Association of pro-inflammatory cytokines with trauma and post-traumatic stress disorder visiting a tertiary care hospital in Kathmandu.

Post-traumatic stress disorder (PTSD) is a mental disorder that can occur after trauma. Although inflammatory markers such as cytokines are found altered in trauma and PTSD, there is no consensus regarding which can be considered as biomarkers. Studies from South Asia region is also rare. We studied cytokines among trauma affected patients and matched healthy controls. Fifty patients (cases) with trauma, visiting the University hospital in Kathmandu and thirty-nine healthy controls were selected, and the levels of cytokines were determined using a Luminex IS 200. We compared the levels of the cytokines in thirty-four age and gender matched pairs of case and control among three groups: healthy volunteers, cases diagnosed as PTSD, and cases without PTSD. Among the 34 pair-matched cases and controls, IL-6 was significantly higher in both PTSD positive cases [2.43 (0.00-14.54) pg/ml; p = 0.004] and PTSD negative cases [3.00 (0.92-3.86) pg/ml; p = 0.005], than in controls [0.39 (0.00-11.38) pg/ml]. IL-1ß was significantly higher in PTSD positive cases [0.17 (0.00-5.27) pg/ml; p = 0.011] than in controls 0.00 (0.00-0.12) pg/ml. Other cytokines did not show significant differences. IL-6 was higher in both the trauma affected groups and IL-1ß was higher in the trauma affected group with PTSD when compared to healthy controls. This supports the immune system activation hypothesis after trauma.

Abnormal Cytokines in Trauma Patients Explained by Obesity, Musculoskeletal Disease, Smoking, and Lung Disease.

INTRODUCTION: Low-grade inflammation observed through abnormal plasma cytokine levels has been associated with post-traumatic stress disorder (PTSD). It is not clear whether PTSD independently causes the inflammation or if it is mainly through co-occurring somatic factors such as smoking and obesity. We wanted to explore the effects of biopsychosocial factors on cytokine levels in a clinical setting. METHODS: The sample consisted of 51 patients with PTSD, 58 trauma patients without PTSD, and 40 matched controls. We selected cytokines and relevant risk factors for systemic inflammation through pairwise correlations. Then, we used linear regression to analyze the individual and combined effects of these on the (Log10) cytokines, particularly estimating the effect of PTSD adjusted for other factors. RESULTS: Higher age, female gender, cigarette smoking, presence of lung and musculoskeletal disease, use of antipsychotic medication, and higher BMI were correlated with higher levels of interleukins IL-1RA, IL-2RA, and IL-6. In the adjusted regression analysis, higher BMI was associated with increased IL-1RA (B = 0.06, p < 0.01), IL-2RA (B = 0.01, p < 0.01), and IL-6 (B = 0.01, p = 0.03). Presence of musculoskeletal disease was associated with increased IL-1RA (B = 0.72, p < 0.01) and IL-6 (B = 0.16, p = 0.01), and decreased IL-2RA (B = -0.09, p < 0.01). Cigarette smoking (B = 0.16, p = 0.01) and presence of lung disease (B = 0.14, p = 0.02) were associated with increased IL-6. PTSD diagnosis was associated with decreased IL-2RA (B = -0.06, p = 0.04). DISCUSSION/CONCLUSION: Altered cytokine levels in distressed trauma-affected individuals are probably mostly through co-occurring risk factors and not PTSD diagnosis. Increased BMI and musculoskeletal (pain) disease may be particularly strong risk factors and should be addressed.

Coping, Social Support and Loneliness during the COVID-19 Pandemic and Their Effect on Depression and Anxiety: Patients' Experiences in Community Mental Health Centers in Norway.

Background: Little is known about psychiatric patients' experiences during the COVID-19 pandemic. The purpose of this study was to investigate associations of coping strategies, social support and loneliness with mental health symptoms among these patients. Methods: We recruited 164 patients from Community Mental Health Centers in June-July 2020. Participants responded to an online questionnaire on corona-related questions, Brief Coping Orientation to Problems Experience, Crisis Support Scale, a 3-item Loneliness Scale, and Hopkins Symptom Checklist-25. We used linear regression models to investigate associations between these and symptoms of depression and anxiety. Results: Almost 51% were aged 31-50 years and 77% were females. Forty-six (28%) participants reported worsened overall mental health due to the pandemic. The reported rates of clinical depression and anxiety were 84% and 76%, respectively. Maladaptive coping was independently associated with both depression and anxiety symptoms. Loneliness was independently associated with depression symptoms. Conclusions: Patients in Community Mental Health Centers in Norway reported high rates of depression and anxiety symptoms. Many of them reported worsening of their mental health due to the pandemic, even at a time when COVID-19 infections and restrictive measures were relatively low. Maladaptive coping strategies and loneliness may be possible explanations for more distress.

