Brain activity patterns after trauma may predict long-term mental health

The way a person’s brain responds to stress following a traumatic event, such as a car accident, may help to predict their long-term mental health outcomes, according to research supported by the National Institute of Mental Health (NIMH), part of the National Institutes of Health. The research, published in the American Journal of Psychiatry, is part of the NIMH-funded AURORA study(link is external), a large-scale, multisite study that followed more than 3,000 people for up to a year after exposure to a traumatic event.

Evidence from previous studies suggests that it’s common for people to show a wide range of responses after a traumatic experience, such as a natural disaster or serious accident. One person may show initial symptoms that diminish naturally over time, while another may have long-lasting symptoms that make it difficult to carry out everyday activities. These different responses do not fall neatly into existing diagnostic categories and, although there are known risk and resilience factors associated with mental health outcomes, researchers aren’t yet able to predict how a specific person will fare after experiencing a traumatic event.

Using a variety of neurobiological, behavioral, and self-report measures, the AURORA study researchers hope to develop a comprehensive picture of the factors that play a role in trauma survivors’ mental health over time. To help advance this effort, AURORA study data will be made available to the broader research community through the NIMH Data Archive.

As part of the study, Jennifer Stevens, Ph.D.(link is external), of Emory University in Atlanta, led an investigation of post-trauma brain activity in an initial group of 69 AURORA participants who were seen in an emergency department following a car crash. Stevens and colleagues hypothesized that different patterns of stress-related brain activity may predict participants’ long-term mental health symptoms across a range of diagnoses.

Two weeks after the accident, the participants had their brain activity measured via functional MRI while they completed a series of standard computer-based tasks. The tasks assessed their brain activity in response to social threat cues, reward cues, and situations that required them to inhibit a response.

Over the next six months, the participants also completed digital surveys in which they self-reported symptoms of post-traumatic stress disorder (PTSD), depression, dissociation, anxiety, and impulsivity.

Analyses of the participants’ brain activity data revealed four distinct profiles:

• Reactive/disinhibited: High activity related to both threat and reward; little activity related to response inhibition
• Low-reward/high-threat: High activity related to threat; low activity related to reward
• High-reward: No activity related to threat; little activity related to response inhibition; high activity related to reward
• Inhibited: De-activation related to threat; some activity related to inhibition; low activity related to reward

The researchers then performed the same analyses with a separate group of 77 AURORA participants who also were seen in an emergency department following exposure to a range of traumatic events not limited to car crashes. In this group, they found evidence for three of the four profiles: reactive/disinhibited, low-reward/high-threat, and inhibited. These profiles were not correlated with other demographic, health-related, trauma-related, or site-specific characteristics.

Looking at participants’ brain activity profiles in relation to their mental health outcomes, Stevens and co-authors found that participants with the reactive/disinhibited profile—those who showed high activity related to both threat and reward—reported higher levels of symptoms of both PTSD and anxiety over the six-month follow-up period compared with the other profiles.

The researchers found no association between any of the brain activity profiles and other mental health outcomes, such as symptoms of depression, dissociation, or impulsivity.

The link between high reward reactivity (as part of the reactive/disinhibited profile) and long-term symptoms was unexpected, as previous studies indicated an association between low reward reactivity and post-trauma PTSD and depression. The divergent findings could be explained by the fact that reactivity to reward and threat are rarely examined together in trauma-related studies. The researchers suggest that reward reactivity warrants greater attention in future studies as a potential risk factor for stress-related symptoms following trauma.

These findings are preliminary and additional research with larger samples will be needed to confirm and refine these brain-based profiles. However, these initial findings suggest that the profiles could provide meaningful information about a person’s vulnerability to stress after experiencing a traumatic event. Establishing reliable, predictive profiles of stress response could improve clinical care, helping providers deliver effective interventions that are tailored to trauma survivors’ individual needs and circumstances.

Determining Depression

Everybody experiences feeling down from time to time; it is an entirely normal part of life. However, sometimes the feelings of hopelessness and despair seem to stick around as an almost permanent fixture, and this could be a telling sign that someone is struggling with depression.

