Klaus Bader

Adverse childhood experiences associated with sleep in primary insomnia

The objectives were to explore the association between self‐reported adverse childhood experiences (ACE) and sleep in adults suffering from primary insomnia and to examine the impact of presleep stress on this relationship. Fifty‐nine patients with primary insomnia, aged 21–55 years, were administered the Childhood Trauma Questionnaire (CTQ) and then divided into two groups according to the achieved scores: with moderate/severe or low/no reports of ACE. The participants spent three consecutive nights in the sleep laboratory in order to record polysomnographic and actigraphic sleep parameters. A stress induction technique was administered by activating negative autobiographical memories immediately before sleep in the second or third night. Results show that 46% of the insomniac patients reported moderate to severe ACE. This group exhibited a significantly greater number of awakenings and more movement arousals compared to patients with low or no reports of ACE. Actigraphic data also indicated more disturbed sleep and increased nocturnal activity for the high‐ACE group. On the other hand, no specific group differences were found with regard to stress condition. The results support the assumption that it is possible to identify a subgroup among patients with primary insomnia who has experienced severe maltreatment in childhood and adolescence. This subgroup appears to differ in several sleep parameters, indicating a more disturbed sleep compared to primary insomniacs with low or no reports of ACE. With regard to sleep‐disturbing nightly patterns of arousal, parallels between individuals with high ACE and trauma victims as well as post‐traumatic stress disorder‐patients suggest themselves.

Childhood Trauma Questionnaire – Psychometrische Eigenschaften einer deutschsprachigen Version

Zusammenfassung. Theoretischer Hintergrund: Erfahrungen von Missbrauch und Vernachlassigung in der Kindheit werden mit dem spateren Auftreten psychischer Storungen in Verbindung gebracht. Zur Erfassung solcher Erfahrungen sind im deutschsprachigen Raum bislang keine validierten Instrumente publiziert worden. Fragestellung: Stimmt die dimensionale Struktur einer deutschen Ubersetzung des Childhood Trauma Questionnaire (CTQ; Bernstein & Fink, 1998) mit der des Originals uberein und verfugt sie uber zufriedenstellende psychometrische Eigenschaften? Methode: Der Fragebogen wurde von 363 Patienten und 61 Studierenden ausgefullt. Die Dimensionalitat, Reliabilitat und Validitat wurden uberpruft. Ergebnisse: Das funf Faktoren umfassende Modell der Originalversion konnte bestatigt werden. Interne Konsistenz und Retestreliabilitat sind zufriedenstellend bis sehr hoch. Einzig die Skala korperliche Vernachlassigung weist eine unbefriedigende interne Konsistenz auf. Schlussfolgerungen: Die hier untersuchte deutschspra...

Blunted endocrine and cardiovascular reactivity in young healthy women reporting a history of childhood adversity

BACKGROUND Chronic or prolonged stress exposure in childhood can alter structural and functional brain development, leading to mental and physical illness and alterations of psychobiological stress systems in adulthood. Recently, attenuation in stress reactivity of the hypothalamic-pituitary-adrenal (HPA) axis and cardiovascular system have been related to the number of adverse childhood experiences (ACEs). We set out to investigate the association of ACE duration and age of ACE occurrence on stress reactivity. METHODS 104 women in the age range 18-25 years (mean=21.7) free of mental and physical illness underwent psychosocial stress testing with the Montreal Imaging Stress Task (MIST). Free saliva cortisol and heart rate were assessed repeatedly before and after the MIST. RESULTS Number of ACEs was associated with attenuated cortisol and heart rate responses to stress in a dose-response relationship. Whereas overall duration of ACEs was significantly associated with an attenuated cortisol response, the specific age of first ACE occurrence did not contribute further to the dampened stress response. CONCLUSIONS ACEs are associated with blunted endocrine and cardiovascular stress reactivity in young and healthy women. Adverse life events in childhood, particularly if they occur repeatedly and chronically, show a strong association with alterations in stress reactivity in adulthood, potentially predisposing for later mental or physical disorders.