Gender differences in a wide range of trauma symptoms after victimization and accidental traumas: a cross-sectional study in a clinical setting.

Background: There are large gender differences in PTSD prevalence. Gender differences in a wide range of trauma symptoms including disturbances in self-organization have not been extensively researched. Objective: To explore gender differences in a wide range of trauma symptoms by comparing victimization trauma (VT) with accidental trauma (AT). Method: A cross-sectional study of 110 traumatized patients attending a mental health outpatient clinic in Oslo, Norway (38.2% men, Mage = 40.4, 40% ethnic Norwegians). The trauma was categorized as VT or AT based on the Life Events Checklist. The Structured Clinical Interview for DSM-IV-PTSD-module and Structured Interview for Disorders of Extreme Stress Not-Otherwise-Specified (DESNOS) assessed a wide range of trauma symptoms. First, we examined gender differences within the trauma categories, then MANCOVA for an adjusted two-by-two between-groups analysis. Results: Among VT patients, men reported more symptoms of alteration of negative self-perception (p = .02, ES = 0.50) and alteration in systems of meaning (p < .01, ES = 1.04). Within the AT group, women reported more symptoms of affect and impulses (p = .01, ES = 0.94). The VT-AT difference was significantly higher in men in intrusion (p < .01, η2 = 0.04), affect and impulses (p < .01, η2 = 0.12), negative self-perception (p < .01, η2 = 0.11), difficulty in relations (p = .01, η2 = 0.10) and alterations in systems of meaning (p = .01, η2 = 0.14). Conclusion: Comparing the VT-AT differences between the genders, men with VT had relatively more symptoms of intrusion, self-organization, identity, ideology/meaning, cognition, and relations difficulties. Effect sizes were moderate to large. Men may be relatively more vulnerable to VT than AT, while women may be more equally affected by VT and AT. Acknowledging possible gender differences in a wider range of trauma symptoms depending on trauma category may have clinical benefits.

Antecedentes: Existen grandes diferencias de género en la prevalencia del trastorno de estrés postraumático. Las posibles diferencias de género en una amplia gama de síntomas de trauma, incluidas las alteraciones en la autoorganización, no se han investigado exhaustivamente.Objetivo: Explorar las diferencias de género en una amplia gama de síntomas de trauma comparando el trauma de victimización (TV) con los traumas accidentales (TA).Método: Un estudio transversal de 110 pacientes traumatizados que asistían a una clínica ambulatoria de salud mental en Oslo, Noruega (38,2% hombres, edad promedio = 40,4, 40% de etnia noruega). El trauma primario se clasificó como TV o TA según la Lista de verificación de eventos vitales. La Entrevista clínica estructurada para el módulo DSM-IV-TEPT y la Entrevista estructurada para trastornos de estrés extremo no especificado (DESNOS en su sigla en inglés) evaluaron una amplia gama de síntomas de trauma, principalmente analizando puntuaciones brutas de síntomas. Primero, examinamos las diferencias de género dentro de las categorías de trauma. Luego usamos MANCOVA para un análisis ajustado de dos por dos entre grupos.Resultados: Entre los afectados por TV, los hombres reportaron más síntomas de alteración de la autopercepción negativa (p = .02, ES = 0.50) y alteración en los sistemas de significado (p < .01, ES = 1.04). Dentro del grupo TA, las mujeres informaron más síntomas de afecto e impulsos (p = 0.01, ES = 0,94). La diferencia TV-TA fue significativamente mayor en los hombres en uno de los tres grupos de síntomas de TEPT, intrusión (p < .01, η2 = 0.04), y cuatro de seis dominios de DESNOS, afecto e impulsos (p < .01, η2 = 0.12), autopercepción negativa (p < .01, η2 = 0.11), dificultad en las relaciones con los demás (p = .01, η2 = 0.10) y alteraciones en los sistemas de significado (p = .01, η2 = 0.14).Conclusión: Al comparar las diferencias de TV y TA entre los géneros, los hombres con TV tenían relativamente más síntomas de intrusión, autoorganización, identidad, ideología/significado, cognición y dificultades en las relaciones. Los tamaños del efecto fueron de moderados a grandes. Los hombres pueden ser relativamente más vulnerables al TV que al TA, mientras que las mujeres pueden verse más igualmente afectadas por el TV y el TA. Reconocer las posibles diferencias de género en una gama más amplia de síntomas de trauma según la categoría del trauma puede tener beneficios clínicos.

COVID-19 infections in the districts of Oslo. / Koronasmitte i Oslos bydeler.

