The aim of the THRIVE study is to examine three key objectives: 1. Does friendship support relate to reduced neural stress responses in young adults with CA?2. Does friendship support relate to enhanced self-esteem stability in young adults with CA?…
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Brief title
Condition
- Other condition
Synonym
Health condition
neurowetenschappenlijk onderzoek
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The goal of the THRIVE study is to examine the neurobiological mechanisms of
friendship support in young adults (aged 18-24 years) with a history of CA. For
that we will investigate three potential mechanisms: neural stress responses,
self-esteem stability, positive autobiographical memory specificity.
Hence, we will use the following main study parameters:
Main predictors
Childhood adversity
To estimate childhood adversity (CA), we will use a principal component
analysis to estimate a latent factor predicting variance across all items that
have assessed CA experiences (using the Childhood Trauma Questionnaire,
Multidimensional Peer Victimization Scale, and the Youth and Childhood
Adversity Scale). The latent factor score for CA will then be extracted and
utilized in all subsequent analyses.
Friendship support
To assess friendship support, we will use a principal component analysis to
estimate a latent factor predicting variance across items that have assessed
perceived friendship support (using the Cambridge Friendship Questionnaire,
McGill Friendship Questionnaire-Friendship Functions, and the Multidimensional
Scale of Perceived Social Support). The latent factor score for friendship
support will then be extracted and utilized in all subsequent analyses.
Main outcomes
Neural stress responses
Neural stress responses will be examined with the Montreal Imaging Stress Task
(MIST; Dedovic et al., 2005), a psychosocial stressor, comprising a series of
computerized mental arithmetic tasks with an induced failure component
(detailed in section 5.2.4.2).
Outcome measures include:
1. Neural activity in the limbic system (Regions of Interest (ROIs): insula,
hippocampus, amygdala, anterior cingulate cortex (ACC), and ventral striatum)
during the MIST (i.e., stress vs. control) (Noack et al., 2019).
2. Self-reported mood (on a visual analogue scale) as well as hormonal
(salivary cortisol) stress responses will be assessed before and after the MIST
to ensure the test is indeed perceived as stressful and elicits a hormonal
stress response.
Self-esteem stability
We will assess self-esteem stability using a task in which participants report
on their self-esteem after receiving computer-generated approval and
disapproval feedback (ostensibly from peers) on an online personality profile
(Will et al., 2017; see 5.2.4.2 for more details regarding this task).
Self-esteem stability is operationalized as the extent to which self-esteem
goes up or down as a function of approval or disapproval feedback, and it will
be assessed both in a baseline self-esteem state as well as in an induced high
or low self-esteem state.
Outcome measures include:
1. Self-esteem stability in response to social feedback (i.e., fluctuations in
self-esteem in response to approval and disapproval feedback). This is measured
through subjective ratings in response to the question *How good do you feel
about yourself right now?* (on a visual analog scale submitted through button
presses).
2. Neural activity co-varying with feedback-induced changes in self-esteem,
with a specific focus insula-vmPFC connectivity during feedback-induced changes
in self-esteem (Will et al., 2017).
Positive autobiographical memory specificity
Positive autobiographical memory specificity will be examined through the ratio
of total specific to total categorical (overgeneral) responses to positive cues
in the Autobiographical Memory Task (AMT; Askelund et al., 2019).
Outcome measures include:
1. Memory specificity for both positive and negative autobiographical memories
as assessed through written responses in the Autobiographical Memory Task
(AMT). We will assess responses to both positive and negative cues in order to
examine whether potentially significant effects are due to memory specificity
in general or specific to positive memory specificity.
Resilient functioning
Resilient functioning will be quantified as the degree to which an individual
functions better or worse than expected given their self-reported history of CA
(for details using this quantification see (Anne-Laura van Harmelen et al.,
2017)). For that, we will use principal component analyses to estimate a single
latent factor score that reflects current psychosocial functioning across
various domains (i.e., mental health, drug and alcohol use, perceived stress,
and aggressive behaviors towards self and others as assessed with the Drugs,
Alcohol, and Self-Injury Inventory, International Self-Report Delinquency
Questionnaire, Mood and Feelings Questionnaire, State-Trait Anxiety Inventory,
Patient Health Questionnaire, and Perceived Stress Scale) as well as a single
latent factor score that reflects CA experiences (assessed with the Childhood
Trauma Questionnaire, Multidimensional Peer Victimization Scale, and Youth and
Childhood Adversity Scale). Individual degree of resilient functioning will
then be estimated as the residual variation from the best fitting relationship
(comparing linear, quadratic, and cubic models) between our latent factor for
psychosocial functioning and our latent factor for CA (see Figure 1).
As such, in our approach resilient functioning reflects the degree to which
psychosocial functioning across domains is better (or worse) than expected
given an individual*s CA experiences. Using this method, individual residual
variation scores will be extracted to indicate individual degree of resilient
functioning as compared to the overall sample. Please refer to Ioannidis et
al., 2020 for an extensive discussion of the benefits and pitfalls of using
this approach to quantify resilient functioning after CA.
