Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis

Socially oriented thinking and the biological stress response: Thinking of friends and family predicts trajectories of salivary cortisol decline

The cortisol stress response has been related to perceived social support, but previous studies rely on self-reported social support variables. The cortisol recovery phase in particular has been theorized to serve a social coping function, but individual differences in recovery slope have not yet been examined in relation to social coping-relevant indices. This study addressed these gaps by examining the relationship of cortisol trajectories after a socioevaluative task to individual differences in covertly assessed cognitions related to close social relationships. We examined trajectories of cortisol change related to socially oriented thinking, the semi-implicit activation of cognitive representations of friends or family. Young adults (N = 64) gave salivary cortisol samples before and for 45 min after a speech task. Participants' thoughts were sampled repeatedly; the frequency of words related to friends or family was assessed to index socially oriented thinking. A free curve slope intercept latent growth curve model showed excellent fit with the cortisol data. Socially oriented thinking was unrelated to overall magnitude of cortisol response to the task (latent intercept) but predicted the latent cortisol trajectory, independently of cortisol intercept and baseline cortisol levels. Socially oriented thinkers showed more gradual cortisol declines, whereas nonsocially oriented thinkers showed a steeper downslope driven primarily by cortisol changes 45 min after the task. Individual differences in socially oriented thinking may manifest in different rates of biological changes following a performance task.

Effects of institutional rearing on children's diurnal cortisol production

Young children living in institutional settings often show a range of deficits in social, physical, and cognitive functioning. Whereas the diurnal production of cortisol has been examined among post-institutionalized children in a number of investigations, studies of children continuing to live in institutions are limited. In this study, we assessed wake-up and bedtime cortisol among 73 children living in Russia, with 52 institutionally-reared (n = 31 at time 2), and 21 family-reared (n = 18 at time 2). Institutionally-reared children showed a blunter wake-up to bedtime slope than family-reared children at both time 1 and time 2, with significantly higher cortisol levels at bedtime. These findings highlight the deleterious effects of institutional care on children's developing neuroendocrine regulation.

Mammary tumors compromise time-of-day differences in hypothalamic gene expression and circadian behavior and physiology in mice

Circadian rhythms influence various aspects of biology, including hormonal, immunological, and behavioral processes. These 24-hour oscillations are necessary to optimize cellular functions and to synchronize these processes with the environment. Breast cancer patients and survivors frequently report disruptions in circadian oscillations that adversely affect quality-of-life, including fragmented sleep-wake cycles and flattened cortisol rhythms, which are associated with negative behavioral comorbidities (e.g., fatigue). However, the potential causal role of tumor biology in circadian dysregulation has not been investigated. Here, we examined the extent to which sham surgery, non-metastatic mammary tumors, or mammary tumor removal in mice disrupts circadian rhythms in brain clock gene expression, locomotor behavior (free-running and entrained), and physiological rhythms that have been associated with cancer behavioral comorbidities. Tumors and tumor resection altered time-of-day differences in hypothalamic expression of eight circadian-regulated genes. The onset of activity in entrained running behavior was advanced in tumor-bearing mice, and the amplitude of free-running rhythms was increased in tumor-resected mice. Tumors flattened rhythms in circulating corticosterone and Ly6c^Hi monocytes which were largely restored by surgical tumor resection. This work implies that tumors alone may directly impact central and/or peripheral circadian rhythmicity in breast cancer patients, and that these effects may persist in cancer survivors, potentially contributing to behavioral comorbidities.

Lower cortisol levels and attenuated cortisol reactivity to daily-life stressors in adults with 22q11.2 deletion syndrome

BACKGROUND

22q11.2 deletion syndrome (22q11DS) is a genetic disorder associated with neurodevelopmental, anxiety and mood disorders, as well as an increased risk for developing psychosis. Cortisol levels and stress reactivity reflect hypothalamic-pituitary-adrenal (HPA)-axis activity, and are believed to be altered in individuals that often experience daily-life stress, depression, and psychotic symptoms. However, it is unknown whether individuals with 22q11DS display an altered stress reactivity.

METHODS

We included 27 adults with 22q11DS (mean age: 34.1 years, 67% female) and 24 age and sex-matched healthy controls (HC; mean age: 39.9 years, 71% female) into an experience sampling study. Throughout 6 consecutive days, we measured participants' subjective stress related to current activity and at the same time collected salivary cortisol samples. Multilevel regression models were used to analyze cortisol reactivity to activity-related stress.

RESULTS

Diurnal cortisol levels were significantly lower in the 22q11DS group compared to HCs (B=-1.03, p < 0.001). 22q11DS adults displayed significantly attenuated cortisol reactivity to activity-related stress compared to HCs (B = -0.04, p = 0.026). Post-hoc exploratory analysis revealed that these results were independent from 22q11DS psychiatric diagnosis or medication use.

CONCLUSION

These results indicate that adults with 22q11DS have lower cortisol levels and attenuated cortisol response to daily stress, possibly resulting from an increased sensitization of the HPA-axis. This suggests that alterations in HPA-axis functioning, previously reported in several psychiatric disorders including post-traumatic stress disorder (PTSD), psychotic disorder, and mood disorder, also appear to be present in adults with 22q11DS.

Socioeconomic Status, Ecologically Assessed Social Activities, and Daily Cortisol Among Older Urban African Americans

Objectives: Higher socioeconomic status (SES) individuals report more social activities than their lower SES counterparts. Yet, SES and racial health disparities are often confounded. Here, we tested whether the frequency of engagement in social activities contributed to the association between SES and daily cortisol secretion among urban African American older adults. Methods: Ninety-two community-dwelling African Americans aged 55 years and older reported what they were doing at regular intervals across the day on an Android smartphone for seven consecutive days. They also provided four saliva samples at four time points a day during the same period. Results: Higher SES older adults engaged in proportionally more social activities than their lower SES counterparts. A greater relative frequency of weekly social activities was associated with a steeper diurnal cortisol decline. Higher SES was indirectly linked to a steeper cortisol decline via increased relative frequency of weekly social activities. Discussion: Our findings suggest that engagement in weekly social activities represents a behavioral intermediary for SES health disparities in endocrine function among older urban African American adults.

Investigating associations between momentary stress and cortisol in daily life: What have we learned so far?

Since cortisol measurement in saliva has been established, it has been used as an indicator of stress-related hypothalamic-pituitary-adrenocortical axis activity. Concurrent development of methodological frameworks such as ambulatory assessment, ecological momentary assessment, and experience sampling have provided opportunities to combine both approaches in daily life research. The current review provides a summary of basic methodological principles and recommendations, as well as abstracts of findings of studies investigating momentary associations between stress and cortisol in daily life with an emphasis on within-subject associations (i.e. average covariance in repeated momentary assessments of stress and cortisol, and individual-specific deviations from the average covariance). Methodological challenges related to stress measurement, sampling principles, and appropriate statistical modeling are discussed, followed by a description of the historical development of studies on within-subject associations between momentary daily life stress and cortisol. The review concludes with a discussion of controversial methodological characteristics of these studies regarding operationalizations of stress, compliance, timing and frequency of stress and cortisol sampling, and reporting of effect sizes. Future research in this area would benefit from automated cortisol assessment, broadening of the scope of stress response measures, use of advanced statistical models that better account for dynamics in the stress process in daily life, and attempts to replicate findings. While previous studies of momentary stress and concurrent cortisol assessments have reliably confirmed some fundamental predictions from stress theory in daily life, future studies should aim at providing progress by testing innovative research questions and utilizing new technological developments.

Ethnic differences in diurnal cortisol profiles in healthy adults: A meta-analysis

PURPOSE

Cortisol is a well-known biomarker of the physiological stress system; atypical cortisol patterns have been linked to many psychological and physiological illnesses. Previous studies have found vast health disparities among ethnic groups; however, studies examining the relationship between cortisol and ethnicity have found mixed results. This meta-analysis investigated whether there are differences in diurnal cortisol outcomes among ethnic groups, while considering the moderating roles of various individual factors and methodological approaches.

