducing levels of psychopathology in the general population, than those focused on a specific disorder. This randomized controlled study evaluated the efficacy of one such intervention program called Resilience Training (RT).

METHODS

College students who reported mildly elevated depressive or subclinical psychotic symptoms ('psychotic experiences' (PEs)) (n = 107) were randomized to receiving RT (n = 54) or to a waitlist control condition (n = 53). RT consists of a four-session intervention focused on improving resilience through the acquisition of mindfulness, self-compassion, and mentalization skills. Measures of symptoms and these resilience-enhancing skills were collected before and after the 4-week RT/waitlist period, with a follow-up assessment 12-months later.

RESULTS

Compared to the waitlist control group, RT participants reported significantly greater reductions in PEs, distress associated with PEs, depression, and anxiety, as well as significantly greater improvements in resilience, mindfulness, self-compassion, and positive affect, following the 4-week RT/waitlist period (all p < 0.03). Moreover, improvements in resilience-promoting skills were significantly correlated with symptom reductions (all p < 0.05). Lastly, the RT-related reductions in PEs and associated distress were maintained at the 12-month follow-up assessment.

CONCLUSIONS

RT is a brief, group-based intervention associated with improved resilience and reduced symptoms of psychopathology, with sustained effects on PEs, in transdiagnostically at-risk young adults. Follow-up studies can further assess the efficacy of RT relative to other interventions and test whether it can reduce the likelihood of developing a serious mental illness.

Measuring resilience and stress during pregnancy and its relation to vulnerability and pregnancy outcomes in a nulliparous cohort study

BACKGROUND

Resilience reflects coping with pregnancy-specific stress, including physiological adaptations of the maternal organism or factors arising from the socioeconomic context, such as low income, domestic violence, drug and alcohol use, lack of a support network and other vulnerability characteristics. Resilience is a dynamic characteristic that should be comparatively evaluated within a specific context; its association with perceived stress and social vulnerability during pregnancy is still not fully understood. This study aimed at exploring maternal resilience, perceived stress and social vulnerability during pregnancy and its associated factors and outcomes.

METHODS

Prospective multicenter cohort study of nulliparous women in Brazil determining resilience (Resilience Scale; RS) and stress (Perceived Stress Scale; PSS) at 28 weeks of gestation (± 1 week). Resilience and stress scores were compared according to sociodemographic characteristics related to maternal/perinatal outcomes and social vulnerability, defined as having low level of education, being adolescent, without a partner or ethnicity other than white.

RESULTS

We included 383 women who completed the RS and PSS instruments. Most women showed low resilience scores (median: 124.0; IQR 98-143). Women with a low resilience score (RS < 125) were more likely from the Northeast region, adolescents, other than whites, did not study or work, had a low level of education, low family income and received public antenatal care. Higher scores of perceived stress were shown in the Northeast, other than whites, at low levels of education, low annual family income and public antenatal care. Pregnant women with low resilience scores (n = 198) had higher perceived stress scores (median = 28) and at least one vulnerability criterion (n = 181; 91.4%).

CONCLUSION

Our results reinforce the role of resilience in protecting women from vulnerability and perceived stress. It may prevent complications and build a positive experience during pregnancy.

Is perceived stress linked to enhanced cognitive functioning and reduced risk for psychopathology? Testing the hormesis hypothesis

Extensive research documents the impact of psychosocial stress on risk for the development of psychiatric symptoms across one's lifespan. Further, evidence exists that cognitive functioning mediates this link. However, a growing body of research suggests that limited stress can result in cognitive benefits that may contribute to resilience. The hypothesis that low-to-moderate levels of stress are linked to more adaptive outcomes has been referred to as hormesis. Using a sample of young adults from the Human Connectome Project (N = 1,206, 54.4% female, M_age = 28.84), the present study aims to test the hormetic effect between low-to-moderate perceived stress and psychopathological symptoms (internalizing and externalizing symptoms), as well as to cross-sectionally explore the intermediate role of cognitive functioning in this effect. Results showed cognitive functioning as a potential intermediating mechanism underlying the curvilinear associations between perceived stress and externalizing, but not internalizing, behaviors. This study provides preliminary support for the benefits of limited stress to the process of human resilience.

Development and psychometric validation of the Dispositional Recovery and Dysfunction Inventory: a tool to assess for positive and negative cognitions following trauma exposure

BACKGROUND

Recovery from trauma can be naturally occurring or facilitated through psychotherapy. Few brief measures exist to provide clinicians with dispositional, empirical assessments of patient's sentiments during psychotherapy.

AIMS

This manuscript presents the Dispositional Recovery and Dysfunction Inventory (DRDI), a measure created to assist clinicians in evaluating patient's treatment progress during psychotherapy, as well as evaluate its factor structure, reliability estimates, measurement invariance, and correlates.

METHOD

The DRDI was created based on feedback from experts with experience treating posttraumatic stress disorder (PTSD) and was structurally validated in two distinct populations. Exploratory factor analysis was conducted in sample 1 consisting of (n=401) university students. Confirmatory factor analysis, measure validity and structure validation were then conducted in sample 2 (n=249) composed of 49% individuals with clinically significant PTSD symptoms.

RESULTS

Exploratory and confirmatory factor analysis revealed that the DRDI was best represented by a two-factor correlated traits model representing sentiments related to dispositional recovery and dysfunctional cognitions. The recovery subscale exhibited relationships with convergent measures including authenticity and psychological hardiness (r values of .30 to .60). The dysfunctional beliefs subscale exhibited relationships with convergent measures: PTSD, depression, suicidality and stress (r values of .55 to 80). Measurement invariance across gender and PTSD status was observed.

