Jansen van Vuren Esmé, van den Heuvel Leigh L, Hemmings Sian Mj, Seedat Soraya
Hypertension in Africa Research Team (HART), North-West University, Private Bag X1290, Potchefstroom, South Africa; South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council Genomics of Brain Disorders Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
J Psychiatr Res. 2025 Feb;182:338-346. doi: 10.1016/j.jpsychires.2025.01.040. Epub 2025 Jan 17.
The pathophysiology of posttraumatic stress disorder (PTSD) involves dysregulation of stress-sensitive biological systems due to repeated trauma exposure, predisposing individuals to the development of cardiovascular disease (CVD). Allostatic load (AL), an indicator of maladaptive stress responses, could shed light on the underlying biological mechanisms. We determined whether CVD risk and AL were associated with trauma load and resilience in women with PTSD and trauma-exposed controls (TEC).
Adults with PTSD N = 114 and TEC N = 95 were administered the Clinician Administered Posttraumatic Stress Disorder Scale for DSM-5, to assess for current PTSD diagnosis and severity, the Life Events Checklist for DSM-5 for lifetime exposure to potentially traumatic events (cumulative trauma) and the Connor-Davidson Resilience Scale. An AL score was calculated as a sum of dichotomous variables from four physiological systems (neuroendocrine, metabolic, cardiovascular, and inflammatory). CVD risk was assessed with the South African Framingham risk score.
In patients with PTSD, cumulative trauma was associated with higher AL (p = 0.04) and CVD risk (p = 0.02). In TEC, AL was inversely associated with resilience (p = 0.04). There was a significant interaction between cumulative trauma and resilience on AL (p = 0.009) in PTSD cases, with a stronger association between cumulative trauma and AL in those with higher resilience.
Resilience may have differential detrimental and protective effects on AL in individuals with PTSD and TEC. Cumulative trauma exposure may, independently, increase the likelihood of high AL and CVD risk in PTSD, with resilience moderating this effect. Remaining resilient while experiencing PTSD symptoms may impose a biological strain that could have long-term harmful effects.
创伤后应激障碍（PTSD）的病理生理学涉及由于反复暴露于创伤而导致的应激敏感生物系统失调，使个体易患心血管疾病（CVD）。应激负荷（AL）是适应不良应激反应的指标，可能有助于揭示潜在的生物学机制。我们确定了CVD风险和AL是否与PTSD女性患者以及创伤暴露对照者（TEC）的创伤负荷和复原力相关。
对114名患有PTSD的成年人和95名TEC成年人进行了《精神疾病诊断与统计手册》第5版临床医生管理的创伤后应激障碍量表评估，以评估当前PTSD的诊断和严重程度、《精神疾病诊断与统计手册》第5版生活事件清单以评估终生暴露于潜在创伤事件（累积创伤）的情况，以及康纳-戴维森复原力量表。AL得分通过四个生理系统（神经内分泌、代谢、心血管和炎症）的二分变量总和来计算。使用南非弗明汉风险评分评估CVD风险。
在PTSD患者中，累积创伤与较高的AL（p = 0.04）和CVD风险（p = 0.02）相关。在TEC中，AL与复原力呈负相关（p = 0.04）。在PTSD病例中，累积创伤和复原力对AL存在显著交互作用（p = 0.009），在复原力较高的个体中，累积创伤与AL之间的关联更强。
复原力可能对PTSD患者和TEC个体的AL产生不同的有害和保护作用。累积创伤暴露可能独立增加PTSD患者高AL和CVD风险的可能性，而复原力可调节这种作用。在经历PTSD症状时保持复原力可能会带来生物学压力，可能产生长期有害影响。
