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Zhang H, Zhang M, Li N, Wei WZ, Yang LX, Li YY, Zu ZY, Ma LJ, Wang HX, Wang K, Li XM. Event-related potentials reveal hypnotherapy's impact on attention bias in social anxiety disorder. World J Psychiatry 2025; 15:102552. [DOI: 10.5498/wjp.v15.i5.102552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 12/24/2024] [Accepted: 03/04/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Exploring hypnotherapy's potential to modulate attention bias offers promising avenues for treating social anxiety disorder (SAD).
AIM To determine if hypnotherapy can alleviate social anxiety by influencing attention bias, specifically identifying the aspects of attention processes affected by hypnosis.
METHODS In this study, 69 SAD participants were divided into three groups based on their Liebowitz Social Anxiety Scale scores: Experimental group, control group, and baseline group. The experimental group (n = 23) underwent six weekly hypnosis sessions, while the control (n = 23) and baseline groups (n = 23) received no treatment. To evaluate alterations in SAD severity and attention bias towards threatening stimuli following hypnotherapy, we employed a combination of self-report questionnaires, an odd-one-out task, and electroencephalography recordings.
RESULTS The experimental group showed significant reductions in P1, N170, N2pc, and late positive potential (LPP) brain wave activities during attention sensitivity and disengagement conditions. This indicates that hypnotherapy modulates early-stage face processing and later-stage emotional evaluation of threat-related stimuli in SAD patients.
CONCLUSION Our findings highlight P1, N170, N2pc, and LPP as key neural markers in SAD treatment. By identifying these neural markers influenced by hypnotherapy, we offer insight into the mechanisms by which this treatment modality impacts attentional processes, potentially easing SAD symptoms.
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Affiliation(s)
- Han Zhang
- School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Mi Zhang
- School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Ni Li
- School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Wen-Zhuo Wei
- School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Lin-Xi Yang
- School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Yong-Yi Li
- School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Zhen-Yue Zu
- School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Li-Jun Ma
- School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Hui-Xue Wang
- School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Kai Wang
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei 230032, Anhui Province, China
- Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Xiao-Ming Li
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, Anhui Province, China
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Ferrer A, Labad J, Salvat-Pujol N, Urretavizcaya M, Obrador-Font R, Menchón JM, Palao D, Soriano-Mas C, Costas J, Barrachina M, Carracedo Á, Soria V. Genetic and epigenetic changes to the glucocorticoid receptor gene (NR3C1) and cognition in major depressive disorder. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2025:S2950-2853(25)00018-3. [PMID: 40189105 DOI: 10.1016/j.sjpmh.2024.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 11/14/2024] [Accepted: 12/18/2024] [Indexed: 04/16/2025]
Abstract
INTRODUCTION Many studies have found that hypothalamic-pituitary-adrenal (HPA) axis abnormalities are related to the pathophysiology of major depressive disorder (MDD) and cognitive functioning. Our aim was to assess the influence of genetic polymorphisms and methylation levels in three different promoter regions throughout the glucocorticoid receptor (GR) gene NR3C1 on cognitive performance in MDD. Plausible interactions with childhood adversity and mediation relationships between genetic and epigenetic variables were explored. MATERIALS AND METHODS The sample included a total of 64 MDD patients and 82 healthy controls. Child maltreatment and neurocognitive performance were assessed in all participants. HPA negative feedback was analyzed using the dexamethasone suppression test after the administration of 0.25mg of dexamethasone. A total of 23 single-nucleotide polymorphisms were genotyped, and methylation levels at several CpGs in exons 1D, 1F and 1H of the GR gene were measured. RESULTS Results show that, beyond the influence of other covariables, NR3C1 single-nucleotide polymorphisms and methylation levels predicted performance in executive functioning and working memory tasks. No significant interactions or mediation relationships were detected. CONCLUSIONS Results suggest that genetic variations and epigenetic regulation of the GR gene are relevant factors influencing cognitive performance in MDD and could emerge as significant biomarkers and therapeutic targets in mood disorders and other stress-related disorders.
