HPA-axis activity and the moderating effect of self-esteem in the context of intimate partner violence in Cameroon

Abstract

Background:The experience of intimate partner violence (IPV) is stressful. One objective way to monitor it is to assess victims' stress response by measuring the concentration of their salivary cortisol, the major stress hormone released by the hypothalamic-pituitary-adrenal axis. Objective: We investigated how the IPV experienced by women in Cameroon affects their stress levels and those of their children. Method: We recruited 50 mother-child dyads exposed to IPV and a control group of 25 mother-child dyads. All mothers completed questionnaires, including the Revised Conflict Tactics Scale to assess IPV, the Sense of Coherence Scale, and the Self-Esteem Scale, to assess their psychological resources. Mothers were asked to collect 3 saliva samples from themselves and 3 from their children on a single weekday: immediately after waking up, 30 minutes after waking up, and 45 minutes after waking up. The total cortisol secretion over the first hour after awakening was determined by calculating the area under the curve with respect to the ground (AUCg). Results: Mothers exposed to IPV exhibited higher total post-awakening cortisol concentrations compared with those in the control group. However, no significant difference was found between exposed and non-exposed children. In addition, higher IPV, specifically injuries, was significantly and positively associated with greater AUCg among mothers exhibiting lower selfesteem. When self-esteem was high, however, no significant effect of IPV on AUCg was observed. Conclusions: Of particular clinical significance is that self-esteem can modulate the stress levels of women exposed to IPV, a valuable insight into the development of effective psychosocial interventions to support IPV victims in sub-Saharan Africa.La actividad del eje HPA y el efecto moderador en la autoestima en el contexto de violencia de pareja en Camerun Antecedentes: La experiencia de violencia de pareja (VIP) es estresante. Una forma objetiva de monitorearla es evaluar la respuesta al estrés de las víctimas midiendo la concentración de su cortisol salival, la principal hormona del estrés liberada por el eje hipotalámico-pituitarioadrenal. Objetivo: Investigamos cómo la VIP que experimentan las mujeres en Camerún afecta sus niveles de estrés y la de sus hijos. Método: Reclutamos 50 díadas madre-hijo expuestas a VIP y un grupo de control de 25 díadas madre-hijo. Todas las madres completaron cuestionarios, incluida

Methylation of the glucocorticoid receptor gene (NR3C1) in dyads mother-child exposed to intimate partner violence in Cameroon: Association with anxiety symptoms

“…In recent works from our group with a larger sample of dyads mother-child exposed to IPV, including the dyads examined in the present paper, we showed on one hand that mothers exposed to IPV compared to the control group have high levels of anxiety and depression symptoms and that their children exhibited high levels of externalizing symptoms such as delinquent and aggressive behaviour (7) and on the other hand exposed mother presented increased HPA-axis activity i.e. higher post-awakening cortisol concentrations (17). Exploring NR3C1 promoter methylation in the region of exon 1F and possible association with total cortisol concentration and symptoms of psychopathology in this sub-sample, can provide a stronger argument for long-term consequences of IPV particularly in an unstudied region like Sub-Saharan Africa where levels of violence are very high.…”

The elephant in the room: Intimate partner violence, women, and traumatic brain injury in sub-Saharan Africa

“…Though the neuroimaging and biomarker studies were not as descriptive, they were comprehensive and included evaluations of Hypothalamic-Pituitary-Adrenal (HPA) dysregulation detected by salivary cortisol levels ( 27 ), magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) to evaluate brain connectivity and white matter changes ( 20 , 24 ). The authors assessed several anatomic features of the brain including the corpus callosum, the caudal anterior cingulate, the middle temporal gyrus, the left amygdala, and ventral diencephalon, including the thalamus.…”

“…Across almost all the studies, the authors make a connection between IPV-induced TBI and health-related support services for victims. The teams of Gass ( 19 ), Joyner ( 21 ), Issahaku ( 22 ), Sedziafa ( 23 ), Saadi ( 26 ), and Wadji ( 27 ) all discuss the need to either increase identification through health-related encounters or improve health-related services to better support victims. In investigating the association between IPV and health seeking behaviors, Gass et al ( 19 ) found that compared with non-abused women, women reporting IPV were 1.5 times more likely to have visited a physician/healthcare facility and nearly twice as likely to have visited a traditional healer in the past 12 months.…”

“…In investigating the association between IPV and health seeking behaviors, Gass et al ( 19 ) found that compared with non-abused women, women reporting IPV were 1.5 times more likely to have visited a physician/healthcare facility and nearly twice as likely to have visited a traditional healer in the past 12 months. Wadji et al ( 27 ) capitalized on the care-seeking nature of IPV victims to investigate the effect of IPV on HPA-axis activity in mother–child dyads exposed to IPV in Cameroon. Knowing that victims seek help, they partnered with the Association for the Fight against Domestic Violence (ALVF), a non-profit organization that provides free legal advice, guidance, and support to women victims of IPV to establish an association between IPV and serum cortisol concentrations.…”

“…And unlike magnetic resonance imagining (MRI), NCCT does not require screening of patients for ferromagnetic substances such as metal or cardiac pacemakers and other contraindicated implantable devices and materials before scanning ( 47 ). Neuroimaging tools can be combined with HPA biomarkers ( 27 ) and the aforementioned TBI specific tools (Rivermead Post-Concussion Symptom Questionnaire, etc.) to identify and prognosticate IPV victims.…”