In the search for integrative biomarker of resilience to psychological stress

Integrative psycho-biophysiological markers in predicting psychological resilience

The hypothalamic-pituitary-adrenal (HPA) and parasympathetic nervous systems have been reported to play important roles in emotion regulation and stress coping. Yet, their direct relationship with psychological resilience remains unclear. These biophysiological features should be considered together with the traditional psychometric properties in studying resilience more comprehensively. The current study aimed to examine the role of these systems during a laboratory stress task and to determine the prediction power of resilience by combining psychological and biophysiological features. One hundred and seven (52 females) university students without psychiatric disorders underwent the Trier Social Stress Task (TSST). Psychometric properties of resilience were measured at rest; vagal heart rate variability (HRV), salivary cortisol, and dehydroepiandrosterone (DHEA) levels were captured at baseline, during, and after TSST. Multivariate linear regression as well as support vector regression machine-learning analyses were performed to investigate significant predictors and the prediction power of resilience. Results showed that positive and negative affects, HRV during the anticipatory phase of stress, and the ratio of cortisol/DHEA at the first recovery time point were significant predictors of resilience. The addition of biophysiological features increased the prediction power of resilience by 1.2-fold compared to psychological features alone. Results from machine learning analyses further demonstrated that the increased prediction power of resilience by adding the ratio of cortisol/DHEA was significant in "cortisol responders"; whereas a trend level was observed in "cortisol non-responders". Our findings extend the knowledge from the literature that high vagal activity during the anticipating phase of stress and the ability to restore the balance between cortisol and DHEA after a stress event could be an important feature in predicting resilience. Our findings also further support the need of combining psychological and biophysiological features in studying/predicting resilience.

Resilience in severe mental disorders: correlations to clinical measures and quality of life in hospitalized patients with major depression, bipolar disorder, and schizophrenia

PURPOSE

To evaluate resilience in severe mental disorders and correlate it with clinical measures and quality of life.

METHODS

Resilience (Resilience Scale, RS) and quality of life (WHOQOL-BREF questionnaire) were prospectively evaluated in a sample of 384 hospitalized patients diagnosed with severe mental disorders (depression, bipolar disorder and schizophrenia). Clinical outcomes were measured using the Global Assessment of Functioning Scale (GAF), Clinical Global Impression (CGI), Cumulative Illness Rating Scale (CIRS), Hamilton Scale-Depression (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS).

RESULTS

Resilience measure showed a difference between the three clinical groups analyzed in the study, with lower scores in depressed patients than in bipolar disorder or schizophrenia patients. There was a trend toward a correlation between resilience and depressive symptoms (Hamilton Scale-Depression; P = 0.052; r_s = - 0.163). The scores in the resilience scale's personal competence domain presented a tendency of association with general psychiatric symptoms (Brief Psychiatric Rating Scale; P = 0.058; r = - 0.138). There was a significantly positive association between resilience and all domains of quality of life (r = 0.306-0.545; P < 0.05). Sociodemographic data like age, education, intelligence quotient, sex, and marital status were associated with resilience.

CONCLUSION

Depressive patients had low scores on the resilience scale compared to patients with other disorders. Resilience was positively associated with quality of life. Therefore, it deserves special attention, as it promotes more positive outcomes and improves patients' quality of life with severe mental disorders.

Prediction of Task Performance From Physiological Features of Stress Resilience

In this paper, we investigate the potential of generic physiological features of stress resilience in predicting air traffic control (ATC) candidates' performance in a highly-stressful low-fidelity ATC simulator scenario. Stress resilience is highlighted as an important occupational factor that influences the performance and well-being of air traffic control officers (ATCO). Poor stress management, besides the lack of skills, can be a direct cause of poor performance under stress, both in the selection process of ATCOs and later in the workplace. 40 ATC candidates, within the final stages of their selection process, underwent a stimulation paradigm for elicitation and assessment of various generic task-unrelated physiological features, related to resting heart rate variability (HRV) and respiratory sinus arrhythmia (RSA), acoustic startle response (ASR) and the physiological allostatic response, which are all recognized as relevant psychophysiological markers of stress resilience. The multimodal approach included analysis of electrocardiography, electromyography, electrodermal activity and respiration. We make advances in computational methodology for assessment of physiological features of stress resilience, and investigate the predictive power of the obtained feature space in a binary classification problem: prediction of high- vs. low-performance on the developed ATC simulator. Our novel approach yields a relatively high 78.16% classification accuracy. These results are discussed in the context of prior work, while considering study limitations and proposing directions for future work.

