The Role of Sex Differences and the Insular Cortex in Post-Traumatic Stress Disorder and Asthma Open Access
Lin, Esther (Spring 2023)
Abstract
Post-traumatic stress disorder (PTSD) is a trauma induced psychiatric condition that affects 12 million adults in the United States during a given year. A potential association exists between PTSD and asthma as growing evidence suggests that inflammation plays a role in the pathophysiology of both PTSD and asthma. There is a higher prevalence of PTSD in individuals with asthma compared to other psychiatric conditions like depression and anxiety disorders. Though the definite pathophysiology linking PTSD and asthma risk remains largely unknown, numerous studies suggest that people who were exposed to airway-related trauma were equally likely to develop asthma later in life as those exposed to non-airway related. Further, both PTSD and asthma are shown to be more prevalent in females compared to males. Neurobiologically, the insula has been found to be associated with PTSD symptoms and to be differentially activated by asthma-relevant cues, making it a strong region of interest to study in relation to asthma and PTSD. This present study investigates (1) the relationship between asthma and PTSD in an urban Atlanta population at high risk for trauma and PTSD, (2) how gender modulates the relationship of asthma and PTSD in this population, and (3) how the relationship between asthma and PTSD relate to insula activity in women. In this study, n=588 participants were approached by study staff in the emergency room and outpatient clinics of Grady Memorial Hospital. Participant information was collected through a 2-hour long interview screen assessing asthma presence and PTSD severity through administration of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) measure. A separate cohort of female participants (n=71) underwent MRI scans during a fearful faces task that measured fear responses. Their responses to the fearful and neutral stimuli were recorded and their insula response were analyzed. Within this population, PCL-5 scores were significantly higher in those with asthma vs. without, while male participants had significantly higher PCL-5 scores than females. There was no significant interaction between sex and asthma on PCL-5 scores. Further, there was no significant interaction between asthma and insula reactivity on PTSD symptom severity. These findings provide continued evidence that sex and asthma separately play a role in PTSD severity, but do not support that the two variables interact to impact PTSD severity or that asthma and insula reactivity interact to predict PTSD severity. Further studies that collect more detailed information regarding asthma, that have more balanced samples, and that analyze subsections of the insula are necessary.
Table of Contents
Table of Contents
Introduction
Methods
Results
Discussion
References
List of Tables and Figures
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