Initial study of anxiety, depression and plasma cortisol in submariners

Nội dung text: Initial study of anxiety, depression and plasma cortisol in submariners

1. JOURNAL OF MILITARY PHARMACO-MEDICINE No7-2015 INITIAL STUDY of ANXIETY, DEPRESSION AND PLASMA CORTISOL IN SUBMARINERS Nguyen Hoang Luyen*; Nguyen Tung Linh* Nguyen Hoang Thanh**; Nguyen Minh Phuong* SUMMARY Objective: To assess the anxiety, depression and cortisol level in submariners. Subjects and methods: A cross-sectional study was done in Vietnamese submariners. Anxiety was assessed by Spielberger questionnaire, depression was assessed by Beck questionnaire. These tests were conducted in submariners a day before training at sea. Cortisol level was assessed before and after training at sea and automatically analysed by Architect Plus CI16200 Biochemical Analyser. Result: Submariners suffer from T-Anxiety at moderate level with mean score 36.47 ± 6.96. Prevalence of moderate T-Anxiety was 70.7%. The mean score of depression was 3.89 ± 3.59, the depression was found in 51.6% of submariners. The prevalence of depression among job groups were significantly defferent (p < 0.05). Cortisol level of submariners after training at sea elevated significantly by 33.16% (p < 0.05) reflect stressfullness in submariners. Conclusions: The working conditions in submarine are related to anxiety, depression and hypercortisolism in submariners that related to stress condition. * Key words: Submariners; Anxiety; Depression; Cortisol. INTRODUCTION related to an individual well-being. Variation in the intensity and duration of these The submarine environment is unique, emotions provide essential information imposing numerous physiological and about a person’s mental health that help psychological stressors, including isolated to identify recent event and long standing confinement, sunlight deprivation, noise, conflict that have significant impact on the hypercarbia, depleted oxygen, sleep individual life. Symptom of anxiety are deprivation, danger in subemergence and typicallly found in almost emotonal disorders. operations, reduced access to fresh food, From a psychoanalytic perspective, Freud micronutrient alterations stemming from regarded anxiety as the “fundamental distilled water supplies, inability to exercise phenomenon and central problem of and circadian desynchronization [4]. neusosis”. Depression has been described as Emotions motivate behavior and have “the common cold of mental health problem”. a significant impact on health and The World Health Organisation esstimates psychological well-being. Manifestation of that 340 million people currently suffer from anxiety, anger and depression are critical clinical depression [8]. Anxiety increases in psychological vital signs that are strongly response to stressful stimulation [1]. * Vietnam Military Medical University ** 103 Hospital Corresponding author: Nguyen Minh Phuong (phuongk21@yayhoo.com) 19
2. JOURNAL OF MILITARY PHARMACO-MEDICINE No7-2015 Cortisol is a stress-response hormone, SUBJECTS AND METHODS release from adrenal cortex under control of 1. Subjects. pituitary secretion of adrenocorticotropin (ACTH) which is controled by the 126 submariners in Camranh Base hypothalamo-pituitary-adrenocortical axis (total submariners at the study time from (HPA axis). Biomedical speaking, stress 9 - 2013 to 6 - 2014), mean age was 30.91 ± often describes as a situation in which 3.18 years. A group of 30 submariners was catecholamine and glucocorticoids from randomly choosen to assess cortisol levels. adrenal gland are elevated in response to an experience. Hypercorticolism is related 2. Study method. to some other disorders: less exercise, - Study method was cross-sectional sleep deprivation [6]. descriptive. - Anxiety levels was measured by psycholigical questionnaire of Spielberger C [1, 8]. State anxiety (S-Anxiety) was defined as intensity at particular time of subject feelings or tension, apprehension, nervousness, with associated activation of autonomic