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Association between traumatic stress load, psychopathology, and cognition in the Philadelphia Neurodevelopmental Cohort

  • Ran Barzilay (a1) (a2), Monica E. Calkins (a1), Tyler M. Moore (a1), Daniel H. Wolf (a1), Theodore D. Satterthwaite (a1), J. Cobb Scott (a1), Jason D. Jones (a2), Tami D. Benton (a2), Ruben C. Gur (a1) (a2) and Raquel E. Gur (a1) (a2)...

Abstract

Background

Traumatic stressors during childhood and adolescence are associated with psychopathology, mostly studied in the context of post-traumatic stress disorder (PTSD) and depression. We investigated broader associations of traumatic stress exposure with psychopathology and cognition in a youth community sample.

Methods

The Philadelphia Neurodevelopmental Cohort (N = 9498) is an investigation of clinical and neurobehavioral phenotypes in a diverse (56% Caucasian, 33% African American, 11% other) US youth community population (aged 8–21). Participants were ascertained through children's hospital pediatric (not psychiatric) healthcare network in 2009–2011. Structured psychiatric evaluation included screening for lifetime exposure to traumatic stressors, and a neurocognitive battery was administered.

Results

Exposure rate to traumatic stressful events was high (none, N = 5204; one, N = 2182; two, N = 1092; three or more, N = 830). Higher stress load was associated with increased psychopathology across all clinical domains evaluated: mood/anxiety (standardized β = .378); psychosis spectrum (β = .360); externalizing behaviors (β = .311); and fear (β = .256) (controlling for covariates, all p < 0.001). Associations remained significant controlling for lifetime PTSD and depression. Exposure to high-stress load was robustly associated with suicidal ideation and cannabis use (odds ratio compared with non-exposed 5.3 and 3.2, respectively, both p < 0.001). Among youths who experienced traumatic stress (N = 4104), history of assaultive trauma was associated with greater psychopathology and, in males, vulnerability to psychosis and externalizing symptoms. Stress load was negatively associated with performance on executive functioning, complex reasoning, and social cognition.

Conclusions

Traumatic stress exposure in community non-psychiatric help-seeking youth is substantial, and is associated with more severe psychopathology and neurocognitive deficits across domains, beyond PTSD and depression.