Analysis of Gender Differences in HRV of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Using Mobile-Health Technology

In a previous study using mobile-health technology (mHealth), we reported a robust association between chronic fatigue symptoms and heart rate variability (HRV) in female patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This study explores HRV analysis as an objective, non-invasive and easy-to-apply marker of ME/CFS using mHealth technology, and evaluates differential gender effects on HRV and ME/CFS core symptoms. In our methodology, participants included 77 ME/CFS patients (32 men and 45 women) and 44 age-matched healthy controls (19 men and 25 women), all self-reporting subjective scores for fatigue, sleep quality, anxiety, and depression, and neurovegetative symptoms of autonomic dysfunction. The inter-beat cardiac intervals are continuously monitored/recorded over three 5-min periods, and HRV is analyzed using a custom-made application (iOS) on a mobile device connected via Bluetooth to a wearable cardiac chest band. Male ME/CFS patients show increased scores compared with control men in all symptoms and scores of fatigue, and autonomic dysfunction, as with women in the first study. No differences in any HRV parameter appear between male ME/CFS patients and controls, in contrast to our findings in women. However, we have found negative correlations of ME/CFS symptomatology with cardiac variability (SDNN, RMSSD, pNN50, LF) in men. We have also found a significant relationship between fatigue symptomatology and HRV parameters in ME/CFS patients, but not in healthy control men. Gender effects appear in HF, LF/HF, and HFnu HRV parameters. A MANOVA analysis shows differential gender effects depending on the experimental condition in autonomic dysfunction symptoms and HF and HFnu HRV parameters. A decreased HRV pattern in ME/CFS women compared to ME/CFS men may reflect a sex-related cardiac autonomic dysfunction in ME/CFS illness that could be used as a predictive marker of disease progression. In conclusion, we show that HRV analysis using mHealth technology is an objective, non-invasive tool that can be useful for clinical prediction of fatigue severity, especially in women with ME/CFS.

Cardinal role of the environment in stress induced changes across life stages and generations

The stress response in rodents and humans is exquisitely dependent on the environmental context. The interactive element of the environment is typically studied by creating laboratory models of stress-induced plasticity manifested in behavior or the underlying neuroendocrine mediators of the behavior. Here, we discuss three representative sets of studies where the role of the environment in mediating stress sensitivity or stress resilience is considered across varying windows of time. Collectively, these studies testify that environmental variation at an earlier time point modifies the relationship between stressor and stress response at a later stage. The metaplastic effects of the environment on the stress response remain possible across various endpoints, including behavior, neuroendocrine regulation, region-specific neural plasticity, and regulation of receptors. The timescale of such variation spans adulthood, across stages of life history and generational boundaries. Thus, environmental variables are powerful determinants of the observed diversity in stress response. The predominant role of the environment suggests that it is possible to promote stress resilience through purposeful modification of the environment.

The role of stress reactivity and pre-injury psychosocial vulnerability to psychological and physical health immediately after traumatic injury

BACKGROUND

Traumatic injuries can have long-term negative impacts on health, especially psychological health. A biopsychosocial approach is recommended to identify those likely to experience psychosocial stress, however large individual differences exist in stress reactivity and post-injury health that remain unexplored. Therefore, we investigated autonomic nervous system (ANS) stress responses and pre-existing psychosocial vulnerability as contributors to health in individuals who sustained a traffic-related injury.