nervous system. Traite anxiety (T-Anxiety) was defined in term of relatively stable. In general classification, the lowest score through 30 was definitely mild anxiety; 31 to 45 defined as moderate anxiety; Figure 1: Diagram of the multiple factor influencing chronic cortisol levels and 46 to 64 defined as severe anxiety; 65 and health consequences. above defined as clinical pathological anxiety. - Depression levels were assessed by (BP: Blood pressure; FG: Fasting glucose; psychological questionnaire of Beck A [1, 8]. HDL: Hight density lipids; CE: Comfort eating; BDz: Bone density; DM: Decision making) In general classification: the lowest score through 3 was normal and not depressed; (Source: Reini (2010) [6]). 4 to 7 defined mild depression; 8 to 15 The objctives of this study are: defined as moderate depression; above - Assess anxiety and depression levels 15 was severe depressed. in Vietnamese submariners using Spielberger and Beck questionnaire scales. - Assessment of plasma cortisol: - Initially assess the cortisol levels of submariners was phlebotomized at the submariners before and after training time from 05h30 - 06h00 in the morning the operation at sea with submarine. submarine crew going to training at sea with 20
3. JOURNAL OF MILITARY PHARMACO-MEDICINE No7-2015 submarine (day 1) and in the morning 3. Analysis. after arriving submarine base (day 6). Results were presented as descriptive Plasma were frozen, transported and analysed stastistic, using percent, mean, standard in Biochemical Department of 103 Hospital. deviation (SD) and Pearson correlation Plasma cortisol levels were automatically coefficient (r). Statistical significance was assessed by Architect Plus CI16200 set at p < 0.05. The data were analyzed Biochemical Analyser with assessment kit using SPSS software (version 19, SPSS (Architect Cortisol) of Abbott Group. Inc, Chicago, IL, UAS). RESULTS Table 1: S-Anxiety levels by Spielberger questionnaire (n = 123). JOB GROUP Mechanic, Cook, medical, Gunners, Yeoman, sonar, TOTAL CLASSIFICATION Navigators engine chemical torpedo radar personnel personnel personnel personnel n % n % n % n % n % n % Mild anxiety 24 92.3 44 84.6 7 100 8 72.7 18 66.7 101 82.1 Moderate anxiety 2 7.7 6 11.5 0 0 3 27.3 9 33.3 20 16.3 Severe anxiety 0 0 2 3.8 0 0 0 0 0 0 2 1.6 Pathological anxiety 0 0 0 0 0 0 0 0 0 0 0 0 Total 26 100 52 100 7 100 11 100 27 100 123 100 Mean score 21 ± 9.76 p > 0.05 Table 1 showed that the anxiety level of submariners at particular time was low with mean score 21 ± 9.76. The number of submariners with mild anxiety was 82.1%. There was no case of pathological anxiety. The differences of S-Anxiety among job groups were not significant (p > 0.05). Table 2: T-Anxiety by Spielberger questionnaire (n = 123). JOB GROUP Mechanic, Cook, medical, Gunners, Yeoman, sonar, TOTAL CLASSIFICATION Navigator engine chemical torpedo radar personnel personnel personnel personnel n % n % n % n % n % n % Mild anxiety 7 26.9 12 23.1 2 28.6 3 27.3 2 7.4 26 21.1 Moderate anxiety 19 73.1 34 65.4 5 71.4 5 45.5 24 88.9 87 70.7 Severe anxiety 0 0 5 9.6 0 0 3 27.3 1 3.7 9 7.3 21
4. JOURNAL OF MILITARY PHARMACO-MEDICINE No7-2015 Pathological anxiety 0 0 1 1.9 0 0 0 0 0 0 1 0.8 Total 26 100 52 100 7 100 11 100 27 100 123 100 Mean score 36.47 ± 6.96 p > 0.05 The mean score of T-Anxiety of submariners was moderate anxiety (36.47 ± 6.96). Most of submariners (70.7%) suffered from moderate anxiety and 0.8% of submariners suffered from pathological anxiety (mechanic, engine personnel). The prevalence of T-Anxiety among job groups was not significantly different (p > 0.05). Table 3: Depression levels of submariners by Beck questionnaire (n = 126). JOB GROUP Mechanic, Cook, medical, Gunners, Yeoman, sonar, TOTAL CLASSIFICATION Navigator engine chemical torpedo radar personnel personnel personnel personnel n % n % n % n % n % n % Normal (no depression) 15 57.7 26 49.1 6 75 5 45.5 9 32.1 61 48.4 Mild depression 10 38.5 23 43.4 2 25 3 27.3 11 39.3 49 38.9 Moderate depression 1 3.8 2 3.8 0 0 3 27.3 8 28.6 14 11.1 Severe depression 0 0 2 3.8 0 0 0 0 0 0 2 1.6 Total 26 100 53 100 8 100 11 100 28 100 126 100 Mean score 3.89 ± 3.59 p < 0.05 The mean score of depression by Beck questionnaire was 3.89 ± 3.59, the depression was found in 51.6% of submariners. The prevalence of depression among job groups were significantly defferent (p < 0.05). Mechanic, engine personnel and yeoman, radar, sonar personnel manifested higher level of depression. 