METHODS

Search phrases were entered into MEDLINE, PsycINFO, EMBASE, Cochrane Library, CINAHL, Scopus, and Web of Science. Effect sizes were extracted for ten diurnal cortisol outcomes, including waking, 30 min after waking, cortisol awakening response, slope, area under the curve, urinary twenty-four-hour secretion, total cortisol output, and midday, evening, and bedtime concentrations, for eight ethnic group comparisons, including Asians, Blacks, Hispanics, Indigenous people, Whites, Minority and Majority groups, and Multiethnic groups. Moderator analyses, including variables such as gender, age, and number of cortisol collection time points, were conducted.

RESULTS

There were significant ethnic differences in diurnal cortisol profiles, including cortisol awakening responses, with more robust differences in ethnic comparisons that included White participants. Differences in diurnal cortisol profiles were also moderated by gender, mean age, and sample size.

CONCLUSIONS

This meta-analysis supports the notion that ethnic groups exhibit distinct diurnal cortisol profiles, which, according to the biopsychosocial model of health, may be a result of unique sociocultural experiences. The limitations of this meta-analysis and future directions for stress research with various ethnic groups are discussed. Statement of contribution What is already known on this subject? Studies have found vast health disparities among ethnic groups. Psychological and physiological illnesses and atypical diurnal cortisol profiles are strongly correlated. Studies have examined the relationship between diurnal cortisol rhythms and ethnicity, but findings are mixed. What does this study add? This study is a systematic examination of the relationship between diurnal cortisol rhythm and ethnicity. Psychosocial and methodological factors moderate the relationship between diurnal cortisol output and ethnicity. This study provides insight on factors that contribute to health disparities among ethnic groups.

Early adversity, child neglect, and stress neurobiology: From observations of impact to empirical evaluations of mechanisms

Research on the effects of early life adversity, and in particular on the absence of responsive caregiving, has shown long-term impacts on well-being and development. These investigations have been conducted both in human populations and in animal models. The work has demonstrated that neglect experienced in the early years can affect not only behavior but also neurobiological functioning. In particular, studies of children in the foster care system show convergence with research on children adopted following institutional rearing in terms of dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which produces the neuroendocrine hormone cortisol. The characteristic pattern that has been most commonly observed involves diminished diurnal cortisol production, particularly in terms of low levels of cortisol upon awakening. Notably, however, a number of evidence-based interventions for infant, toddler, and preschool-aged foster children have been shown to produce more typical patterns of cortisol production, in combination with improved behavioral, socioemotional, and foster care placement outcomes. In this paper, we review the literature on the effects of early disruptions in care on biobehavioral development, and summarize the results of the interventions for young foster children.

Maternal early pregnancy body mass index and diurnal salivary cortisol in young adult offspring

Background Maternal early pregnancy overweight (body mass index [BMI] 25.0-29.9 kg/m²) and obesity (BMI ≥ 30 kg/m²) are associated with mental and physical health adversities in the offspring. Prenatal programming of the hypothalamic-pituitary-adrenal (HPA) axis has been put forward as one of the mechanisms that may play pathophysiological role. However, evidence linking maternal overweight and obesity with offspring HPA-axis activity is scarce. We studied if maternal early pregnancy BMI is associated with diurnal salivary cortisol, a marker of HPA-axis activity, in young adult offspring. Methods At a mean age of 25.3 (standard deviation [SD) = 0.6) years, 653 Arvo Ylppö Longitudinal Study participants collected saliva samples for cortisol analyses, at awakening, 15 and 30 min thereafter, 10:30AM, 12:00PM, 5:30PM and at bedtime. Maternal BMI was calculated from weight and height verified by a measurement in the first antenatal clinic visit before 12 weeks of gestation derived from healthcare records. Results Per each one kg/m² higher maternal early pregnancy BMI offspring diurnal average salivary cortisol was -1.4% (95% CI:-2.6, -0.2, p_FDR = 0.033) lower, at awakening it was -2.4% (95% CI:-4.0, -0.7, p_FDR = 0.025) lower and the morning average salivary cortisol was -2.0% (95% CI:-3.4, -0.5, p_FDR=0.017) lower. These associations were independent of the offspring's own young adulthood BMI, and other important covariates. Conclusion Our findings show that young adult offspring born to mothers with higher early pregnancy BMI show lower average levels of diurnal cortisol, especially in the morning. Whether these findings reflect prenatal programming of the offspring HPA-axis activity warrants further investigation.

Dehydroepiandrosterone and cortisol as markers of HPA axis dysregulation in women with low sexual desire

Previous research has found lower serum levels of dehydroepiandrosterone (DHEA) or its sulfated form, DHEA-S, in women diagnosed with Hypoactive Sexual Desire Disorder (HSDD). Given that DHEA and DHEA-S have multiple direct actions on the brain as well as anti-glucocorticoid properties, it is possible that lower levels of DHEA directly impact women's sexual functioning. To date, the significance of the lower DHEA levels remains unclear. To our knowledge, there has been no empirical study of stress hormones as markers of HPA dysregulation in women with HSDD. To attend to this gap, the present study utilized several measures of HPA axis function - morning and evening cortisol and DHEA, the cortisol awakening response (CAR), diurnal cortisol slope, and cortisol:DHEA ratio - and examined their relationship with sexual functioning in N = 275 women with (n = 137) and without (n = 138) HSDD. Results demonstrated multiple hormonal markers of HPA dysregulation in women diagnosed with HSDD compared to control participants, specifically, lower AM cortisol and AM DHEA levels, a flatter diurnal cortisol slope, and a lower CAR. Overall, results of the present study indicate that persistently low sexual desire in women is associated with HPA axis dysregulation, with both cortisol and DHEA alterations potentially detrimental to sexual desire.

Diurnal Cortisol Dynamics, Perceived Stress, and Language Production in Aphasia

Purpose The current study investigated diurnal cortisol dynamics in adults with and without aphasia, along with subjective reports of stress and measures of language production. Dysregulation of cortisol, a common biomarker of stress, is associated with cognitive dysfunction in different clinical populations. However, little is known about the consequences of stress-induced cortisol disturbances for stroke survivors, including those with aphasia. Method Nineteen participants with aphasia and 14 age-matched neurotypical adults were tested. Saliva samples were collected from participants to assess the cortisol awakening response, a marker of the integrity of the hypothalamic-pituitary-adrenal (HPA) axis. Participants also completed 2 subjective stress questionnaires. Language was evaluated using 3 short, picture description narratives, analyzed for discourse (dys)fluency and productivity markers. Results In contrast to neurotypical participants, adults with aphasia did not show the predictable cortisol awakening response. Participants with aphasia also showed an unusual heightened level of cortisol upon awakening. Additionally, neurotypical participants demonstrated an association between intact language performance and the cortisol awakening response, whereas the participants with aphasia did not, although they did perceive the language tasks as stressful. Conclusion This study indicates that the functionality of the HPA axis, as indexed by cortisol, contributes to optimal language performance in healthy adults. The absence of an awakening response among participants with aphasia suggests that stroke leads to dysregulation of the HPA axis, although the degree to which this impairment affects language deficits in this population requires further investigation.

Repressors exhibit lower cortisol reactivity to group psychosocial stress

Repressors are well-known to monitor potential psychosocial threats to their self-esteem and self-concept. In research, repressors are traditionally categorised as those scoring low on trait anxiety and high on defensiveness (as measured by social desirability scales). Examining repressors' cortisol reactivity to a group socio-evaluative laboratory stressor could be an important way to extend work on the classic 'repressor dissociation', which proposes that this group experience higher levels of physiological stress, but lower levels of subjective affect, during stressful situations. Research however has focused mainly on repressors' higher, more risk-prone levels of autonomic, rather than hypothalamic-pituitary-adrenal (HPA), reactivity to stressful stimuli. We assessed cortisol reactivity using a group-based acute psychosocial stressor, the Trier Social Stress Test for groups (TSST-G), which required participants to individually perform public speaking and mental arithmetic tasks in front of up to six other group members, as well as an evaluative panel of judges. Seventy-seven healthy young females (mean age ± SD: 20.2 ± 3.2 years) took part, of which 64 met the conventional criterion for a response to the TSST-G (<15.5% increase from baseline sample). The Stress-Arousal Checklist was completed pre- and post-TSST-G. Participants also completed the Perceived Stress Scale, the Trait Anxiety Inventory and the Marlow-Crowne Social Desirability Scale. The latter two measures were used to provide a categorisation of repressive coping style. Participants identified as repressive copers exhibited significantly lower cortisol reactivity during the TSST-G. Repressors also self-reported less subjective stress. These findings provide some evidence against the notion of the repressor dissociation and are discussed in terms of how cortisol hyporeactivity may be a pathway through which repressive coping adversely affects health.

