EMERGES – Emergency Services Groups Epigenetics Study

This is a four-year project (2021-2025) funded by the National Health and Medical Research Council (NHMRC) and led by Associate Professor Divya Mehta, QUT (CIA). Other chief investigators include Professor Jane Shakespeare-Finch, QUT, Associate Professor Caroline Nievergelt, University of California San Diego, USA and Dr Marcus Ising, Max Planck Institute of Psychiatry, Germany.

This project is in collaboration with industry partners, the Queensland Ambulance Service (QAS) and the Queensland Fire and Rescue Service (QFES).

 

Study aim

There are individual differences in response to trauma exposure and this response is driven by epigenetic, psychological and/or social risk and protective factors.

The aim of this study is to identify epigenetic and psychosocial factors associated with vulnerability and resilience in response to trauma exposure in Australian first responders (paramedics, emergency medical dispatchers and firefighters), providing a holistic exploration of the aftermath of trauma exposure. This research will provide support for the influence of modifiable factors on post-trauma outcomes, such as a sense of organisational belonging and social support more broadly.

Project outline

Using a transdisciplinary design, this project will collect saliva samples and self-reported data (described below) and will uncover the molecular mechanisms underlying highly challenging experiences and their biological consequences. The project will achieve this by identifying genomic sites where stress has persistent and enduring effects and modulates the pathway to risk of disease and/or resilience and growth.

All trainees over a defined period at the training facilities at QAS and QFES will be invited to participate in this study. Over two years, baseline and follow-up data (survey answers and saliva samples) will be collected. Baseline data will be collected from new recruits in training. Depending on the industry partner and work role, there are training cohorts recruited every six weeks to three months. Follow-up data (survey answers and saliva samples) will be collected about six to 12 months later, respectively, for timepoint two. We aim to recruit 250-300 participants across three different cohorts (emergency medical dispatchers, paramedics and firefighters).

Description

The purpose of this research is to investigate biological changes occurring after the experience of a potentially traumatic event and how they contribute to various trauma responses, such as post-traumatic stress, resilience, and post-traumatic growth. Biological changes occurring after exposure to such events and their association with psychological processes may provide important insights into effective prevention strategies. This is done by evaluating your responses to an online survey (psychological and social factors, mental health, and wellbeing) together with DNA extracted from the saliva samples you will provide (genes and epigenetics collectively called genomics). You are invited to participate in this research project because you are working as a first responder, and your exposure to potential trauma is part of your work role.

Genetic and epigenetic information

Genetic material or DNA carries information on building and maintaining the cells of an organism. This information is organised into units called genes, which are blueprints for molecules that maintain the cells. One way to picture this is to think of the body as a house. In the house there is wiring, just as there are genes in your body. Within the house, there are devices such as light switches that you turn on and off in response to your needs. Epigenetic changes are like light switches that can be flipped on and off in response to environmental factors such as exercise, smoking and stress and this in turn affects your mental health.

This project involves the collection of saliva samples from you which will allow us to extract your DNA. We will use this information to identify epigenetic changes in response to factors such as psychological stress, social support and belongingness, and changes in mental health. We are interested in learning about genetic (you may compare this to the wiring within a house) and epigenetic (the light switches flipping on and off) changes and their impact on your mental health as you go through your training and commencement of your job. The genomic information is used at a group level only. At no time will your individual DNA be assessed.

Understanding these genomic changes will help us better understand the biological basis of mental health and stress-related conditions such as depression and anxiety, and other positive psychological outcomes like resilience and post-traumatic growth. Please be advised that this is discovery research, and the likely impact of genomic information may change over time as new knowledge/insight is gained and new technologies develop. It will take a long time for scientists to fully understand the biological basis of mental health. This project is funded by the Australian Government’s National Health and Medical Research Council (NHMRC).