METHODS

120 adults with traffic-related injury and 112 non-injury controls underwent an integrative ANS (cardiac and skin conductance) assessment and a health-related assessment at 3-6 weeks post-injury. Propensity score matching based on six pre-injury psychosocial vulnerability factors (age, sex, education, prior mental/physical health, socioeconomic status) guided the definition of high vulnerability (HV) and low vulnerability (LV) injury subgroups, with the LV subgroup having similar propensity scores to non-injury controls. A three-group comparative analysis of ANS responsivity (baseline, reactivity, recovery/rebound) and post-injury health was performed.

RESULTS

The HV subgroup exhibited the most negative immediate post-injury mental health profile and less adaptive ANS response patterns, indicating greater stress vulnerability/reactivity. Significant differences were found for psychological health (elevated psychological distress and catastrophizing), but not physical health (injury factors, pain, fatigue, physical wellbeing). HV participants showed sympathetic predominance at resting baseline (lower parasympathetic activity and/or elevated heart rate) compared to the LV and control groups, as well as smaller parasympathetic decrease during a cognitive task compared to controls. Despite preserved capacity for restoring initial homeostasis in both injury subgroups during recovery, there was some indication of blunted post-task sympathetic deactivation (larger sympathetic decrease) and reduced overall ANS adaptability (reduction in total power of heart rate variability spectrum), suggesting relative reduced capacity to face stressors compared to controls.

CONCLUSIONS

Findings suggest that baseline resting ANS regulation, particularly parasympathetic activity, and pre-injury psychosocial factors are key contributors to individual psycho-biological responses following traumatic injury, and are therefore potential stress vulnerability markers. Post-stress recovery patterns may represent a novel physiological signature for a "biological intrinsic" vulnerability early after the injury. These findings provide direction for improved early identification and management of injured individuals, including innovative preventive interventions that target ANS regulation.

Real-world stress resilience is associated with the responsivity of the locus coeruleus

Individuals may show different responses to stressful events. Here, we investigate the neurobiological basis of stress resilience, by showing that neural responsitivity of the noradrenergic locus coeruleus (LC-NE) and associated pupil responses are related to the subsequent change in measures of anxiety and depression in response to prolonged real-life stress. We acquired fMRI and pupillometry data during an emotional-conflict task in medical residents before they underwent stressful emergency-room internships known to be a risk factor for anxiety and depression. The LC-NE conflict response and its functional coupling with the amygdala was associated with stress-related symptom changes in response to the internship. A similar relationship was found for pupil-dilation, a potential marker of LC-NE firing. Our results provide insights into the noradrenergic basis of conflict generation, adaptation and stress resilience.

Blood and affective markers of stress in Elite Airmen during a preparatory training course: A pilot study

In highly stressful environments, individuals with diverging stress-reactivity can perform differently. Identification of blood markers of stress-reactivity is of major significance to help human performance during stress. Candidate transcripts were identified between stressed and non-stressed strains of rats’ blood and brain, and overlapping significant differentially expressed genes were selected. Serum levels of human orthologues of these proteins, in lieu of blood RNA, in addition to classic stress and general clinical markers, were measured in 33 Battlefield Airmen undergoing a 52 day long preparatory training course before their course of initial entry (COIE). Blood samples and factors of affective state, negative valence “Threat” and positive valence “Challenge”, were obtained five times across different days of training which included either routine physical exercise or prolonged and intense physical and mental training. During training, levels of chloride (Cl), dehydroepiandrosterone-sulfate (DHEA-S), creatinine kinase (CK), and total carbon dioxide (TCO2) differed between airmen who subsequently graduated from their COIE and those who did not. Time dependent changes of serum TCO2 and neuropeptide Y (NPY), as well as the affective factor Challenge differed by future graduation status throughout the training. Serum levels of parvin beta (PARVB) correlated with the affective factor Threat, while those of NPY, testosterone, coactosin like F-actin binding protein 1 (COTL1) and C-reactive protein (CRP) correlated with factor Challenge during the extended, intensive periods of training, consistently. These pilot data suggest that the identified panel of blood markers can measure stress responsiveness, which has the potential to advance individualized stress-management strategies.