BACKGROUND: Belonging to certain ethnic groups, socioeconomic status and cramped living conditions are assumed to affect the risk of infection with SARS-CoV-2. We wanted to examine correlations between a selection of sociodemographic variables and infection rates in Oslo's districts. MATERIAL AND METHOD: Aggregated data on districts obtained from Oslo City Government's statistics database were collated with cumulative figures for PCR-confirmed cases of SARS-CoV-2 as of 3 December 2020. We selected some variables from the living conditions indicators that showed a strong correlation with infection rates. The composite variable 'socioeconomic status' included income, education and labour market attachment. 'Household density' included the proportion of people in cramped living conditions and multi-family households. We performed an unadjusted and adjusted standard multiple linear regression analysis of the impact of immigrant ratio, socioeconomic status and household density on infection rates. RESULTS: Immigrant ratio, socioeconomic status and household density were all associated with infection rates in the districts. Pearson's correlation coefficients (95 % CI) were 0.97 (0.93 to 0.99), -0.93 (-0.97 to -0.86) and 0.88 (0.77 to 0.98) respectively, all with p <0.001. In the adjusted model, immigrant ratio was still associated with the infection rate, B = 3.95 (2.16 to 5.73), p <0.001, however there was no longer a statistically significant association between socioeconomic status or household density and infection rates. INTERPRETATION: Immigrant ratio seems to be an important risk factor for infection in Oslo. Our analysis suggests that the correlation may be due to factors other than low socioeconomic status and high household density.

Trauma related psychiatric disorders and their correlates in a clinical sample: A cross-sectional study in trauma affected patients visiting a psychiatric clinic in Nepal.

BACKGROUND: Nepal, like many other low-income countries, has a great burden of mental health issues but few resources to meet them. In addition, Nepal has endured several traumatic events in recent decades but the impact on mental health has not been studied in clinical settings. This study explores trauma-related psychiatric disorders and their correlates. METHODS: 100 patients with a history of trauma who visited the outpatient psychiatry clinic at a University hospital in Kathmandu were assessed. The Composite International Diagnostic Interview 2.1 (CIDI) was used to evaluate lifetime and current depressive disorder, generalized anxiety disorder (GAD) and lifetime post-traumatic stress disorder (PTSD). Current PTSD was evaluated using PSTD Checklist-Civilian Version (PCL-C). RESULTS: The median number of lifetime traumatic events was two. Natural disaster was the most common trauma type (84%) compared to other types of trauma. Rape was reported as the most traumatizing. Current PTSD was found in 15%, depression in 33% and GAD in 38% of the patients. The lifetime rates were PTSD 83%, depression 45% and GAD 40%. There was high comorbidity between the disorders. The 31 to 45 years age group, above high school education level and trauma types other than earthquake were independently associated with current PTSD. Marital status and upper socioeconomic status (SES) compared to upper-middle SES were independently associated with lifetime PTSD. Both lifetime and current depression rates were independently associated with the upper SES compared to upper-middle SES. Place of living, education above high school and lower-middle SES were significantly associated with lifetime and current GAD. CONCLUSION: PTSD, depression and GAD were prevalent in a trauma exposed patient population visiting a psychiatric clinic in Nepal. High rates of comorbidities and several risk factors were identified. Our findings highlight the need for addressing trauma related disorders in clinical settings in developing countries.

Variations in psychiatric morbidity between traumatized Norwegian, refugees and other immigrant patients in Oslo.

Background: There is a lack of clinical studies that focus on different psychiatric disorders after trauma and the relationship with migration status.Purpose: To examine differences in psychiatric morbidity in traumatized patients referred to psychiatric treatment in Southern Oslo.Materials and methods: Hundred and ten patients with trauma background attending an outpatient clinic in Southern Oslo were studied. Forty-four of the participants (40%) were ethnic Norwegians, 25 (22.7%) had refugee background and 41 (37.3%) were first- or second-generation immigrants without refugee background. Thorough diagnostic assessment was done by experienced psychiatrists through several structured clinical interviews and self-report questionnaires.Results: Ninety-eight patients (89%) were diagnosed with at least one Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) disorder. There was a clear difference in the presentation of certain psychiatric disorders between the groups. Ethnic Norwegian patients were more likely to have anxiety disorders: agoraphobia, social phobia and panic disorder than non-refugee immigrant patients. They also had higher rates of alcohol abuse/dependence. Somatoform pain disorder was more common in both the refugee and other-immigrant groups than among the ethnic Norwegian patients. The refugee patients had significantly more major depressive disorder, post-traumatic stress disorder (PTSD) and both co-occurring.Conclusion: Trauma is frequently associated with depression, anxiety disorders, somatoform pain disorder and PTSD in a clinical population. The clinical presentation and comorbidity of these disorders seem to vary significantly between traumatized patients with Norwegian, refugee and non-refugee immigrant backgrounds. After a major trauma, refugees may be at greater risk for both PTSD and depression than other immigrants and the native population.