Reliabilität des Diagnostischen Interviews bei Psychischen Störungen (DIPS für DSM-IV-TR) unter klinischen Routinebedingungen

Hintergrund: Ziel dieser Studie ist die Überprüfung der Interrater- und Retest-Reliabilität des an die DSM-IV-TR-Kriterien angepassten und erweiterten Diagnostischen Interviews bei Psychischen Störungen [DIPS für DSM-IVTR; Schneider und Margraf, 2006]. Methode: 10 geschulte Interviewerinnen führten 237 Interviews in klinischen ambulanten und stationären Einrichtungen durch. Ergebnisse: Die Ergebnisse sprechen für eine gute bis sehr gute Interrater-Reliabilität der Oberklassen Angststörungen, affektive Störungen, somatoforme Störungen, Schlafstörungen, Essstörungen, Substanz- und Alkoholmissbrauch/-abhängigkeit sowie aller überprüfbarer Diag nosekategorien und für den Ausschluss psychischer Störungen. Ein vergleichbares Bild ergab sich für die Retest-Reliabilitäten: Lediglich die Störungsoberklasse Schlafstörungen sowie die Diagnoseklassen generalisierte Angststörung und dysthyme Störung zeigten eine nicht zufriedenstellende Reliabilität. Die Reliabilitätswerte waren für die verschiedenen klinischen Settings (ambulant vs. stationär) vergleichbar. Schlussfolgerung: Die Ergebnisse zeigen, dass auch das vollständig überarbeitete und erweiterte DIPS für DSM-IV-TR ein reliables Interview zur Diagnostik psychischer Störungen darstellt und komorbide Störungsbilder, wie sie insbesondere im klinischen Alltag häufig anzutreffen sind, zuverlässig abbilden kann.

Increased nocturnal activity associated with adverse childhood experiences in patients with primary insomnia

The present study examined to what extent adverse childhood experiences (ACE), in addition to demographic characteristics, current level of stress, depression, and arousability predisposition, are associated with sleep measures in adult insomnia. Thirty-nine adults suffering from primary insomnia completed self-report questionnaires assessing ACE, current level of stress, predisposition towards increased arousability, and depression. They were monitored for 7 consecutive nights at home with wrist actigraphs to evaluate objective sleep-related activity. Blockwise multiple regression analyses were performed to determine which variables were the most important predictors of sleep measures. ACE proved to be important predictors of actigraphically assessed sleep onset latency, sleep efficiency, number of body movements, and moving time, whereas the set of the remaining variables had no significant impact on these sleep measures. These findings suggest that there is an association between childhood maltreatment history and sleep in patients with primary insomnia. We presume that sleep-related nightly activity can be regarded as an aftereffect of long-lasting stressful experiences in childhood.

Daily stress, presleep arousal, and sleep in healthy young women: a daily life computerized sleep diary and actigraphy study

OBJECTIVE Our study aimed to further elucidate the mediating role of presleep arousal in the relationship between daily stress and sleep by investigating subjective sleep quality and actigraphy-assessed sleep efficiency (SE) on both within- and between-participant levels in a sample of healthy young women. METHODS Multilevel modeling was applied on electronically assessed data comprising 14 consecutive nights in 145 healthy young women to assess the relationship between daily stress, presleep (somatic and cognitive) arousal, and sleep on both levels between participants and within participants across days. RESULTS Higher levels of daily stress were consistently and significantly associated with higher levels of somatic and cognitive arousal. Somatic arousal mediated the relationship between daily stress and worsened subjective sleep quality on the between-participant level, while cognitive arousal mediated the relationship between daily stress and worsened subjective sleep quality on the within-participants level. Unexpectedly, healthy young women showed higher SE following days with above-average stress with somatic arousal mediating this relationship. CONCLUSIONS Our data corroborate the role of presleep arousal mediating the relationship between daily stress and subjective sleep quality. Interestingly this effect was restricted to somatic arousal being relevant on interindividual levels and cognitive arousal on intraindividual levels. For young and healthy individuals who experience high stress and arousal, well-established cognitive-behavioral techniques could be useful to regulate arousal and prevent worse subjective sleep quality.

Relationship Between Early‐life Stress Load and Sleep in Psychiatric Outpatients: A Sleep Diary and Actigraphy Study

The present study aimed to investigate whether stress experienced early in life is associated with actigraphic and subjective sleep measures in a sample of adult psychiatric outpatients. A total of 48 psychiatric outpatients completed self-report questionnaires assessing current depression, current anxiety symptoms and stress load during childhood (before the age of 13 years), adolescence (between the age of 13 and 18 years) and adulthood (between the age of 19 and current age). Sleep-related activity was measured using 24-h wrist actigraphy over a 7-day period at home, during which participants also kept a sleep diary. High stress load in childhood, but not in adolescence, was associated with shortened actigraphically assessed total sleep time, prolonged sleep onset latency, decreased sleep efficiency and an increased number of body movements in sleep, even after accounting for the effects of later occurring stress and psychopathological symptoms such as depression and anxiety scores. Unexpectedly, no significant associations between early-life stress load and subjective sleep measures were found. Results are consistent with findings from previous studies indicating an association between childhood adversities and higher levels of nocturnal activity. The findings suggest that high stress load during childhood might be a vulnerability factor for sleep continuity problems in adulthood.

