Chronic and acute stress and the prediction of major depression in women

Negative affect, childhood adversity, and adolescents' eating following stress

Obesity commonly emerges by adolescence and is associated with serious health consequences. Emotional eating (consuming calories, fats, and sugars in response to negative affect) may promote obesity; however, evidence is mixed as to whether negative affect increases obesogenic eating. Early-life adversity may shape malleable neurobiological systems that govern inhibitory control, physiological regulation, coping strategies, and eating behavior, contributing to greater obesogenic eating in response to negative affect. Therefore, this study tested whether childhood adversity moderates the association between negative affect and food consumption in a diverse sample of female adolescents. After completing a childhood adversity assessment, 157 female adolescents (13-17 years; 28.7% African American, 39.5% Hispanic/Latina, 31.8% Non-Hispanic White) rated their negative affect in response to a standard social stress paradigm before consuming a buffet lunch, which was evaluated for calories, added sugars, and solid fats consumed. Results did not support that negative affect exerted a main effect on eating behavior. However, negative affect and childhood adversity interacted to predict calories and solid fats consumed, such that negative affect was associated with more obesogenic eating for those with high adversity exposure but not for those with low adversity exposure. Adversity and affect did not interact to predict added sugars consumed. Findings support that eating patterns in response to negative affect may differ by childhood adversity history. Reducing children's adversity exposure and bolstering emotion regulation techniques for adolescents who have been exposed to adversity may provide pathways to protect health and well-being by reducing maladaptive eating patterns.

Mental health assessment of Spanish healthcare workers during the SARS-CoV-2 pandemic. A cross-sectional study

INTRODUCTION

The SARS-CoV-2 outbreak is posing unprecedented care scenarios, increasing the psychological distress among healthcare workers while reducing the efficiency of health systems. This work evaluated the psychological impact of the Covid-19 pandemic on Spanish frontline healthcare workers of two tertiary hospitals.

MATERIAL AND METHODS

Healthcare workers were recruited from the medical units designated for the care of Covid-19 patients. The psychological assessment consisted of an individual, face-to-face session where gold-standard psychometric tests were administered to assess stress (VASS & PSS-10), anxiety (STAI), depression (PHQ-2) and posttraumatic stress disorder (PCL-5). Regression models were also fitted to identify predictors of psychological distress.

RESULTS

Overall, almost 13% of healthcare workers showed severe anxiety, while more than 26% had high levels of perceived stress. More than 23% presented severe posttraumatic stress symptoms, and another 13% had PHQ-2 scores equal to or above 3, compatible with Major Depressive Disorder (MDD) diagnosis, respectively. Women, stress-related medication, overworking, performing in Covid-19 wards, and substance abuse were risk factors for increased psychological distress. Instead, practising exercise reduced the burden.

CONCLUSION

This study outlines the severe psychological impact of the Covid-19 pandemic on Spanish frontline healthcare workers. The stress, depression and anxiety levels found were similar to those reported in similar works but much higher than in Wuhan healthcare workers. Knowledge of risk factors for increased psychological distress may help to develop comprehensive intervention strategies to prevent, control and reduce the mental health exacerbation of healthcare workers, thereby maintaining the effectiveness of health systems in critical scenarios.

Perceived chronic stress influences the effect of acute stress on cognitive flexibility

Executive functions are cognitive processes that facilitate goal-directed behavior by enabling us to direct and control our thoughts. Cognitive flexibility is an executive function characterized by the ability to mentally shift between rules, strategies, or tasks. Several studies have reported that acute (brief) stress impairs cognitive flexibility. Even though an individual's perception of their chronic stress levels is shown to influence effects of future stressors, the interactive effect of acute and perceived chronic stress on cognitive flexibility is not known. We conducted two experiments to address this gap. In both studies, perceived chronic stress was measured using the Perceived Stress Scale. Acute stress was induced using the Cold Pressor Test. Number of perseverative errors on the Wisconsin Card Sorting Test was used as an indicator of cognitive flexibility. In Study 2, we also measured salivary alpha amylase as a marker of the physiological stress response. Data from our two studies are consistent with the hypothesis that an individual's perception of their chronic stress level may impact the effect of acute stress on perseveration. In Study 1, we observed a significant interaction between acute and perceived chronic stress on perseverative errors, such that only individuals who reported high levels of perceived chronic stress prior to acute stress exposure showed no change in perseveration following the acute stress manipulation. This effect did not differ based on participant sex. In Study 2, we found a similar interaction effect of acute and perceived chronic stress on perseverative errors in an all-woman sample. After identifying salivary alpha amylase responders and non-responders, we observed a strong, negative correlation between perceived chronic stress and perseverative errors amongst the responders only. Our data highlight the value in studying salivary alpha amylase in response to acute stress exposure. Additionally, perceived chronic stress emerged as a key variable in the relationship between acute stress and cognitive flexibility. Overall, our work suggests that future research interested in interrogating moderators in the relationship between acute stress and cognition would benefit from inclusion of measures of chronic stress.

Do greater levels of in-cage waking inactivity in laboratory mice reflect a spontaneous depression-like symptom? A pharmacological investigation

We previously identified in laboratory mice an inactive state [being awake with eyes open motionless within the home cage; inactive but awake, 'IBA'] sharing etiological factors and symptoms with human clinical depression. We further test the hypothesis that greater time spent displaying IBA indicates a depression-like state in mice by investigating whether the antidepressant Venlafaxine, environmental enrichment, and their combination, alleviate IBA. Seventy-two C57BL/6J and 72 DBA/2J female mice were pseudo-randomly housed post-weaning in mixed strain-pairs in non-enriched (NE; 48 pairs) or in environmentally enriched (EE; 24 pairs) cages. After 34 days, half of the mice housed in NE cages were either relocated to EE cages or left in NE cages. For each of these conditions, half of the mice drank either a placebo or the antidepressant Venlafaxine (10 mg/kg). The 48 mice housed in EE cages were all relocated to NE cages and allocated to either the placebo (n = 24) or Venlafaxine (n = 24). IBA data were collected prior to and after environmental adjustment by trained observers blind to the pharmacological and environmental adjustment treatments. Data were analyzed using GLM models. NE cages triggered more IBA than EE cages (Likelihood-Ratio-Test Chi²₃ = 53.501, p < 0.0001). Venlafaxine and environmental enrichment appeared equally effective at reducing IBA (LRT Chi²₃ = 18.262, p < 0.001), and combining these approaches did not magnify their effects. Enrichment removal triggered IBA increase (LRT Chi²₁ = 23.050, p < 0.001), but Venlafaxine did not overcome the increase in IBA resulting from enrichment loss (LTR Chi²₁ = 0.081, p = 0.775). Theoretical implications for putative depression-like states in mice, and further research directions, are discussed.

Sympathetic nerve-adipocyte interactions in response to acute stress

Psychological stress predisposes our body to several disorders. Understanding the cellular and molecular mechanisms involved in the physiological responses to psychological stress is essential for the success of therapeutic applications. New studies show, by using in vivo inducible Cre/loxP-mediated approaches in combination with pharmacological blockage, that sympathetic nerves, activated by psychological stress, induce brown adipocytes to produce IL-6. Strikingly, this cytokine promotes gluconeogenesis in hepatocytes, that results in the decline of tolerance to inflammatory organ damage. The comprehension arising from this research will be crucial for the handling of many inflammatory diseases. Here, we review recent advances in our comprehension of the sympathetic nerve-adipocyte axis in the tissue microenvironment.

Specific symptoms of the General Health Questionnaire (GHQ) in predicting persistence of psychological distress: Data from two prospective cohort studies

Persistent psychological distress is more harmful than transient psychological distress, but little is known about the development of persistent distress. We examined whether some specific symptoms of the 12-item General Health Questionnaire (GHQ-12) were more important than others in predicting the persistence of psychological distress over a 3-year follow-up period among individuals who had at least moderate psychological distress at baseline (GHQ≥3). Participants were from the UK Household Longitudinal Study (UKHLS; n = 6430) and British Household Panel Survey (BHPS; n = 5954). Sense of worthlessness, loss of self-confidence, loss of sleep over worry, and feelings of strain were associated with increasingly persistent distress. General happiness, feelings of unhappiness or depressed mood, and enjoyment of activities showed no such increasing associations. Symptoms of social functioning (capability of making decisions, concentration problems, feelings of usefulness, ability to face problems) showed some but not consistent associations. These results suggest that feelings of worthlessness, loss of self-confidence, loss of sleep over worry, and strain may be particularly important markers for persistent psychological distress.