Participation

Your participation will involve the completion of a questionnaire and the provision of two saliva samples at two time points. The first data collection will be at the start of your career with your employer. The second appointment for data collection will be about six to 12 months later when you complete your training and have commenced your work role. At each time point, if you decide to participate, you will be invited to do so during your time at work/in a training session which the QUT research team will attend.

Online survey:

If you choose to participate after reading this information, we will ask you to provide your consent. Once we have received your consent, the survey will prompt you to generate a unique participant number. You will fill in an online questionnaire comprising 179 questions. The survey takes approximately 30 minutes and contains a variety of questions ranging from Yes/No answers, rating scale answers (ranging from strongly agree to strongly disagree, for example), and multiple choice answers. Questions will include several demographic questions such as your height, weight, if you smoke and your ethnicity, among others. These questions are included as they can impact your epigenetics, hence we need to account for these in our analyses.

Some questions in this survey ask about your mental health and other aspects of your life, but this survey does not provide any feedback on your scores on these questions. Rather, they are used in an amalgamated form to look at the relationships between the broad constructs examined in this research. Some questions might cause distress or discomfort, and these questions will be preceded with a short warning message:

“The following questions might be confronting or might cause distress, please feel free to stop at any time. If you feel distressed or uncomfortable and wish to seek help, please contact either your respective staff support services or get in touch with 07 3138 0999 (Monday–Friday only 9am–5pm), QUT Psychology and Counselling Clinic, 44 Musk Avenue, Kelvin Grove, Alternatively, Lifeline provides access to online, phone or face-to-face support, call 13 11 14 for 24-hour telephone crisis support. For people aged up to 25, you can also call the Kids Helpline on 1800 551 800.”

Some prompts or questions that may cause distress include: “A trauma can be defined as an event that a person ‘witnessed, or was confronted with, that involved actual or threatened death or serious injury, or a threat to the physical integrity of the self or others’. Using this definition, have you ever experienced a traumatic event?” and you will be asked to provide an answer if you are comfortable doing so; or “I felt down-hearted and blue” or “I have repeated, disturbing, and unwanted memories of the stressful experience?”. You will need to indicate to what extent this is true for you.

Your answers will be saved to a protected database once you have finished the survey. Once you have finished the questionnaire, you will be asked for your email contact details so that we can contact you for data collection at the second time point. This information will be stored separately from the information collected for the study.

Saliva samples:

After you are done with the survey and the provision of your contact details, you will be handed two saliva collection tubes into which you will spit. Once you have filled up each tube with saliva to the line indicated, the tube will be closed. Both test tubes will be labelled with the same unique participant number that you generated for the questionnaires. This procedure may take about 30 minutes. Providing saliva samples is minimally invasive and most people do not experience discomfort when providing saliva. Research team members present during the saliva sample collection are trained in biospecimen collection. They will collect the saliva samples in a COVID-19 safe manner. We will endeavour to allow you to provide samples in full privacy, and water and disinfectants will be provided. Your DNA will be extracted from your saliva.

Your saliva and DNA samples will be stored securely at QUT and will not leave the QUT premises at any time. Please note that both the questionnaire set and the saliva collection tube will only carry your unique participant number, and never any information that may identify you (e.g., names or contact email addresses), to protect your privacy. Only aggregate results will be reported in research publications – your name or other identifying information will not be used.

When the study is completed (five years duration), your de-identified data (survey answers and genomic information) and any remaining DNA will be retained for an additional seven years to enable checking of data integrity. Data (survey answers and genomic information) and any remaining DNA will thereafter be destroyed using appropriate methods according to university policy of the time for electronic and physical data.

Withdrawal options:

Your participation in this research project is entirely voluntary. You can withdraw from this research project at any time and without comment or penalty. Your decision to participate will in no way impact your current or future relationship with your employer or QUT. If you agree to participate, you do not have to complete any question(s) you are uncomfortable answering. You will be able to review your responses before submitting. You can either walk out of the room during data collection (while filling in the survey or providing the saliva sample) or if you change your mind after participation in the data collection, you can reach out to the research team.