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Levels of novel and classical serum markers signal stress severity in men.

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Biomarker levels reflect stress reactivity of Battlefield Airmen in training.

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Affective measures correlate with serum biomarkers after extended stress.

Topical Review: Examining Multidomain Pain Resilience in Late Adolescents and Young Adults

OBJECTIVE

Upwards of 14% of late adolescents and young adults (AYAs) experience chronic pain; however, limited research has focused on factors specifically influencing late AYAs as they transition to adulthood. In this topical review, we propose a conceptual model of multidomain pain resilience (MDPR) in late AYAs with chronic pain that extends existing pain resilience literature, including the Ecological Resilience-Risk Model for Pediatric Chronic Pain.

METHOD

A conceptual framework for MDPR in late AYAs was developed from the existing literature on resilience in young people with chronic pain. Gaps in knowledge specific to late AYAs are identified, and relevant research examining MDPR in adults with pain are summarized to inform applications of this concept to youth as they transition to adulthood.

RESULTS

Few studies have explored resilience factors in pediatric pain. Of note, these endeavors have largely neglected late adolescence and young adulthood, despite unique considerations germane to this crucial developmental period. Existing research has also focused exclusively on assessing resilience as a unitary, rather than a multidimensional construct. Although limited, MDPR has been examined in midlife and older adults with chronic pain, highlighting the need to expand prior models of pain resilience and extend these principles to emerging adulthood.

CONCLUSIONS

Understanding MDPR in late AYAs with chronic pain may provide insights regarding measurable and modifiable resilience factors (e.g., adaptive and personal resources) that promote healthy pain-related outcomes (e.g., reduced pain and enhanced physical functioning) and optimize prevention and/or treatment strategies for this group.

Methyl-CpG binding protein 2 dysfunction provides stress vulnerability with sex- and zygosity-dependent outcomes

Stress vulnerability is a critical factor for the development of trauma-related disorders; however, its biological underpinnings are not clear. We demonstrated that dysfunctions in the X-linked epigenetic factor methyl-CpG binding protein 2 (MeCP2) provide trauma vulnerability in male mice. Given the prominent role of sex in stress outcomes, we explored the effects of MeCP2 hypofunctionality in females. Female mice carrying truncated MeCP2 (heterozygous and homozygous) and wild type controls (wt) were tested for fear memory. Stress-induced corticosterone release and brain expression of hypothalamic-pituitary-adrenal (HPA) axis regulatory genes were also evaluated in wt and mutant mice of both sexes. Although heterozygous females displayed a normal stress-related behavioural profile, homozygous mice showed enhanced memory recall for the threatening context compared to wt, thus recapitulating the phenotype previously evidenced in hemizygous males. Interestingly, MeCP2 truncation abolished the sex differences in stress-induced corticosterone release, which was found increased in mutant males, whereas blunted in mutant females in a zygosity-independent manner. Although heterozygous mice did not differ from controls, homozygous females and hemizygous males showed increased hypotalamic Crh and Avp mRNAs and a differentially altered expression of Fkbp5 in cortical areas. Present results demonstrate that in female mice carrying truncated MeCP2, altered stress responsivity is driven by homozygosity, whereas heterozygosity does not lead to maladaptive stress outcomes. MeCP2 dysfunctions thus provide stress vulnerability in mice with sex- and zygosity-dependent outcomes.