In sickness and in health: partner's physical and mental health predicts cortisol levels in couples

Individuals in stable relationships tend to be healthier than those not in stable relationships. Despite this general positive influence of relationships on health, the mechanisms for the impact of relationship quality on health are not clear. Research has focused on many factors to explain this connection, including inter- and intra-couple dynamics of physiology and behavior. To address this issue, we examined the relationship between perceived health, depressive symptoms, and relationship quality on diurnal cortisol in 30 male/female romantic dyads (N = 60). Participants provided saliva samples on two weekdays to assess total cortisol output. Females' lower perceived physical health, lower relationship satisfaction, and higher depression scores were each related to higher cortisol output in their male partners. Males' physical health, relationship satisfaction, and depression scores were unrelated to females' cortisol output. Further, physical health, relationship satisfaction, and depression scores did not predict intra-individual cortisol levels for either sex. Measures of diurnal cortisol slope (DCS) were unrelated to psychosocial factors in males and females. Results provide further support for the interpersonal influence of partners' mental and physical health on physiological outcomes and suggest females may influence their male partners more than vice versa.

Basal cortisol, cortisol reactivity, and telomere length: A systematic review and meta-analysis

The objective of the present study is to synthesize the existing empirical literature and perform a meta-analysis of published data on the relationship between cortisol and telomere length. We systematically searched studies that examined the relationship between cortisol and telomere length in humans on electronic databases and screened reference sections of included articles. Fourteen studies were included in the meta-analysis, with effect sizes being extracted for two cortisol measures: basal cortisol levels and cortisol reactivity to acute psychological stress. Results from random effects models showed that basal cortisol levels (13 effect sizes from 12 cross-sectional studies, N = 3675 participants) were not significantly correlated with telomere length (r =-0.05, 95% CI [-0.11, 0.02]). Further, results stratified by the specimen type for cortisol measurement (i.e., saliva, urine, blood) showed that none of the three basal cortisol level measures were correlated with telomere length. However, we found a statistically significant correlation between salivary cortisol reactivity to acute psychosocial stress (6 cross-sectional studies, N = 958 participants) and telomere length (r = -0.13, 95% CI [-0.23, -0.03]). Subgroup analyses revealed that correlations between salivary cortisol reactivity and telomere length were more evident in studies conducted among children (vs. adults) and in studies that included female participants only (vs. both genders). However, the small number of available studies limits the conclusions derived from subgroup analyses, and more studies are needed before moderator effects can be properly established. Overall, findings of this study support the existence of a relationship between cortisol reactivity and telomere shortening.

Feeling bad is not always unhealthy: Culture moderates the link between negative affect and diurnal cortisol profiles

Prior research has demonstrated that the daily experience of negative affect is associated with increased levels of proinflammatory activity as evidenced by higher interleukin-6 among Americans but not among Japanese. This cultural difference may be driven by culturally divergent beliefs about negative affect as a source of threat to self-image versus as natural and integral to life. Here, we examined whether culture may moderate the relationship between negative affect and biological stress responses, with a focus on the hypothalamic-pituitary-adrenal (HPA) axis activity. By using culturally matched surveys of Americans (N = 761) and Japanese (N = 328), we found that negative affect was associated with a flattening of the diurnal cortisol slope among Americans after controlling for demographic variables, personality traits, sleep patterns, and health behaviors. In contrast, the association between negative affect and the HPA axis activity was negligible among Japanese. Moreover, we assessed biological health risk with biomarkers of both inflammation (interleukin-6 and C-reactive protein levels) and cardiovascular function (higher systolic blood pressure and total-to-HDL cholesterol ratio) and found that the relationship between negative affect and increased biological health risk, which was observed only among Americans, was mediated by the flattening of the diurnal cortisol rhythm. These findings suggest that cultural differences in how emotions are construed may make the experience of negative affect more or less stressful and differentially consequential for health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Relative sensitivity of cortisol indices to psychosocial and physical health factors

OBJECTIVE

Regulation of cortisol under resting conditions is widely used to assess physical and psychological status, but due to the diversity of possible assessments (e.g., cumulative levels; diurnal patterns), considering one or a few at a time hampers understanding and interpretation. Moreover, most studies of cortisol regulation focus on negatively-valanced experiences. This study examined the inter-correlations among cortisol indices and their relative contribution to the explained variance in diverse psychosocial and health factors, including positive functioning.

METHODS

Data are from midlife and older adults (N = 513; 47.2% male). Cortisol was assessed in urine (overnight) and saliva (at rest and over 4 consecutive days). Positive and negative psychosocial and health factors were assessed by self-report. In addition to examining associations among cortisol indices, relative weight analysis was used to determine which indices were most robustly linked to specific psychosocial factors.

RESULTS

Inter-correlations among indices were weak-to-moderate, suggesting that they measure different aspects of hypothalamic-pituitary-axis activity. Overall variance in psychosocial and health factors (R2) explained by the cortisol indices ranged from 0.01 to 0.07. Of this explained variance, relative weight analysis showed that waking cortisol contributed most to the variance in hedonic well-being (32.1%-38.2%), bedtime cortisol to depression-related factors (32.1%-46.9%), the cortisol awakening response to eudaimonic well-being (35.8%-50.5%), cortisol slope to perceived stress (29.2%), and urinary cortisol to physical factors (38.5% and 62.7%).

CONCLUSIONS

Positive and negative factors were related to largely non-overlapping cortisol indices. This study illuminates nuanced associations among cortisol indices and diverse aspects of mental and physical health, facilitating thoughtful examination of the complex role of hypothalamic-pituitary-axis activity in health.

Depressive symptoms in caregivers immediately after stroke

BACKGROUND

Caregivers of stroke survivors often suffer depressive symptoms that interfere with their own health. Early recognition may lead to attenuation of symptoms and better health and well-being for caregivers.

OBJECTIVE

We examined characteristics of caregivers and stroke survivors associated with caregivers' depressive symptoms in the early poststroke period.

METHODS

We conducted a prospective, longitudinal exploratory observational study with a convenience sample of 63 caregivers of older adult (≥ 65 years) stroke survivors recruited from urban acute-care settings. We enrolled caregivers by 2 weeks poststroke (T1) and revisited them 4 weeks later (T2). Depressive symptoms were measured using the Patient Health Questionnaire-9. A separate unadjusted linear mixed model was computed to explore significant associations between each caregiver or stroke-survivor characteristic and depressive symptoms.

RESULTS

Caregivers, on average, reported mild depressive symptoms at T1 and T2. Each of the following characteristics was independently associated with caregiver depressive symptoms over the first 6 weeks poststroke: caregiver uncertainty (p < 0.001), perceived stress (p < 0.001) but not cortisol levels (p = 0.858 on waking, p = 0.231 evening), coping (p < 0.001), social support (p = 0.006), race (p = 0.022), income (p = 0.001), time spent on care (p = 0.039), and stroke-survivor race (p = 0.033) and functional status (p = 0.003). At T2, caregiver depressive symptoms were correlated with evening cortisol level (p = 0.001).

CONCLUSIONS

Caregiver and stroke-survivor characteristics may help identify caregivers at highest risk for early depressive symptoms and guide interventions aimed at their resolution.

The Dual Impact of Early and Concurrent Life Stress on Adults' Diurnal Cortisol Patterns: A Prospective Study

Major life stress often produces a flat diurnal cortisol slope, an indicator of potential long-term health problems. Exposure to stress early in childhood or the accumulation of stress across the life span may be responsible for this pattern. However, the relative impact of life stress at different life stages on diurnal cortisol is unknown. Using a longitudinal sample of adults followed from birth, we examined three models of the effect of stress exposure on diurnal cortisol: the cumulative model, the biological-embedding model, and the sensitization model. As its name implies, the cumulative model focuses on cumulative life stress. In contrast, the biological-embedding model implicates early childhood stress, and the sensitization model posits that current life stress interacts with early life stress to produce flat diurnal cortisol slopes. Our analyses are consistent with the sensitization model, as they indicate that the combination of high stress exposure early in life and high current stress predict flat diurnal cortisol slopes. These novel findings advance understanding of diurnal cortisol patterns and point to avenues for intervention.

