Qing Yulan, van Zuiden Mirjam, Eriksson Cynthia, Lopes Cardozo Barbara, Simon Winnifred, Ager Alastair, Snider Leslie, Sabin Miriam Lewis, Scholte Willem, Kaiser Reinhard, Rijnen Bas, Olff Miranda
Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience and Public Health Research Institutes, University of Amsterdam, Amsterdam, The Netherlands.
Graduate School of Psychology, Fuller Theological Seminary, Pasadena, CA, USA.
Eur J Psychotraumatol. 2020 Dec 21;11(1):1816649. doi: 10.1080/20008198.2020.1816649.
: Internationally deployed humanitarian aid (HA) workers are routinely confronted with potentially traumatic stressors. However, it remains unknown whether HA deployment and related traumatic stress are associated with long-term changes in hypothalamic-pituitary-adrenal (HPA) axis function. Therefore, we investigated whether cortisol awakening response (CAR) decreased upon deployment and whether this was moderated by previous and recent trauma exposure and parallel changes in symptom severity and perceived social support. : In this prospective study, = 86 HA workers (68% females) completed questionnaires regarding trauma exposure, posttraumatic stress disorder (PTSD), anxiety and depressive symptoms and perceived social support, as well as salivary cortisol assessments at awakening and 30 minutes post-awakening at before, early and 3-6 months post-deployment. : Linear mixed models showed significantly decreased CAR (= -.036(.011), = .002) and awakening cortisol over time (= -.007(.003), = .014). The extent of awakening cortisol change was significantly moderated by interactions between previous and recent trauma exposure. Also, a steeper awakening cortisol decrease was significantly associated with higher mean anxiety and PTSD symptoms across assessments. No significant effects were found for social support. : We observed attenuated CAR and awakening cortisol upon HA deployment, with a dose-response effect between trauma exposure before and during the recent deployment on awakening cortisol. Awakening cortisol change was associated with PTSD and anxiety symptom levels across assessments. Our findings support the need for organizational awareness that work-related exposures may have long-lasting biological effects. Further research assessing symptoms and biological measures in parallel is needed to translate current findings into guidelines on the individual level.
国际部署的人道主义援助（HA）工作者经常面临潜在的创伤性应激源。然而，HA部署及相关创伤性应激是否与下丘脑-垂体-肾上腺（HPA）轴功能的长期变化相关仍不清楚。因此，我们调查了皮质醇觉醒反应（CAR）在部署后是否降低，以及这是否受到既往和近期创伤暴露以及症状严重程度和感知社会支持的平行变化的调节。
在这项前瞻性研究中，86名HA工作者（68%为女性）完成了关于创伤暴露、创伤后应激障碍（PTSD）、焦虑和抑郁症状以及感知社会支持的问卷调查，以及在部署前、早期和部署后3 - 6个月觉醒时和觉醒后30分钟的唾液皮质醇评估。
线性混合模型显示，随着时间的推移，CAR显著降低（β = -0.036（0.011），P = 0.002），觉醒时的皮质醇也显著降低（β = -0.007（0.003），P = 0.014）。觉醒时皮质醇变化的程度受到既往和近期创伤暴露之间相互作用的显著调节。此外，在各项评估中，觉醒时皮质醇下降越显著，平均焦虑和PTSD症状越高。未发现社会支持有显著影响。
我们观察到HA部署后CAR和觉醒时的皮质醇减弱，在近期部署前和期间的创伤暴露与觉醒时的皮质醇之间存在剂量反应效应。在各项评估中，觉醒时皮质醇的变化与PTSD和焦虑症状水平相关。我们的研究结果支持组织需要认识到与工作相关的暴露可能具有长期的生物学影响。需要进一步开展同时评估症状和生物学指标的研究，以便将当前研究结果转化为个体层面的指导方针。
