Micronutrients reduce stress and anxiety in adults with Attention-Deficit/Hyperactivity Disorder following a 7.1 earthquake
Introduction
Attention-Deficit/Hyperactivity Disorder (ADHD), characterized by problems with inattention, hyperactivity, and impulsivity, is estimated to occur in 4–5% of adults (Kessler et al., 2006). Research consistently shows that based on both self-report and physiological responses to artificially created stressors, adults with ADHD report higher levels of stress, anxiety and mood problems than adults without ADHD (Hirvikoski et al., 2009, Lackschewitz et al., 2008).
Numerous articles from around the globe report on the psychological distress symptoms, including heightened anxiety, fear and depression, in those who survive a destructive earthquake (Suhail et al., 2009, Wang et al., 2010). A range of factors impact the amount of psychological distress experienced by survivors including severity of injury to self and important others, level of destruction of one's home and place of business and general loss of resources (Kuwabara et al., 2008, Sattler et al., 2006). Most relevant to this study, researchers in Turkey examining nutritional status and stress symptoms in earthquake survivors found that those who were identified by the researchers as having a ‘bad appetite’ in the 15–18 months following a 7.6 earthquake also reported poorer psychological recovery (Yesilyaprak et al., 2007). However, no one has previously had the opportunity of examining whether micronutrient supplementation could play a role in people's emotional resilience following the distress of a natural disaster.
On Saturday, September 4, 2010, at 4:35 am, an earthquake with a magnitude of 7.1, struck Christchurch, New Zealand, population 340,000. Property damage and on-going disruption to services such as water, power, and sewage, was extensive. If the initial earthquake was not distressing enough, Christchurch experienced 935 aftershocks, of which 10 were a magnitude 5 or greater and 105 were a magnitude of 4 or greater (source: www.geonet.co.nz; see Fig. 1) in the two weeks period when data were collected. These quakes caused on-going disturbance of sleep and heightened arousal, as well as property damage (source: http://earthquake.usgs.gov).
No studies have investigated the impact of treatment on post-earthquake emotional recovery in a sample of adults with ADHD. Recently, the use of micronutrients, defined as vitamins, minerals and amino acids, has been revisited for the treatment of ADHD symptoms. Researchers have also reported on the impact of the nutrients on other areas of functioning such as depression, anxiety and stress. Most studies examining micronutrients in the treatment of ADHD have been published within the last decade and have been more positive than earlier studies (Arnold et al., 1978), perhaps because different doses have been evaluated as well as different combinations of micronutrients (Rucklidge et al., 2009). One micronutrient formula, known as EMPowerplus (EMP+), which consists of 36 ingredients (14 vitamins including all the B vitamins, vitamins A, C, D, E and H, 16 minerals (calcium, iron, phosphorus, iodine, magnesium, zinc, selenium, copper, manganese, chromium, molybdenum, potassium, boron, vanadium, nickel, and germanium), 3 amino acids and 3 antioxidants — list of ingredients and doses can be found at www.truehope.com), has been shown to be beneficial for ADHD symptoms across open label case series, database analyses and case studies (Kaplan et al., 2004, Rucklidge et al., 2010, Rucklidge et al., 2011, Rucklidge and Harrison, 2010). Symptoms noted to improve include ADHD symptoms, mood, anxiety and stress (Rucklidge et al., 2011).
There is a longer history of studies, including controlled trials, investigating the impact of micronutrients on a variety of emotional disturbances albeit different studies use different combinations and doses of micronutrients so cross comparison is problematic. Nevertheless, studies consistently show good effects. For example, Schlebusch et al. (2000) found that adults given a broad micronutrient formulation showed improved stress during a 30-day clinical trial, compared with participants receiving a placebo. Carroll et al. (2000) showed similar changes in that their sample of 80 healthy men who consumed a complex nutrient formula reported significant decreases in anxiety and perceived stress as compared to a placebo control group. Studies of geriatric populations have also shown that mood can be improved with micronutrient interventions (Gariballa and Forster, 2007, Gosney et al., 2008).
The 7.1 earthquake occurred in the context of ongoing trials of New Zealand adults with ADHD taking a micronutrient supplement (EMP+). The earthquake provided an opportune moment to use a real-life stressor to compare the self-reported depression, anxiety and stress responses of adults with ADHD who were and were not taking the micronutrient supplement at the time of the earthquake. We expected that those consuming micronutrients (micronutrient group) would have lower scores on measures of emotional responses post-earthquake compared with a sample of adults with ADHD not taking micronutrients at the time of the earthquake (control group) and that this group difference would increase over time. We hypothesized that differences would not be explained by other variables such as pre-earthquake measures of psychological functioning, psychiatric status, gender, ethnicity, age, pre-earthquake responses to micronutrients, and time between the earthquake and when the pre-earthquake measures were taken. We also expected that compared to baseline, post-earthquake scores of depression, anxiety and stress would be significantly lower for the micronutrient group but not for the control group.
Section snippets
Participants
Participants were recruited from ongoing and completed studies investigating the role of micronutrients on ADHD symptoms in adults aged 16 and over. Three studies were pooled: 1) 14 adults with ADHD who had participated in an 8 week open-label trial in 2008 (Rucklidge et al., 2011); 2) an ongoing case series of 3 young adults with ADHD being studied in an ABAB design in which participants are on the micronutrients (8 weeks), off (8 weeks), and back on for six months; and 3) an ongoing
Results
Based on interview responses, both groups suffered similar levels of injury and personal loss. No one sustained serious physical injuries or extensive damage to or loss of their homes. Typical experiences included minor bruises and cuts, fallen chimneys, broken windows and cracks in the walls of homes.
Independent sample t-tests (two-tailed) were used to examine specific between-group differences. There were no between-group differences on baseline reports of depression (t(31) = − 0.007, ns, Cohen's
Discussion
This study investigated whether individuals with ADHD taking micronutrients showed more emotional resilience associated with a 7.1 earthquake than individuals with ADHD not taking the micronutrients. Some but not all of the hypotheses were supported and several key findings emerged. While there were no group differences in self reports of depression, anxiety and stress one week post-earthquake (Time 1), at two weeks post-quake (Time 2), those taking micronutrients reported feeling significantly
Financial disclosures
None of the authors have any competing financial interests.
Acknowledgments
We thank the University of Canterbury for its ongoing research support, the Vic Davis Memorial Trust for grant support, Marie Lockie for her private donation, and Dr Nicola Ward and Petra Hoggarth for assistance with data collection. We also thank the participants who agreed to be interviewed following the earthquake and to Truehope Nutritional Support Ltd. for providing the formula for the duration of the research trials.
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