Secondary outcome
The secondary study parameters include age, gender identity, sex assigned at
birth, ethnic orientation, sexual orientation, highest level of education,
occupation, caregiver household income, caregiver education status and covid
related experiences. These factors will be analyzed in exploratory post-hoc
analyses and added as covariates in our models.
Background summary
Up to 50% of all children and adolescents growing up worldwide are exposed to
at least one form of childhood adversity (CA; e.g., abuse, neglect, bullying,
or poverty) (Bellis, Hughes, Leckenby, Perkins, & Lowey, 2014; McLaughlin,
2016). CA can be defined as *exposure during childhood or adolescence to
[highly stressful and potentially traumatic] environmental circumstances that
are likely to require significant psychological, social, or neurobiological
adaptation [*]* (McLaughlin, 2016; p. 363). As such, CA refers to a wide range
of negative life experiences including child maltreatment (emotional, sexual,
and physical abuse, and emotional and physical neglect) as well as intra-family
adversity (e.g., martial distress/conflict, parental alcohol dependence,
aggressive parenting behavior, parental violence, parental mental health
problems, or stressful family-level life events) (Fritz, de Graaff, Caisley,
van Harmelen, & Wilkinson, 2018). In addition, CA is a strong predictor of
problems in adolescence, such as depression or anxiety, behavioral problems,
and aggression towards the self and others (Gilbert et al., 2009; Green et al.,
2010). However, not all individuals with a history of CA move on to develop
such internalizing or externalizing problems. Those individuals adapt well
despite their early-life stressful experiences and can therefore be described
as resilient. Social relationships are an important resource for resilient
functioning (Ungar, Ghazinour, & Richter, 2013). Friendships, defined as
voluntary, reciprocal, and nurturing relationships, may be a particularly
important source of social support for young adults (Orben, Tomova, &
Blakemore, 2020). We have shown that friendship support improves mental
well-being in adolescents and young adults with a history of CA (A-L van
Harmelen, Blakemore, Goodyer, & Kievit, 2021; Anne-Laura van Harmelen et al.,
2016, 2017). However, the exact mechanisms through which friendships aid
resilient functioning are currently unknown (Gunnar, 2017; Scheuplein & van
Harmelen, 2022). To inform intervention and prevention efforts aimed towards
increasing resilience in individuals with CA, the THRIVE study will examine
three potential mechanisms (i.e., neural stress responses, self-esteem
stability, positive autobiographical memory specificity) through which
friendships may aid resilient functioning in young adults with CA.
Study objective
The aim of the THRIVE study is to examine three key objectives:
1. Does friendship support relate to reduced neural stress responses in young
adults with CA?
2. Does friendship support relate to enhanced self-esteem stability in young
adults with CA?
3. Does friendship support relate to greater positive autobiographical memory
specificity in young adults with CA?
In addition, we will examine whether friendship support relates to improved
resilient functioning through its effects on the three mechanisms (i.e., neural
stress responses, self-esteem stability, positive autobiographical memory
specificity).
Study design
This cross-sectional study will be conducted in Dutch and consists of a
screening and two main sessions. The screening will be conducted via telephone
during which interested participants will be screened for our inclusion and
exclusion requirements (see appendix E4 for the telephone screening). Eligible
participants will then be invited to the first online session (Session 1)
during which they will be asked to complete self-reports assessing CA
experiences, personality characteristics, and perceived social support. After
completing Session 1, participants will be invited for an in-unit assessment
(Session 2) at the Leiden University Medical Center (LUMC). Session 2 will
consist of MRI scanning, saliva sampling, self-reports, and cognitive tasks
(Autobiographical Memory Task (AMT), Self-Esteem Task, Montreal Imaging Stress
Task (MIST); see section 3 for a detailed explanation of the full study
procedure).
Study burden and risks
Group relatedness Our participants will comprise of healthy young adults
(18-24-year-olds without a current (past month) mental health diagnosis) with a
self-reported history of CA. One out of two young people growing up worldwide
are exposed to at least one form of CA, making it very prevalent in the general
population (Bellis et al., 2014). In the light of potential burdens associated
with participation in the THRIVE study, we have selected our exclusion criteria
to ensure that our sample will not consist of very vulnerable individuals.
Meaning, we will screen and exclude individuals based on a self-reported
current (past month) mental health diagnosis, high depressive symptomatology
(i.e., >14 on the PHQ; (Urtasun et al., 2019) indicating *severe depressive*
symptoms) and/or current suicidal ideation (i.e., score >0 on question 9 of the
PHQ). See section 4.2 & 4.3 for more details and appendix E4 for our telephone
screening. Benefits of the study Although we know that friendships improve
mental health and well-being in young people with CA, the underlying mechanisms
of this effect are unknown (Scheuplein & van Harmelen, 2022). Our study will
establish whether and how friendships improve mental health and well-being
through their effects on three potential mechanisms of vulnerability (neural
stress responsivity, self-esteem stability, and positive autobiographical
memory specificity) in young adults with CA. An improved understanding about
the protective role of friendships and their impact on these mechanisms of
vulnerability has the potential to inform novel intervention and prevention
efforts. These efforts could for example aim to mimic the beneficial effects of
friendship support through specifically targeting the mechanisms of
vulnerability. Burdens and risks associated with participation There are two
types of burdens/risks associated with participation in the THRIVE study.