Children's Cortisol and Cell-Free DNA Trajectories in Relation to Sedentary Behavior and Physical Activity in School: A Pilot Study

The worldwide prevalence of mental disorders in children and adolescents increased constantly. Additionally, the recommended amount of physical activity (PA) is not achieved by this age group. These circumstances are associated with negative impacts on their health status in later life and can lead to public health issues. The exposure to natural green environments (NGE) seems to be beneficial for human health. The compulsory school system offers great opportunities to reach every child with suitable health-related contents and interventions at an early stage. The concept of Education Outside the Classroom (EOtC) uses NGE and sets focus on PA. Therefore, EOtC might be a beneficial educational intervention to promote students health. The association between biological stress markers and sedentary behavior (SB) plus PA is insufficiently evaluated in school settings. This exploratory study aims to evaluate the association between students' cortisol, plus circulating cell-free deoxyribonucleic acid (cfDNA) levels, and their SB, light PA (LPA), and moderate-to-vigorous PA (MVPA). We assessed data from an EOtC program (intervention group [IG], n = 37; control group [CG], n = 11) in three seasons (fall/spring/summer) in outdoor lessons (IG) in a NGE and normal indoor lessons (CG). SB and PA were evaluated by accelerometry, and cortisol and cfDNA levels by saliva samples. Fitted Bayesian hierarchical linear models evaluated the association between cortisol and cfDNA, and compositional SB/LPA/MVPA. A steady decline of cortisol in the IG is associated with relatively high levels of LPA (posterior mean = −0.728; credible interval [CRI 95%]: −1.268; −0.190). SB and MVPA tended to exhibit a similar effect in the CG. A high amount of cfDNA is positively associated with a relatively high amount of SB in the IG (posterior mean, 1.285; CRI: 0.390; 2.191), the same association is likely for LPA and MVPA in both groups. To conclude, LPA seems to support a healthy cortisol decrease in children during outdoor lessons in NGEs. Associations between cfDNA and SB/PA need to be evaluated in further research. This study facilitates the formulation of straightforward and directed hypotheses for further research with a focus on the potential health promotion of EOtC.

Does Prenatal Maternal Distress Contribute to Sex Differences in Child Psychopathology?

PURPOSE OF REVIEW

Prenatal maternal psychological distress is an established risk factor for the development of psychopathology in offspring. The purpose of this review is to evaluate whether sex differences in fetal responses to maternal distress contribute to sex differences in subsequent psychopathology.

RECENT FINDINGS

Male and female fetuses respond differently to stress signals. We review recent evidence that demonstrates a sex-specific pattern of association between prenatal maternal distress and pathways associated with risk for psychopathology including offspring hypothalamic pituitary adrenocortical (HPA) axis regulation, brain development, and negative emotionality. Prenatal maternal distress exerts sex-specific consequences on the fetus. These differences may contribute to the well-established sex differences in psychopathology and in particular to greater female vulnerability to develop internalizing problems.

Chronic stress exposure, diurnal cortisol slope, and implications for mood and fatigue: Moderation by multilocus HPA-Axis genetic variation

Chronic stress exposure has been shown to alter hypothalamic-pituitary-adrenal (HPA) axis functioning, which may mediate its effects on psychopathology and negative health outcomes. The nature of the chronic stress-HPA axis dysregulation is unclear and individuals likely vary in the extent to and manner in which indices of HPA axis regulation, such as diurnal cortisol slope, are influenced by chronic stress. We examined whether HPA-axis-linked genetic variation moderates the association between chronic stress and diurnal cortisol slope, and potential implications for mood and fatigue (possible manifestations of negative clinical outcomes). 211 adolescents (M age 15.89, 54.5% female) completed chronic stress interviews and provided DNA samples. Participants then provided saliva samples at waking and 12 h post-waking for two consecutive weekdays. HPA-axis genetic variation was calculated using a multilocus genetic profile score (MGPS) approach, using ten SNPs from CRHR1, NR3C1, NR3C2, and FKBP5 to generate an additive score of HPA-axis-linked genetic risk. Neither chronic stress nor MGPS directly predicted diurnal slope, but MGPS moderated the association between chronic stress and diurnal slope, with stress predicting a high waking cortisol followed by steep slope among youth with low but not high MGPS scores. MGPS also interacted with chronic stress to predict both negative affect and fatigue, and moderated the indirect effect of chronic stress on mood and fatigue via diurnal slope. Results suggest that diurnal cortisol regulation may be one mechanism by which genetic risk intensifies the association between chronic stress and negative outcomes.

Coupling the Circadian Clock to Homeostasis: The Role of Period in Timing Physiology

A plethora of physiological processes show stable and synchronized daily oscillations that are either driven or modulated by biological clocks. A circadian pacemaker located in the suprachiasmatic nucleus of the ventral hypothalamus coordinates 24-hour oscillations of central and peripheral physiology with the environment. The circadian clockwork involved in driving rhythmic physiology is composed of various clock genes that are interlocked via a complex feedback loop to generate precise yet plastic oscillations of ∼24 hours. This review focuses on the specific role of the core clockwork gene Period1 and its paralogs on intra-oscillator and extra-oscillator functions, including, but not limited to, hippocampus-dependent processes, cardiovascular function, appetite control, as well as glucose and lipid homeostasis. Alterations in Period gene function have been implicated in a wide range of physical and mental disorders. At the same time, a variety of conditions including metabolic disorders also impact clock gene expression, resulting in circadian disruptions, which in turn often exacerbates the disease state.

Happiness and Health

Research into the relationship between happiness and health is developing rapidly, exploring the possibility that impaired happiness is not only a consequence of ill-health but also a potential contributor to disease risk. Happiness encompasses several constructs, including affective well-being (feelings of joy and pleasure), eudaimonic well-being (sense of meaning and purpose in life), and evaluative well-being (life satisfaction). Happiness is generally associated with reduced mortality in prospective observational studies, albeit with several discrepant results. Confounding and reverse causation are major concerns. Associations with morbidity and disease prognosis have also been identified for a limited range of health conditions. The mechanisms potentially linking happiness with health include lifestyle factors, such as physical activity and dietary choice, and biological processes, involving neuroendocrine, inflammatory, and metabolic pathways. Interventions have yet to demonstrate substantial, sustained improvements in subjective well-being or direct impact on physical health outcomes. Nevertheless, this field shows great potential, with the promise of establishing a favorable effect on population health.

Perceived Partner Responsiveness, Daily Negative Affect Reactivity, and All-Cause Mortality: A 20-Year Longitudinal Study

OBJECTIVE

This study tested longitudinal associations between absolute levels of perceived partner responsiveness (PPR; how much people perceive that their romantic partners understand, care for, and appreciate them), daily negative affect reactivity and positive affect reactivity, and all-cause mortality in a sample of 1,208 adults for three waves of data collection spanning 20 years. We also tested whether longitudinal changes in PPR predicted mortality via affect reactivity.

METHODS

Data were taken from the National Survey of Midlife Development in the United States. PPR was assessed at waves 1 and 2, affect reactivity to stressors was assessed by daily diary reports at wave 2, and mortality status was obtained at wave 3.

RESULTS

Mediation analyses revealed absolute levels of PPR at wave 1 predicted wave 3 mortality via wave 2 affective reactivity in the predicted direction, but this did not remain robust when statistically accounting for covariates (e.g., marital risk, neuroticism), β = .004, 95% confidence interval = -.03 to .04. However, wave 1-2 PPR change predicted negative affect (but not positive affect) reactivity to daily stressors at wave 2, which then predicted mortality risk a decade later (wave 3); these results held when adjusting for relevant demographic, health, and psychosocial covariates, β = -.04, 95% confidence interval = -.09 to -.002.

CONCLUSIONS

These findings are among the first to provide direct evidence of psychological mechanisms underlying the links between intimate relationships and mortality and have implications for research aiming to develop interventions that increase or maintain responsiveness in relationships over time.