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Affiliation(s)
- Alex Ferrer
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Catalonia, Spain; Institut de Investigació i Innovació Parc Taulí (I3PT), Sabadell, Catalonia, Spain; Escoles Universitàries Gimbernat, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Javier Labad
- Institut de Investigació i Innovació Parc Taulí (I3PT), Sabadell, Catalonia, Spain; Department of Mental Health, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Neus Salvat-Pujol
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Catalonia, Spain; Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Catalonia, Spain
| | - Mikel Urretavizcaya
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Catalonia, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Roser Obrador-Font
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Catalonia, Spain
| | - José M Menchón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Catalonia, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Diego Palao
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Catalonia, Spain; Institut de Investigació i Innovació Parc Taulí (I3PT), Sabadell, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Carles Soriano-Mas
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Catalonia, Spain; Department of Social and Quantitative Psychology, Universitat de Barcelona, Catalonia, Spain
| | - Javier Costas
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, A Coruña, Spain
| | - Marta Barrachina
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Ángel Carracedo
- Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Centro Nacional de Genotipado - Instituto Carlos III, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Virginia Soria
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain.
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Dosanjh LH, Lauby S, Fuentes J, Castro Y, Conway FN, Champagne FA, Franklin C, Goosby B. Five hypothesized biological mechanisms linking adverse childhood experiences with anxiety, depression, and PTSD: A scoping review. Neurosci Biobehav Rev 2025; 171:106062. [PMID: 39952339 DOI: 10.1016/j.neubiorev.2025.106062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 02/03/2025] [Accepted: 02/08/2025] [Indexed: 02/17/2025]
Abstract
Adults with symptoms of anxiety, depression, or PTSD and a history of adverse childhood experiences (ACEs) may experience more severe symptoms than those without ACEs. The identification of mechanisms linking ACEs to later mental health problems may provide salient treatment targets to improve outcomes. Several biological markers (cortisol, inflammation, allostatic load, DNA methylation, and telomere length) that are indicative of functional variation in stress response systems, have been hypothesized as potential mechanisms linking ACEs to later mental health outcomes. Much of the evidence supporting this hypothesis examines isolated pairwise associations between variables and it is unclear whether statistical tests of mediation support these conclusions. It is also unclear how much of the extant research has used theory to guide mediation analyses, which may be a salient factor in the recognition of a mechanism. This scoping review surveyed research conducting mediation analysis examining the indirect effect of any of these five biological markers on the relationship between ACEs and anxiety, depression, or PTSD. It further surveyed the use of theory in these analyses. Pubmed and seven electronic databases were searched: (1) APA PsychInfo (2) CINAHL Plus (3) Health Source: Nursing/Academic Edition (4) MEDLINE (5) Psychology and Behavioral Sciences Collection (6) Science and Technology Collection, and (7) SocINDEX. A total of 16 articles were identified. The majority of studies examined depression as an outcome and the statistical significance of indirect effects were mixed across mediators. Common theoretical models and frameworks were consistent with life course theory and evolutionary or developmental perspectives.
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Affiliation(s)
- Laura H Dosanjh
- Population Research Center, The University of Texas at Austin, USA.
| | - Samantha Lauby
- Department of Psychology, The University of Texas at Austin, USA
| | - Jaime Fuentes
- The Steve Hicks School of Social Work, The University of Texas at Austin, USA
| | - Yessenia Castro
- The Steve Hicks School of Social Work, The University of Texas at Austin, USA
| | - Fiona N Conway
- The Steve Hicks School of Social Work, The University of Texas at Austin, USA
| | | | - Cynthia Franklin
- The Steve Hicks School of Social Work, The University of Texas at Austin, USA
| | - Bridget Goosby
- Population Research Center, The University of Texas at Austin, USA; Department of Sociology, The University of Texas at Austin, USA
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Leypoldt M, Wiegand A, Munk M, Drohm S, Fallgatter AJ, Nieratschker V, Kreifelts B. Alterations in cerebral resting state functional connectivity associated with social anxiety disorder and early life adversities. Transl Psychiatry 2025; 15:80. [PMID: 40082409 PMCID: PMC11906641 DOI: 10.1038/s41398-025-03301-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 01/20/2025] [Accepted: 02/25/2025] [Indexed: 03/16/2025] Open
Abstract
Social Anxiety Disorder (SAD) involves fear of negative evaluation and social avoidance, impacting quality of life. Early life adversities (ELA) are recognized as risk factors for SAD. Previous research indicated inconsistent alterations in resting state functional connectivity (RSFC) in SAD, particularly in the prefrontal cortex and precuneus. This study investigated the interaction between SAD and ELA at the RSFC level. Functional magnetic resonance imaging (fMRI) was conducted on 120 participants (aged 19-48). Four groups were formed: low/ high ELA controls (n = 49, n = 22) and low/ high ELA SAD participants (n = 30, n = 19). Seed-based correlation analyses (SCA) and multi-voxel pattern analysis (MVPA) were applied. A network in which ELA moderates the neural correlates of SAD during the resting state was identified, involving key nodes like the subgenual anterior cingulate cortex, left middle frontal gyrus, and an area in the calcarine fissure/precuneus. Five distinct interaction patterns of SAD and ELA were observed, showcasing opposite RSFC patterns in individuals with SAD based on ELA experience. Results remained significant when controlled for general anxiety and depression measures. Emotional aspects of ELA played a significant role in these interactions. These findings stress the necessity of considering primarily emotional ELA as covariate in neuroimaging studies investigating SAD and potentially also other psychiatric disorders, addressing inconsistencies in prior research. The left middle frontal gyrus emerges as a link in the SAD-ELA interaction during resting state and anxiety-relevant stimulation. Longitudinal studies, starting from childhood, are needed to understand ELA's impact on brain function and to identify potential neuromarkers for SAD predisposition post-ELA exposure.