Depression is undoubtedly more than simply feeling sad about setbacks – it changes how people think, feel, responds, and function in their everyday lives. Major depression can have a negative impact on work, schooling, eating, sleeping, and socializing. 

Unfortunately, there is no such thing as a simple depression test, and individuals experience this mental health issue in highly different ways. Some may feel like they are lifeless or apathetic. Others get an impending sense of doom. However depression is experienced by the person, if it is left untreated, it can become a life-threatening health condition. 

It is important to remember that depression isn’t the reality of the situation, and it can be treated with innovative medical processes and therapy sessions. The most important thing is knowing how to recognize the signs of depression so that you, or a loved one, can seek help at the earliest opportunity.

Symptoms of Depression

Photo credit: Harvard Health

As mentioned, everyone experiences depression in their own way. The signs of depression will also vary according to how severe it is. In general, however, these are the most commons signs to keep an eye out for:

1. Feelings of Hopelessness
2. Complete Loss of Interest
3. Changes in Sleep Patterns
4. Anxiety or Restlessness
5. Appetite and Weight Changes
6. Anger and Irritability
7. Uncontrollable Emotions
8. Reckless Behaviors
9. Physical Pain and Discomfort, and
10. Self-Harm or Talking About Death

Variations of Depression Symptoms

Of course, depression is something that people experience in completely different ways. However, there is a link between the signs of depression and how people of different ages and genders experience them:

• Men: Men who struggle with depression are less likely to acknowledge emotional aspects like self-loathing or hopelessness. Instead, they generally show signs such as irritability, sleep issues, loss of interest, and they are more likely to act out aggressively or engage in reckless behaviors like substance abuse.

• Women: Women tend to struggle with excessive self-guilt or loathing. Weight changes are incredibly common, with overeating and weight gain being particularly symptomatic of depression. Of course, depression is also impacted by the extreme hormonal changes women go through during menstruation, pregnancy, and menopause.

• Teens: Irritability, moodiness, and excessive sleeping are common in teens with depression. They may complain of physical symptoms like stomach and headaches to get out of activities like sports and school. They could also isolate themselves from friends and family.

• Older Adults: Older adults generally struggle more with physical symptoms. Aches, pains, fatigue, and memory problems are common. They could also begin to neglect personal hygiene, appearance, and health.

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The article is published courtesy of Addiction Rehab Treatment

President Julius Maada Bio explains why massive investment in mental health matters in present-day Sierra Leone

President Dr Julius Maada Bio has said at the commissioning of the renovated Sierra Leone Psychiatric Teaching Hospital Complex, SLPTH, that mental health intervention is within government’s overarching human capital development priority.

“Here is why all this matters. Our country has been bludgeoned over the last three decades by traumatic event after traumatic event – from the bloody violence and chaos of the civil war, to catastrophic natural disasters like the mudslide and flooding, through the Ebola virus disease epidemic, and now the COVID-19 pandemic.

“All these events and beyond have induced conditions from post-traumatic stress disorder and grief, to anxiety, depression, psychosis, acute stress, and harmful substance abuse. Combine this with autism, epilepsy, bipolar and psychotic disorders, intellectual and cognitive disabilities, and more, and we recognise that as a nation, we must act now. We must invest heavily in mental healthcare.

“We believe, as a government, in harnessing the full potential of every Sierra Leonean. We believe that improving and promoting mental health care is an essential part of achieving Universal Health Care coverage with positive outcomes for the physical health of our citizens,” he stated. 

He also added that they believed that elevated investments in mental healthcare would have positive implications for human and socio-economic development in the country because it would protect human rights and reduce social and economic disparities.

“In our 2018 manifesto, we committed to ‘developmental health treatment and care facilities in Freetown and build new facilities in the provinces’. We made our commitment against the background of decades of neglect of mental health care and the premier psychiatric hospital in the country.

“This was an unsanitary site of unspeakable neglect and abuse. Nothing seemed to work- from ramshackle buildings with broken toilets, broken windows, empty pharmacies, no water supply, to insecure perimeter fencing that was regularly breached by patients. Mental health care was still offered within an outdated century-old mental health legislation and evidence abound of inhumane isolation and chaining practices and overall poor outcomes for patients. This institutional neglect was complicated with little to no dedication to staff training or to modernising mental healthcare practices. For us, the burden of doing little to nothing hung on our conscience like a millstone.