Insomnia and Fatigue Symptom Trajectories in Breast Cancer: A Longitudinal Cohort Study

Objective: Insomnia and fatigue are common, although not inevitable, during breast cancer. This study is one of the first aiming to describe distinct trajectory classes of insomnia and fatigue symptoms, and their correlates, from diagnosis through treatment.Methods: This longitudinal cohort study was conducted at a comprehensive cancer center and community oncology practices. Participants (N = 460) were women diagnosed with any stage of breast cancer in the previous 4 months. Primary outcomes for this ancillary study of the existing cohort were self-reported insomnia and fatigue symptoms assessed repeatedly across 12 months.Results: Four distinct classes of insomnia symptoms emerged: persistently very high, clinically elevated symptoms (13.7%); high, clinically elevated symptoms (65.9%); stable low (17.2%) or very low (2.6%) symptoms. Five fatigue symptom classes included high, increasing fatigue (9.6%), two recovery classes starting at high (26.3%), or moderate (18.0%) severity at diagnosis, stable low (33.3%) or very low (12.2%) classes. In multivariate analyses, higher depressive symptoms, anxiety, and chronic life stress were associated with being in the very high insomnia class versus the low symptom class. Oncologic factors were not associated with insomnia class membership. Receiving chemotherapy was linked significantly to high and recovery fatigue symptom classes versus the low class. Higher chronic life stress was associated with more persistent fatigue symptoms.Conclusions: Distinct classes of insomnia and fatigue symptoms were evident; 79.6% of the women had clinically elevated, persistent insomnia symptoms, 53.9% had elevated fatigue. A substantial minority evidenced low symptoms, suggesting targeted or stepped-care approaches to symptom management.

Assessing the disproportionality of depressive reactions to life stress

BACKGROUND

Prior to DSM-5, depression had long been conceptualized as symptoms without cause or disproportionate to one's circumstances. A central challenge to considering whether a depressive reaction is disproportionate is the lack of measures assessing disproportionality. Drawing on a study of patients participating in cognitive behavioural therapy for depression, we evaluate two new measures of the disproportionality of one's depressive symptoms to their recent life circumstances.

METHODS

To assess the disproportionality of depressive symptoms, we developed an interview-based assessment and a brief self-report measure. We employed both assessments in a sample of 126 patients who participated in cognitive behavioural therapy for depression.

RESULTS

Initial evidence for the reliability and validity of both self-report and interview-based approaches appeared promising. Interview judges demonstrated strong inter-rater reliability on life stress ratings, and both forms of disproportionality showed a pattern of correlations with variables reflecting greater clinical complexity, including self-reported personality dysfunction and symptom severity. Comorbid generalized anxiety disorder (GAD) was the only previously proposed marker of complicated depression to significantly predict both disproportionality scores.

LIMITATIONS

The sample had limited ethnic diversity and tended to be highly educated. Participants all met criteria for major depressive disorder and sought treatment.

CONCLUSIONS

Two assessments of the disproportionality of depressive reactions demonstrated evidence of reliability and validity. Despite limited efforts at assessment to date, these results suggest these measures may be able to reliably distinguish the disproportionality of depressive reactions and allow clinicians to better assess contextual life stress depressive disorders.

Mediators and Moderators of the Association Between Perceived Stress and Episodic Memory in Diverse Older Adults

OBJECTIVE

Stress is a risk factor for numerous negative health outcomes, including cognitive impairment in late-life. The negative association between stress and cognition may be mediated by depressive symptoms, which separate studies have identified as both a consequence of perceived stress and a risk factor for cognitive decline. Pathways linking perceived stress, depressive symptoms, and cognition may be moderated by sociodemographics and psychosocial resources. The goal of this cross-sectional study was to identify modifying factors and enhance understanding of the mechanisms underlying the stress-cognition association in a racially and ethnically diverse sample of older adults.

METHOD

A linear regression estimated the association between perceived stress and episodic memory in 578 older adults (Mage = 74.58) in the Washington Heights-Inwood Columbia Aging Project. Subsequent models tested whether depressive symptoms mediated the stress-memory relationship and whether sociodemographics (gender, race, and ethnicity) or perceived control moderated these pathways.

RESULTS

Independent of sociodemographics and chronic diseases, greater perceived stress was associated with worse episodic memory. This relationship was mediated by more depressive symptoms. Higher perceived control buffered the association between stress and depressive symptoms. There was no significant moderation by gender, race, or ethnicity.

CONCLUSION

Depressive symptoms may play a role in the negative association between perceived stress and cognition among older adults; however, longitudinal analyses and studies using experimental designs are needed. Perceived control is a modifiable psychological resource that may offset the negative impact of stress.

Mental Health in Times of the COVID-19 Pandemic

Abstract. The COVID-19 pandemic is one of the most serious health and economic crises of the 21st century. From a psychological point of view, the COVID-19 pandemic and its consequences can be conceptualized as a multidimensional and potentially toxic stressor for mental health in the general population. This selective literature review provides an overview of longitudinal studies published until June 2021 that have investigated the impact of the COVID-19 pandemic on mental health in the European population. Risk and protective factors identified in the studies are summarized. Forty-two studies that met inclusion and search criteria ( COVID-19, mental health, longitudinal, and Europe) in PubMed, PsycInfo, and Web of Science databases indicate differential effects of the pandemic on mental distress, depression, and anxiety, depending on samples and methods used. Age-specific (e.g., young age), social (e.g., female, ethnical minority, loneliness), as well as physical and mental health-related factors (e.g., pre-pandemic illness) were identified as risk factors for poor mental health. The studies point to several protective factors such as social support, higher cognitive ability, resilience, and self-efficacy. Increasing evidence supports the assumption of the pandemic being a multidimensional stressor on mental health, with some populations appearing more vulnerable than others, although inconsistencies arise. Whether the pandemic will lead to an increase in the prevalence of mental disorders is an open question. Further high-quality longitudinal and multi-national studies and meta-analyses are needed to draw the complete picture of the consequences of the pandemic on mental health.

Academic burnout among medical students: respective importance of risk and protective factors

OBJECTIVES

Prior research has found a high prevalence of academic burnout among medical students (33-55%), and medical education institutions have begun to address the issue. In this research, we hypothesized an increase in academic burnout during medical education, as supported by previous findings. The second purpose was to identify the significant predictors (among perceived stress, empathy, and perceived social support) of academic burnout and determine their respective importance.

STUDY DESIGN

The study design was a cross-sectional online and anonymous survey.

METHODS

We recruited medical students (N = 342) from four education year-groups (i.e. Bachelor 1 and 3; Master 1 and 3). All participants voluntarily responded to our anonymous study and filled in four questionnaires assessing academic burnout, perceived stress, empathy, and perceived social support. We performed a multivariate analysis of variance on academic burnout and hierarchical regression analyses to determine the respective importance of risk and protective factors of academic burnout.

RESULTS

We found that two academic burnout domains (i.e. emotional exhaustion and cynicism) significantly changed according to the study year. Cynicism increased as the academic years progressed (F_(3,334) = 9.50; P < 0.001), and emotional exhaustion was highest at critical graduation moments during the academic curriculum (i.e. Bachelor 3 and Master 3; F_(3,334) = 11.2; P < 0.001). Overall, women presented higher academic burnout traits than men (ᴧ = 0.963; F_(3,332) = 4.26; P = 0.006), but univariate analysis revealed that they especially displayed higher emotional exhaustion (F_(1,334) = 12.1; P < 0.001). Hierarchical regression analyses showed that perceived stress, cognitive empathy, and perceived social support were significant predictors of academic burnout. We found that perceived stress was a major predictor of academic burnout (from 10% to 28% of the part of variance) in comparison to other factors such as empathy (around 5%) and perceived social support (around 6%).