Complicated Grief and Cortisol Response: An Integrative Review of the Literature

BACKGROUND

The loss of a loved one, especially by a caregiver, can be stressful. Grief can affect one emotionally, mentally, behaviorally, spiritually, and physically and affects individuals differently. Complicated grief (CG), especially for a caregiver, can be intense, prolonged, and interfere with normal activities accompanied by destructive thoughts and behaviors.

AIM

To synthesize the available research on persons experiencing CG and the effect on cortisol levels.

METHODS

A literature search for articles published on CG and cortisol was performed using PubMed, Cochrane Library, PsychINFO, and Web of Science. Search terms included CG, cortisol, and their variants. No date limitations were applied. In accordance with PRISMA, articles were sorted and evaluated against specific inclusion and exclusion criteria.

RESULTS

The search yielded 18 articles, of which 5 were included in the review.

CONCLUSIONS

Cortisol levels and diurnal patterns are shown to be affected in individuals experiencing CG. With prolonged bereavement and dysregulated cortisol, physical and mental health outcomes may result warranting a need for effective stress reduction therapies for this population.

Cultural neurobiology and the family: Evidence from the daily lives of Latino adolescents

Culturally linked family influences during adolescence are important predictors of health and well-being for Latino youth, yet few studies have examined whether these familial influences are associated with indicators of typical physiological stress processes. Following a cultural neurobiology framework, we examined the role of family in the everyday lives of Latino adolescents (N = 209; Mage = 18.10; 85.1% Mexican descent; 64.4% female) by investigating familism values and perceptions of parent support as well as daily family assistance behaviors in relation to hypothalamic-pituitary-adrenal axis diurnal patterns, indexed by salivary cortisol five times a day for 3 weekdays. Three-level growth curve analyses revealed that perceptions of parental support were associated with greater cortisol awakening responses, whereas familism values were not associated with diurnal cortisol patterns. In day-to-day analyses, assisting family during the day (compared to not assisting family) was associated with lower waking cortisol levels and flatter diurnal slopes the next day. Our findings highlight the dynamic associations and multiple time courses between cultural values and behaviors, daily experiences, and physiological stress processes for Latino adolescents. Further, we identified important cultural risk and promotive factors associated with physiological regulation in daily life and potential pathways toward health outcomes in adulthood.

Maternal attachment avoidance is linked to youth diurnal cortisol slopes in children with asthma

Prior evidence suggests that an individual's attachment orientation is linked to the health and health-related biology of his/her romantic relationship partners. The current study examined whether this effect extends to parent-child relationships. Specifically, we investigated the association between maternal attachment anxiety and avoidance and diurnal cortisol of offspring. In a sample of 138 youth with asthma and their primary caregivers, caregivers reported their attachment orientations, and their children (aged 10-17) supplied four saliva samples per day over four days to assess diurnal cortisol patterns. Growth curve analyses revealed no links to caregiver attachment anxiety, but caregiver attachment avoidance was significantly associated with children's diurnal cortisol slopes, such that greater attachment avoidance predicted flatter diurnal cortisol slopes. Maternal warmth did not mediate this link. These results support the possibility that an individual's adult attachment orientation may "get under the skin" of family members to influence their health-related biology. Future research should seek to determine the causal direction of this association and mechanisms of this effect.

Sex Differences in Salivary Oxytocin and Cortisol Concentration Changes during Cooking in a Small Group

Background: Oxytocin (OT), a neuropeptide, has positive effects on social and emotional processes during group activities. Because cooking is an integrated process in the cognitive, physical, and socio-emotional areas, cooking in a group is reported to improve emotion and cognition. However, evidence for efficacy in group cooking has not been well established at the biological level. Methods: To address this shortcoming, we first measured salivary levels of OT and cortisol (CORT), a biomarker of psychological stress, before and after group cooking for approximately 1 h by people who know each other in healthy married or unmarried men and women. We then compared the initial OT and CORT concentrations with those during individual non-cooking activities in isolation. Results: Baseline OT concentrations before group and non-group sessions did not significantly differ and OT levels increased after both types of activity in men and women. In men, however, the percentage changes of OT levels in the first over the second saliva samples were significantly small during cooking compared with those in individual activities. In women, however, such a difference was not observed. In contrast, the mean salivary CORT concentrations after group cooking were significantly decreased from the baseline level in both sexes, though such decreases were not significant after individual activity sessions. The sex-specific differences were marital-status independent. Conclusion: These results indicate that OT and CORT concentrations after two activity sessions by a familiar group changed in opposite directions in a sex-specific manner. This suggests that, because cooking is experience-based, we need to consider the sex-specific features of group cooking if we apply it for intervention.

Do workplace-based mindfulness meditation programs improve physiological indices of stress? A systematic review and meta-analysis

OBJECTIVE

Mindfulness-based interventions (MBI) have been related with improved job satisfaction, wellbeing, health, and reduced workplace stress with employees. However, until now, synthesis of the evidence of the effect of MBIs on physiological indices associated with stress and ill-health has been lacking. Therefore the current systematic review aimed to synthesise the literature from employee samples to provide guidance for future investigations in terms of which physiological indicators and biological systems may be most impacted by MBIs.

METHODS

Electronic databases were searched. Studies that conducted a mindfulness-based program with an employee sample, which targeted workplace stress or work engagement, and measured a physiological outcome were selected for inclusion. Studies using either a between-group or within-group design were included. Nine papers were found to meet the inclusion criteria for our systematic review and meta-analysis of the literature.

RESULTS

MBIs were found to be effective in reducing cortisol production, as indicated by lowered high and low diurnal cortisol slopes. However, no changes were found for cortisol awakening response or concentrations for single a.m. and p.m. time-points. MBIs also improved autonomic balance, assessed by heart rate variability coherence measures, but not blood pressure. Sympathetic nervous system reactivity as measured by salivary alpha amylase was also reduced following MBI. While aspects of immune function were also improved following MBIs, specifically, increased antibody response to a viral vaccine and reduced C-reactive protein concentrations, each of these outcomes were only assessed in a single study.

CONCLUSION

Taken together, the findings suggest that MBIs are a promising avenue for intervention for improving physiological indices of stress. Our findings suggest that changes in daytime cortisol secretion and HRV coherence may be particularly influenced by MBIs. Future studies should aim to assess multiple physiological indices to confirm the current findings and further improve current understanding of which biological systems (and indices within these systems) show responses indicative of reduced stress due to MBI.

Peer victimization and diurnal cortisol rhythm among children affected by parental HIV: Mediating effects of emotional regulation and gender differences

The hypothalamic-pituitary-adrenal (HPA) axis activity has been demonstrated as one of the physiological mechanisms underlying the long-lasting effects of peer victimization on physical and mental health. However, the mechanisms linking peer victimization to dysregulations of HPA axis activity remain inadequately understood. The present study examined the potential mediating role of emotional regulation in the association between peer victimization and HPA axis activity in a large community-based sample of 645 children affected by parental HIV (Mage = 10.67 years, ranging from 8 to 15 years old). The three-level growth curve model revealed that higher peer victimization was associated with lower emotional regulation, which in turn was related to lower cortisol at awakening and more blunted diurnal slopes in girls, but not in boys. The findings highlight the protective effect of emotional regulation in relation to HPA axis activity in victimized children, particularly in girls.

An experimental test of the fetal programming hypothesis: Can we reduce child ontogenetic vulnerability to psychopathology by decreasing maternal depression?

Maternal depression is one of the most common prenatal complications, and prenatal maternal depression predicts many child psychopathologies. Here, we apply the fetal programming hypothesis as an organizational framework to address the possibility that fetal exposure to maternal depressive symptoms during pregnancy affects fetal development of vulnerabilities and risk mechanisms, which enhance risk for subsequent psychopathology. We consider four candidate pathways through which maternal prenatal depression may affect the propensity of offspring to develop later psychopathology across the life span: brain development, physiological stress regulation (hypothalamic-pituitary-adrenocortical axis), negative emotionality, and cognitive (effortful) control. The majority of past research has been correlational, so potential causal conclusions have been limited. We describe an ongoing experimental test of the fetal programming influence of prenatal maternal depressive symptoms using a randomized controlled trial design. In this randomized controlled trial, interpersonal psychotherapy is compared to enhanced usual care among distressed pregnant women to evaluate whether reducing prenatal maternal depressive symptoms has a salutary impact on child ontogenetic vulnerabilities and thereby reduces offspring's risk for emergence of later psychopathology.