“So, the argument to make is simple. We know that persons with mental health needs and their families, in cases, are subjected to severe discrimination, stigma, harassment, and victimisation. Their constitutional rights and their security are not guaranteed. Because of cultural insensitivities, children are often not educated and abandoned to a life of vagrancy, abuse, and early death. They are also susceptible to other chronic physical disease conditions, unhealthy diets, unsafe living conditions, and most often, early death,” he said, adding that government’s commitment remained not only to guarantee the rights of every citizen, but also to protect and nurture every citizen to their fullest potential.

The President noted what other speakers had said before him, highlighting initiatives the leadership of the SLPTH had undertaken, and the collaboration with the Ministry of Health and Sanitation, with support from partners, and the professional services of Dr. George Eze, who was singled out in Dir. Jalloh’s statement for his profound impact.

He emphasised that professional memberships organisations and efforts by the United Nations Office on Drugs and Crime to designate the hospital in Freetown as a Centre for International Collaboration and Research are highly commendable.

“My Government, through the Ministry of Health and Sanitation will also pursue the ECOWAS Commission’s agreement to establish the first drug treatment and rehabilitation centre here in Sierra Leone. My Government is ready to support and promote the SLPTH in its mission to deliver quality care to its patients. In order to augment and support the training of an indigenous medical workforce, my Government fully supports the establishment of a separate Department of Psychiatry in the College of Medicine and Allied Health Sciences to train mental health professionals such as nurses, occupational therapists, addiction specialists, and more from diploma to postgraduate levels,” he assured.

Minister of Health and Sanitation, Professor Alpha Tejan Wurie, said that the event was special because it reflected the preparedness of the government and, in particular, President Bio to take leadership in starting the process to destigmatise mental health. He added that mental health was key in achieving universal health coverage.

Executive Director for Partners in Health, working on access to quality health care, John Lascher, said that the facility was a pragmatic example of how nongovernmental organisations could partner effectively with government and the people of Sierra Leone. He added that Sierra Leoneans should be proud of the response and leadership in the COVID-19 fight.

Psychiatrist-in-Charge, Dr Abdul Jalloh, said that the hospital was the face of mental health in the country, established in 1820 for recaptives and those with physical and mental illness. He said that with support from the government, Partners in Health and other organisations, they had improved on services of the hospital in line with international best practices. He also encouraged the government to establish a separate department of psychiatry in the College of Medicines and Allied Health Sciences to produce homegrown specialised staff.

Persistent HIV in central nervous system linked to cognitive impairment

Many people with HIV on antiretroviral therapy (ART) have viral genetic material in the cells of their cerebrospinal fluid (CSF), and these individuals are more likely to experience memory and concentration problems, according to new data published online today in the Journal of Clinical Investigation.

A study of 69 individuals on long-term ART found that nearly half of the participants had persistent HIV in cells in their CSF, and 30% of this subset experienced neurocognitive difficulties.

These findings suggest that HIV can persist in the nervous system even when the virus is suppressed in a patient’s blood with medication. The study was funded by the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Mental Health (NIMH), both parts of the National Institutes of Health.

Investigators from the University of North Carolina, the University of Pittsburgh, and Yale University studied participants enrolled in the AIDS Clinical Trials Group (ACTG) HIV Reservoirs Cohort Study. This primarily male group — aged 45 to 56 — of long-term HIV survivors had infections controlled with ART for on average nine years.

Researchers analyzed each participant’s CSF for HIV DNA and then compared these data to each participants’ results from standard neurocognitive evaluations.

About half of participants had viral DNA in cells in the CSF, indicating the presence of latent virus, even though standard HIV RNA ‘viral load’ tests of the cell-free CSF fluid were positive in only 4% of participants. Investigators also found that 30% of individuals with persistent HIV DNA in the CSF experienced clinical neurocognitive impairment compared with 11% of individuals whose CSF did not contain viral DNA.