Heightened beta EEG activity during nonrapid eye movement sleep in primary insomnia patients with reports of childhood maltreatment.

Summary: The present study explores the relationship between childhood maltreatment experiences and spectral power in high-frequency EEG activity during sleep in a sample of adults experiencing primary insomnia. Forty-five nontreated patients with primary insomnia spent three consecutive nights in the sleep laboratory, during which polysomnographic recordings were carried out. Nonrapid eye movement and rapid eye movement EEG data were analyzed using spectral analysis. In addition, each participant completed several self-report questionnaires assessing maltreatment in childhood and adolescence, current level of stress, and current depressivity. Insomnia patients with self-reported history of moderate to severe childhood maltreatment (MAL group; n = 25), as measured by the Childhood Trauma Questionnaire, were compared with insomnia patients without such a history (non-MAL group; n = 20). The MAL group exhibited more absolute and relative beta 1 and beta 2 power in nonrapid eye movement sleep and more absolute beta 1 and beta 2 activity in rapid eye movement sleep than the non-MAL group. Contrary to hypothesis, no group differences were found in gamma frequency band. The results suggest an association between history of childhood maltreatment and increased beta EEG activity particularly during nonrapid eye movement sleep in adult insomnia, what may reflect heightened psychophysiologic arousal during sleep.

Adverse childhood experiences and autonomic regulation in response to acute stress: the role of the sympathetic and parasympathetic nervous systems

ABSTRACT Background and objectives: After a previous report demonstrated blunted heart rate (HR) reactivity in association with adverse childhood experiences (ACEs) [Voellmin, A., Winzeler, K., Hug, E., Wilhelm, F. H., Schaefer, V., Gaab, J., … Bader, K. (2015). Blunted endocrine and cardiovascular reactivity in young healthy women reporting a history of childhood adversity. Psychoneuroendocrinology, 51, 58–67. doi:10.1016/j.psyneuen.2014.09.008], the present analysis aimed at clarifying the role of the sympathetic and parasympathetic branches of the autonomic nervous system in this relationship. Design and Methods: One hundred eighteen healthy young women provided data on ACEs and underwent psychosocial stress testing. Systolic blood pressure (SBP) and respiratory sinus arrhythmia (RSA, quantified by high-frequency HR variability) were assessed as measures of sympathetic and parasympathetic cardiovascular activity, respectively. A mediation model was calculated to test the indirect effects of ACEs on HR via SBP and RSA. Results: The effect of ACEs on HR reactivity was mediated by SBP reactivity but not by RSA reactivity. ACEs were associated with reduced SBP at rest. Conclusions: ACEs were associated with down-regulation in a measure of sympathetic but no alteration in a measure of parasympathetic cardiovascular stress reactivity in adulthood. Future research will need to clarify whether this indicates risk or resilience.

Validation of the Symptom Checklist SCL-27 in psychiatric patients: Psychometric testing of a multidimensional short form

Abstract SCL-90-R, a multidimensional assessment instrument for mental health status, is among the most widely used instruments for the evaluation of therapies and quality management in mental institutions. With 90 items it is rather long and has a high redundancy as can be seen in its highly correlated scales. Thus many short versions have been constructed, among them the SCL-27, which was devised as a screening tool. It has 27 items, retains six of the nine SCL-90 dimensions and has shown a good factor structure. So far it has only been validated in non-psychiatric samples. The aim of this study is to determine validity and other psychometric qualities of the SCL-27, compared to the SCL-90-R within a group of 449 psychiatric patients. The study found a large concordance between the symptom scales of the SCL-27 and the corresponding scales of the SCL-90-R. The SCL-27 further showed good reliability and a sensitivity to change comparable to that of the 90-item version. A confirmatory factor analysis yields an acceptable factor validity which is better than that of the long version. This study concludes that the SCL-27 is suitable as a short assessment instrument for psychological health in psychiatric patients.