CONCLUSIONS

We found that emotional exhaustion and cynicism significantly changed over medical education and that women presented greater vulnerability than men for emotional exhaustion. Furthermore, risk and protective factors of academic burnout were identified: (1) perceived stress was a decisive risk factor; (2) paradoxically, cognitive empathy had a double edge nature (the two cognitive empathy domains had opposite effects); and (3) perceived social support was identified as a protective factor. Thus, a novel dimension of this research was to investigate and describe the importance of several predictors of academic burnout. The implications are crucial for education, and several recommendations are discussed to prevent academic burnout.

Couple processes of family economic hardship, depressive symptoms, and later-life subjective memory impairment: moderating role of relationship quality

OBJECTIVES

To examine a) processes through which family economic hardship (FEH) contributes to spouses' mental health and subsequent subjective memory impairment (SMI) in later years and b) the moderating effect of overall relationship quality on these associations.

METHODS

With prospective data over 27 years from a sample of 224 husbands and wives in enduring marriages, the present study utilized latent growth curves to identify how FEH trajectories are associated with both spouses' depressive symptoms trajectories across their mid-later years (average age 40-65 years) and subsequent SMI in later life (> 67 years). The moderating role of relationship quality between depressive symptoms and SMI was also examined.

RESULTS

FEH experiences across the mid-later years (1991-2015) explained variation in husbands' and wives' depressive symptoms trajectories (1994-2015). Change in depressive symptoms was associated with husbands' and wives' SMI in later life (2017) after taking the level of depressive symptoms into account. Spousal dependencies, including partner effects, existed among husbands' and wives' depressive symptoms trajectories and SMI outcomes. Some of these dependencies were moderated by couples' overall relationship quality.

CONCLUSION

FEH has a persistent influence on husbands' and wives' SMI in later years. Depressive symptoms mediated the influence of FEH on later wellbeing. The findings are discussed as they relate to family systems and life course stress process theories. Implications are addressed at multiple levels including national- and state-policies and clinical interventions.

Neighborhood safety concerns and daily well-being: A national diary study

People living in unsafe neighborhoods often report poor health. The reasons for this are multi-faceted, but one possibility is that unsafe neighborhoods create a situation of chronic stress, which may deplete people's resources to cope with the daily stressors of life. How people respond to daily stressors (e.g., with increased self-reported negative affect and physical symptoms) is positively associated with health problems and may thus be one pathway linking perceptions of neighborhood safety to poor health. The current study investigated the relationship between neighborhood safety concerns, daily stressors, affective well-being, and physical health symptoms in a national sample of adults from the Midlife in the United States Study II (n = 1748). In 2004, participants reported neighborhood safety concerns and history of chronic stress exposure. Across eight days, they also reported daily stressors, physical symptoms and negative affect. Greater neighborhood safety concerns were associated with higher negative affect and more physical symptoms, adjusting for other sources of chronic stress. Moreover, lower perceived neighborhood safety was related to greater increases in negative affect and physical symptoms on days during which stressors were reported, even after accounting for established interactions between daily stressors and other sources of chronic stress. Exposure to neighborhoods perceived as unsafe is associated with poorer daily well-being and exacerbated responses to daily stressors, which may serve as an individual-level pathway contributing to poorer health among people living in neighborhoods perceived as unsafe.

Steeling or sensitizing? A longitudinal examination of how ongoing accumulation of negative life events affects depressive symptoms in older adults

OBJECTIVES

To examine whether: 1) as people age, accumulation of negative events increases ('sensitizing') or decreases ('steeling') the detrimental effects of subsequent events on depressive symptoms, and 2) how particular psychosocial factors are associated with the strength of these steeling or sensitizing effects.

METHOD

We used data from six measurement waves from 2,069 adults aged 55-84 (M=68.0) at baseline in the Longitudinal Aging Study Amsterdam, the Netherlands. We included 18 different life events across the life course. Using hybrid multilevel models, we tested whether the effects of proximate life events (<3 years) on depressive symptoms (measured by the CES-D) were moderated by previous cumulative events (childhood until previous measurement wave). Additionally, we tested whether education, mastery, emotional support, neuroticism, having strong faith, and loneliness were associated with the strength of steeling/sensitizing effects.

RESULTS

Cumulative and proximate life events were independently associated with more depressive symptoms. Interaction effects indicated that the more cumulative life events, the weaker the effects of recent life events, suggesting a 'steeling' effect. Unexpectedly, three-way interaction effects showed that higher mastery and lower neuroticism were associated with weaker steeling effects. These effects were predominantly attributable to within-person changes rather than to fixed between-person differences. Results from analyses with event severity scores were similar.

CONCLUSIONS

As a population, older adults appear to become more resilient against new stressors as they accumulate experience in dealing with negative life events. Findings on mastery tentatively suggest that accepting limits to one's own control over life circumstances may foster a steeling effect.

Focusing on Resilience and Renewal From Stress: The Role of Emotional and Social Intelligence Competencies

Individuals are subject to stressful events from daily chronic stress to traumatic life-changing experiences and the resulting impairment. Efforts to reduce stress or stressors are misdirected. Instead, bouncing back or recovering from such experiences, often called resilience is a far more potent way to ameliorate the ravages of chronic stress and move to a state of renewal, thriving and flourishing. Because we infect each other with stress or renewal through emotional contagion, each person's ability to manage their own emotions as well as those of others and their relationships becomes key to health. These capabilities are called emotional and social intelligence. At the trait level, they are personal dispositions but at the behavioral level they are patterns of behavior we call emotional and social intelligence competencies (ESI). This paper is a review addressing the role of emotional and social intelligence competencies in resilience. By focusing on the behavioral level of ESI, designs for more precise research and practical applications as to how to develop ESI and resilience are offered.

The Interplay of Chronic Interpersonal Stress and Rumination on Nonsuicidal Self-Injury in Youth

Nonsuicidal self-injury (NSSI) describes deliberate self-destructive behaviors without the intention to die. Little is known about what factors contribute to NSSI especially among youth. The current study tested two conceptual models for how chronic interpersonal stress and rumination may contribute to NSSI engagement across 18 months in a community sample of youth: (1) a mediation pathway based on the Emotional Cascade Model (i.e., stress contributes to rumination and then to subsequent NSSI), and (2) a moderation model based on the cognitive vulnerability-stress framework (i.e., rumination moderates the relation between stress and NSSI). 516 youth aged 7-16 (M_age = 12.0; 56% female; 90% Non-Hispanic or Non-Latinx) reported on ongoing interpersonal stress occurring between T1-T2 (every 6 months from T1 to 12 months) via the Youth Life Stress Interview, rumination via the Children's Response Styles Questionnaire (at T1 and 18 months later, T2), and NSSI engagement every six months from 18 to 36 months (T2-T3) via the Self-Injurious Thoughts and Behaviors Interview. Interpersonal stress predicted later rumination (b = .43, p < .01), rumination forecasted later NSSI occurrence (OR = 1.06, p < .01), and mediation was supported via a significant indirect effect of interpersonal stress on NSSI through rumination (b = .03, 95% CI = .01, .07). Rumination did not significantly moderate the relation between stress and NSSI. The prospective relation between chronic interpersonal stress and NSSI engagement was partly explained by rumination, aligning with the Emotional Cascade Model's prediction that rumination contributes to NSSI. Youth may conduct NSSI to interrupt rumination elicited by chronic interpersonal stress.

The Role of HPA Axis and Allopregnanolone on the Neurobiology of Major Depressive Disorders and PTSD

Under stressful conditions, the hypothalamic-pituitary-adrenal (HPA) axis acts to promote transitory physiological adaptations that are often resolved after the stressful stimulus is no longer present. In addition to corticosteroids (e.g., cortisol), the neurosteroid allopregnanolone (3α,5α-tetrahydroprogesterone, 3α-hydroxy-5α-pregnan-20-one) participates in negative feedback mechanisms that restore homeostasis. Chronic, repeated exposure to stress impairs the responsivity of the HPA axis and dampens allopregnanolone levels, participating in the etiopathology of psychiatric disorders, such as major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). MDD and PTSD patients present abnormalities in the HPA axis regulation, such as altered cortisol levels or failure to suppress cortisol release in the dexamethasone suppression test. Herein, we review the neurophysiological role of allopregnanolone both as a potent and positive GABAergic neuromodulator but also in its capacity of inhibiting the HPA axis. The allopregnanolone function in the mechanisms that recapitulate stress-induced pathophysiology, including MDD and PTSD, and its potential as both a treatment target and as a biomarker for these disorders is discussed.