Many researchers hypothesize that HIV-related inflammation causes HIV-associated neurocognitive disorder (HAND). The new findings suggest that the presence of persistent HIV-infected cells in the central nervous system (CNS), despite long-term ART, may play a role in neurocognitive impairment.

The authors note that the overall frequency of neurocognitive impairment in this group was relatively low and that the association does not confirm that HIV DNA causes HAND.

Overall, the current study found that examining CSF cells revealed a higher-than-expected prevalence of persistent HIV in the CNS, which may be a significant obstacle to efforts to eradicate HIV from the body.

Family, community bonds help decrease mental health problems of former child soldiers

NIH-funded study documents transition to adulthood of Sierra Leone’s child soldiers.

An estimated 15,000 to 22,000 boys and girls of all ages were subject to repeat sexual violence and forced use of alcohol and drugs

Acceptance and support from communities and families appear to lessen the toll of mental health conditions experienced by former child soldiers transitioning to early adulthood, according to a study by researchers at the National Institutes of Health and other institutions.

The study appears in the Journal of the American Academy of Child and Adolescent Psychiatry.

When civil war broke out in Sierra Leone in 1991, several warring factions abducted children and forced their involvement in armed groups. An estimated 15,000 to 22,000 boys and girls of all ages were subject to repeat sexual violence, forced use of alcohol and drugs, hard physical labor, and acts of violence until the war ended in 2002.

“Sierra Leone’s child soldiers experienced violence and loss on a scale that’s hard to comprehend,” said study author Stephen Gilman, Sc.D., chief of the Social and Behavioral Sciences Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). “Our study provides evidence that there may be steps we can take to modify the post-war environment to alleviate mental health problems arising from these experiences.”

The study’s first author, Theresa S. Betancourt, Sc.D., of the Boston College School of Social Work in Chestnut Hill,  was funded by NICHD’s Child Development and Behavior Branch.

According to the study authors, former child soldiers may face rejection from family and their communities, along with physical injuries and psychological trauma. Previous studies have found former child soldiers have high rates of post-traumatic stress disorder, anxiety and depression.

To conduct the study, researchers analyzed data from the Longitudinal Study of War-Affected Youth, a 15-year study of more than 500 former child soldiers who participated in Sierra Leone’s Civil War. Participants were interviewed four times (in 2002, 2004, 2008 and 2016 to 2017) about their involvement with armed groups, exposure to violence in the war, and about their family and community relationships after the war. Interviewers also asked participants a series of questions to gauge their mental health status and their psychological adjustment at multiple time points.

From the data, researchers were able to group the participants into three developmental trajectories:

• A socially protected group, encompassing 66% of the study participants whose members were not heavily stigmatized for their war involvement and had high levels of acceptance from their families and communities. Members of this group also had lower levels of exposure to adverse war events.
• An improving social integration group that was initially highly stigmatized and had low community and family acceptance when the study began in 2002, but showed a large decrease in stigma and increase in acceptance by 2004, with slight increases in stigma and acceptance after that. This group had a high level of exposure to war events, was more likely to have been female, and more likely to have been raped.
• A socially vulnerable group that was highly stigmatized and had low family and community acceptance in 2002 and only marginal improvements in stigma and acceptance. Compared to the other groups, members of this group were more likely to be male, to have been in fighting forces for longer, and more likely to have injured or killed during the war.
• Members of the socially vulnerable group were about twice as likely as those in the socially protected group to experience high levels of anxiety and depression. They were three times more likely to have attempted suicide and over four times more likely to have been in trouble with the police. Those in the improving social integration group had violence exposure similar to that of the socially vulnerable group but were not significantly more likely than the socially protected group to experience any negative outcomes, apart from a slightly higher level of trouble with police.

The authors concluded that efforts to increase social and family acceptance while reducing stigma remain important components of interventions to help former child soldiers adapt to post-conflict life. They added that, in addition to understanding the mental health conditions that may afflict former child soldiers, it is important to monitor their family and community relationships after the war.

Former Liberia president, Ellen Johnson Sirleaf, and three others appointed WHO new goodwill ambassadors

Ellen Johnson Sirleaf

WHO Director-General Dr Tedros Adhanom Ghebreyesus in his speech to open the 72nd World Health Assembly in Geneva announced that former Liberia president, Ellen Johnson Sirleaf, is WHO Goodwill Ambassador for Health Workforce.