Priorities in stress research: a view from the U.S. National Institute of Mental Health

The mission of the National Institute of Mental Health is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure. In consultation with a broad range of experts, the NIMH has identified a set of priorities for stress biology research aimed squarely at creating the basic and clinical knowledge bases for reducing and alleviating mental health burden across the lifespan. Here, we discuss these priority areas in stress biology research, which include: understanding the heterogeneity of stressors and outcomes; refining and expanding the experimental systems used to study stress and its effects; embracing and exploiting the complexity of the stress response; and prioritizing translational studies that seek to test mechanistic hypotheses in human beings. We emphasize the challenge of establishing mechanistic links across levels of analysis to explain how and when specific and diverse stressors lead to enduring changes in neural systems and produce lasting functional deficits in mental health relevant behaviors. An improved understanding of mechanisms underlying stress responses and the functional consequences of stress can and will speed translation from basic research to predictive markers of risk and to improved, personalized interventions for mental illness.

Maternal Psychological Resilience During Pregnancy and Newborn Telomere Length: A Prospective Study

OBJECTIVE

In the context of the importance of elucidating the determinants of the initial, newborn setting of telomere length (TL), it is increasingly evident that maternal stress and stress-related processes during pregnancy play a major role. Although psychological resilience may function as a buffer, research in this area has not yet examined its potential role vis-à-vis that of stress. The authors examined the relationship between maternal psychological resilience during pregnancy and newborn TL.

METHODS

In a sample of 656 mother-child dyads from the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction cohort, multiple serial assessments were conducted over the course of pregnancy to quantify maternal stress, negative and positive emotional responses to pregnancy events, positive affect, and perceived social support. Principal component analysis identified two latent factors: stress and positivity. A measure of resilience was computed by regressing the positivity factor on the stress factor, in order to quantify positivity after accounting for stress. TL was measured using quantitative polymerase chain reaction in leukocytes extracted from cord blood shortly after birth. Linear regression was used to predict newborn TL from maternal resilience during pregnancy, adjusting for other potential determinants.

RESULTS

Maternal stress significantly predicted shorter newborn TL (β=-0.079), and positivity significantly predicted longer TL (β=0.135). Maternal resilience (positivity accounting for stress) was significantly and positively associated with newborn TL (β=0.114, 95% CI=0.035, 0.189), with each standard deviation increase in resilience predicting 12% longer newborn TL.

CONCLUSIONS

The results indicate that maternal psychological resilience may exert a salubrious effect on offspring telomere biology and highlight the importance of enhancing maternal mental health and well-being during pregnancy.

The Relationship Between the Perceived Social Support and Psychological Resilience in Caregivers of Patients with Schizophrenia

The present study aimed to explore the relationship between perceived social support and psychological resilience levels of caregivers of patients with schizophrenia. The study was designed as a descriptive relational study and conducted in Community Mental Health Center. Resilience Scale for Adults (RSA) and the Multidimensional Scale of Perceived Social Support (MSPSS) were used for data collection. There were significant, positive and high correlations between RSA and MSPSS. Findings of this study may be referenced in the development of resilience-based nursing caring models in the future.

Association Between Serum Lipid Levels, Resilience, and Self-Esteem in Japanese Adolescents: Results From A-CHILD Study

Previous studies have found that serum lipid levels independently associate with mental health problems in adulthood. However, little is known about the association between serum lipid levels and positive aspects of mental health such as resilience and self-esteem, which develop in adolescence. The aim of this study is to examine the association between serum lipid levels and resilience and self-esteem in Japanese adolescents. Data were pooled data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study in 2016 and 2018, a school-based, cross-sectional study in Adachi City, Tokyo, Japan (N = 1,056, aged 13–14 years). Resilience of the child was assessed by caregivers, and self-esteem was self-identified via questionnaires. Serum lipid levels [total cholesterol, low-density lipoproteins (LDL), and high-density lipoproteins (HDL)] were assessed in school health checkup, in addition to height and weight measurements. Multiple linear regression was applied to investigate the association between standardized serum lipid levels and resilience and self-esteem. LDL showed inverse association with resilience [β = −1.26, 95% confidence interval (CI) = −2.39 to −0.14] after adjusting for child’s BMI, month of birth, sex, absence of parent, household income, caregiver’s mental health, and lifestyle (e.g., habits of eating, physical activity, and sleep). We also found an inverse association of total cholesterol and higher LDL cholesterol with self-esteem (β = −0.58, 95% CI = −0.99 to −0.18; β = −0.42, 95% CI = −0.83 to −0.01, respectively). HDL cholesterol was not associated with resilience and self-esteem. Among Japanese adolescent, total and LDL cholesterol may be biomarkers of resilience and self-esteem.