3.8% of mechanic, engine personnel suffered from severe depression. Plasma cortisol (µg/dl) cortisol Plasma Cortisol day 1 Cortisol day 6 Figure 2: Plasma cortisol of submariners (n = 30). 22
5. JOURNAL OF MILITARY PHARMACO-MEDICINE No7-2015 Basal plasma cortisol of submariners The mean score of T-Anxiety of before training operation at sea was 11.43 ± submariners was moderate anxiety (36.47 ± 2.93 µg/dL (n = 30). After 5 days of training 6.96). Most of submariners (70.7%) suffered at sea, the plasma cortisol concentration from moderate anxiety and 0.8% of was 13.83 ± 2.79 µg/dL. Plasma cortisol submariners suffered from pathological concentration increased significantly by anxiety. Typically, emotional characteristics 2.73 ± 4.01 µg/dL (33.16%; n = 30; p < 0.05). of submariners were trait stressfull. Our study results consistent with Nguyen Minh Table 4: Correlation among psychological Hai’s study on pilot [2], in his study: the factors. S-Anxiety score was 35.78 ± 7.56; the DEPRESSION S-ANXIETY T-Anxiety score was 38.94 ± 7.29. SCORE SCORE S-Anxiety score R 0.712 T-Anxiety reflect frequency that anxiety state have been manifested in the past and P 0,000** the probality that feelings of S-Anxiety will N 123 be experienced in future. T-Anxiety is T-Anxiety score R 0.758 0.825 subjective feeling of submariners about stress P 0.000** 0.000** event and situation they experienced. Our N 123 123 study consistent with study of Miller on T-Anxiety of U.S submariners with mean There was a strong relation among score 35.3 ± 5.9 (p > 0.05) [5]. Our result depression level, S-Anxiety and T-Anxiety study of T-Anxiety was higher than (p < 0.01). Trousselard’s study on French submariners with mean score 33.79 ± 9.13 (p < 0.01) [9]. DISCUSSION Trait anxiety reflects psychological factors Occupational and environmental problems of submariners in prolong time including in submarine including isolated confinement, training time at sea that was the most hazardous noise, direct exposure to chemicals stressfull. Uncomfortable environment in including diesel exhaust, exposure to air submarine effects on submariners health, contaminants, depleted oxygen, sleep causes physiological and psychological deprivation Many of the submariners also changes in different levels, that exist after attributed psychological problems such as work and cause stressfull and anxious depression, anxiety, sleep disorders and situation in submariners. stress to their time on the submarines [4]. The mean score of depression by Mean score of S-Anxiety by Spielberger Beck questionnaire was 3.89 ± 3.59, questionaire of submariners operating the depression was found in 51.6% of submarine at base was 21 ± 9.7. The number submariners. Mild depression was 38.9%. of submariners who had mild anxiety was Moderate depression was 11.1%. The predominant (82.1%). The severe anxiety prevalence of depression among job groups was 1.6%, there was not clinical anxiety. was significantly defferent (p < 0.05). 23