“I welcome President Ellen Johnson

Alisson Becker

Sirleaf, Cynthia Germanotta, Alisson Becker and Natália Loewe Becker as WHO’s new Goodwill Ambassadors and look forward to working with them over the coming years,” said Dr Tedros. “Each of our new ambassadors are champions in their own right, from helping their communities rebuild and develop sustainably, to fighting for better mental health and well-being, to being role models for healthier living.”

Dr Natália Loewe Becker

Cynthia Germanotta

Alisson Becker, goalkeeper of the Brazilian national and Liverpool football teams, Cynthia Germanotta, President of Born This Way Foundation, which was co-founded with her daughter Lady Gaga, as WHO Goodwill Ambassador for Mental Health; and Dr Natália Loewe Becker, medical doctor and health advocate from Brazil, as WHO Goodwill Ambassadors for Health Promotion.

NIH study reveals differences in brain activity in children with anhedonia

Using fMRI, researchers uncover the neural underpinnings, which could aid development of potential treatments.

Image showing differences in fMRI activation between children with and without anhedonia during reward-anticipation. JAMA Network

Researchers have identified changes in brain connectivity and brain activity during rest and reward anticipation in children with anhedonia, a condition where people lose interest and pleasure in activities they used to enjoy.

The study, by scientists at the National Institute of Mental Health (NIMH), part of the National Institutes of Health, sheds light on brain function associated with anhedonia and helps differentiate anhedonia from other related aspects of psychopathology. The findings appear in the journal JAMA Psychiatry. 

Anhedonia is a risk factor for, and a symptom of, certain mental disorders and is predictive of illness severity, resistance to treatment, and suicide risk. While researchers have sought to understand the brain mechanisms that contribute to anhedonia, investigations on this condition have more commonly focused on adults rather than children. Importantly, previous studies often did not separate anhedonia from other related psychopathologies, such as low mood, anxiety, or attention-deficit/hyperactivity disorder.

“Understanding the neural mechanisms of anhedonia that are distinguishable from other psychiatric concerns is important for clinicians to develop on-target treatments,” said lead study author Narun Pornpattananangkul, Ph.D., a postdoctoral fellow in the Emotion and Development Branch, part of NIMH’s Division of Intramural Research Programs. “Yet, disentangling shared characteristics from unique neural mechanisms of anhedonia is challenging because it often co-occurs with other psychiatric conditions.”

To learn more about the neurological underpinnings of anhedonia in children, researchers from the NIMH Division of Intramural Research Programs examined fMRI data collected from more than 2,800 children (9-10 years old) as part of the Adolescent Brain Cognitive Development (ABCD) Study(link is external). Some of the children included in the sample were identified as having anhedonia, low mood, anxiety, or attention-deficit/hyperactivity disorder (ADHD). fMRI data were collected while the children were at rest and while they completed tasks assessing reward anticipation and working memory.

Analysis of brain connectivity at rest revealed significant differences in children with anhedonia compared to children without anhedonia. Many of these differences were related to the connectivity between the arousal-related cingulo-opercular network and the reward-related ventral striatum area. These findings suggest that children with anhedonia have altered integration of reward and arousal compared to children without anhedonia. 

When the researchers examined brain activity during the tasks, they found that children with anhedonia showed hypoactivation of brain regions involved in integrating reward and arousal during the reward anticipation task — but not the working memory task. This hypoactivation was not seen in children with low mood, anxiety, or ADHD. In fact, children with ADHD showed the opposite pattern: abnormalities in brain activation during the working memory task — but the not the reward anticipation task.

The study suggests that children with anhedonia have differences in the way their brain integrates reward and arousal and in the way their brain activates when anticipating rewards.

“We found anhedonia-specific alterations, such that youth with anhedonia, but not youth with low mood, anxiety, or ADHD, showed differences in the way they integrated reward and arousal and also showed diminished activity in reward-anticipation contexts,” said Dr. Pornpattananangkul. “This finding may start to provide the specific neural targets for treating anhedonia in youth.”

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Article published courtesy of the NIH