Salivary Biosensors for Screening Trauma-Related Psychopathology

Abstract

Summary Following facial trauma, a distinct subset of patients will go on to develop mental health problems including recalcitrant psychopathology. Early identification of maladaptive stress reactions provides opportunities for initiating preemptive mental health interventions and hinges on the surgeon’s ability to differentiate between transient distress and precursors of recalcitrant psychiatric sequelae. The comprehensive care of injured patients will benefit greatly from objective adjuncts and decision-making tools to complement the clinical evaluation. This chapter addresses meeting the need for practical, standardized and reliable screening strategies through the use of promising developments in the use of stress response biomarkers and biosensing technology. The systematic interrogation of differentially expressed stress response biomarkers in saliva now permit rapid, assessment of the psychopathogical response to the stressor. Quantitative, point-of-use measurements of the traumatic stress response will greatly improve the nosology of post-traumatic stress disorders, and help advance the screening, diagnosis, treatment, and prevention of mental health consequences of violence and trauma.

Relationship between salivary cortisol and depression in adolescent survivors of a major natural disaster

“…The psychometric properties of self-report measures also suffer from the fact that stress symptoms can be consciously or unconsciously minimized or exaggerated by the respondent [17]. Furthermore, the time-intensive administration of many psychological assessments can render them impractical in community settings with constrained resources [18]. …”

“…We posit that reliable, quantifiable and readily obtained biological measures that reflect existing psychological states could facilitate rapid and objective screening of post-traumatic psychopathology including depression. One focus of our efforts has been the measurement of salivary cortisol, a commonly used biomarker of the stress response and psychopathology [18–21]. Salivary cortisol has been used in a range of clinical studies of stress-related diseases including depression [15], PTSD [16] and irritable bowel syndrome [17].…”

Point-of-Care Testing in the Time of P5 Medicine: A Preface

“…Enabled by this "smart systems" technology, trauma care providers would be able to identify "at-risk" patients, conduct timely restorative interventions, or refer individuals for specialized mental health care, in addition to monitoring progress and response to therapy. (19) …”

“…Saliva samples can be obtained without difficulty from children and individuals with physical or mental handicaps. (19,29) Saliva does not clot and is neither infectious nor considered biohazardous, making processing and disposal much easier. Furthermore, multiple saliva samples can be collected over a period of time without the use of specialized equipment or personnel, thereby allowing for easier monitoring of time-dependent changes in biomarker levels for extended periods.…”

“…Research groups have been developing portable biosensors to allow for near ''real-time'' detection and quantification of stress-response biomarkers, including salivary α-amylase and cortisol. (16)(17)(18)(19) Executable algorithms and treatment decision trees inputted into the biosensor microprocessor would eventually be able to analyze patterns in salivary stress biomarkers to generate simple feedback that is readily accessible to even a non-specialist. Enabled by this "smart systems" technology, trauma care providers would be able to identify "at-risk" patients, conduct timely restorative interventions, or refer individuals for specialized mental health care, in addition to monitoring progress and response to therapy.…”