engleski

Traumatic stress and immune reactivity during the war and early post-war period.

A war is paradigmatic source of appalling traumatic situations with deliberate violence that affect armed forces as well as civilian population. Exposure to such repeated and ongoing events creates longer lasting mental and physical health effects than natural disasters or accidents. Literature data on the effect of war-related stress on neuroendocrine and immune system mostly refer to Vietnam, or even World War II veterans and Holocaust survivors suffering from posttraumatic stress disorder (PTSD), examined decades after trauma. Although still somewhat controversial, different groups have found changes in the number and proportion of lymphocyte populations in peripheral blood, a reduced proliferative response to mitogen stimulation, reduced natural killer cell cytotoxicity, changes in the production of cytokines, as well as low cortisol level and increased concentration and responsiveness of glucocorticoid receptors. Due to recent war in former Yugoslavia we have studied immune reactivity and stress hormones in civilians - displaced persons (n = 20), refugees (n = 22), and detainees (n = 29) during the war, and soldiers - professional and enrolled shortly after the war. All combat veterans (n = 39) met DSM-IV criteria for PTSD, while two groups of professional soldiers, with (n = 128) and without (n = 63) PTSD were investigated. In general, fewer changes in immune and hormonal parameters were found in professional soldiers than in civilians or enrolled soldiers. Thus, professional soldiers had an increased proportion of B lymphocytes and decreased proportion of Tc lymphocytes, enhanced NK activity, increased level of IL-6 but not of other proinflammatory cytokines (TNF- , IL-1 , or IFN- ), and increased levels of T3 and T4 but not of cortisol and prolactin. Almost the same alterations were found traumatized soldiers without PTSD. Enrolled soldiers had an increased total lymphocyte count and proportions of T, Th, and memory Th cells, enhanced NK activity and increased levels of TNF- , as well as of stress hormones, cortisol and prolactin but a decreased level of lymphocyte glucocorticoid receptors. These results are opposite to those in chronic PTSD. The lymphocyte pattern of civilian victims was mainly characterized by increased proportions of activated T and B lymphocytes in peripheral circulation. In contrast to both groups of soldiers with diagnosed PTSD, civilians showed a decreased NK activity and phagocytic function (ingestion). Detainees had an increased level of TNF- and decreased level of cortisol while displaced persons had increased levels of stress hormones, cortisol, prolactin and  -endorphin. The in vitro mitogen stimulated proliferative lymphocyte response in displaced persons was unchanged, but the proportion of proliferating lymphocytes in freshly isolated (ex vivo) peripheral blood was increased. Taken as a whole, the results of psychoneuroimmunologic studies of stress, during or shortly after traumatizatin, convincingly indicate considerable alterations in the neuroendocrine and immune system response that seems to be trauma-, rather than PTSD-related.

lymphocyte populations; NK activity; phagocytosis; cytokines; IL-1; IL-6; TNF; IFN; hormones; T3; T4; cortisol prolactin

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