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Affiliation(s)
- Melina Leypoldt
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany
| | - Ariane Wiegand
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany
- Max Planck Fellow Group for Precision Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Matthias Munk
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany
| | - Sanja Drohm
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany
- German Center for Mental Health (DZPG), partner site Tuebingen, Tuebingen, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany
- German Center for Mental Health (DZPG), partner site Tuebingen, Tuebingen, Germany
| | - Benjamin Kreifelts
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany.
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Forum DMK, Bjerregaard C, Thomsen PH. The significance of DNA methylation of the NR3C1 gene encoding the glucocorticoid receptor for developing resilience in individuals exposed to early life stress. Nord J Psychiatry 2025; 79:1-14. [PMID: 39773140 DOI: 10.1080/08039488.2024.2436987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 11/27/2024] [Accepted: 11/28/2024] [Indexed: 01/11/2025]
Abstract
PURPOSE To analyze and interpret why some individuals are resilient to ELS while others are susceptible, resulting in psychiatric outcome later in life, with a focus on the role of DNAm of the NR3C1 gene as a mediating mechanism between ELS and the risk of psychiatric outcomes. We hypothesized that a high level of mental resilience to ELS, expressed as lower incidence of psychiatric outcomes, was associated with attenuated NR3C1 DNAm levels. MATERIALS AND METHODS The first authors conducted a systematic search on PubMed to identify primary research studies. Abstract were screened and full-text were reviewed to assess the eligibility for inclusion. Consensus on assessment was reached after discussion of eligibility criteria. Studies were sorted based on whether they investigated the association between ELS and NR3C1 DNAm in 1) individuals exposed compared to unexposed to ELS both without a psychiatric outcome or in 2) individuals exposed to ELS with a psychiatric outcome compared to exposed individuals without a psychiatric outcome. RESULTS AND CONCLUSION Seven studies met the eligibility criteria. The results were inconsistent; two studies supported our hypothesis, two studies indicated that increased NR3C1 DNAm mediated resilience to ELS, and three studies found no association.
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Affiliation(s)
- Ditte Mathilde Klith Forum
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Camilla Bjerregaard
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
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Zhang H, Xue X, Wen J, Li Y, Fan C, Ma L, Wang H, Zhang M, Zhang S, Hu D, Wang K, Li X. Hypnotherapy modulating early and late event-related potentials components of face processing in social anxiety. Front Psychiatry 2024; 15:1449946. [PMID: 39493428 PMCID: PMC11528304 DOI: 10.3389/fpsyt.2024.1449946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 09/27/2024] [Indexed: 11/05/2024] Open
Abstract
BACKGROUND Hypnotherapy has a potential role in modulating attention bias to treat social anxiety disorder (SAD). This study aimed to verify whether hypnotherapy can reduce social anxiety by changing attentional bias. The primary objective of our study is to explore the influence of hypnosis on various aspects of attention processes, specifically focusing on how it affects attention bias and social anxiety. METHODS This study included 69 participants with SAD who were assigned to three groups based on their scores on the Liebowitz Social Anxiety Scale (LSAS). The experimental group (n = 23) received a hypnosis treatment once a week, for a total of six sessions, while the control group (n = 23) and the baseline group (n = 23) did not receive any treatment. To evaluate whether hypnosis could alleviate SAD and attention bias towards threatening stimuli, we employed questionnaires and an odd-one-out task accompanied by electroencephalography (EEG) recordings. RESULTS Under the attention sensitivity conditions, the experimental group exhibited a reduced N170 and LPP at the posttest stage, and a similar N170 and LPP reduction under the attention disengagement conditions. Notably, the symptom improvements were positively correlated with the reduction in N170 and LPP amplitude across conditions. CONCLUSION Hypnosis treatment modulates the early face processing and late emotional evaluation of threat-related stimuli in SAD patients. These findings suggest that N170 and LPP are important biomarkers for the treatment of SAD.