Copyright

Corresponding author

Author for correspondence: Ran Barzilay, E-mail: barzilayr@chop.email.edu

References

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Asselmann, E, et al. (2018) Sociodemographic, clinical, and functional long-term outcomes in adolescents and young adults with mental disorders. Acta Psychiatrica Scandinavica 137, 617.
Baldwin, JR, et al. (2018) Childhood victimization and inflammation in young adulthood: a genetically sensitive cohort study. Brain, Behavior, and Immunity 67, 211217.
Bale, TL and Epperson, CN (2015) Sex differences and stress across the lifespan. Nature Neuroscience 18, 14131420.
Barnhofer, T, et al. (2014) A comparison of vulnerability factors in patients with persistent and remitting lifetime symptom course of depression. Journal of Affective Disorders 152–154, 155161.
Baumeister, D, et al. (2016) Childhood trauma and adulthood inflammation: a meta-analysis of peripheral C-reactive protein, interleukin-6 and tumour necrosis factor-α. Molecular Psychiatry 21, 642649.
Berens, AE, Jensen, SKG and Nelson, CA (2017) Biological embedding of childhood adversity: from physiological mechanisms to clinical implications. BMC Medicine 15, 135.
Busso, DS, et al. (2017) Child abuse, neural structure, and adolescent psychopathology: a longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry 56, 321328.e1.
Calkins, ME, et al. (2015) The Philadelphia Neurodevelopmental Cohort: constructing a deep phenotyping collaborative. Journal of Child Psychology and Psychiatry 56, 13561369.
Calkins, ME, et al. (2014) The psychosis spectrum in a young U.S. Community sample: findings from the Philadelphia Neurodevelopmental Cohort. World Psychiatry 13, 296305.
Carliner, H, et al. (2017) Trauma exposure and externalizing disorders in adolescents: results from the national comorbidity survey adolescent supplement. Journal of the American Academy of Child and Adolescent Psychiatry 56, 755764.e3.
Cort, NA, et al. (2012) Predictors of treatment outcomes among depressed women with childhood sexual abuse histories. Depression and Anxiety 29, 479486.
Cowell, RA, et al. (2015) Childhood maltreatment and its effect on neurocognitive functioning: timing and chronicity matter. Development and Psychopathology 27, 521533.
Danese, A, et al. (2017) The origins of cognitive deficits in victimized children: implications for neuroscientists and clinicians. American Journal of Psychiatry 174, 349361.
Derry, HM, et al. (2015) Sex differences in depression: does inflammation play a role? Current Psychiatry Reports 17, 78.
Elton, A, et al. (2014) Childhood maltreatment is associated with a sex-dependent functional reorganization of a brain inhibitory control network. Human Brain Mapping 35, 16541667.
Evans, GW, Li, D and Whipple, SS (2013) Cumulative risk and child development. Psychological Bulletin 139, 13421396.
Everaerd, D, et al. (2012) Sex modulates the interactive effect of the serotonin transporter gene polymorphism and childhood adversity on hippocampal volume. Neuropsychopharmacology 37, 18481855.
Everaerd, D, et al. (2016) Childhood abuse and deprivation are associated with distinct sex-dependent differences in brain morphology. Neuropsychopharmacology 41, 17161723.
Gilman, SE, et al. (2015) Contributions of the social environment to first-onset and recurrent mania. Molecular Psychiatry 20, 329336.
Gur, RC, et al. (2010) A cognitive neuroscience-based computerized battery for efficient measurement of individual differences: standardization and initial construct validation. Journal of Neuroscience Methods 187, 254262.
Hardt, J and Rutter, M (2004) Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. Journal of Child Psychology and Psychiatry, and Allied Disciplines 45, 260273.
Heim, C and Binder, EB (2012) Current research trends in early life stress and depression: review of human studies on sensitive periods, gene–environment interactions, and epigenetics. Experimental Neurology 233, 102111.
Karam, EG, et al. (2014) Cumulative traumas and risk threshold: 12-month PTSD in the world mental health (WMH) surveys. Depression and Anxiety 31, 130142.
Kaufman, J, et al. (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry 36, 980988.
Kelly, KM and Mezuk, B (2017) Predictors of remission from generalized anxiety disorder and major depressive disorder. Journal of Affective Disorders 208, 467474.
Kessler, RC, et al. (2009) National comorbidity survey replication adolescent supplement (NCS-A): II. Overview and design. Journal of the American Academy of Child and Adolescent Psychiatry 48, 380385.
Lee, FS, et al. (2014) Adolescent mental health–Opportunity and obligation. Science 346, 547549.
Liu, H, et al. (2017) Association of DSM-IV posttraumatic stress disorder with traumatic experience type and history in the World Health Organization World Mental Health Surveys. JAMA Psychiatry 74, 270.
Lowe, SR, et al. (2017) Pathways from assaultive violence to post-traumatic stress, depression, and generalized anxiety symptoms through stressful life events: longitudinal mediation models. Cambridge University Press. Psychological Medicine 47, 25562566.
MacMillan, HL, et al. (2001) Childhood abuse and lifetime psychopathology in a community sample. American Journal of Psychiatry 158, 18781883.
MacPherson, HA, et al. (2014) Predictors and moderators in the randomized trial of multifamily psychoeducational psychotherapy for childhood mood disorders. Journal of Clinical Child & Adolescent Psychology 43, 459472.