A Case of Acute Stress in Post-hypnotized Patient

Background: Mental health conditions that can occur immediately after a traumatic event is called acute stress reaction; in this case, happens after hypnosis. This can cause a variety of psychological symptoms without attention or treatment, causesost-traumatic stress disorder. The psychological symptoms can negatively affect the quality of life, especially the reactions arise after a traumatic event that after being hypnotized. Hypnosis works by changing the activity in brain regions associated with attention or alertness. At the time hypnotised, we saw a very high level of concentration, so that suggestions given to him will be more easily accepted. Case Report: The case presented is the hypnotic impact of acute stress reactions. A woman named Mrs. J 63 years old. The Karo tribe who experienced anxiety, fear, and difficulty sleeping after experiencing hypnosis four days ago. This experienced it after being hypnotized at home. Conclusion: Hypnosis plays a role in all parts of life involving human mind. Hypnosis is a science that exploits the potential mental and hidden in humans, known as the subconscious. in medical health, hypnosis therapy is very important, what we need to realize is that hypnosis with bad intentions can harm humans. Hypnosis incident was reported in patients who suffer from post traumatic stress disorder. found in many women. older women are more vulnerable to acute stress. Previous research has shown that hypnotic susceptibility correlated with personality traits.

Reduced anterior cingulate cortex volume induced by chronic stress correlates with increased behavioral emotionality and decreased synaptic puncta density

Clinical and preclinical studies report that chronic stress induces behavioral deficits as well as volumetric and synaptic alterations in corticolimbic brain regions including the anterior cingulate cortex (ACC), amygdala (AMY), nucleus accumbens (NAc) and hippocampus (HPC). Here, we aimed to investigate the volumetric changes associated with chronic restraint stress (CRS) and link these changes to the CRS-induced behavioral and synaptic deficits. We first confirmed that CRS increases behavioral emotionality, defined as collective scoring of anxiety- and anhedonia-like behaviors. We then demonstrated that CRS induced a reduction of total brain volume which negatively correlated with behavioral emotionality. Region-specific analysis identified that only the ACC showed significant decrease in volume following CRS (p < 0.05). Reduced ACC correlated with increased behavioral emotionality (r = -0.56; p = 0.0003). Although not significantly altered by CRS, AMY and NAc (but not the HPC) volumes were negatively correlated with behavioral emotionality. Finally, using structural covariance network analysis to assess shared volumetric variances between the corticolimbic brain regions and associated structures, we found a progressive decreased ACC degree and increased AMY degree following CRS. At the cellular level, reduced ACC volume correlated with decreased PSD95 (but not VGLUT1) puncta density (r = 0.35, p < 0.05), which also correlated with increased behavioral emotionality (r = -0.44, p < 0.01), suggesting that altered synaptic strength is an underlying substrate of CRS volumetric and behavioral effects. Our results demonstrate that CRS effects on ACC volume and synaptic density are linked to behavioral emotionality and highlight key ACC structural and morphological alterations relevant to stress-related illnesses including mood and anxiety disorders.

Hair Cortisol Concentration and Perceived Chronic Stress in Low-Income Urban Pregnant and Postpartum Black Women

Black women are more likely to experience short- or long-term health consequences from their labor and delivery and die from pregnancy-related causes than White women. Similarly, infants born to Black women also have heightened health risks. Developing research suggests that a contributing factor to Black health disparities may be maternal chronic stress. A widely used biomarker for chronic stress is hair cortisol concentration (HCC). Few prior studies have explored the HCC of pregnant Black women or comprehensively examined perceived chronic stress in this population. Using a mixed-methods focus group framework, we assessed HCC and perceived chronic stress among low-income pregnant and postpartum Black women. Four focus groups were conducted (N = 24). The mean HCC for our pregnant Black participants was greater than pregnant White women in reviewed published studies. The high levels of stress evidenced at all pregnancy stages indicate that many of these women are experiencing chronic stress, which can contribute to higher Black maternal morbidity and mortality rates, and possibly infant mortality rates. From the open coding of the focus group transcripts, 4 themes emerged: chronic stress, experiences of racism, experiences of trauma, and negative thinking. Selective coding based on these themes revealed cumulative experiences of chronic stress, various traumatic experiences, and frequent encounters with racism. Negative thinking styles were observed across the 4 focus groups. More studies of HCC and perceived stress among pregnant Black women are encouraged. Findings suggest the need for tailored multi-level interventions given the layers of stressors present in this population.

Factors related to age at depression onset: the role of SLC6A4 methylation, sex, exposure to stressful life events and personality in a sample of inpatients suffering from major depression

BACKGROUND

An early onset of depression is associated with higher chronicity and disability, more stressful life events (SLEs), higher negative emotionality as described by the primary emotion SADNESS and more severe depressive symptomatology compared to depression onset later in life. Additionally, methylation of the serotonin transporter gene (SLC6A4) is associated with SLEs and depressive symptoms.

METHODS

We investigated the relation of SLEs, SLC6A4 methylation in peripheral blood, the primary emotions SADNESS and SEEKING (measured by the Affective Neuroscience Personality Scales) as well as depressive symptom severity to age at depression onset in a sample of N = 146 inpatients suffering from major depression.

RESULTS

Depressed women showed higher SADNESS (t (91.05) = - 3.17, p = 0.028, d = - 0.57) and higher SLC6A4 methylation (t (88.79) = - 2.95, p = 0.02, d = - 0.55) compared to men. There were associations between SLEs, primary emotions and depression severity, which partly differed between women and men. The Akaike information criterion (AIC) indicated the selection of a model including sex, SLEs, SEEKING and SADNESS for the prediction of age at depression onset. SLC6A4 methylation was not related to depression severity, age at depression onset or SLEs in the entire group, but positively related to depression severity in women.

CONCLUSIONS

Taken together, we provide further evidence that age at depression onset is associated with SLEs, personality and depression severity. However, we found no associations between age at onset and SLC6A4 methylation. The joint investigation of variables originating in biology, psychology and psychiatry could make an important contribution to understanding the development of depressive disorders by elucidating potential subtypes of depression.

Development and Effects of Cognitive Behavior-Based Healing Programs Using Mobile Apps

Purpose: There has been a recent surge in interest in mental health and how to improve individuals’ health-related quality of life. Mental health management using mobile apps can be a useful intervention method. The development and application of verified and highly efficient apps for mental health and stress management are needed. We developed healing programs and verified their effectiveness based on apps designed to promote adult mental health. Methods: We conducted a one-group pretest-posttest study in which 85 participants used the app for 12 weeks. We assessed its effects on participants’ stress (perceived stress scale, effort–reward imbalance, and photoplethysmogram (PPG)), anxiety, depression, emotional labor, and well-being. Results: The stress survey results post-intervention increased or stayed the same; however, the PPG results decreased (p = 0.002) after using the app. Depression (p = 0.043) and anxiety (p = 0.003) also decreased; however, emotional labor and well-being remained unchanged. The awareness of, knowledge of, and attitude toward mental health management all increased post-intervention. Discussion: The developed mobile app was an efficient and highly accessible way to promote mental health. However, the app requires modification and supplementation for continual use. Additionally, ongoing research concerning the study, evaluation, and integration of mobile apps is required.

Maternal Stress Before Conception Is Associated with Shorter Gestation

BACKGROUND

Stress in pregnancy predicts adverse birth outcomes. Stressors occurring prior to conception may also pose risk for the mother and child. The few published studies on preconception stress test a single stress measure and examine only linear associations with birth outcomes.

PURPOSE

Guided by findings in the prenatal stress literature, the current study aimed to (i) identify latent factors from a set of preconception stress measures and (ii) examine linear and curvilinear associations between these stress factors and length of gestation.