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Affiliation(s)
- Han Zhang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xinrong Xue
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Jialin Wen
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Yongyi Li
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Chuan Fan
- Department of Psychiatry, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lijun Ma
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Huixue Wang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Mi Zhang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Shuyu Zhang
- School of Psychology, Australian National University, Canberra, Australia
| | - Die Hu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Kai Wang
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, China
| | - Xiaoming Li
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
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Rosenbaum D, Int-Veen I, Laicher H, Woloszyn L, Wiegand A, Ladegast S, Eßer U, Kroczek A, Sippel D, Menkor S, Lawyer G, Albasini F, Frischholz C, Mössner R, Nieratschker V, Leehr EJ, Rubel J, Fallgatter AJ, Ehlis AC. Neural correlates of stress-reactive rumination in depression - The role of childhood trauma and social anxiety. Neurobiol Stress 2024; 31:100640. [PMID: 38800538 PMCID: PMC11127161 DOI: 10.1016/j.ynstr.2024.100640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/29/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024] Open
Abstract
Recent work showed an association of prefrontal dysfunctions in patients with Major Depressive Disorder (MDD) and social stress induced rumination. However, up to date it is unclear which etiological features of MDD might cause prefrontal dysfunctions. In the study at hand, we aimed to replicate recent findings, that showed prefrontal activation alterations during the Trier Social Stress Test (TSST) and subsequently increased stress-reactive rumination in MDD compared to healthy controls. Moreover, we aimed to explore the role of adverse childhood experiences and other clinical variables in this relationship. N = 55 patients currently suffering from MDD and n = 42 healthy controls (HC) underwent the TSST, while cortical activity in areas of the Cognitive Control Network (CCN) was measured via functional near-infrared spectroscopy (fNIRS). The TSST successfully induced a stress reaction (physiologically, as well as indicated by subjective stress ratings) and state rumination in all subjects with moderate to large effect sizes. In comparison to HC, MDD patients showed elevated levels of state rumination with large effect sizes, as well as a typical pattern of reduced cortical oxygenation during stress in the CCN with moderate effect sizes. Self-reported emotional abuse and social anxiety were moderately positively associated with increased stress-reactive rumination. Within the MDD sample, emotional abuse was negatively and social anxiety positively associated with cortical oxygenation within the CCN with moderate to large effect sizes. In conclusion, our results replicate previous findings on MDD-associated prefrontal hypoactivity during stress and extends the research toward specific subtypes of depression.
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Affiliation(s)
- David Rosenbaum
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
| | - Isabell Int-Veen
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
| | - Hendrik Laicher
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
| | - Leonie Woloszyn
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
| | - Ariane Wiegand
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Sandra Ladegast
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
| | - Ute Eßer
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
| | - Agnes Kroczek
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
| | - Daniel Sippel
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
| | - Sebastian Menkor
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
| | | | - Francesco Albasini
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
- Central Institute of Mental Health (CIMH), Mannheim, Germany
- Dept. of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Christian Frischholz
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
| | - Rainald Mössner
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
- German Center for Mental Health (DZPG), Germany
| | | | - Julian Rubel
- Psychotherapy Research Lab, Psychology and Sport Sciences, Justus-Liebig-University Giessen, Giessen, Germany
| | - Andreas J. Fallgatter
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
- German Center for Mental Health (DZPG), Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital of Tuebingen, Tuebingen, Germany
- German Center for Mental Health (DZPG), Germany
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Ohi K, Fujikane D, Takai K, Kuramitsu A, Muto Y, Sugiyama S, Shioiri T. Epigenetic signatures of social anxiety, panic disorders and stress experiences: Insights from genome-wide DNA methylation risk scores. Psychiatry Res 2024; 337:115984. [PMID: 38820651 DOI: 10.1016/j.psychres.2024.115984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/15/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024]