CONCLUSION

Initial findings indicate that the DRDI has the potential to be a useful tool to assess individuals' beliefs about their propensity to recover from and thrive through adversity.

A decennial review of psychotraumatology: what did we learn and where are we going?

On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma. This editorial is part of a special issue/collection celebrating the 10 years anniversary of the journal where we will acknowledge some of our most impactful articles of the past decade (also discussed below and marked with * in the reference list). In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline. These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience. We address innovations in psychological, medication (enhanced) and technology-assisted treatments, mediators and moderators like social support and finally how new research methods help us to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions 1. Where did we stand in 2010? 2. What did we learn in the past 10 years? 3. What are our knowledge gaps? We conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.

Resilience as a translational endpoint in the treatment of PTSD

Resilience is a neurobiological entity that shapes an individual's response to trauma. Resilience has been implicated as the principal mediator in the development of mental illness following exposure to trauma. Although animal models have traditionally defined resilience as molecular and behavioral changes in stress responsive circuits following trauma, this concept needs to be further clarified for both research and clinical use. Here, we analyze the construct of resilience from a translational perspective and review optimal measurement methods and models. We also seek to distinguish between resilience, stress vulnerability, and posttraumatic growth. We propose that resilience can be quantified as a multifactorial determinant of physiological parameters, epigenetic modulators, and neurobiological candidate markers. This multifactorial definition can determine PTSD risk before and after trauma exposure. From this perspective, we propose the use of an 'R Factor' analogous to Spearman's g factor for intelligence to denote these multifactorial determinants. In addition, we also propose a novel concept called 'resilience reserve', analogous to Stern's cognitive reserve, to summarize the sum total of physiological processes that protect and compensate for the effect of trauma. We propose the development and application of challenge tasks to measure 'resilience reserve' and guide the assessment and monitoring of 'R Factor' as a biomarker for PTSD.

No gene-by-environment interaction of BDNF Val66Met polymorphism and childhood maltreatment on anxiety sensitivity in a mixed race adolescent sample

Background: Anxiety disorders in youth are attributable to multiple causal mechanisms, comprising biological vulnerabilities, such as genetics and temperament, and unfavourable environmental influences, such as childhood maltreatment (CM). Objective: A gene-environment (G x E) interaction study was conducted to determine the interactive effect of the BDNF Val66Met polymorphism and CM to increase susceptibility to anxiety sensitivity (AS) in a sample of mixed race adolescents. Method: Participants (n = 308, mean age = 15.8 years) who were all secondary school students and who completed measures for AS and CM were genotyped for the BDNF Val66Met polymorphism. Hierarchical multiple regression analysis was conducted to assess G x E influences on AS. Age and gender were included in the models as covariates as age was significantly associated with AS total score (p < .05), and females had significantly higher AS scores than males (p < .05). Results: A main effect of CM on AS was evident (p < .05), however, no main effect of BDNF genotype on AS was observed (p > .05). A non-significant G x E effect on AS was revealed (p < .05). Conclusions: Our results suggest that CM does not have a moderating role in the relationship between the BDNF Val66Met genotype and the increased risk of anxiety-related phenotypes, such as AS. Given the exploratory nature of this study, findings require replication in larger samples and adjustment for population stratification to further explore the role of BDNF Val66Met and CM on AS in mixed race adolescents.

Children's Mental Health in the Area Affected by the Hebei Spirit Oil Spill Accident

OBJECTIVES

Children are one of the most vulnerable populations to the impact of disasters. We aimed to examine children's mental health in the area affected by the Hebei Spirit oil spill accident on December 7, 2007.

METHODS

A cross-sectional questionnaire survey was conducted using the Korean versions of the Children's Depression Inventory and State Anxiety Inventory for Children on 1,362 children attending elementary schools in the affected area. The information on distances between the nearest contaminated coastline to the child's residential house or attending school were obtained using a web-based map by inputting two address points. The symptom risks of depression and state anxiety were estimated by multiple logistic regression analyses adjusted for age, gender, and other covariates.

RESULTS

Children with the closest distance (in the fourth quartile) to the school from the contaminated coastline showed a significantly higher symptom risk of depression compared to those with the farthest distance (first quartile)(odds ratio, 2.73; 95% confidence interval, 1.40-5.33), while there was no significant association between anxiety symptoms and distance.

CONCLUSIONS

Children, a vulnerable population for mental health impact by the oil spill accident, should be included in mental health programs in the community along with their family as victims of the disaster.

Stress, vulnerability and resilience, a developmental approach

BACKGROUND

The origins of mental disorders arise often in childhood. Early life is a period of unique sensitivity with long lasting effects on mental health. However, the mechanisms for these effects remain unclear.

OBJECTIVE

This thesis describes a variety of studies using a developmental framework to promote greater understanding of the influence of nature (genotypes) and nurture (e.g., environmental risk and protective factors) on outcomes later in childhood.

METHOD

The aim of this thesis is to investigate gene and environmental influences on behavioural, emotional, and cognitive outcomes in different samples from the Netherlands and Singapore, most derived from the general population. We assessed early life influences from a neurobiological, social, and a psychological perspective by using a biopsychosocial framework.

RESULTS

Our studies support the hypothesis that all experiences during life, including early experiences in utero, will influence the expression of genes and in the end the mental health of individuals. However, genotypes influencing stress responses are found to be "plastic," which implies that they can be modulated by environmental experiences during life. In line with this, patterns of resilience are found to be context-dependent too.

CONCLUSIONS

The model of "epigenetic programming" suggests the predictive power of the environment in utero and early childhood on mental health later in life. This association is probably determined by a neurodevelopmental pathway with individual differences in neural and endocrine responses to stress.