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- Koppner, Jenny, 1973-
(author)
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Stress and mental health in populations of societies exposed to extraordinary circumstances : with focus on perceived and biological stress, perceived health, psychosocial factors, and sense of coherence
- 2024
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Doctoral thesis (other academic/artistic)abstract
- As our societies have grown larger, and communications have become global and fast-paced, our bodies and minds have been subjected to a mental stress different from the "fight or flight" situations we have adapted to through evolution. Furthermore, mental health issues are now seen to be on the rise all over the world. Globalisation has enabled social crises of different origins, e.g. financial or biological, to influence nations worldwide and spread faster than ever before. This thesis aims to investigate how populations are affected in regard to stress and mental health by the extraordinary circumstances of the global financial crisis of 2008 and the COVID-19 pandemic of 2020-2023.The first two studies in this thesis focus on the effects of the financial crisis on young adults (Paper I) and adults in working ages (Paper II). Greece was severely affected by the global financial crisis of 2008 and went into a decade long recession, whereas Scandinavian countries were less affected. University students were recruited from the psychology and medicine programs in Athens, Greece and Linköping, Sweden. Primary care visitors were recruited consecutively at primary health care centres (PHCC) in Greece, Sweden, and Norway. Data was collected in connection to recruitment. All participants filled out the same short questionnaire and gave hair samples that were analysed for cortisol concentrations (HCC) as a biological measure of stress.Papers III and IV are based on the Healthy OLD-study and investigate mental health, stress, and coping in older adults (70-80 years) during the COVID-19 pandemic. This age group was particularly vulnerable to the virus and therefore subjected to protective restrictions like social isolation. Participants were randomly recruited from five PHCC in south-east Sweden. Data was collected during one visit at the participant’s own PHCC and consisted of a comprehensive questionnaire, biometrics, and samples of blood, hair, and saliva. In Paper III only the questionnaire was used, and in Paper IV both the questionnaire and hair samples (analysed for HCC) were used.In Papers I and II the Greek participants reported a significantly higher occurrence of self-reported stress, anxiety, and depressive symptoms than their Swedish/Scandinavian peers. They also experienced more serious life events, and less hope for the future. In Paper I, cortisol levels were significantly lower for the Greek participants than the Swedish, which could indicate a fatigued Hypothalamic-Pituitary-Adrenal (HPA) axis due to longterm stress exposure, and/or genetic differences, and/or cultural differences. However, there was no significant difference in cortisol values between adults in working ages for Greeks and Scandinavians in Paper II, although significantly poorer overall health was reported in the Greek population compared to the Scandinavian population in Paper II. The strongest predictors explaining self-reported poor health were being Greek and feeling hopeless about the future. The strongest predictors for high perceived stress were moderate and high anxiety, and moderate depression.In Paper III social distancing was the factor most participants found had affected them the most during the COVID-19 pandemic. The participants who stated they had suffered a decline in mental health due to the COVID-19 pandemic reported more anxiety, depression, and stress than the participants who stated they had not been affected mentally. Risk factors for experiencing deteriorating mental health due to the pandemic were found to be a negative change in social life, experiencing a bad family situation, a change in physical activity, anxiety, and being a woman.In Paper IV, a low sense of coherence was significantly associated with anxiety, self-reported poor financial status, little belief in the future, and perceived negative mental effect from the COVID-19 pandemic. Anxiety was found to be a possible mediator between being mentally affected and sense of coherence. No association was found between sense of coherence and hair cortisol levels in this study. In general, women reported poorer mental health and quality of life than men, but there was no significant difference in hair cortisol levels.To conclude, the findings of this thesis show a high occurrence of stress, anxiety, and depression in adults living in societies exposed to financial crisis or the COVID-19 pandemic. Symptoms of anxiety and depression were shown to be predictors of high levels of perceived stress in young adults. Anxiety was especially prominent in older adults during the pandemic and is suggested to be a mediator in the association between sense of coherence (SoC) and participants who reported a decline in mental health due to the pandemic. A multitude of psychosocial factors were strongly correlated with SoC, respectively those mentally affected by the pandemic. Young Greek adults presented with lower HCC than their Swedish peers, which could be caused by fatigue of the HPA axis due to long-term stress exposure.The aim of this thesis does not have a direct clinical application, but the high occurrence of mental health issues, especially anxiety, found among adults living in societies exposed to extreme events emphasizes the importance of actively asking a patient how he/she is affected by a difficult life event, not least older women.
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| 2. |
- Barchiesi, Riccardo, 1989-
(author)
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Overlapping Neural Substrates of Alcohol- and Anxiety-Related Behavior in the Rat
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Alcohol use is a leading cause of death and disease worldwide. A large part of this disease burden is associated with alcohol use disorder (AUD), a diagnostic category characterized by excessive use in spite of negative consequences ("compulsive use"), a loss of control over intake, and choice of alcohol over natural rewards. These behavioral symptoms are believed to reflect the emergence of persistent neuroadaptations in key brain regions that exert control over motivated behavior. A major challenge to addressing the treatment needs of patients with AUD is the high prevalence of co-occurring psychiatric disorders, of which anxiety disorders are the most common. Both AUD and anxiety disorders are characterized by broad changes in gene expression within brain regions that include the prelimbic cortex (PL) and the amygdala complex. Although the risk for AUD has a substantial genetic component, heavy alcohol use and stress also contribute to disease risk. Our lab previously identified DNA hypermethylation as a mechanism behind alcohol-induced downregulation of prelimbic Syt1 and Prdm2. In a subsequent study, our lab demonstrated a functional role of Prdm2 in alcohol-associated behaviors. In the work that constitutes this thesis, we have further investigated the behavioral consequences of Syt1 and Prdm2 downregulation. We found that Syt1 knock-down in the PL of non-dependent rats is sufficient to promote several behaviors that model critical aspects of AUD. We further identified the PL-basolateral amygdala (BLA) projection as a key brain circuit within which Syt1 knock-down promotes compulsive-like alcohol intake. In another study, we showed that Prdm2 knock-down in the PL increases the expression of fear memory, a central feature of anxiety disorders. Knock-down after memory formation (consolidation) did not increase the fear expression, indicating that Prdm2 regulates fear memory consolidation. We further showed that knock-down of Prdm2 in the PL-BLA projection was sufficient to promote the increased fear expression. Transcriptome analysis specifically in neurons projecting from the PL to the BLA showed a marked up-regulation of genes involved in synaptogenesis, suggesting that Prdm2 downregulation leads to excessive fear by strengthening fear memory consolidation in the PL-BLA circuit. In a third study, we used a model of social defeat- and witness stress to investigate mechanisms of co-occurring escalated alcohol intake and increased anxiety-like behavior ("comorbidity"). We recapitulated the broad range of individual stress responses observed in human populations. With gene expression analysis, we identified a marked upregulation of Avp in the amygdala of rats with "co-morbid" characteristics, and this upregulation correlated with the magnitude of the comorbidity. Together, our findings highlight the contribution of epigenetic mechanisms in regulating the behavioral consequences of alcohol-dependence, and identify specific downstream target genes whose expression is influenced by alcohol-induced epigenetic reprogramming to mediate long-term behavioral consequences. Our work also identifies amygdala Avp as a possible neurobiological substrate of individual susceptibility for stress-induced alcohol- and anxiety-related behaviors.
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