The Impact of Healthy Parenting As a Protective Factor for Posttraumatic Stress Disorder in Adulthood: A Case-Control Study

et al. (2014) The Impact of Healthy Parenting As a Protective Factor for Posttraumatic Stress Disorder in Adulthood: A Case-Control Study. PLoS ONE 9(1): e87117. doi:10.1371/journal.pone.0087117 The Impact of Healthy Parenting As a Protective Factor for Posttraumatic Stress Disorder in Adulthood: A Case- Control Study Adriano R. Lima 0 Marcelo F. Mello 0 Se rgio B. Andreoli 0 Victor Fossaluza 0 Ce lia M. de Arau jo 0 Andrea P. Jackowski 0 Rodrigo A. Bressan 0 Jair J. Mari 0 Michel Botbol, University of Western Brittany, France 0 1 Department of Psychiatry, Sa o Paulo School of Medicine, Federal University of Sa o Paulo (UNIFESP), Sa o Paulo, Brazil, 2 Department of Mathematics and Statistics, University of Sa o Paulo/USP, Sa o Paulo, Brazil, 3 Interdisciplinary Laboratory of Clinical Neuroscience (LiNC), Federal University of Sa o Paulo (UNIFESP) , Sa o Paulo , Brazil Background: Early life social adversity can influence stress response mechanisms and is associated with anxious behaviour and reductions in callosal area later in life. Objective: To evaluate the association between perceptions of parental bonding in childhood/adolescence, hypothalamicpituitary-adrenal (HPA) axis response, and callosal structural integrity in adult victims of severe urban violence with and without PTSD. Methods: Seventy-one individuals with PTSD and 62 without the disorder were assessed with the Parental Bonding Instrument (PBI). The prednisolone suppression test was administered to assess cortisol levels, and magnetic resonance imaging was used to assess the total area of the corpus callosum (CC), as well as the areas of callosal subregions. Results: The PBI items related to the perception of 'not having a controlling mother' (OR 4.84; 95%CI [2.26-10.3]; p = 0.01), 'having a caring father' (OR 2.46; 95'%CI [1.18-5.12]; p = 0.02), and 'not having controlling parents' (OR 2.70; 95%CI [1.106.63]; p = 0.04) were associated with a lower risk of PTSD. The PTSD group showed a blunted response to the prednisolone suppression test, with lower salivary cortisol levels upon waking up (p = 0.03). Individuals with PTSD had smaller total CC area than those without the disorder, but these differences were not statistically significant (e-value = 0.34). Conclusions: Healthy parental bonding, characterized by the perception of low parental control and high affection, were associated with a lower risk of PTSD in adulthood, suggesting that emotional enrichment and the encouragement of autonomy are protective against PTSD in adulthood. - Funding: This study is part of the Millennium Institute of Mental Health and Violence funded by the National Research Council (CNP grant 420122/2005-2) http:// www.brasil.gov.br/para/study/exchange/cnpq-national-council-for-scientific-and-technological-development/br, and the State of Sao Paulo Funding Agency (FAPESP) by the Grant: 2004/15039-0. http://www.fapesp.br/en/1. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Investigations of the etiology of PTSD have revealed that nearly 30% of individuals exposed to traumatic events will develop, among other stress-related disorders, the disorder in its full form. The incomplete penetrance of the traumatic event suggests that other factors may also contribute to the development of PTSD [1,2]. One such factor may be an innate, instinctive system of emotional and behavioral patterns, referred to by Bowlby as the attachment system [3]. The influence of parental bonding on genetic expression and modulation, affective regulation, mentalization and social interactions are at the core of investigations of geneenvironment interactions and, consequently, of the repercussions of such interactions on development as a whole [4]. Many of the risk and resilience factors for PTSD are related to biological stress response mechanisms, which, in addition to being heritable, can be modulated by features of the childs early environment, such as parental bonding patterns [5]. Studies with animal models have demonstrated the importance of parental bonding for rodent development [6;7;8]. It has been verified that rats subjected to daily periods of maternal separation during the first two weeks of life presented persistently elevated corticotropinreleasing factor (CRF) mRNA levels not only in the hypothalamus, but also in the entire limbic system, including the amygdala. It is important to note that the long-term effects of maternal separation are influenced by factors such as the duration of the separation period and maternal behavior following separation from pups. In a study by Plotsky and Meaney [6], rat pups 214 days old were placed in one of three conditions: handling (15 min of separation from mother and home cage on a daily basis), maternal separation (MS; 180 min of comparable separation on a daily basis), or were (...truncated)