Abstract
Social anxiety disorder (SAD) and panic disorder (PD) are prevalent anxiety disorders characterized by a complex interplay of genetic and environmental factors. Both disorders share overlapping features and often coexist, despite displaying distinct characteristics. Childhood life adversity, overall stressful life events, and genetic factors contribute to the development of these disorders. DNA methylation, an epigenetic modification, has been implicated in the pathogenesis of these diseases. In this study, we investigated whether whole-genome DNA methylation risk scores (MRSs) for SAD risk, severity of social anxiety, childhood life adversity, PD risk, and overall stressful life events were associated with SAD or PD case‒control status. Preliminary epigenome-wide association studies (EWASs) for SAD risk, severity of social anxiety, and childhood life adversity were conducted in 66 SAD individuals and 77 healthy controls (HCs). Similarly, EWASs for PD risk and overall stressful life events were performed in 182 PD individuals and 81 HCs. MRSs were calculated from these EWASs. MRSs derived from the EWASs of SAD risk and severity of social anxiety were greater in PD patients than in HCs. Additionally, MRSs derived from the EWASs of overall stressful life events, particularly in PD individuals, were lower in SAD individuals than in HCs. In contrast, MRSs for childhood life adversity or PD risk were not significantly associated with PD or SAD case‒control status. These findings highlight the epigenetic features shared in both disorders and the distinctive epigenetic features related to social avoidance in SAD patients, helping to elucidate the epigenetic basis of these disorders.
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Affiliation(s)
- Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan; Department of General Internal Medicine, Kanazawa Medical University, Ishikawa, Japan.
| | - Daisuke Fujikane
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kentaro Takai
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Ayumi Kuramitsu
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yukimasa Muto
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shunsuke Sugiyama
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Toshiki Shioiri
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
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Zhang W, Wang Z. The longitudinal relationship between childhood trauma and adolescents' externalizing problems: A moderated mediation model. CHILD ABUSE & NEGLECT 2024; 149:106646. [PMID: 38266582 DOI: 10.1016/j.chiabu.2024.106646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Externalizing problems among adolescents are prevalent, which are associated with a range of maladaptive developmental outcomes. Existing studies investigated the influence of childhood trauma, and attentional control on and how sensory processing sensitivity (SPS) is related to adolescents' externalizing problems. However, it is unknown whether attentional control plays a mediating role in the relationships between childhood trauma and adolescents' externalizing problems, and whether SPS plays a moderating role in these relationships. The present study examined these issues with a six-month-interval longitudinal study design. METHODS A total of 1933 junior school students (Grade 7, Mage = 12.82, 47.7 % girls) from a large follow-up project in a city of eastern China participated in the study. After half a year (wave 2), the data of 1890 participants (Grade 8) were collected. The Childhood Trauma Questionnaire (CTQ), Attentional Control Scale (ACS-C), Highly Sensitive Child Scale (HSCS), and the Child Behavior Checklist (CBCL-YSR) were administered to the participants to assess their childhood trauma, attentional control, SPS, and externalizing problems in two waves. The immediate and longitudinal moderated mediation models were utilized to investigate the relationships among these factors. RESULTS Childhood trauma significantly and positively predicted adolescents' externalizing problems. Attentional control played an immediate and longitudinal mediating role in the relationship between childhood trauma and externalizing problems. SPS moderated the relationship between childhood trauma and adolescents' attentional control. Childhood trauma had a greater effect on the attentional control of adolescents with SPS levels. CONCLUSIONS This study suggests that childhood trauma might impair adolescents' attentional control and then increase their externalizing problems. The influence of childhood trauma on attentional control is more serious among adolescents with lower SPS levels. Therefore, decreasing and preventing childhood trauma and building a warm nurturing environment might be beneficial to improving adolescents' attentional control ability and then reduce their externalizing problems.
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Affiliation(s)
- Wen Zhang
- School of Psychology, Shaanxi Normal University, Shaanxi Provincial Key Research Center of Child Mental and Behavioral Health, Xi'an, China
| | - Zhenhong Wang
- School of Psychology, Shaanxi Normal University, Shaanxi Provincial Key Research Center of Child Mental and Behavioral Health, Xi'an, China.