Malarbi, S, et al. (2017) Neuropsychological functioning of childhood trauma and post-traumatic stress disorder: a meta-analysis. Neuroscience & Biobehavioral Reviews 72, 6886.
Markon, KE, Chmielewski, M and Miller, CJ (2011) The reliability and validity of discrete and continuous measures of psychopathology: a quantitative review. Psychological Bulletin 137, 856879.
McCutcheon, VV, et al. (2009) Accumulation of trauma over time and risk for depression in a twin sample. Psychological medicine 39, 431441.
McEwen, BS (1998) Stress, adaptation, and disease: Allostasis and Allostatic Load. Blackwell Publishing Ltd Annals of the New York. Academy of Sciences 840, 3344.
McEwen, BS (2017) Allostasis and the epigenetics of brain and body health over the life course. JAMA Psychiatry 74, 551.
McGrath, JJ, et al. (2017) The association between childhood adversities and subsequent first onset of psychotic experiences: a cross-national analysis of 23 998 respondents from 17 countries. Psychological Medicine 47, 12301245.
McLaughlin, KA (2016) Future directions in childhood adversity and youth psychopathology. Journal of Clinical Child & Adolescent Psychology 45, 361382.
McLaughlin, KA, et al. (2012) Childhood adversities and first onset of psychiatric disorders in a national sample of US adolescents. Archives of General Psychiatry 69, 1151.
McLaughlin, KA, et al. (2017) Childhood adversities and post-traumatic stress disorder: evidence for stress sensitisation in the World Mental Health Surveys. The British Journal of Psychiatry 211, 280288.
McLaughlin, KA and Sheridan, MA (2016) Beyond cumulative risk: a dimensional approach to childhood adversity. Current Directions in Psychological Science 25, 239245.
Merikangas, K, et al. (2009) National comorbidity survey replication adolescent supplement (NCS-A): I. Background and measures. NIH Public Access. Journal of the American Academy of Child and Adolescent Psychiatry 48, 367369.
Messman-Moore, TL and Bhuptani, PH (2017) A review of the long-term impact of child maltreatment on posttraumatic stress disorder and its comorbidities: an emotion dysregulation perspective. Clinical Psychology: Science and Practice 24, 154169.
Miller, ML and Brock, RL (2017) The effect of trauma on the severity of obsessive-compulsive spectrum symptoms: a meta-analysis. Journal of Anxiety Disorders 47, 2944.
Miller, S, et al. (2015) Cognition-childhood maltreatment interactions in the prediction of antidepressant outcomes in major depressive disorder patients: results from the i-SPOT D trial. Depression and Anxiety 32, 594604.
Moore, TM, et al. (2016) Characterizing social environment's association with neurocognition using census and crime data linked to the Philadelphia Neurodevelopmental Cohort. Psychological Medicine 46, 599610.
Moore, TM, et al. (2015) Psychometric properties of the Penn computerized neurocognitive battery. Neuropsychology 29, 235246.
Nemeroff, CB (2016) Paradise lost: the neurobiological and clinical consequences of child abuse and neglect. Neuron 89, 892909.
Newbury, JB, et al. (2017) Measuring childhood maltreatment to predict early-adult psychopathology: comparison of prospective informant-reports and retrospective self-reports. Elsevier. Journal of Psychiatric Research 96, 5764.
Pinheiro, J, et al. and RCT (2017) Linear and Nonlinear Mixed Effects Models. 3.1-128.
Ribeiro, WS, et al. (2013) The impact of epidemic violence on the prevalence of psychiatric disorders in Sao Paulo and Rio de Janeiro, Brazil. Ed. U Schmidt. PLoS ONE 8, e63545.
Scott, JC, et al. (2015) A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder. Psychological Bulletin 141, 105140.
Shaffer, D, et al. (1983) A children's global assessment scale (CGAS). Archives of General Psychiatry 40, 12281231.
Shanmugan, S, et al. (2016) Common and dissociable mechanisms of executive system dysfunction across psychiatric disorders in youth. American Journal of Psychiatry 173, 517526.
Shonkoff, JP, Boyce, WT and McEwen, BS (2009) Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. JAMA 301, 22522259.
Suliman, S, et al. (2009) Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Comprehensive Psychiatry 50, 121127.
Teicher, MH and Samson, JA (2013) Childhood maltreatment and psychopathology: a case for ecophenotypic variants as clinically and neurobiologically distinct subtypes. American Psychiatric AssociationArlington, VA. American Journal of Psychiatry 170, 11141133.
Teicher, MH, Tomoda, A and Andersen, SL (2006) Neurobiological consequences of early stress and childhood maltreatment: are results from human and animal studies comparable? Annals of the New York Academy of Sciences 1071, 313323.
Tyrka, AR, et al. (2013) The neurobiological correlates of childhood adversity and implications for treatment. Acta Psychiatrica Scandinavica 128, 434447.
Walker, SP, et al. (2011) Inequality in early childhood: risk and protective factors for early child development. The Lancet 378, 13251338.
Wiersma, JE, et al. (2009) The importance of childhood trauma and childhood life events for chronicity of depression in adults. Physicians Postgraduate Press, Inc. The Journal of Clinical Psychiatry 70, 983989.
Wilkinson, G (2006) WRAT 4: wide range achievement test professional manual, 4th edn., Lutz, FL: Psychological Assessment Resources Inc.
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