Interaction of recent stressful life events and childhood abuse on orbitofrontal grey matter volume in adults with depression

BACKGROUND

The diathesis-stress model of major depressive disorder (MDD) predicts interactions of recent stressful life events (SLEs) in adulthood and early developmental risk factors. We tested, for the first time, the diathesis stress model on brain structure in a large group of MDD patients.

METHODS

Structural magnetic resonance imaging data of 1465 participants (656 with lifetime diagnosis MDD; 809 healthy controls) were analyzed using voxel-based morphometry to identify clusters associated with recent SLEs (Life Events Questionnaire). Those clusters were then examined for group (healthy/MDD) × early developmental risk (operationalized as childhood abuse [Childhood Trauma Questionnaire] and a major psychiatric disorder [i.e., MDD, bipolar disorder, schizophrenia, and schizoaffective disorder] in a first-degree relative) × recent SLEs three-way interactions on grey matter volume.

RESULTS

There was a group × childhood abuse × recent SLEs interaction on left medial orbitofrontal cortex grey matter volume. This three-way interaction arose because childhood abuse and recent SLEs interacted in MDD subjects but not in healthy subjects.

LIMITATIONS

We are not able to draw conclusions about the cause and effect relationship due to our cross-sectional study design.

CONCLUSIONS

Our data provides evidence for an interplay between orbitofrontal cortex structure, childhood abuse and recent SLEs. These factors have previously been linked to MDD and their complex interaction contributes to the pathogenesis of MDD.

Perfectionistic cognitions, Interleukin-6, and C-Reactive protein: A test of the perfectionism diathesis stress model

Previous research has demonstrated that perfectionism is implicated in poorer health and earlier mortality. However, to our knowledge, research has not yet determined how individual differences in perfectionistic cognitions are related to intermediary health markers such as inflammation. Thus, within the theoretical frameworks of the perfectionism diathesis-stress model (Hewitt and Flett, 1993) and the cognitive theory of perfectionism (Flett et al., 2018; Flett et al., 2016) the aims of our study were to test whether individual differences in perfectionistic cognitions were associated with low-grade inflammation via c-reactive CRP and IL-6 biomarkers and whether these relationships varied as a function perceived stress. The sample included 248 Canadian young adults (52% female, Mage ​= ​22.89, SD ​= ​1.53) who completed surveys assessing key constructs such as perfectionistic cognitions and perceived stress along with providing assessments of body fat percentage and serum samples of IL-6 and CRP. Regression analyses indicated that perfectionistic cognitions were not related to IL-6 under any conditions of stress. However, under high levels of stress perfectionistic cognitions were associated with elevated levels of CRP and these findings held after accounting for the effects of smoking status, body fat percentage, and respondent sex. The present work adds to the growing body of evidence supporting links between personality and inflammation. These findings raise the possibility that experiencing more frequent thoughts centered on the need to be perfect when coupled with higher levels of stress may set the stage for greater vulnerability for chronic inflammation.

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Perfectionistic cognitions were related to elevated levels of CRP under high levels of perceived stress.

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Perfectionistic cognitions were not related to CRP under low or moderate levels of perceived stress.

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Perfectionistic cognitions were not related to IL-6 under any conditions of stress.

Does Negative Emotional Reactivity Moderate the Relation between Contextual Cohesion and Adolescent Well-Being?

Although well-being is a chief indicator of positive mental health, much research has neglected to consider individual-specific and contextual factors that may promote this important outcome among youth. To address this gap, we examined whether neighborhood and family social cohesion are associated with well-being among youth varying in negative emotional reactivity, and whether findings were consistent with the diathesis-stress or differential susceptibility hypothesis. Participants were assessed at 3 time points: Time 1 (N = 775, M age = 10.95 ± 0.88 years; 71% male); Time 2 (n = 660, M age = 12.99 ± 0.95 years); and Time 3 (n = 633, M age = 15.50 ± 0.56 years). At Time 1, caregivers reported on family and neighborhood cohesion. Youth reported on their negative emotional reactivity at Time 2 and well-being at Time 3. Negative emotional reactivity moderated the relation between family cohesion and well-being. Among youth higher in negative emotional reactivity, lower family cohesion was associated with lower levels of well-being compared to higher family cohesion. Youth higher and lower in emotional reactivity evidenced similar levels of well-being when exposed to higher family cohesion. The findings thus support the diathesis-stress model, suggesting that less cohesive families may contribute to reduced happiness and well-being, particularly among youth with higher negative emotional reactivity.

Peritraumatic Neural Processing and Intrusive Memories: The Role of Lifetime Adversity

BACKGROUND

Pathological peritraumatic encoding is proposed as a proximal risk factor for the development of posttraumatic stress disorder (PTSD), with trauma-analog studies linking increased neural processing of trauma films to intrusive trauma recollections, a core symptom of PTSD. Cumulative lifetime adversity is proposed as a more distal risk factor, with research indicating a tipping point at about five events with regard to PTSD development following re-exposure to trauma. Thus, within a diathesis × stress framework, increased peritraumatic neural processing may constitute a specific risk factor for PTSD, particularly in individuals with several lifetime adversities.

METHODS

Fifty-three healthy women watched highly aversive films depicting severe interpersonal violence versus neutral films during functional magnetic resonance imaging, and they reported involuntary recollections during subsequent days. Moderation analyses tested the interactive relationship between peritraumatic neural processing and lifetime adversity in predicting intrusion load, i.e., the total number of intrusions weighted for their average distress.

RESULTS

Increased processing of aversive versus neutral films in the amygdala, anterior insula, dorsal and rostral anterior cingulate cortices, and hippocampus predicted increased intrusion load only in participants reporting above five lifetime adversities; for participants reporting few to none, no such relationship was found. This interactive relationship explained ≤59% of variance. Conditioned stimuli preceding film viewing mirrored this pattern.

CONCLUSIONS

Peritraumatic neural processing in multiple salience network regions and cumulative lifetime adversity interactively predicted PTSD-like symptomatology, representing a diathesis × stress framework that might guide identification of at-risk individuals and potential targets for symptom prevention after traumatic incidents.

A test of the diathesis-stress model in the emergency department: who develops PTSD after an acute coronary syndrome?

Most acute coronary syndrome (ACS) patients first present to the emergency department (ED). Patients who present to overcrowded EDs develop more posttraumatic stress disorder (PTSD) symptoms due to the ACS than do patients who present to less crowded EDs, but no research has indicated whether some patients may be more vulnerable to the effects of ED crowding than others. In an observational cohort study, we tested whether depressed patients developed more ACS-induced PTSD symptoms under conditions of ED overcrowding than patients who had never been depressed. We conducted psychiatric interviews for current and past depression in 189 ACS patients admitted through the ED within a week of hospitalization, and screened for PTSD symptoms 1 month later using the Impact of Events Scale-Revised. The sum of ED admissions for the 12 h prior to and 12 h after each participant's admission was categorized into tertiles for analysis. In a 3 (ED crowding tertile) by 3 (never, past, current depression) analysis of covariance adjusted for demographic and clinical factors, we found significant effects for ED crowding, depression status, and their interaction (all p's < .05). Mean PTSD scores were significantly higher (p = .005) for participants who were currently depressed and were treated during times of high ED crowding [25.38, 95% CI = 16.18-34.58], or had a history of depression [10.74, 95% CI = 6.86-14.62], relative to all other participants, who scored 5.6 or less. These results suggest that depressed ACS patients may be most vulnerable to the stress-inducing effects of ED crowding.