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Luo X, Yang X, Tan S, Zhang Y, Liu Y, Tian X, Huang Y, Zhou Y, He C, Yin K, Xu D, Li X, Sun F, Tang R, Cao J, Zheng K, Yu Y, Pan W. Gut microbiota mediates anxiety-like behaviors induced by chronic infection of Toxoplasma gondii in mice. Gut Microbes 2024; 16:2391535. [PMID: 39182245 PMCID: PMC11346544 DOI: 10.1080/19490976.2024.2391535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 07/05/2024] [Accepted: 08/08/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Chronic infection with the neurotropic parasite Toxoplasma gondii (T. gondii) can cause anxiety and gut microbiota dysbiosis in hosts. However, the potential role of gut microbiota in anxiety induced by the parasite remains unclear. METHODS C57BL/6J mice were infected with 10 cysts of T. gondii. Antibiotic depletion of gut microbiota and fecal microbiota transplantation experiments were utilized to investigate the causal relationship between gut microbiota and anxiety. Anxiety-like behaviors were examined by the elevated plus maze test and the open field test; blood, feces, colon and amygdala were collected to evaluate the profiles of serum endotoxin (Lipopolysaccharide, LPS) and serotonin (5-hydroxytryptamine, 5-HT), gut microbiota composition, metabolomics, global transcriptome and neuroinflammation in the amygdala. Furthermore, the effects of Diethyl butylmalonate (DBM, an inhibitor of mitochondrial succinate transporter, which causes the accumulation of endogenous succinate) on the disorders of the gut-brain axis were evaluated. RESULTS Here, we found that T. gondii chronic infection induced anxiety-like behaviors and disturbed the composition of the gut microbiota in mice. In the amygdala, T. gondii infection triggered the microglial activation and neuroinflammation. In the colon, T. gondii infection caused the intestinal dyshomeostasis including elevated colonic inflammation, enhanced bacterial endotoxin translocation to blood and compromised intestinal barrier. In the serum, T. gondii infection increased the LPS levels and decreased the 5-HT levels. Interestingly, antibiotics ablation of gut microbiota alleviated the anxiety-like behaviors induced by T. gondii infection. More importantly, transplantation of the fecal microbiota from T. gondii-infected mice resulted in anxiety and the transcriptomic alteration in the amygdala of the antibiotic-pretreated mice. Notably, the decreased abundance of succinate-producing bacteria and the decreased production of succinate were observed in the feces of the T. gondii-infected mice. Moreover, DBM administration ameliorated the anxiety and gut barrier impairment induced by T. gondii infection. CONCLUSIONS The present study uncovers a novel role of gut microbiota in mediating the anxiety-like behaviors induced by chronic T. gondii infection. Moreover, we show that DBM supplementation has a beneficial effect on anxiety. Overall, these findings provide new insights into the treatment of T. gondii-related mental disorders.
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Affiliation(s)
- Xiaotong Luo
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- The Second Clinical Medical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
- National Demonstration Center for Experimental Basic Medical Science Education, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiaoying Yang
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shimin Tan
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- The Second Clinical Medical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
- National Demonstration Center for Experimental Basic Medical Science Education, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yongsheng Zhang
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- National Demonstration Center for Experimental Basic Medical Science Education, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yunqiu Liu
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiaokang Tian
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- National Demonstration Center for Experimental Basic Medical Science Education, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yingting Huang
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- The Second Clinical Medical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
- National Demonstration Center for Experimental Basic Medical Science Education, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yuying Zhou
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- National Demonstration Center for Experimental Basic Medical Science Education, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Cheng He
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Kun Yin
- Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, Shandong, China
| | - Daxiang Xu
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiangyang Li
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Fenfen Sun
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- National Demonstration Center for Experimental Basic Medical Science Education, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Renxian Tang
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- National Demonstration Center for Experimental Basic Medical Science Education, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jianping Cao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, Shanghai, China
| | - Kuiyang Zheng
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- National Demonstration Center for Experimental Basic Medical Science Education, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yinghua Yu
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wei Pan
- Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Key Laboratory of Immunity and Metabolism, Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- National Demonstration Center for Experimental Basic Medical Science Education, Xuzhou Medical University, Xuzhou, Jiangsu, China
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, Shanghai, China
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Azargoonjahromi A. The role of epigenetics in anxiety disorders. Mol Biol Rep 2023; 50:9625-9636. [PMID: 37804465 DOI: 10.1007/s11033-023-08787-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/30/2023] [Indexed: 10/09/2023]
Abstract
Anxiety disorders (ADs) are extremely common psychiatric conditions that frequently co-occur with other physical and mental disorders. The pathophysiology of ADs is multifaceted and involves intricate connections among biological elements, environmental stimuli, and psychological mechanisms. Recent discoveries have highlighted the significance of epigenetics in bridging the gap between multiple risk factors that contribute to ADs and expanding our understanding of the pathomechanisms underlying ADs. Epigenetics is the study of how changes in the environment and behavior can have an impact on gene function. Indeed, researchers have found that epigenetic mechanisms can affect how genes are activated or inactivated, as well as whether they are expressed. Such mechanisms may also affect how ADs form and are protected. That is, the bulk of pharmacological trials evaluating epigenetic treatments for the treatment of ADs have used histone deacetylase inhibitors (HDACi), yielding promising outcomes in both preclinical and clinical studies. This review will provide an outline of how epigenetic pathways can be used to treat ADs or lessen their risk. It will also present the findings from preclinical and clinical trials that are currently available on the use of epigenetic drugs to treat ADs.