If you wish to withdraw, please submit your withdrawal form, send an email, or call any of the researchers with your unique participant number. Once you submit your withdrawal request, the saliva sample collected (or extracted DNA) will be incinerated unless you prefer to have the sample returned to you. Your questionnaire data will be deleted.

Measurement outcomes:

Once you provide the survey answers and saliva samples at both time points, your saliva will be extracted to obtain your DNA to measure your genes. Therefore, the final data will include your survey answers and your genomic information. Your DNA will be stored securely at QUT and will not leave QUT premises at any time.

We would like to store your DNA samples and survey data in a biobank for future research projects that continue directly on from this project. Biobanking involves storing health information and/or blood, tissue or DNA for future research studies. Storage in this biobank will be for as long as the project is continued at our laboratory (five years). Once the project is completed, your data (survey answers and genomic information) and any remaining DNA samples will be stored for an additional seven years to allow for verification of published data.

Only aggregated results of the survey and genomic information will be reported in research publications. Your name or other identifying information will not be used. Data (survey answers and genomic information) and any remaining DNA samples will thereafter be destroyed using appropriate methods according to university policy of the time for electronic and physical data.

Project findings and information for participants

Updates on the project will be provided via newsletters sent to you at various intervals. Alternatively, information can be seen on our Stress Genomics Lab website. Updates will be of a general nature regarding the discoveries made in the project and will not include any information specific to you. This is in part to protect your privacy, and because most of the genes we examine will have small effects on disease risk.

To properly assess their significance to you personally, we would need a complete lifestyle and genetic profile, which this research will not produce. This means that the reliability of results for prediction of your personal health or that of your relatives is unknown. While some questions in this survey ask about your mental health and other aspects of your life, this survey does not provide any feedback on your scores on these questions, rather they are used in an amalgamated form to look at the relationships between the broad constructs examined in this research.

Expected benefits

It is expected that this research project will not directly benefit you. The goals of the research are long term. However, it may benefit future first responders in their training and preparation for potential traumatic experiences and post-event interventions. Our research findings will be published in peer-reviewed scientific journals and reports will be prepared for our industry partners (QAS and QFES). Results may inform further prevention and intervention training and can enhance the provision of mental health training for frontline staff in general.

Risks

There are some possible risks with your participation in this research project. However, the research team have taken considerable measures to try to minimise these risks. It is also not believed that the research will pose any risks that are outside of what a first responder would normally encounter as a result of their work.

You may experience potential emotional discomfort when filling in questions that ask you to reflect on potentially traumatic experiences you have had in your past. To mitigate this risk, information on support services will be provided should you require them. Potentially triggering questions will be preceded by a warning message. You also have the option to not answer any questions you are not comfortable with.

You may also feel uncomfortable providing saliva samples by spitting into a saliva collection tube (physical discomfort). However, this process is sterile and all bio-specimens will be handled with appropriate protective gear. If you wish, you may ask the researcher conducting the data collection for protective gloves.

Your participation in this project is entirely voluntary. If you agree to participate, you can withdraw from the research project without comment or penalty. Your data (survey answers and genomic information) will be destroyed if you choose to withdraw while you are filling in the questionnaires. If you choose to withdraw after you have submitted your questionnaire data, you will need to disclose your unique participant number so the research team can identify your data (survey answers and genomic information) and destroy it accordingly.

Support services

QUT provides for limited free psychology, family therapy or counselling services for research participants of QUT research projects who may experience discomfort or distress as a result of their participation in the research. Should you wish to access this service, please call the clinic receptionist and indicate that you are a research participant:

QUT Psychology and Counselling Clinic – ph: 07 3138 0999 (Monday–Friday only 9am–5pm) – 44 Musk Avenue, Kelvin Grove.

Alternatively:

Lifeline provides access to online, phone or face-to-face support – call 13 11 14 for 24-hour telephone crisis support.