METHODS

Study 1 utilized a sample of 2,637 racially/ethnically diverse women to develop a measurement model of maternal stress from assessments of seven acute and chronic stress measures. Factor analysis revealed three latent factors representing stressors (life events, financial strain, interpersonal violence, discrimination), stress appraisals (perceived stress, parenting stress), and chronic relationship stress (family, partner stress). Study 2 examined the associations of these three latent preconception stress factors with the length of gestation of a subsequent pregnancy in the subset of 360 women who became pregnant within 4.5 years.

RESULTS

Controlling for prenatal medical risks, there was a significant linear effect of stress appraisals on the length of gestation such that more perceived stress was associated with shorter gestation. There was a curvilinear effect of stressors on the length of gestation with moderate levels associated with longer gestation.

CONCLUSIONS

These results have implications for research on intergenerational origins of developmental adversities and may guide preconception prevention efforts. Findings also inform approaches to the study of stress as a multidimensional construct.

The association between prior physical fitness and depression in young adults during the COVID-19 pandemic-a cross-sectional, retrospective study

Background

The COVID-19 pandemic has led to a spike in deleterious mental health. This dual-center retrospective cross-sectional study assessed the prevalence of depression in young adults during this pandemic and explored its association with various physical fitness measures.

Methods

This study enrolled 12,889 (80% female) young adults (mean age 20 ± 1) who performed a National Student Physical Fitness battery from December 1st, 2019, to January 20th, 2020, and completed a questionnaire including Beck’s Depression Inventory in May 2020. Independent associations between prior physical fitness and depression during the pandemic were assessed using multivariable linear and binary logistic regressions accordingly, covariates including age, dwelling location, economic level, smoking, alcohol, living status, weight change, and exercise volume during the pandemic. Sex- and baseline stress-stratified analyses were performed.

Results

Of the study population 13.9% of men and 15.0% of women sampled qualified for a diagnosis of depression. After multivariable adjustment, anaerobic (mean change 95% CI −3.3 [−4.8 to 1.8]) aerobic (−1.5 [−2.64 to −0.5]), explosive (−1.64 [−2.7 to −0.6]) and muscular (−1.7 [−3.0 to −0.5]) fitness were independently and inversely associated with depression for the overall population. These remained consistent after sex- and baseline stress-stratification. In binary logistic regression, the combined participants with moderate, high or excellent fitness also showed a much lower risk compared to those least fit in anaerobic (odd ratio (OR) 95% CI 0.68 [0.55–0.82]), aerobic (0.80 [0.68–0.91]), explosive (0.72 [0.61–0.82]), and muscular (0.66 [0.57–0.75]) fitness.

Conclusions

These findings suggest that prior physical fitness may be inversely associated with depression in young adults during a pandemic.

The COVID-19 Pandemic and Psychosocial Outcomes Across Age Through the Stress and Coping Framework

Background and Objectives

The emergence of the Coronavirus Disease 2019 (COVID-19) and the measures implemented to curb its spread may have deleterious effects on mental health. Older adults may be at increased risk for adverse psychosocial outcomes because opportunities to remain socially connected have diminished. Research is needed to better understand the impact of pandemic-related stress on mental health. The purpose of this study is 3-fold: (a) to examine the influences of COVID-19 pandemic-related stress on depression, anxiety, and loneliness; (b) to assess the mediating role of coping style and social support; and (c) to investigate whether these relationships vary across age.

Research Design and Methods

Participants (N = 1,318) aged 18–92 years completed an online survey assessing pandemic-related stress, mental health, social support, coping, and their experiences with social distancing, during the initial implementation of social distancing measures in the United States.

Results

Social support and coping style were found to relate to psychosocial outcomes. Avoidant coping was the strongest mediator of the relationship between pandemic-related stress and psychosocial outcomes, particularly depression. Avoidant coping more strongly mediated the relationship between stress and depression in younger adults compared to older adults.

Discussion and Implications

Results were consistent with the stress and coping framework and recent work highlighting older adults’ resilience during the COVID-19 pandemic. Findings highlight the associations between positive coping behaviors and psychosocial well-being and indicate that older adults may use unique adaptive mechanisms to preserve well-being during the COVID-19 pandemic.

Neuroadaptability and Habit: Modern Medicine and Ayurveda

In our increasingly stressed world, especially with the COVID-19 pandemic, the activation of the threat network in everyday situations can adversely affect our mental and physical health. Neurophysiological response to these threats/challenges depends on the type of challenge and the individual’s neuroadaptability. Neuroadaptability is defined as the ability of the nervous system to alter responsiveness over time to reoccurring stimuli. Neuroadaptability differs from neuroplasticity, which is more inclusive and refers to the ability of the nervous system to change and learn from any experience. We examine neuroadaptability and how it affects health from the perspective of modern medicine and Ayurveda.

Loss of Brain-Derived Neurotrophic Factor (BDNF) Resulting From Congenital- Or Mild Traumatic Brain Injury-Induced Blood-Brain Barrier Disruption Correlates With Depressive-Like Behaviour

Brain-derived neurotrophic factor (BDNF) plays an important role in processes associated with neuroplasticity and neuroprotection. Evidence suggests that decreased BDNF levels in the central nervous system (CNS) represent a mechanism underlying the development of mood disorders. We hypothesize that both congenital and traumatic brain injury (mTBI)-induced blood-brain barrier (BBB) breakdown are responsible for brain BDNF depletion that contributes to the development of depressive-like symptoms. We employed a mouse model of innate differences in BBB integrity with high (HA) and low (LA) permeability. Depressive-like behaviours were determined under chronic mild stress (CMS) conditions or following mTBI using the tail suspension test (TST). Microvascular leakage of the BBB was evaluated using the Evans Blue Dye (EBD) extravasation method. BDNF concentrations in the brain and plasma were measured using the ELISA. Control HA mice with congenitally high BBB permeability showed exacerbated depressive-like behaviours compared with LA mice. In LA mice, with normal BBB function, mTBI, but not CMS, facilitated depressive-like behaviours, which correlated with enhanced BDNF efflux from the brain. In addition, mTBI triggered upregulation of the Bdnf gene in LA mice to compensate for BDNF loss. No alterations in BDNF levels were observed in mTBI and CMS-exposed HA mice. Moreover, CMS did not induce BBB damage or affect depressive-like behaviours in HA mice despite downregulating Bdnf gene expression. To conclude, BDNF efflux through the mTBI-disrupted BBB is strongly linked to the development of depressive-like behaviours, while the depressive phenotype in mice with congenital BBB dysfunction is independent of BDNF leakage.

The involvement of ADAR1 in antidepressant action by regulating BDNF via miR-432

Brain-derived neurotrophic factor (BDNF) is a biomarker of depression. Recent studies have found adenosine deaminase acting on RNA1 (ADAR1) is a novel target being sensitive to stress at epigenetic level. The epigenetic regulation mechanism of stress-related depression is still unclear so far. To explore the potential regulating mechanism of ADAR1 on BDNF, over and low expression of ADAR1 in PC12 and SH-SY5Y cell lines are prepared. In the meanwhile, chronic unpredictable stress (CUS) mice are treated with ADAR1 inducer (interferon-γ, IFN-γ). ADAR1 regulates BDNF expression, which is proven by that over and low expressions of ADAR1 increase and decrease BDNF mRNA and protein respectively in vitro. Additionally, ADAR1 inducer alleviates the depressive-like behavior of CUS mice by recovering the decreased BDNF protein in brain and serum. Moreover, over and low expressions of ADAR1 reduce and enhance microRNA-432 (miR-432) expression respectively in vitro. Furtherly, over and low miR-432 expressions lead to decreased and increased BDNF and ADAR1 mRNA, protein and immunoreactivity respectively in vitro. The above results demonstrate that ADAR1 is involved in antidepressant action by regulating BDNF via miR-432. Those novel findings can provide a new idea for the study of epigenetic regulation mechanism, early diagnosis, and effective treatment of stress-related depression.