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Hua Y, Huang C, Guo Y, Du X, Guo L, Wang W, Lu C, Guo L. Association between academic pressure, NR3C1 gene methylation, and anxiety symptoms among Chinese adolescents: a nested case-control study. BMC Psychiatry 2023; 23:376. [PMID: 37254074 DOI: 10.1186/s12888-023-04816-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Academic pressure is a prevalent stressor among Chinese adolescents and is often linked to anxiety symptoms, although the underlying mechanism remains unclear. This study aimed to investigate the association between NR3C1 gene methylation, academic pressure, and anxiety symptoms among Chinese adolescents. METHODS This nested-case control study included 150 adolescents (boys: 38.7%; baseline age: 12-17 years) from a school-based longitudinal study of Chinese adolescents. Cases (n = 50) were defined as those with anxiety symptoms at both baseline and follow-up, while controls (n = 100) were randomly selected from those without anxiety symptoms at both timepoints. The cases and controls were 1:2 matched by age. Academic pressure, anxiety symptoms, and potential covariates were measured using a self-report questionnaire. Peripheral whole blood samples were collected from each participant for the detection of cortisol level (i.e., morning serum cortisol level) and DNA methylation. The methylation analysis included a total of 27 CpG units at the NR3C1 promoter region. RESULTS The final adjusted models showed that students with heavy academic pressure at baseline were at a higher risk of anxiety symptoms at follow-up compared to those with mild academic pressure (β estimate: 6.24 [95% CI: 3.48 ~ 9.01]). After adjusting for covariates, the methylation level of one CpG unit (NR3C1-16 CpG10) in NR3C1 differed significantly between cases and controls (F = 6.188, P = 0.014), and the difference remained significant after correction for multiple testing (P < 0.025). The adjusted regression models showed that moderate (β estimate = 0.010 [95% CI: 0.000 ~ 0.020], P = 0.046) and heavy (β estimate = 0.011 [95% CI: 0.001 ~ 0.020], P = 0.030) academic pressure were significantly associated with the methylation level of NR3C1-16 CpG 10. Further mediation analysis demonstrated that the association of academic pressure and anxiety symptoms was significantly mediated by the methylation of NR3C1-16 CpG 10 (β estimate for indirect effect = 0.11 [95% CI: 0.005 ~ 0.32]; indirect/total effect = 8.3%). CONCLUSION The present study suggests that NR3C1-16 CpG 10 DNA methylation might be a potential mechanism that partially explains the lasting effects of academic pressure on subsequent anxiety symptoms among adolescents. Further studies with larger sample sizes are recommended to replicate this finding.
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Affiliation(s)
- Yilin Hua
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, 510080, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, 510080, Guangzhou, People's Republic of China
| | - Cuihong Huang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, 510080, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, 510080, Guangzhou, People's Republic of China
| | - Yangfeng Guo
- Health Promotion Center for Primary and Secondary Schools, Guangzhou, People's Republic of China
| | - Xueying Du
- Health Promotion Center for Primary and Secondary Schools, Guangzhou, People's Republic of China
| | - Liling Guo
- Health Promotion Center for Primary and Secondary Schools, Guangzhou, People's Republic of China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, 510080, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, 510080, Guangzhou, People's Republic of China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, 510080, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, 510080, Guangzhou, People's Republic of China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, 510080, Guangzhou, People's Republic of China.
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, 510080, Guangzhou, People's Republic of China.
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