Post-traumatic Stress Disorder: The Influence of the Environmental Context and Analysis of Oxidative Stress and Inflammatory and Glycemic Markers in Women Living in Kurdistan Regional Government-Iraq

Abstract

Background Internally displaced persons (IDP) camps are still home to a large number of female survivors of the Yazidi genocide carried out in Iraq in 2014 by the Islamic organization known as the Islamic State of Iraq and Syria (ISIS). Many of these women suffer from a persistent form of post-traumatic stress disorder (PTSD), which can last for many years. On the other hand, little is known about the intricate etiology of PTSD. Objectives In this observational cross-sectional study, the biochemical parameters, including inflammatory and oxidative stress (OXS) markers, were evaluated in two groups: the case group (women with newly diagnosed PTSD) and the control group (apparently healthy women). Furthermore, how the environment impacts the biochemical and OXS parameters of people not diagnosed with PTSD but living in IDP camps was also analyzed. Materials and methods The PTSD group (n=55, age=30.0 years) was made up of women survivors of genocide-related events living in IDP camps in the Kurdistan region of Iraq. The studied parameters in the PTSD group have been compared to two healthy control groups: (1) internal control group (n=55, age=28.1 years): healthy women living inside the IDP camps; and (2) external control group (n=55, age=28.3 years): healthy women living outside the IDP camps. The diagnosis of PTSD was conducted using a validated Kurdish version of the PTSD Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PCL-5) scale. Blood samples were collected to determine the level of glycated hemoglobin (HbA1c) and the concentrations of fasting serum glucose (FSG), C-reactive protein (CRP), ceruloplasmin (CP), 8-hydroxydeoxyguanosine (8-OHdG), glutathione (GSH), malondialdehyde (MDA), protein carbonyls (PC), and catalase (CAT) activity. Results Women with PTSD presented increased values of FSG (4.41%, p<0.05), HbA1c (4.74%, p<0.05), and CRP (114.29%, p<0.05), as well as increased levels of 8-OHdG (185.97%, p<0.001), CP (27.08%, p<0.001), MDA (141.97%, p<0.001), and PC (63.01%, p<0.001), besides increased CAT activity (121.5%, p<0.001), when compared with the control groups. A significant reduction of GSH (-20.33%, p<0.05) was observed in PTSD patients as compared to the external control group. In relation to the internal control group, women diagnosed with PTSD presented significantly increased levels of FSG (3.88%, p<0.05), HbA1c (2.83%, p<0.05), CRP (77.97%, p<0.05), and PC (41.3%, p<0.05), as well as increased levels of 8-OHdG (118.84%, p<0.001), CP (22.72%, p<0.001), MDA (90.67%, p<0.001), and CAT activity (55.31%, p<0.001). Healthy individuals residing in IDP camps, compared with external healthy control, presented significantly elevated levels of 8-OHdG (30.68%, p<0.001), MDA (26.91%, p<0.001), PC (15.37%, p<0.001), and CAT activity (42.62%, p<0.001). Conclusion Our findings indicate that PTSD significantly influences glycemic, inflammatory, oxidant, and antioxidant parameters, as evidenced by increased levels of FSG, HbA1C, CRP, PC, MDA, 8-OHdG, and CP, as well as increased CAT activity and a reduced GSH concentration in the PTSD group in comparison to the external control group. Additionally, our results suggest that the environmental context in IDP camps by itself can potentially affect oxidant and antioxidant parameters, as evidenced by the increased concentrations of 8-OHdG, MDA, and PC and increased CAT activity found in individuals not diagnosed with PTSD but living inside the camps.

Keywords: antioxidants; biochemical parameters; environmental context; genocide; inflammation; oxidative stress; post-traumatic stress disorder; yazidi.

Figure 1. Percentage of change in fasting serum glucose and glycated hemoglobin among the studied groups.

The comparison of fasting serum glucose (FSG) and glycated hemoglobin (HbA1c) within the studied groups was assessed through an independent t-test. Results with p>0.05 were regarded as non-significant, while significant and highly significant findings were marked with * for p<0.05 and ** for p<0.001, respectively.

Figure 2. Percentage of change in serum C-reactive protein among the studied groups.

The comparison of C-reactive protein (CRP) within the studied groups was assessed through an independent t-test. Results with p>0.05 were regarded as non-significant, while significant and highly significant findings were marked with * for p<0.05 and ** for p<0.001, respectively.

Figure 3. Percentage of change in serum protein carbonyl, serum malondialdehyde, and 8-hydroxydeoxyguanosine among the studied groups.

The comparison of serum protein carbonyl (PC), serum malondialdehyde (MDA), and 8-hydroxydeoxyguanosine (8-OHdG) within the studied groups was assessed through an independent t-test. Results with p>0.05 were regarded as non-significant, while significant and highly significant findings were marked with * for p<0.05 and ** for p<0.001, respectively.

Figure 4. Percentage of change in serum glutathione, serum ceruloplasmin, and serum catalase activity among the studied groups.

The comparison of glutathione (GSH), ceruloplasmin (CP), and catalase activity (CAT) within the studied groups was assessed through an independent t-test. Results with p>0.05 were regarded as non-significant, while significant and highly significant findings were marked with * for p<0.05 and ** for p<0.001, respectively.

Figure 5. Impact of post-traumatic stress disorder on glycemic, inflammatory, oxidative, and antioxidant parameters.

The impact of post-traumatic stress disorder (PTSD) on fasting serum glucose (FSG), glycated hemoglobin (HbA1c), C-reactive protein (CRP), protein carbonyls (PC), malondialdehyde (MDA), 8-hydroxydeoxyguanosine (8-OHdG), ceruloplasmin (CP), catalase activity (CAT), and glutathione (GSH) is represented by arrows, where ↑ elevated and↓ reduced. The PTSD group was compared with the external control group. Image created by author Husni M. Hasan

Figure 6. Environmental influence of living in internally displaced persons camps on glycemic, inflammatory, oxidative, and antioxidant parameters.

The influence of living in internally displaced persons (IDP) camps on fasting serum glucose (FSG), glycated hemoglobin (HbA1c), C-reactive protein (CRP), protein carbonyls (PC), malondialdehyde (MDA), 8-hydroxydeoxyguanosine (8-OHdG), ceruloplasmin (CP), catalase activity (CAT), and glutathione (GSH) is represented by arrows, where: ↑ elevated, ↓ reduced, and Ø no change. The internal control group was compared with the external control group. Image created by author Husni M. Hasan