Is correlation between plasma and salivary cortisol levels an important indicator of stress?: A meta-analysis study

The purpose of this study was to examine the practical importance of the correlation values between plasma and salivary cortisol levels using meta-analysis study. In this way, researchers focusing on cortisol levels in different individuals can use more systemic, practical and reliable evidence than using just salivary or plasma cortisol levels separately. For this purpose, correlational studies from 2000 up to now were collected and analyzed by meta-analysis. Results based on 18 effect sizes (n = 743) revealed that effect sizes of the correlations between plasma and salivary cortisol levels represented large effects. The overall combined effect size (Hedges's = 1.55) also represented a large effect. This finding indicates the practical importance of the correlation values for stress studies. The use of the correlation values for examining the cortisol levels in stress studies will be discussed in detail.

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

OBJECTIVES

To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility.

METHODS

Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders.

RESULTS

The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg²⁰²⁰) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care.

CONCLUSION

The MDcpg²⁰²⁰ builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.

MOOD DISORDERS COMMITTEE

Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.

How Midlife Chronic Stress Combines with Stressful Life Events to Influence Later Life Mental and Physical Health for Husbands and Wives in Enduring Marriages

Objectives: To investigate how midlife chronic stress (40-50 years) and subsequent acute stressful events (50-65 years) influence husbands' and wives' later life mental and physical health (65+ years). Methods: Dyadic structural equation modeling was used with prospective data over 25 years from 256 husbands and wives in enduring marriages. Results: For both spouses, midlife chronic stress influenced the occurrence of subsequent acute stressful life events, which in turn influenced both depressive symptoms and poor physical health in later years. For both spouses, midlife chronic stress also directly influenced depressive symptoms. Wives' midlife chronic stress also directly influenced their own poor physical health and husbands' depressive symptoms in later years. Discussion: These findings enhance our knowledge about the long-term joint influence of midlife chronic stress and acute stressful life events on health outcomes of husbands and wives in later years and identify dependencies between spouses, which can inform health preventive intervention programs.

Association of Stress, Glucocorticoid Receptor, and FK506 Binding Protein Gene Polymorphisms With Internalizing Disorders Among HIV-Infected Children and Adolescents From Kampala and Masaka Districts-Uganda

Children and adolescents living with human immunodeficiency virus (CA-HIV) suffer a considerable burden of internalizing disorders (IDs; depressive and anxiety disorders). Environmental and genetic factors have been reported to influence the vulnerability to IDs in western settings; however, their role among African populations remains inadequately explored. We investigated the individual and interactive effects of stress and single-nucleotide polymorphisms within the FK506 binding protein 5 (rs1360780) and glucocorticoid receptor (rs10482605) genes on ID status in a cohort of CA-HIV in Uganda. We genotyped rs10482605 (309 cases and 315 controls) and rs1360780 (350 cases and 335 controls) among CA-HIV with and without IDs using Kompetitive Allele-Specific PCR. Socio-demographic variables, as well as allele and genotype distributions, were compared between cases and controls using chi-square tests. Genotypes were assessed for Hardy-Weinberg equilibrium. Composite indices of recent and chronic stress classes were also generated. A hierarchical cluster analysis was used to generate cutoff points within each of the indices of recent and chronic stress. Logistic regression was used to assess the association between IDs and each of recent stress, chronic stress, and the investigated genotypes. The interaction effect of chronic/recent stress on the association between each of the polymorphisms and IDs was determined using a likelihood ratio test. We observed no significant association between IDs and rs1360780 and rs10482605 polymorphisms within the FKBP5 and glucocorticoid receptor genes, respectively (P > 0.050). Severe recent stress increased the vulnerability to IDs among CA-HIV (P = 0.001). We did not observe any gene-environment effect on vulnerability to IDs in this population. These findings support the currently held opinion that polymorphisms at single genetic loci only contribute a very small effect to the genetic vulnerability to IDs.

Historical trauma and social support as predictors of psychological stress responses in American Indian adults during the COVID-19 pandemic

BACKGROUND

American Indians (AIs) live with historical trauma, or the cumulative emotional and psychological wounding that is passed from one generation to the next in response to the loss of lives and culture. Psychological consequences of historical trauma may contribute to health disparities.

PURPOSE

Here, we investigate whether historical trauma predicts changes in psychological stress associated with the onset of the COVID-19 pandemic in AI adults. Based on the stress-sensitization theory, we hypothesize that greater historical trauma will predict greater increases in levels of psychological stress from before the onset of the pandemic to after.

METHOD

Our analytic sample consisted of 205 AI adults. We measured historical trauma and levels of psychological stress before and after the onset of the pandemic.

RESULTS

Using hierarchical regression models controlling for age, biological sex, income, symptoms of depression and anxiety, psychological stress at Time 1, COVID-19 specific stress, and childhood trauma, we found that greater historical trauma preceding the pandemic predicted greater increases in psychological stress (β = 0.38, t = 5.17 p < .01, ΔR² = 0.12), and levels of social support interacted with historical trauma to predict changes in psychological stress (β = -0.19, t = -3.34, p = .001, ΔR² = 0.04). The relationship between historical trauma and changes in stress was significant for individuals with low levels of social support.

CONCLUSIONS

Historical trauma may contribute to AI mental health disparities, through heightened psychological stress responses to life stressors and social support appears to moderate this relationship.

The Factorial Validity of the Norwegian Version of the Multicomponent Training Distress Scale (MTDS-N)

BACKGROUND

Athlete self-report measures (ASRM) are methods of athlete monitoring, which have gained considerable popularity in recent years. The Multicomponent Training Distress Scale (MTDS), consisting of 22 items, is a promising self-report measure to assess training distress among athletes. The present study aimed to investigate the factorial validity of the Norwegian version of MTDS (MTDS-N) among student-athletes (n = 632) attending the optional program subject "Top-Level Sports" in upper secondary schools in Norway.

METHODS

A confirmatory factor analysis (CFA) was conducted to assess the six-factor model proposed by Main and Grove (2009). McDonald's omega (ω) along with confidence intervals (CIs) were used to estimate scale reliability. After examining the fit of the CFA model in the total sample, covariates were included to investigate group differences in latent variables of MTDS-N, resulting in the multiple indicators multiple causes (MIMIC) model. Further, direct paths between the covariates and the factor indicators were included in an extended MIMIC model to investigate whether responses to items differed between groups, resulting in differential item functioning (DIF).

RESULTS

When modification indices (MIs) were taken into consideration, the alternative CFA model revealed that MTDS-N is an acceptable psychometric tool with a good fit index. The factors in MTDS-N all constituted high scale reliability with McDonald's ω ranging from 0.725-0.862. The results indicated statistically significant group differences in factor scores for gender, type of sport, hours of training per week, school program, and school level. Further, results showed that DIF occurred in 13 of the MTDS-N items. The student-athletes' reports of training distress were moderate.

CONCLUSION

The MTDS-N may be suitable for use in a Norwegian population to assess student-athletes' training distress in a reliable manner. The indications of group effects suggest that caution should be used if one is interested in making group comparisons when the MTDS-N is used among student-athletes in Norway until further research is conducted.

Psychological flexibility and inflexibility as sources of resiliency and risk during a pandemic: Modeling the cascade of COVID-19 stress on family systems with a contextual behavioral science lens

BACKGROUND

The coronavirus disease (COVID-19) pandemic and the historic economic shutdown and stay-at-home efforts to slow its spread have radically impacted the lives of families across the world, completely disrupting routines and challenging them to adjust to new health risks as well as to new work and family demands. The current study applied a contextual behavioral science lens to the spillover hypothesis of Family Systems Theory to develop a multi-stage mechanistic model for how COVID-19 stress could impact family and child functioning and how parents' psychological flexibility could shape those processes.

METHODS

A total of 742 coparents (71% female; 84% Caucasian, 85% married, M = 41 years old) of children (ages 5-18, M = 9.4 years old, 50% male) completed an online survey from March 27th to the end of April 2020.

RESULTS

Path analyses highlighted robust links from parent inflexibility to all components of the model, predicting: greater COVID-19 stress, greater coparenting discord and family discord, greater caustic parenting, and greater parent and child distress. Parent flexibility was associated with greater family cohesion, lower family discord and greater use of constructive parenting strategies (inductive, democratic/autonomy supportive, positive). Results further suggested that COVID-19 stressors predicted greater family and coparent discord, which in turn predicted greater use of caustic parenting (reactive, inconsistent, aggressive), which in turn predicted greater child and parent distress.