For people aged up to 25, you can also call the Kids Helpline on 1800 551 800.

You are also eligible to access the comprehensive staff support services provided to all staff and their families through your employer.

Privacy and confidentiality

All comments and responses will be treated confidentially unless required by law. The research uses Qualtrics to collect survey responses and survey data will be stored on a secure, password-protected Qualtrics server in the specific QUT account used for this research project. The QUT research team members are the only individuals with access to this account. Qualtrics does not sell or make available specific information about participants. The data on Qualtrics servers are protected by high-end firewall systems and access to systems is restricted to specific individuals. Qualtrics encrypts all data in transit using Hypertext Transfer Protocol Secure (HTTPS) and enforces HTTP Strict Transport Security (learn more). The data centre is in Australia, in compliance with data sovereignty requirements. Any data collected as part of this project will be stored securely as per QUT’s management of research data policy.

This research project requires a follow-up appointment for data collection, so we will need to retain your contact details (only email addresses). When signing the consent form, you will be asked to consent to being contacted again. Any contact information provided by participants (email addresses only) will be stored securely and separately from any data collected. This contact data and all other electronic data will be stored on a secure, password-protected university server by the research team. Electronic research data will be deposited in QUT’s Research Data Storage system, a password-protected data storage facility that is compliant with all security and ethics requirements.

Once the project is completed (after five years), your data (survey answers and genomic information) and any remaining DNA samples will be stored for an additional seven years. Data (survey answers and genomic information) and any remaining DNA will thereafter be destroyed using appropriate methods according to university policy of the time for electronic and physical data.

At no time will your name or other private information be associated with data collection materials that you will provide to us. All data (survey answers and genomic information) collected for the research project will be labelled with your unique participant number only. In preparation for time point two, a member of the research team will contact you again. Only the unique participant number will be used on data collection material at time point two. Prompts will help you remember this number.

Your contact details (email addresses only) will be maintained separately from the other data (survey answers and genomic information) you provide to us and will be stored securely. De-identified data (survey answers and genomic information) from this research project may be used as comparative data across participating institutions and in future projects, or stored on an open access database for secondary analysis.

Consent to participate

Submission of the consent form and the completed survey is an indication of your consent to participate in this research project. We are asking you for an extended consent such that if you consent, you agree that your de-identified data (survey answers and genomic information) will be used for this described project and for any related research project, such as those investigating risk and protective psychological, social and genetic factors associated with mental health and wellbeing including collaborative projects.

Concerns or complaints regarding the conduct of the research project

QUT is committed to research integrity and the ethical conduct of research projects. If you do have any concerns or complaints about the ethical conduct of the research project, you may contact the QUT Research Ethics Advisory Team on 3138 5123 or email humanethics@qut.edu.au. The QUT Research Ethics Advisory Team is not connected with the research project and can facilitate a resolution to your concern in an impartial manner.

 

Some research papers from our team

Recalibrating the epigenetic clock after exposure to trauma: The role of risk and protective psychosocial factors

DNA methylation of NR3C1 and FKBP5 is associated with posttraumatic stress disorder, posttraumatic growth, and resilience

A systematic review of DNA methylation and gene expression studies in posttraumatic stress disorder, posttraumatic growth, and resilience

 

This study has two parts.

  1. Filling out an online health questionnaire: This can be done online via a QR code we will provide you on your own devices or on devices provided by the research team. You can also complete the survey here.
  2. Provision of a saliva sample: This involves spitting into two self-collection Oragene kits for saliva collection to extract your DNA. This will be done in person under supervision of the research team. Further information on guidelines for saliva collection in the tubes is shown in this video: 

The same questionnaire and saliva collection protocol will be followed approximately 12 months from the first time point of collection. At that time, you will again fill in the questionnaires and provide new saliva samples.

THANK YOU FOR HELPING WITH THIS RESEARCH PROJECT. 

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