Tucker Phebe, Pfefferbaum Betty, North Carol S, Zhao Yan Daniel, Nitiema Pascal, Zettl Rachel, Jeon-Slaughter Haekyung
Emeritus and Volunteer Faculty, Department of Psychiatry and Behavioral Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, OklahomaUSA.
Adjunct Professor of Psychiatry (Volunteer), The University of Texas Southwestern Medical Center, Dallas, TexasUSA.
Prehosp Disaster Med. 2024 Oct;39(5):335-343. doi: 10.1017/S1049023X24000360. Epub 2025 Jan 8.
Terrorism and trauma survivors often experience changes in biomarkers of autonomic, inflammatory and hypothalamic-pituitary-adrenal (HPA) axis assessed at various times. Research suggests interactions of these systems in chronic stress.
This unprecedented retrospective study explores long-term stress biomarkers in three systems in terrorism survivors.
Sixty healthy, direct terrorism survivors were compared to non-exposed community members for cardiovascular reactivity to a trauma script, morning salivary cortisol, interleukin 1-β (IL-1β), and interleukin 2-R (IL-2R). Survivors' biomarkers were correlated with psychiatric symptoms and diagnoses and reported functioning and well-being seven years after the Oklahoma City (OKC) bombing.Main outcome measures were the Diagnostic Interview Schedule (DIS) Disaster Supplement for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnoses, Impact of Events Scale-Revised (IES-R), Beck Depression Inventory-II (BDI-II), Distress and Functioning Scale (DAF), and General Physical Well-Being Scale.
Survivors had higher inflammatory IL-1β, lower anti-inflammatory IL-2R, lower cortisol, higher resting diastolic blood pressure (BP), and less cardiovascular reactivity to a trauma script than comparisons. Survivors' mean posttraumatic stress (PTS) symptom levels did not differ from comparisons, but survivors reported worse well-being. None of survivors' biomarkers correlated with PTS or depressive symptoms or diagnoses or reported functioning.
Alterations of biological stress measures in cardiovascular, inflammatory, and cortisol systems coexisted as an apparent generalized long-term response to terrorism rather than related to specific gauges of mental health. Potential interactions of biomarkers long after trauma exposure is discussed considering relevant research. Longer-term follow-up could determine whether biomarkers continue to differ or correlate with subjective measures, or if they accompany health problems over time. Given recent international terrorism, understanding long-term sequelae among direct survivors is increasingly relevant.
恐怖主义事件的幸存者和创伤幸存者常常在不同时间点出现自主神经、炎症及下丘脑 - 垂体 - 肾上腺（HPA）轴生物标志物的变化。研究表明这些系统在慢性应激中存在相互作用。
这项史无前例的回顾性研究探索了恐怖主义事件幸存者三个系统中的长期应激生物标志物。
将60名健康的直接恐怖主义事件幸存者与未暴露于恐怖事件的社区成员进行比较，检测他们对创伤脚本的心血管反应性、早晨唾液皮质醇、白细胞介素1 - β（IL - 1β）和白细胞介素2受体（IL - 2R）。将幸存者的生物标志物与精神症状、诊断结果以及俄克拉荷马城（OKC）爆炸事件七年后报告的功能和幸福感进行关联分析。主要结局指标包括《精神疾病诊断与统计手册》第四版修订版（DSM - IV - TR）诊断用的诊断访谈表（DIS）灾难补充版、事件影响量表修订版（IES - R）、贝克抑郁量表第二版（BDI - II）、痛苦与功能量表（DAF）以及总体身体健康量表。
与对照组相比，幸存者具有更高的炎症性IL - 1β、更低的抗炎性IL - 2R、更低的皮质醇、更高的静息舒张压（BP），并且对创伤脚本的心血管反应性更低。幸存者创伤后应激（PTS）症状的平均水平与对照组无差异，但幸存者报告的幸福感更差。幸存者的生物标志物均与PTS或抑郁症状、诊断结果或报告的功能无关。
心血管、炎症和皮质醇系统中生物应激指标的改变共同存在，这似乎是对恐怖主义的一种明显的全身性长期反应，而非与特定的心理健康指标相关。结合相关研究讨论了创伤暴露后很长时间生物标志物的潜在相互作用。长期随访可以确定生物标志物是否继续存在差异或与主观指标相关，或者它们是否会随着时间推移伴随健康问题出现。鉴于近期的国际恐怖主义事件，了解直接幸存者的长期后遗症变得越来越重要。