CONCLUSIONS

The current results highlight parental flexibility and inflexibility as key points of intervention for helping families navigate the current global health crisis, highlighting the crucial role they play in the lives of families.

Husbands’ and wives’ stressful work, couple BMI dynamics, and later-life physical health

Previous research has not adequately investigated the persistent influence of stressful work experiences, particularly person-work mismatch (PWM), on later-life physical health outcomes of working husbands and wives. Using prospective data collected from 235 working husbands and wives over a period of 27 years (1991-2017), this study examined PWM in early middle years (40-50 years of age) and body mass index (BMI) trajectories in mid-later years (50-65 years of age) in a dyadic actor-partner interdependence modelling framework. Results showed PWM in early middle years was related to BMI trajectories in mid-later years, which contributed to multiple physical health outcomes in later life. Spouses' PWM influenced not only their BMI trajectories but also their partners' BMI trajectories, providing evidence for partner effects. This couple-level BMI process over the mid-later years was related to spouses' physical health in later years. Husbands' elevated BMI level resulted in adverse physical health outcomes. In contrast, for wives, it was the change in BMI over time that resulted in adverse physical health outcomes in their later years. These findings are particularly important for couple-focused family interventions as they highlight the need to consider couple-level lifestyle and behavioural factors that can safeguard spouses from the negative health consequences of PWM.

Stress in Women with Acute Myocardial Infarction: A Closer Look

BACKGROUND

Women seem to be more susceptible to psychosocial stress than men, and stress is associated with worse outcomes after acute myocardial infarction (AMI).

OBJECTIVES

To investigate whether the female gender is an independent predictor of risk for stress and to compare stress levels between women and men after AMI.

METHODS

Cross-sectional study of a case series. Patients aged 18 to 65 years who were treated for AMI at the study facility between January 2017 and June 2018 were eligible. The presence of stress was assessed using Lipp's Stress Symptoms Inventory for Adults (ISSL), which categorizes stress into four phases (alertness, resistance, near-exhaustion, and exhaustion), through a list of physical and psychological symptoms. Data were analyzed using SPSS Version 24.0. The significance level was set at p<0.05.

RESULTS

Of the 330 respondents, 89% of women and 70% of men experienced stress. The female gender was associated with nearly threefold higher odds of experiencing stress (EXP (B)2.79, p = 0.02). Regarding the phases of stress, women were more often in the near-exhaustion and exhaustion phases, while men were more often in the resistance phase.

CONCLUSIONS

This study showed that women are most often in the third and fourth phases of stress, i.e., in situations of long-standing psychosocial stress. These findings can assist in the development of gender-specific strategies for health promotion and disease prevention, aiming to minimize the effects of stress in this population.

Acupuncture in persons with an increased stress level-Results from a randomized-controlled pilot trial

Background

In today’s Western societies a high percentage of people experience increased or chronic stress. Acupuncture could serve as treatment for persons affected adversely by the increased stress.

Methods

The AkuRest study was a two-centre randomized controlled pilot study in adult persons with increased stress levels. Participants were randomly allocated to one of three groups: verum acupuncture treatment, sham acupuncture, and a waiting control group. The feasibility of the study was assessed. In addition, effects on stress level (measured by the Perceived Stress Questionnaire (PSQ-20)) and other variables were assessed at the end of treatment and a 3-month follow-up.

Results

Altogether, N = 70 persons were included in the study. At the end of the treatment 15.7% were lost to follow-up. The adherence to the protocol was good: 82.9% of the participants completed 100% of their treatment. The stress level of the participants was high at baseline (mean PSQ-20 score 75.5, SD = 8.2). Effect sizes (ES) at T1 showed that verum and sham acupuncture were superior to the waiting condition in reducing stress (ES (verum) = -1.39, 95%-CI = [-2.11; -0.67]: ES (sham) = -1.12, CI = [-1.78;-0.44]). At follow-up, effect sizes were in favour of the verum group (as compared to sham). However, confidence intervals and t-tests showed that these differences were not significant.

Conclusion

The pilot study demonstrated the feasibility of the acupuncture RCT in persons with increased stress levels. Estimated parameters can be used to design a larger RCT to prove the–here indicated—efficacy of verum acupuncture to decrease stress.

Trial registration number

ISRCTN15259166.

Tinnitus-related distress and pain perceptions in patients with chronic tinnitus - Do psychological factors constitute a link?

OBJECTIVE

To investigate the co-occurrence of tinnitus-related distress and pain experiences alongside psychological factors that may underlie their association.

METHOD

Patients with chronic tinnitus (N = 1238) completed a questionnaire battery examining tinnitus-related distress and affective and sensory pain perceptions. A series of simple, parallel- and serial multiple mediator models examined indirect effects of psychological comorbidities as well as -process variables including depressivity, perceived stress and coping attitudes. Moderator and moderated mediation analyses examined differential relational patterns in patients with decompensated vs. compensated tinnitus.

RESULTS

There were significant associations between tinnitus-related distress and pain perceptions. These were partially mediated by most specified variables. Psychological comorbidities appeared to influence tinnitus-pain associations through their impact on depressivity, perceived stress, and coping attitudes. Some specific differences in affective vs. sensory pain perception pathways emerged. Patients with decompensated tinnitus yielded significantly higher symptom burden across all measured indices. Tinnitus decompensation was associated with heightened associations between [1] tinnitus-related distress and pain perceptions, depressivity and negative coping attitudes; and [2] most psychological comorbidities and sensory, but not affective pain perception. Moderated mediation analyses revealed stronger indirect effects of depressivity and anxiety in mediating affective-, and anxiety in mediating sensory pain perception in patients with decompensated tinnitus.

CONCLUSION

Psychological constructs mediate the co-occurrence of tinnitus- and pain-related symptoms across different levels of tinnitus-related distress. Psychological treatment approaches should conceptualize and address individualised interactions of common cognitive-emotional processes in addressing psychosomatic symptom clusters across syndromatic patients with varying distress levels.

Is Postpartum Depression Different From Depression Occurring Outside of the Perinatal Period? A Review of the Evidence

Whether a major depressive episode occurring in the postpartum period (i.e., postpartum depression [PPD]) is sufficiently distinct from major depressive episodes occurring at other times (i.e., major depressive disorder) to warrant a separate diagnosis is a point of debate with substantial clinical significance. The evidence for and against diagnostic distinction for PPD is reviewed with respect to epidemiology, etiology, and treatment. Overall, evidence that PPD is distinct from major depressive disorder is mixed and is largely affected by how the postpartum period is defined. For depression occurring in the early postpartum period (variably defined, but typically with onset in the first 8 weeks), symptom severity, heritability, and epigenetic data suggest that PPD may be distinct, whereas depression occurring in the later postpartum period may be more similar to major depressive disorder occurring outside of the perinatal period. The clinical significance of this debate is considerable given that PPD, the most common complication of childbirth, is associated with immediate and enduring adverse effects on maternal and offspring morbidity and mortality. Future research investigating the distinctiveness of PPD from major depressive disorder in general should focus on the early postpartum period when the rapid decline in hormones contributes to a withdrawal state, requiring profound adjustments in central nervous system function.

Elite coaches have a similar prevalence of depressive symptoms to the general population and lower rates than elite athletes

Objective

The primary aim of this study was to estimate the prevalence of depressive symptoms and life stress in elite coaches. The secondary aim was to explore the associations of depressive symptoms and life stress with demographic and lifestyle variables.

Methods

National-level coaches were invited to participate in an online survey. Depressive symptoms were measured by the Centre for Epidemiological Studies Depression Scale-Revised (CESD-R). Life stress was measured using daily life hassle frequency and severity scores calculated from the Daily Hassles Questionnaire, with associations evaluated using linear regression.

