A prospective examination of sex differences in posttraumatic autonomic functioning,Neurobiology of Stress

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A prospective examination of sex differences in posttraumatic autonomic functioning
Neurobiology of Stress ( IF 4.3 ) Pub Date : 2021-08-21 , DOI: 10.1016/j.ynstr.2021.100384
Antonia V Seligowski _{1,

2} , Elizabeth R Steuber ₃ , Rebecca Hinrichs ₄ , Mariam H Reda ₅ , Charis N Wiltshire ₆ , Cassandra P Wanna ₅ , Sterling J Winters ₅ , Karlye A Phillips _{7,

8} , Stacey L House ₉ , Francesca L Beaudoin ₁₀ , Xinming An ₁₁ , Jennifer S Stevens ₄ , Donglin Zeng ₁₂ , Thomas C Neylan ₁₃ , Gari D Clifford _{14,

15} , Sarah D Linnstaedt ₁₁ , Laura T Germine _{1,

16,

17} , Kenneth A Bollen ₁₈ , Guia Guffanti _{1,

2} , Scott L Rauch _{1,

16,

19} , John P Haran ₂₀ , Alan B Storrow ₂₁ , Christopher Lewandowski ₂₂ , Paul I Musey ₂₃ , Phyllis L Hendry ₂₄ , Sophia Sheikh ₂₄ , Christopher W Jones ₂₅ , Brittany E Punches _{26,

27} , Michael C Kurz _{28,

29,

30} , Vishnu P Murty ₃₁ , Meghan E McGrath ₃₂ , Lauren A Hudak ₃₃ , Jose L Pascual _{34,

35} , Mark J Seamon _{35,

36} , Elizabeth M Datner _{37,

38} , Anna M Chang ₃₉ , Claire Pearson ₄₀ , David A Peak ₄₁ , Roland C Merchant ₄₂ , Robert M Domeier ₄₃ , Niels K Rathlev ₄₄ , Brian J O'Neil ₄₀ , Leon D Sanchez _{42,

45} , Steven E Bruce ₄₆ , Mark W Miller _{47,

48} , Robert H Pietrzak _{49,

50} , Jutta Joormann ₅₁ , Deanna M Barch ₅₂ , Diego A Pizzagalli _{1,

2} , John F Sheridan _{53,

54} , Beatriz Luna ₅₅ , Steven E Harte _{56,

57} , James M Elliott _{58,

59,

60} , Karestan C Koenen ₆₁ , Ronald C Kessler ₆₂ , Samuel A McLean _{11,

63} , Kerry J Ressler _{1,

2} , Tanja Jovanovic ₅

Affiliation

Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA.
Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA.
Department of Psychiatry, Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA.
Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA.
Wayne State University, Detroit, MA, 48202, USA.
McLean Hospital, Belmont, MA, 02478, USA.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA.
Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and the Miriam Hospital, Providence, RI, 02930, USA.
Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA.
Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27559, USA.
Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA.
Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA.
Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA.
Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA.
The Many Brains Project, Belmont, MA, 02478, USA.
Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA.
Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA.
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, 48202, USA.
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA.
Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA.
Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA.
College of Nursing, University of Cincinnati, Cincinnati, OH, 45221, USA.
Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, 35294, USA.
Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, 35294, USA.
Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
Department of Psychology, Temple University, Philadelphia, PA, 19121, USA.
Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA.
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA.
Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA.
Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA.
Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA.
Department of Emergency Medicine, Einstein Healthcare Network, Pennsylvania, PA, 19141, USA.
Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA, 19107, USA.
Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, 19107, USA.
Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA.
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA.
Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA.
Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA.
Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA.
Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA.
National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, 02130, USA.
Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA.
National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA.
Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA.
Department of Psychology, Yale School of Medicine, New Haven, CT, 06510, USA.
Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA.
Department of Biosciences, OSU Wexner Medical Center, Columbus, OH, 43210, USA.
Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA.
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.
Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.
Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, 2065, Australia.
Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, 2006, Australia.
Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA.
Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA.
Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA.

Background

Cross-sectional studies have found that individuals with posttraumatic stress disorder (PTSD) exhibit deficits in autonomic functioning. While PTSD rates are twice as high in women compared to men, sex differences in autonomic functioning are relatively unknown among trauma-exposed populations. The current study used a prospective design to examine sex differences in posttraumatic autonomic functioning.

Methods

192 participants were recruited from emergency departments following trauma exposure (Mean age = 35.88, 68.2% female). Skin conductance was measured in the emergency department; fear conditioning was completed two weeks later and included measures of blood pressure (BP), heart rate (HR), and high frequency heart rate variability (HF-HRV). PTSD symptoms were assessed 8 weeks after trauma.

Results

2-week systolic BP was significantly higher in men, while 2-week HR was significantly higher in women, and a sex by PTSD interaction suggested that women who developed PTSD demonstrated the highest HR levels. Two-week HF-HRV was significantly lower in women, and a sex by PTSD interaction suggested that women with PTSD demonstrated the lowest HF-HRV levels. Skin conductance response in the emergency department was associated with 2-week HR and HF-HRV only among women who developed PTSD.

Conclusions

Our results indicate that there are notable sex differences in autonomic functioning among trauma-exposed individuals. Differences in sympathetic biomarkers (BP and HR) may have implications for cardiovascular disease risk given that sympathetic arousal is a mechanism implicated in this risk among PTSD populations. Future research examining differential pathways between PTSD and cardiovascular risk among men versus women is warranted.

中文翻译：

创伤后自主神经功能性别差异的前瞻性研究

背景

横断面研究发现，患有创伤后应激障碍（PTSD）的个体表现出自主神经功能缺陷。虽然女性的创伤后应激障碍（PTSD）发病率是男性的两倍，但在遭受创伤的人群中，自主神经功能的性别差异相对未知。目前的研究采用前瞻性设计来检查创伤后自主神经功能的性别差异。

方法

192 名创伤暴露后的参与者从急诊室招募（平均年龄 = 35.88，68.2% 为女性）。在急诊科测量了皮肤电导率；两周后完成恐惧调节，包括测量血压（BP）、心率（HR）和高频心率变异性（HF-HRV）。创伤后 8 周评估 PTSD 症状。

结果

男性的 2 周收缩压显着较高，而女性的 2 周 HR 显着较高，并且 PTSD 相互作用的性别表明，患有 PTSD 的女性表现出最高的 HR 水平。女性的两周 HF-HRV 显着较低，并且 PTSD 相互作用的性别表明，患有 PTSD 的女性表现出最低的 HF-HRV 水平。仅在患有 PTSD 的女性中，急诊室的皮肤电导反应与 2 周 HR 和 HF-HRV 相关。