Social buffering of the maternal and infant HPA axes: Mediation and moderation in the intergenerational transmission of adverse childhood experiences

Supportive social relationships can reduce both psychological and physiological responses to stressful experiences. Recently, studies have also assessed the potential for social relationships to buffer the intergenerational transmission of stress. The majority of these studies, however, have focussed on social learning as a mechanism responsible for the intergenerational transmission of stress. Evidence of biological mechanisms is lacking. The objective of the current study was, therefore, to determine whether the association between maternal adverse childhood experiences (ACEs) and infant hypothalamic-pituitary-adrenal (HPA) axis function is mediated by maternal HPA axis function during pregnancy and moderated by social support. Data were from 243 mother-infant dyads enrolled in a prospective longitudinal cohort (the Alberta Pregnancy Outcomes and Nutrition Study). Maternal history of ACEs was retrospectively assessed while maternal perceived social support and salivary cortisol were assessed prospectively at 6-22 weeks gestation (Time 1) and 27-37 weeks gestation (Time 2), and infant cortisol reactivity to a laboratory stressor and maternal perceived social support were assessed at 5-10 months postnatal (Time 3). Results revealed that maternal HPA axis function during pregnancy mediated the effects of maternal ACEs on infant HPA axis reactivity, suggesting that the maternal HPA axis is a mechanism by which maternal early life stress is transmitted to offspring. Furthermore, social support in the prenatal and postnatal periods moderated the cascade from maternal ACEs to infant HPA axis reactivity. Specifically, prenatal social support moderated the association between ACEs and maternal HPA axis function during pregnancy, and postnatal social support moderated the association between maternal HPA axis function and infant cortisol reactivity. These findings highlight the social sensitivity of the HPA axis and suggest the utility of social relationships as an intervention target to reduce the effects of maternal early life stress on infant outcomes.

Interactions of momentary thought content and subjective stress predict cortisol fluctuations in a daily life experience sampling study

Daily life stress is an omnipresent phenomenon in modern society. Research has linked prolonged activation of the hypothalamic-pituitary-adrenal axis to psychiatric and somatic diseases. Everyday stressors substantially contribute to these health risks. Despite the notion that the physiological stress response is highly dependent on concurrent psychological processes, investigations associating diurnal cortisol levels with subjective experience have primarily focused on affective states. The impact of everyday cognitive processes including thought content has been largely neglected. To investigate this link, moment-to-moment associations of psychological experience including subjective stress, thought content and affect, and cortisol levels were assessed throughout the daily routines of 289 healthy adult participants. We found that subjective stress interacted with current thought content and affect in predicting cortisol release: more negative and future-directed thoughts were associated with higher cortisol levels after experiencing subjective stress, suggesting an increase in negative future anticipation. Concurrent cortisol rises might reflect proactive coping to adequately prepare for upcoming demands. In the absence of subjective stress, more past-directed thoughts and negative affect were associated with higher cortisol levels. These findings provide evidence for a fundamental link between thought content and daily cortisol activation, and highlight the significant contribution of thought patterns to physiological stress levels.

The development of the cortisol response to dyadic stressors in Black and White infants

Acute reactivity of the stress hormone cortisol is reflective of early adversity and stress exposure, with some studies finding that the impact of adversity on the stress response differs by race. The objectives of the current study were to characterize cortisol reactivity to two dyadically based stress paradigms across the first year of life, to examine cortisol reactivity within Black and White infants, and to assess the impact of correlates of racial inequity including socioeconomic status, experiences of discrimination, and urban life stressors, as well as the buffering by racial socialization on cortisol patterns. Salivary cortisol reactivity was assessed at 4 months of age during the Still Face paradigm (N = 207) and at 12 months of age across the Strange Situation procedure (N = 129). Infants demonstrated the steepest recovery after the Still Face paradigm and steepest reactivity to the Strange Situation procedure. Race differences in cortisol were not present at 4 months but emerged at 12 months of age, with Black infants having higher cortisol. Experiences of discrimination contributed to cortisol differences within Black infants, suggesting that racial discrimination is already "under the skin" by 1 year of age. These findings suggest that race-related differences in hypothalamic-pituitary-adrenal reactivity are present in infancy, and that the first year of life is a crucial time period during which interventions and prevention efforts for maternal-infant dyads are most likely able to shape hypothalamic-pituitary-adrenal reactivity thereby mitigating health disparities early across the life course.

Racial/ethnic disparities in cortisol diurnal patterns and affect in adolescence

Racial/ethnic minorities are more vulnerable to mental and physical health problems, but we know little about the psychobiological underpinnings of these disparities. In this study, we examined racial/ethnic differences in cortisol diurnal patterns and affect as initial steps toward elucidating long-term health disparities. A racially/ethnically diverse (39.5% White, 60.5% minority) sample of 370 adolescents (57.3% female) between the ages of 11.9 and 18 years (M = 14.65 years, SD = 1.39) participated in this study. These adolescents provided 16 cortisol samples (4 samples per day across 4 days), allowing the computation of diurnal cortisol slopes, the cortisol awakening response, and diurnal cortisol output (area under the curve), as well as daily diary ratings of high-arousal and low-arousal positive and negative affect. Consistent with prior research, we found that racial/ethnic minorities (particularly African American and Latino youth) exhibited flatter diurnal cortisol slopes compared to White youth, F (1, 344.7) = 5.26, p = .02, effect size g = 0.25. Furthermore, African American and Asian American youth reported lower levels of positive affect (both high arousal and low arousal) compared to White youth. Racial/ethnic differences in affect did not explain differences in cortisol patterns, suggesting a need to refine our models of relations between affect and hypothalamic-pituitary-adrenocortical activity. We conclude by proposing that a deeper understanding of cultural development may help elucidate the complex associations between affect and hypothalamic-pituitary-adrenocortical functioning and how they explain racial/ethnic differences in both affect and stress biology.

Microaggressions and Diurnal Cortisol: Examining Within-Person Associations Among African-American and Latino Young Adults

PURPOSE

We examined the relations between African-American and Latino young adults' microaggressions and subsequent changes in weekly diurnal cortisol parameters (i.e., cortisol awakening responses, overall cortisol output (AUC), and diurnal slopes).

METHODS

Young adults (N = 53, M_age = 20years, SD = .90; 72% female) participated in a 4-week diary study in which they reported their weekly experiences of microaggressions and completed 2 days ofsaliva samples each week. Saliva samples were obtained at waking, 30-minutes after waking, and bedtime on each sampling day (six samples each week; 24 samples total). In line with an idiographic approach to stress, young adults' increases and decreases in microaggressions (relative to their own average) were linked to changes in cortisol parameters the following week.

RESULTS

Increases in microaggressions predicted greater AUC the subsequent week, controlling for gender, race, parental education, prior week's AUC, and weekly behavioral controls. Follow-up analyses of specific types of microaggressions indicated that experiences centered around criminality and second-class citizenship also related to increases in young adults' cortisol awakening responses the subsequent week. Microaggressions were unrelated to changes in diurnal slopes.

CONCLUSIONS

Microaggressions were linked to subsequent changes in diurnal cortisol among African-American and Latino young adults. Given the rigorous within-person design, findings point to the importance and impact of subtle forms of discrimination on young adults' hypothalamic-pituitary-adrenal axis activity, which is theorized to underlie health and well-being.

Positive and negative social support and HPA-axis hyperactivity: Evidence from glucocorticoids in human hair

INTRODUCTION

While positive social support is associated with lower prevalence of disease and better treatment outcomes, negative social relationships can instead have unfavourable consequences for several physical and mental health conditions. However, the specific mechanisms by which this nexus might operate remain poorly understood. Hypothalamic-pituitary-adrenal (HPA) axis hyperactivity owing to psychosocial stress has been proposed as a potential pathway underlying the link between social support and health. Hair glucocorticoids such as cortisol and cortisone are emerging as promising biomarkers of long-term retrospective HPA activation. Therefore, the aim of this investigation was to examine the effects of positive and negative experiences of social support within key relationships (i.e. spouse/partner, children, other family members, and friends) on cortisol and cortisone.