Results

Of 110 potential participants, 69 completed and two partially completed surveys were received. The majority of respondents were male (77%), coaching individual sports (70%) and aged under 50 (71%). Overall, 14% of coaches reported at least moderate depressive symptoms according to the CESD-R. Those contemplating retirement were more likely to show depressive symptoms. Reported life stress was higher in females and in those contemplating retirement. There was a strong association between life stress and the odds of experiencing depressive symptoms (p=0.006).

Conclusions

Depressive symptoms are as prevalent in elite coaches as in general population, with potential risk factors including high levels of life stress and impending retirement.

Co-Occurring Trajectories of Depression and Social Anxiety in Childhood and Adolescence: Interactive Effects of Positive Emotionality and Domains of Chronic Interpersonal Stress

Deficits in positive emotionality (PE) have been implicated in the etiology of both social anxiety and depression; however, factors that contribute to divergent social anxiety and depression outcomes among youth low in PE remain unknown. Extant research suggests that parent-child stress and peer stress demonstrate differential patterns of associations with social anxiety and depression. Thus, the present study examined prospective interactive effects of PE and chronic parent-child and peer stress on simultaneously developing trajectories of social anxiety and depression symptoms among 543 boys and girls (age 8-16 at baseline, M[SD] = 11.94[2.32] 55.6% female). Parents reported on youth PE at baseline. Domains of chronic interpersonal (parent-child and peer) stress occurring between baseline and 18-months were assessed via child-report by trained interviews using the Youth Life Stress Interview (Rudolph and Flynn Development and Psychopathology, 19(2), 497-521, 2007). Youth completed self-report measures of depression and social anxiety every three months from 18- to 36- months (7 assessments). Conditional bivariate latent growth curve models indicated that main effects of parent-child stress, but not peer stress, predicted trajectories of depression in boys and girls. In girls, high levels of chronic interpersonal stress in both domains predicted stable, elevated trajectories of social anxiety symptoms regardless of PE. In boys, PE contributed to a pattern of differential susceptibility whereby boys high in PE were particularly susceptible to the effects of chronic interpersonal stress, for better or worse.

Chronic Stress and Unhealthy Dietary Behaviors among Low-Income African-American Female Caregivers

BACKGROUND

Chronic stress increases the risk of excess intake of calorie-dense foods. Low-income minority caregivers in the United States are cumulatively exposed to stressors and unhealthy foods, but evidence of this association is limited in this population group. The objective of the current study was to assess the association between chronic stress and unhealthy dietary behaviors among low-income African-American caregivers in Detroit, Michigan.

METHODS

Data came from Detroit Dental Health Project, a longitudinal study of pairs of African-American caregivers and children during 2002-2007. A sample of 912 female caregivers were included and their baseline (2002-2003) survey responses were analyzed to identify those with chronic stress and patterns of dietary behaviors. The likelihood of having unhealthy dietary behaviors was compared between chronically stressed caregivers and others, and the mediator role of depressive symptoms or current smoking was tested.

RESULTS

Approximately 10% of caregivers experienced chronic stress as they all reported discrimination, residential movement, and lack of social support. Twenty-five percent of the caregivers were found to have an unhealthy dietary pattern characterized by excess intake of high fatty foods and soda. Chronically stressed caregivers were more likely to exhibit unhealthy dietary behaviors (prevalence ratio: 1.39; 95% CI: 1.05, 1.84), and this relation was significantly mediated by depressive symptoms, not current smoking.

CONCLUSIONS

These findings suggest that chronic stress played a role in negatively influencing dietary behaviors. As this association might be mediated by depressive symptoms, an intervention to reduce depressive symptoms can be considered as an effective strategy to promote healthy dietary behaviors among chronically stressed minority caregivers.

Early Detection of the Risk of Developing Psychiatric Disorders: A Study of 461 Chinese University Students under Chronic Stress

Chronic stress, a characteristic of modern time, has a significant impact on general health. In the context of psychiatric disorders, insufficient coping behavior under chronic stress has been linked to higher rates of (1) depressive symptoms among subjects of the general population, (2) relapse among patients under treatment for clinical depression, and (3) negative symptoms among subjects with an elevated vulnerability to psychosis. In this normative study we assessed basic coping behavior among 461 Chinese freshman university students along with their consumption behavior and general health in terms of regular exercises, physical health, psychosomatic disturbances, and mental health. The assessments relied on two instruments that have already demonstrated their capability of (1) reliably detecting insufficient coping behavior under chronic stress and (2) reliably quantifying the interrelation between coping behavior and mental health in the Western world. Thus, we aimed to complement existing data and to develop a generally available, socioculturally independent tool that can be used for the early detection of subjects with an elevated risk of mental health problems. Structural analyses yielded essentially the same scales "activity" and "defeatism" as previous studies on 2,500 students from Switzerland, Italy, Spain, the USA, and Argentina. These scales explained 74.3% of the observed variance in coping behavior among the 461 Chinese students. We found highly significant correlations (p < 0.0001) between the "defeatism" scale on the one hand, and the scales "regular use of medicine," "psychosomatic disturbances," and "impaired mental health" on the other. Particularly intriguing was the finding that a neural net classifier could be constructed to identify students with the highest contributions to the interrelation between "coping behavior" and "mental health," yielding a correlation coefficient as high as r = 0.597 for the respective subgroup. Based on the normative data, an online tool for risk assessments was developed with immediate feedback to users. This study provided another piece of evidence regarding the close link between basic coping behavior and mental health, across cultures and ethnicities. In consequence, our approach to quantifying basic coping behavior, along with other risk factors, can be expected to clear the way for an "early" detection of students with an elevated risk of stress-related mental health problems, nota bene prior to the development of clinically relevant symptoms. The socioeconomic impact of the potential prevention of depressive -disorders, and psychiatric disorders in general, may be enormous.

Interpersonal life stress, inflammation, and depression in adolescence: Testing Social Signal Transduction Theory of Depression

BACKGROUND

Depression rates increase markedly for girls across the adolescent transition, but the social-environmental and biological processes underlying this phenomenon remain unclear. To address this issue, we tested a key hypothesis from Social Signal Transduction Theory of Depression, which posits that individuals who mount stronger inflammatory responses to social stress should exhibit greater increases in depressive symptoms following interpersonal life stress exposure than those who mount weaker inflammatory responses to such stress.

METHOD

Participants were 116 adolescent girls (M_age  = 14.71) at risk for psychopathology, defined as having a history of mental health concerns (e.g., psychiatric treatment, significant symptoms) over the past 2 years. At baseline, we characterized their inflammatory reactivity to social stress by quantifying their salivary proinflammatory cytokine responses to a laboratory-based social stressor. Then, 9 months later, we assessed the interpersonal and noninterpersonal stressful life events that they experienced over the prior 9 months using an interview-based measure of life stress.

RESULTS

As hypothesized, greater interpersonal life stress exposure was associated with significant increases in depression over time, but only for girls exhibiting stronger salivary tumor necrosis factor-α and interleukin-1β reactivity to social stress. In contrast, noninterpersonal stress exposure was unrelated to changes in depression longitudinally, both alone and when combined with youths' cytokine reactivity scores.

DISCUSSION

These results are consistent with Social Signal Transduction Theory of Depression and suggest that heightened inflammatory reactivity to social stress may increase adolescents' risk for depression. Consequently, it may be possible to reduce depression risk by modifying inflammatory responses to social stress.

Acute mental health symptoms among individuals receiving a sexual assault medical forensic exam: the role of previous intimate partner violence victimization

Sexual assault and intimate partner violence (IPV) are common in the USA, and they often co-occur. Individuals with multiple victimization experiences have more severe mental health outcomes compared to those with one victimization. The current study examined mental health symptoms and their association with IPV victimization history among a sample of individuals who experienced a recent sexual assault and received a sexual assault medical forensic examination. A total of 82 participants (92.70% female) completed a post-sexual assault survey as part of clinical care to coordinate follow-up services. IPV history and prior sexual assault were assessed as well as mental health symptoms including acute stress and depressive symptoms. It was found that individuals with an IPV history reported more acute stress and depressive symptoms compared to those without an IPV history. No differences were found based on prior sexual assault history. These findings highlight the importance of screening for IPV history during the sexual assault medical forensic examination to coordinate care.