Promising research sheds light on PTSD in SA women

Posted on 19 October 2017

A psychiatrist in private practice at Mediclinic is pioneering clinical research that focuses on identifying biomarkers to indicate PTSD in SA women including victims of sexual violence.

Mental illnesses are complex in nature, but syndromically well recognisable. Research into biomarkers for posttraumatic stress disorder (PTSD) aims to not only provide supporting evidence for an early diagnosis of the disorder but also gauge treatment responses. Women who have experienced sexual violence are particularly at risk of developing the disorder, as well as severe health consequences thereafter.

Dr Eileen Thomas, a psychiatrist at Mediclinic Panorama hospital and research fellow at The South African Research Chairs Initiative in Posttraumatic Stress Disorder, has embarked on a doctoral research project to explore the environmental and genetic determinants of trauma-related disorders particularly in the field of women’s health.

‘One of our challenges with PTSD is that a definitive diagnosis can only be made one month after the incidence of a life-threatening traumatic event,’ says Dr Thomas. ‘This results in potential treatment delays and failure to initiate treatment that may alter the disease course.’

With her research paper focused on the potential role of adiponectin* (the most abundant plasma protein) in the development of PTSD in female rape survivors in South Africa, Dr Thomas aims to provide clinical support for a key area of need in South Africa.

Posttraumatic stress disorder and metabolic disorders

‘In South Africa, sexual violence perpetrated against women is unfortunately a common criminal offence,’ explains Dr Thomas. ‘This violence is associated with multiple, potentially adverse and long-lasting physical and mental health consequences, including the development of PTSD.’

‘PTSD is a trauma-related mental health disorder that occurs in approximately 2 to 9% of individuals following exposure to a life-threatening traumatic event,’ she continues. Studies conducted in South Africa, other African countries and elsewhere have shown that 20 to 30% of women develop PTSD after rape (White et al., 2015). Women in general are more likely to develop PTSD than men (Silove et al., 2017). ‘However, not all individuals exposed to a traumatic event go on to develop PTSD,’ she says.

A large body of evidence clearly links trauma-exposure to poor physical health. More specifically, studies suggest that PTSD is associated with cardio-metabolic diseases such as hypertension, type 2 diabetes, strokes and cardiac disease. Several potential mechanisms that help to explain this relationship have been explored.

Adiponectin dysregulation* may share common biological pathways with PTSD and metabolic disease. Identification of those with PTSD at highest risk for metabolic syndrome (MetS) requires innovative research and novel treatments to improve both conditions.

‘My interest in pursuing this research stems from a need to establish a potential unifying pathognomonic mechanism,’ she explains. ‘My proposed doctoral study is in line with research goals of the Department of Health, with its focus on women’s health and chronic medical illness. The study will provide valuable information to both researchers and clinicians to gain insight into the etiology and treatment of PTSD and may inform the need for and nature of interventions to minimise debilitating physical and mental health outcomes in rape survivors.’

‘A lab test may in future be able to positively predict which trauma-exposed individuals go on to develop PTSD and metabolic disease in the early period post-traumatic event,’ Dr Thomas concludes. ‘A greater understanding of genetic profiles and biological processes may also contribute to the development of personalised medication to increase the effectiveness of current psychotropic and medical treatment.’

More about the study

The study Exploring the potential role of adiponectin in the development of posttraumatic stress disorder in female rape survivors in South Africa is nested in a larger study by the Medical Research Council that is examining physical and mental health outcomes in a cohort of 1 000 rape-exposed women in KwaZulu-Natal over a two-year period. Researchers will be examining serum samples collected in the days following the rape exposure and preforming enzyme-linked immunosorbent assay (ELISA) and genetic studies measuring adiponectin-serum levels and variants of the adiponectin gene.

The hypothesis: Low adiponectin-serum levels at baseline are associated with a higher risk for development of PTSD and MetS in female rape survivors.

The main objective: Whether adiponectin-serum concentrations at baseline are a predictor for the development of PTSD symptom severity and development of metabolic disease following rape.

*Adiponectin (also known as ADIPOQ) is the most abundant peptide-hormone and is secreted exclusively by adipocytes. It circulates as oligomeric complexes and is involved in glucose homeostasis and fatty acid catabolism. It modulates sensitivity to insulin peripherally and exerts anti-inflammatory and anti-atherogenic functions. Hypo-adiponectinemia has been associated with obesity, metabolic syndrome, atherosclerosis, coronary artery disease and type 2 diabetes. Adiponectin thus serves as a putative biomarker for the expression and regulation of metabolic hormones (Blessing et al., 2017; Solomon et al., 2017).

References

Abrahams, N., Jewkes, R., & Mathews, S. (2013). Depressive symptoms after a sexual assault among women: understanding victim-perpetrator relationships and the role of social perceptions. African Journal of Psychiatry, 16(4), 288–93. https://doi.org/http://dx.doi.org/10.4314/ajpsy.v16i4.39

Blessing, E. M., Reus, V., Mellon, S. H., Wolkowitz, O. M., Flory, J. D., Bierer, L., … Marmar, C. R. (2017). Biological predictors of insulin resistance associated with posttraumatic stress disorder in young military veterans. Psychoneuroendocrinology, 82, 91–97. https://doi.org/10.1016/j.psyneuen.2017.04.016

Rugema, L., Mogren, I., Ntaganira, J., & Krantz, G. (2015). Traumatic episodes and mental health effects in young men and women in Rwanda, 17 years after the genocide. BMJ Open, 5(6), e006778. https://doi.org/10.1136/bmjopen-2014-006778

Silove, D., Baker, J. R., Mohsin, M., Teesson, M., Creamer, M., O’Donnell, M., … Rees, S. (2017). The contribution of gender-based violence and network trauma to gender differences in Post-Traumatic Stress Disorder. PLOS ONE, 12(2), e0171879. https://doi.org/10.1371/journal.pone.0171879

Solomon, Z., Levin, Y., Assayag, E. Ben, Furman, O., Shenhar-Tsarfaty, S., Berliner, S., & Ohry, A. (2017). The Implication of Combat Stress and PTSD Trajectories in Metabolic Syndrome and Elevated C-Reactive Protein Levels. The Journal of Clinical Psychiatry. https://doi.org/10.4088/JCP.16m11344

White, J., Pearce, J., Morrison, S., Dunstan, F., Bisson, J. I., & Fone, D. L. (2015). Risk of post-traumatic stress disorder following traumatic events in a community sample. Epidemiology and Psychiatric Sciences, 24(3), 249–257. https://doi.org/10.1017/S2045796014000110