6. JOURNAL OF MILITARY PHARMACO-MEDICINE No7-2015 Mechanic, engine personnel and yeoman, cortisol, that cause physiological changes. radar, sonaman manifested higher level of By cortisol measurement, stress situation depression. 3.8% of mechanic, engine in submariners can be assessed. The room personnel suffered from severe change of cortisol reflects stress levels of depression. The mechanic, engine room submarine training operations at sea in personnel work in noisy and small chamber. particular and tactical military operations The yeoman, radar and sona personnel in general. cope with less exercise, stressfull work In our study, there was correlation that required highly attention. Our study among psychological questionnaire mean results consistent with Miller’s study on U.S score (p 0.7; n = 123). Both submariners with mean score 5.4 ± 4.6 [5]. Darwin and Freud considered anxiety, Cortisol level regulated by circadian depression and anger are fundamental with the peak in 1 hour after awakening, emotional state that had powerfull effect gradual decrease in day time and the on thought and behavior. They recognised lowest at midnight. Over-activation of HPA that depression generally resulted from system resulting in chronically elevated the interation of anxiety and anger [8]. cortisol levels commonly occurs during psychological stress when no “fight or flight” CONCLUSION response is needed. The basal cortisol levels of submariners - Submariners suffered from T-Anxiety was 11.43 ± 2.93 µg/dL, higher than cortisol at moderate level with mean score 36.47 ± level of medical student in Nguyen Thi 6.96. Prevalence of moderate T-Anxiety Hien’s sudy (M = 9.86 ± 2.51 µg/dL; n = 15; was 70.7%. p < 0.01), might be students were - The mean score of depression by phlebotomized at 8 - 10 AM, later than the Beck questionnaire was 3.89 ± 3.59, time submariners were phlebotomized [3]. the depression was found in 51.6% of submariners. After 5 days training at sea with submarine, the cortisol level of submariners - Cortisol level of submariners after significantly elevated was 13.83 ± 2.79 training at sea elevated significantly by µg/dL (n = 30; p < 0.01), relative change 33.16% (p < 0.05) reflect stressfullness in was 33.16%. Our study results were higher submariners. than Santtila’s study, the author studied The working conditions in submarine plasma cortisol of Finnish’s soldiers before are related to anxiety, depression and and after 8 weeks training, their cortisol hypercortisolism in submariners that related concentration increased by 11.1% [7]. to stress condition. Stress is unspecific hormonal response A logitudinal study on submariner’s stress in wich there were elevated ACTH and situation is needed for bettter medical care. 24
7. JOURNAL OF MILITARY PHARMACO-MEDICINE No7-2015 REFERENCES submariner physiology, performance and mood. Technical report 1226. Naval Submariner Medical 1. Học viện Quân y. Tâm thần học và tâm Research Laboratory, Groton, Connecticut, USA. lý y học. NXB Quân đội nhân dân. Hà Nội. 2003, p.29. 2007, tr.82-83; 343. 6. Reini S. Hypercorticolism as a potential 2. Nguyễn Minh Hải. Nghiên cứu một số concern for submariners. Aviation, Space and chỉ số sức khỏe tâm thần trong hoạt động bay Environmental Medicine. 2010, 81 (12), ở phi công quân sự. Luận án Tiến sỹ Y học. pp.1114-1122. Học viện Quân y. Hà Nội. 2009, tr. 56, 59. 7. Santtila M, Kyrolainen H, Hakkinen K. 3. Nguyễn Thị Hiền. Nghiên cứu một số chỉ Serum hormone in soldiers after basic training: số chức năng tim mạch, tâm thần kinh của Effect of added strength or endurance sinh viên Đại học Y Thái Bình ở trạng thái tĩnh regiments. Aviation, Space and Environmental Medicine. 2009, 80 (7), pp.615-620. và sau khi thi. Luận án Tiến sỹ Y học. Học viện Quân y. Hà Nội. 2013, tr.82-109. 8. Spielberger CD, Reheiser EC. Assessment of emotion: Anxiety, anger, depression and 4. Bennett S, Pisaniello D. Oberon class curiosity, applied psychology. Health and submarine occupational hygiene project, Final Well-being. 2009, 1 (3), pp.271-302. report, Conducted by Center for Military & Veterant Health. University of Queensland, 9. Trousselard M, Steiler D, Claverie D, University of Adelaide Nodes. 2006, pp.66-67. Canini F. Relationship between mindfulness www. adelaide.edu.au/oeh/research/oberon.pdf. and psychological adjustment in soldiers according to their confrontation with repeated 5. Miller JC, Dyche J, Cardenas R, Carr W. deployments and stressors. Psychology. Effect of three watchstanding schedules on 2012, 3 (1), pp.100-115. 25