First, the burden associated with Magnetic Resonance Imaging (MRI). MRI may in
some cases be perceived as slightly uncomfortable, however, the burden is
minimal, and we have proper procedures in place to make MRI scanning a
relatively safe situation. Some participants can become claustrophobic while
inside the scanner, in which case the session can be terminated immediately if
the participant*s requests so. To reduce the risk of distress due to MRI,
interested participants will be screened via telephone for standard MRI
contraindications (e.g., claustrophobia, braces, or pregnancy) as well as prior
to the start of the in-unit session. Second, our study population will consist
of young adults with CA, who despite their experiences do not have mental
health problems (i.e., we exclude those with a self-reported mental health
diagnosis, as well as those scoring above the severe range for depression on
the PHQ). In this resilient sample, recalling CA experiences, negative
autobiographical memories, as well as completing the cognitive tasks
(Self-Esteem Task and MIST) may still be perceived as stressful by some. The
Autobiographical Memory Task (AMT), Self-Esteem Task, and MIST have been used
by the principal investigator and co-investigators in previous studies that
included adolescents and young adults (i.e., 14 years and older). For instance,
in a large sample of 14-year-old adolescents with a self-reported history of
CA, we assessed positive and negative autobiographical memories (Askelund,
Schweizer, Goodyer, & van Harmelen, 2019). In the Resilience after Individual
Stress Exposure (RAISE) study, we assessed neural stress responses using the
MIST in adolescents and young adults with self-reported CA experiences
(Moreno-Lo*pez et al., 2021). Moreover, we have extensive experience assessing
reactions to social stressors such as social exclusion in samples of
adolescents (12-15 years; (Will, van Lier, Crone, & Gu*rog*lu, 2016)) and young
adults (mean age = 18 years; (Anne-Laura van Harmelen et al., 2014)) with
mental health disorders and histories of CA experiences (e.g., emotional
maltreatment). Across these studies, participants did not report lasting
emotional distress as a function of our experimental tasks. This may be due to
our sensitive approach in our assessments as well as our interactions with the
participants. Our sensitive approach means that we prioritize participants
well-being during all aspects of the assessment day; making sure they
understand that some tasks will be stressful, and that they know they can stop
participation at any given time. During the debriefing, we make sure that
participants have ample time to discuss their experiences and feelings and
leave in a good mood. Furthermore, our recruitment strategy further ensures
that those most sensitive to stress may not volunteer for our study. During
recruitment the RAISE study, it was clearly stated that participants would
undergo stressful tasks, which likely resulted in a self-selection bias of less
easily distressed participants for these studies. In the current THRIVE study,
we will adhere to a similar recruitment and assessment approach. In addition,
we will screen and exclude interested participants that are particularly
vulnerable to stress (i.e., excluding those with a self-reported current (past
month) mental health diagnosis, high depressive symptomatology, and current
suicidal ideation (both assessed with the PHQ during our telephone screening);
see section 4.2 & 4.3 for more details and appendix E4 for our telephone
screening). These measures have been chosen to minimize the possibility of
participants becoming distressed during the study. However, in case a
participant does experience distress during the study, we have a substantial
risk protocol in place to alleviate distress in the most secure, empathic, and
effective way possible.
Wassenaarseweg 52
Leiden 2333AK
NL
Wassenaarseweg 52
Leiden 2333AK
NL
Listed location countries
Age
Inclusion criteria
Right-handed young adults aged between 18-24 years (inclusive).
Able and willing to provide digital informed consent.
Able to speak, write, and understand Dutch fluently.
Any experience of CA as retrospectively assessed with the YCAS (i.e., death of
a very close friend or family member, major upheaval between parents, traumatic
sexual experience, victim of violence, extreme illness or injury, and any other
major traumatic event) up until the age of 18.
Exclusion criteria
Current (past month) diagnosis of mental health problems.
High depressive symptoms and/or current self-injury or active suicidal thoughts.
History of significant head trauma, premature birth, or learning disabilities.
Current neurodevelopmental disorders like autism spectrum disorder (ASD) or
attention deficit hyperactivity disorder (ADHD).
MRI contraindications (e.g., metal implants, surgical clips, pacemakers,
claustrophobia, or pregnancy).
Design
Recruitment
metc-ldd@lumc.nl
metc-ldd@lumc.nl
metc-ldd@lumc.nl
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| Register | ID |
|---|---|
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