METHODS

These associations were tested in a sample of 2520 older adults (mean age 68.1) from the English Longitudinal Study of Ageing. Hair samples were collected in wave 6 (2012/13). To understand the impact of cumulative exposure to poor social support, the analysis used self-reported data from waves 4 (2008/09) and 6. Covariates included demographic, socioeconomic, lifestyle, and hair characteristics.

RESULTS

In cross sectional analyses, lower positive support from all sources and specifically from children were associated with higher cortisol. Additionally, lower positive support from children was positively associated with cortisone. Similarly, higher overall negative support was related to higher cortisol, and greater negative support from children was also positively associated with cortisone. In longitudinal analyses, there was evidence for positive associations between hair glucocorticoids and cumulative exposure to poorer social support.

CONCLUSIONS

Experiences of low positive and high negative social support, particularly from children, were both related to higher hair glucocorticoids. Hence, social relationships of poorer quality in later life may have adverse effects on the HPA axis thereby increasing the individual's susceptibility to poor health.

Protocol for the Imagine HEALTH Study: Guided imagery lifestyle intervention to improve obesity-related behaviors and salivary cortisol patterns in predominantly Latino adolescents

Innovative lifestyle interventions are needed to reduce type 2 diabetes risk in adolescents. This report describes the protocol of the Imagine HEALTH cluster randomized control trial, that tests an intervention based in Self-Determination Theory (SDT) and uses lifestyle education combined with the mind-body, complementary health modality of guided imagery (GI), to address obesity prevention and treatment in predominantly Latino adolescents. The primary aim is to determine the unique effects of each of the three major components of the 12-week lifestyle intervention (lifestyle education, stress reduction guided imagery, and lifestyle behavior guided imagery) compared to control on primary outcomes of physical activity (accelerometry), dietary intake (3-day recall), and stress biomarker levels (salivary cortisol). Secondary aims assess changes compared to controls in psychosocial outcomes (stress, well-being, depression), diabetes-related metabolic outcomes (adiposity, insulin resistance), maintenance of outcome changes for one year post-intervention, and SDT-based mediation of intervention effects. The development and rationale for each of the intervention components, study design, and outcome measurement processes are described. Adolescent participants recruited from four urban schools are cluster randomized by school into one of four arms of the 12-week (3-month) intervention, followed by 6 months of maintenance and 6 months of no contact. Outcome measures are assessed at the end of each period (3-, 9-, and 15-months). Results to date show successful recruitment of 97% of the target study population. Future results will demonstrate the effects of this integrative intervention on primary and secondary outcome measures in adolescents at risk for lifestyle-related metabolic disease.

Diurnal cortisol profiles, inflammation, and functional limitations in aging: Findings from the MIDUS study

OBJECTIVE

The current study examined the association between diurnal cortisol profiles, inflammation, and functional limitations, among adults ranging in age from 34-84 years.

METHOD

Participants (N = 799) completed Waves 2 (between 2004 and 2006) and 3 (between 2014 and 2016) of the Midlife Development in the United States Survey. At Wave 2, participants provided saliva samples across 4 consecutive days, from which cortisol was assayed. Previously validated diurnal cortisol profiles (i.e., normative, flattened, or elevated) were examined in relation to concurrent inflammation risk burden and to predict long-term changes in functional limitations.

RESULTS

Compared with participants with normative profiles across all interview days, participants with dysregulated profiles across all interview days (i.e., all days elevated, flattened, or a combination of elevated and flattened) showed greater concurrent inflammation risk burden and more functional limitations at follow-up. Regions of significance testing indicated that the association was significant beginning at age 60 for inflammation risk burden and beginning at age 66 for functional limitations. Variable profiles (i.e., a mix of normative and flattened and/or elevated across the four days of assessment) were not significantly associated with these health indices.

CONCLUSIONS

Findings, consistent with the theoretical model of Strength and Vulnerability Integration, illustrate the importance of considering age when examining cortisol and its association with other health indices. (PsycINFO Database Record

Hypothalamic-pituitary-adrenal axis activity in the comorbidity between obsessive-compulsive disorder and major depression

Major depressive disorder (MDD) is the most common psychiatric comorbidity in patients with obsessive-compulsive disorder (OCD). Hypothalamic-pituitary-adrenal (HPA) axis abnormalities have been described in both disorders and might play a role in the association between them. We aimed to study the role of HPA axis activity in the comorbidity between OCD and MDD, while controlling for psychopathological dimensions such as anxiety and depressive symptoms. We studied 324 participants belonging to four diagnostic groups: 1) MDD (n = 101), 2) OCD with comorbid MDD (n = 33), 3) OCD without MDD (n = 52), and 4) healthy subjects (n = 138). State anxiety, trait anxiety and depressive symptoms were assessed. Three HPA axis measures were analyzed in saliva: cortisol awakening response (CAR), diurnal cortisol slope (calculated using two formulas: [1] awakening to 11 p.m. [AWE diurnal slope]; [2] considering fixed time points [FTP diurnal slope] from 10 a.m. to 11 p.m.), and dexamethasone suppression test ratio after 0.25 mg of dexamethasone (DSTR). Multiple linear regression analyses were conducted to explore the contribution of clinical diagnosis and symptom dimensions to each HPA axis measure. A more flattened FTP diurnal cortisol slope was observed for OCD patients with comorbid MDD. Regarding the CAR and DSTR, a significant interaction was found between trait anxiety and OCD, as OCD patients with greater trait anxiety showed an increased CAR and reduced cortisol suppression after dexamethasone administration. Our results suggest that trait anxiety plays an important role in the relationship between HPA axis measures and OCD/MDD comorbidity.

Association of activity status and patterns with salivary cortisol: the population-based CoLaus study

PURPOSE

Physical activity (PA) has been shown to influence salivary cortisol concentrations in small studies conducted among athletes. We assessed the association of activity status and patterns with salivary cortisol in the general population.

METHODS

Cross-sectional study including 1948 adults (54.9% women, 45-86 years). PA and sedentary behaviour (SB) were measured for 14 days by accelerometry. Low PA and high SB status were defined, respectively, as the lowest and highest tertile of each behaviour. 'Inactive', 'Weekend warrior', and 'Regularly active' patterns were also defined. Four salivary cortisol samples were collected over a single day and the following parameters were calculated: area under the curve to ground (AUCg), awakening response (CAR) and diurnal slope.

RESULTS

After multivariable adjustment, low SB remained associated to steeper slopes relative to high SB (- 1.54 ± 0.03 vs. - 1.44 ± 0.04 nmol/l per hour). Non-significant trends were found for high PA relative to low PA with steeper slopes (- 1.54 ± 0.03 vs. - 1.45 ± 0.04) and lower AUCg (208.7 ± 2.0 vs. 215.9 ± 2.9 nmol.h/l). Relative to 'Inactives', 'Regularly actives' had lower AUCg (205.4 ± 2.4 vs. 215.5 ± 2.9) and 'Weekend warriors' had steeper slopes (- 1.61 ± 0.05 vs. - 1.44 ± 0.04). No associations were found for CAR.

CONCLUSION

Low SB and high PA are related to lower cortisol secretion as measured by different parameters of salivary cortisol, but the effects were only modest.

Gender-Based Violence, Physiological Stress, and Inflammation: A Cross-Sectional Study

BACKGROUND

Female sex workers (FSWs) are at high risk for gender-based violence (GBV) and HIV infection. This study aimed to identify associations between GBV exposure in the past 12 months and biomarkers of physiologic stress and inflammation that may play a role in increased HIV risk among Kenyan FSWs.

MATERIALS AND METHODS

Participating women responded to a detailed questionnaire on GBV and mental health. Plasma was collected for assessment of systemic C-reactive protein (CRP) and interleukin-6 (IL-6) levels. Hair proximal to the scalp was collected to measure cortisol concentration. CRP and IL-6 were measured by enzyme-linked immunosorbent assay, and hair cortisol concentration was determined by enzyme immunoassay. Log-transformed biomarker values were compared across GBV exposure categories using Kruskal-Wallis or Wilcoxon rank sum tests. Multivariable linear regression was used to explore associations between recent GBV and hair cortisol concentration.

RESULTS

Two hundred eighty-three women enrolled, of whom 112 (39.6%) reported physical, sexual, or emotional violence in the past 12 months, 134 (47.3%) reported more remote exposure, and 37 (13.1%) reported no exposure. CRP and IL-6 levels did not differ across groups (p = 0.57 and p = 0.62, respectively). Among 141 women who provided hair, cortisol concentrations were higher among recently exposed women compared to the other two groups combined (p = 0.02). In multivariable regression, recently exposed women had higher hair cortisol levels than remotely exposed or unexposed women (adjusted beta = 0.52, 95% confidence interval 0.02-1.02, p = 0.04).

CONCLUSIONS

While CRP and IL-6 levels did not differ by GBV category, recent GBV was associated with increased hair cortisol concentration. GBV-related increases in cortisol could affect health outcomes and merit study in relation to HIV acquisition risk.

Age moderates the association between social integration and diurnal cortisol measures

Social integration is defined as the degree to which an individual participates in a broad range of social relationships. Although measures of social integration vary across studies, it is often assessed as the number of social roles (e.g., parent, friend, student, volunteer) that an individual reports actively participating in. More socially integrated individuals tend to be healthier than those less socially integrated, but the biological mechanisms through which this occurs remain unclear. One possibility is that social integration might alter the function of the hypothalamic-pituitary-adrenal axis, of which cortisol is a key product, and in turn influence a broad range of health outcomes. This study examined the association between social integration and two indices of cortisol in a community sample of 680 healthy men and women aged 18-55. Because the social roles held by younger individuals may be more numerous yet superficial than those held by older individuals, this study also tested the hypothesis that these associations could be moderated by age such that lower levels of integration would be associated with cortisol dysregulation for older but not younger individuals in our sample. Participants provided salivary cortisol samples during waking hours on three days that were used to calculate diurnal cortisol levels and slopes. Increased social integration was associated with lower cortisol AUC among older (ages 35-55) but not younger (ages 18-34) individuals in our sample. Moreover, while increased social integration was associated with steeper diurnal cortisol slopes regardless of age, this association was strongest among older individuals. Differences in health behaviors, affect, and psychological stress did not mediate these associations. The results of this study support cortisol as a candidate biological mechanism through which increased social integration is associated with better physical health among older individuals.

The Health Correlates of Culture: Examining the Association Between Ethnic-Racial Identity and Diurnal Cortisol Slopes

PURPOSE

The objective of this study was to examine the link between ethnic-racial identity (ERI) components (exploration, resolution, and affirmation) and youths' diurnal cortisol slopes.

METHODS

A sample of 103 U.S.-Mexican adolescents (M_age = 15.29 years) living in the Southwest participated in an in-home interview and 3-day salivary sampling protocol.

RESULTS

ERI affirmation, but not exploration or resolution, was related to steeper diurnal slopes (greater declines in cortisol from waking to bedtime) after controlling for adolescents' life stressors, acculturation level, ethnic-racial discrimination, and daily behaviors (i.e., caffeine use, hours of exercise, hours of sleep, and medication level).

CONCLUSIONS

This study provides initial evidence of the physiological benefits of ERI affirmation. Given that steeper diurnal slopes are thought of as an indicator of positive health, our findings point to the importance of examining cultural processes in the well-being of ethnic-racial minority youth.

Cognitive control moderates parenting stress effects on children's diurnal cortisol

This study investigated associations between parenting stress in parents and self-reported stress in children with children's diurnal cortisol secretion and whether these associations are moderated by known stress-regulating capacities, namely child cognitive control. Salivary cortisol concentrations were assessed from awakening to evening on two weekend days from 53 6-to-7-year-old children. Children completed a cognitive control task and a self-report stress questionnaire with an experimenter, while parents completed a parenting stress inventory. Hierarchical, linear mixed effects models revealed that higher parenting stress was associated with overall reduced cortisol secretion in children, and this effect was moderated by cognitive control. Specifically, parenting stress was associated with reduced diurnal cortisol levels in children with lower cognitive control ability and not in children with higher cognitive control ability. There were no effects of self-reported stress in children on their cortisol secretion, presumably because 6-to-7-year-old children cannot yet self-report on stress experiences. Our results suggest that higher cognitive control skills may buffer the effects of parenting stress in parents on their children's stress regulation in middle childhood. This could indicate that training cognitive control skills in early life could be a target to prevent stress-related disorders.

The effects of six-day SSRI administration on diurnal cortisol secretion in healthy volunteers

RATIONALE

Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis has been widely reported in depression, and evidence suggests that selective serotonin reuptake inhibitors (SSRIs) might exert their therapeutic effects through altering cortisol secretion.

OBJECTIVE

This study assessed the effects of SSRI administration on diurnal cortisol secretion in healthy volunteers.

METHODS

Sixty-four healthy men and women were randomised to receive either 10 mg escitalopram or placebo for six days in a double-blind fashion. On day six of medication, saliva samples were obtained at home for measurement of diurnal cortisol parameters (cortisol slope, cortisol awakening response, total daily cortisol output).

RESULTS

Women receiving escitalopram had significantly steeper cortisol slopes across the day compared with those receiving placebo (F(1, 36) = 7.54, p = 0.009). This alteration in cortisol slope was driven by increases in waking cortisol levels (F(1, 35) = 9.21, p = 0.005). Escitalopram did not have any significant effect on the cortisol awakening response or the total daily cortisol output.

CONCLUSIONS

Flattened cortisol slopes have been seen in depression. The results of this study suggest that escitalopram might exert its therapeutic effect in women in part through correction of a flattened diurnal cortisol rhythm.

Racial discrimination and cortisol output: A meta-analysis

RATIONALE

Although the relation between stress and physiology is well documented, attempts at understanding the link between racial discrimination and cortisol output, specifically, have produced mixed results, likely due to study characteristics such as racial/ethnic composition of the samples (e.g., African American, Latino), measures of discrimination, and research design (e.g., cross-sectional, experimental).

OBJECTIVES

To estimate the overall association between racial discrimination and cortisol output among racial/ethnic minority individuals and to determine if the association between racial discrimination and cortisol output is moderated by age, race/ethnicity, type of discrimination measure, sex, and research design.

RESULTS

Using a random effects model, the overall effect size based on k = 16 studies (19% unpublished) and N = 1506 participants was r¯ = 0.040, 95% CI = -0.038 to 0.117. Studies were conducted predominantly in the U.S. (81%). Notably, experimental studies (r¯ = 0.267) exhibited larger effect sizes compared to non-experimental studies (r¯ = -0.007). Age, race/ethnicity, type of discrimination measure, and sex did not moderate the effect sizes.

CONCLUSION

This meta-analysis provides evidence that the measurement of the association between racial discrimination and cortisol is complex, and it offers valuable insight regarding methods and designs that can inform future research on this topic. Limitations and future directions are discussed.

Long-term Associations of an Early Corrected Ventricular Septal Defect and Stress Systems of Child and Mother at Primary School Age

INTRODUCTION

Ventricular septal defect (VSD) is the most common congenital heart defect, with larger VSDs typically being corrected with an open-heart surgery during infancy. Long-term consequences of a VSD-corrective surgery on stress systems of child and mother are still unknown. The aim of the present study is to investigate the associations of an early corrected VSD and diurnal cortisol release of child and mother.

METHODS

26 children (12 boys) between 6 and 9 years old, who underwent surgery for an isolated VSD within the first 3 years of life, and their mothers participated in the study. Their diurnal cortisol profiles were compared to a sex-, age-, and socioeconomic status-matched healthy control group. Within the VSD group, associations between cortisol and characteristics of surgery and hospitalization were investigated. Child and mother psychopathological symptoms were considered as a possible interfering mechanism of altered cortisol profiles.

RESULTS

Diurnal cortisol profiles of children with an early corrected VSD did not differ from those of controls. However, mothers of affected children exhibited higher cortisol levels in the morning (p < 0.001, [Formula: see text]) and a steeper diurnal cortisol slope (p = 0.016, [Formula: see text]) than mothers of healthy children.

CONCLUSION

Results indicate a favorable development of children with an early corrected VSD, in terms of comparable diurnal cortisol profiles with healthy controls, according to a comparable mother-rated psychopathology. Mothers of affected children reveal altered diurnal cortisol levels, without differences in self-rated psychopathology. This divergence should be clarified in future research.