Multimodal Imaging Analysis Reveals Frontal-Associated Networks in Relation to Individual Resilience Strength

Psychological resilience is regarded as a critical protective factor for preventing the development of mental illness from experienced adverse events. Personal strength is one key element of resilience that reflects an individual's reactions to negative life events and is crucial for successful adaptation. Previous studies have linked unimodal imaging measures with resilience. However, applying multimodal imaging measures could provide comprehensive organization information at the system level to examine whether an individual's resilience strength is reflected in the brain's structural and functional network. In this study, MRI was used to acquire multimodal imaging properties and subscales of personal strength in terms of resilience from 109 participants (48 females and 61 males). We employed a method of fusion independent component analysis to link the association between multimodal imaging components and personal strength of psychological resilience. The results reveal that a fusion component involving multimodal frontal networks in connecting with the parietal, occipital, and temporal regions is associated with the resilience score for personal strength. A multiple regression model further explains the predictive role of frontal-associated regions that cover a visual-related network regulating cognition and emotion to discern the perceived adverse experience. Overall, this study suggests that frontal-associated regions are related to individual resilience strength.

Association between declines in objective masticatory performance and salivary stress markers: The Suita study

Dentists often encounter patients suffering from psychological and social stress due to declines in masticatory performance, making this a critical issue to manage. We aimed to clarify the relationships between salivary stress markers as objective indices of chronic stress and objective masticatory performance in a general urban Japanese population. Data from 880 participants (mean age, 65.8 years) in the Suita study were used. Salivary interleukin (IL)-6 and cortisol concentrations were measured by enzyme-linked immunosorbent assay. Objective masticatory performance was determined by measuring the increase in surface area test gummy jelly after 30 times chewing. Participants were divided into two groups based on masticatory performance: a decreased group (lowest quartile) and a non-decreased group (second to fourth quartiles). Odds ratios (ORs) of higher salivary levels of stress markers (highest quartile) according to masticatory performance were estimated using logistic regression analysis adjusting for age, sex, periodontal status, salivary flow rate and smoking habit. Salivary IL-6 level was significantly higher in the decreased group than in the non-decreased group. Logistic regression analysis showed the adjusted OR for higher salivary IL-6 was significantly higher in the decreased group than in the non-decreased group (OR = 1.92; 95% confidence interval = 1.33-2.76; P < .001). No significant associations were found between salivary cortisol and decreased masticatory performance in any analyses. Declines in objective masticatory performance may correlate with higher salivary IL-6 level as an objective index of chronic stress.

Effects of Dynamic Resilience on the Reactivity of Vagally Mediated Heart Rate Variability

Dynamic resilience is a novel concept that aims to quantify how individuals are coping while operating in dynamic and complex task environments. A recently developed dynamic resilience measure, derived through autoregressive modeling, offers an avenue toward dynamic resilience classification that may yield valuable information about working personnel for industries such as defense and elite sport. However, this measure classifies dynamic resilience based upon in-task performance rather than self-regulating cognitive structures; thereby, lacking any supported self-regulating cognitive links to the dynamic resilience framework. Vagally mediated heart rate variability (vmHRV) parameters are potential physiological measures that may offer an opportunity to link self-regulating cognitive structures to dynamic resilience given their supported connection to the self-regulation of stress. This study examines if dynamic resilience classifications reveal significant differences in vagal reactivity between higher, moderate and lower dynamic resilience groups, as participants engage in a dynamic, decision-making task. An amended Three Rs paradigm was implemented that examined vagal reactivity across six concurrent vmHRV reactivity segments consisting of lower and higher task load. Overall, the results supported significant differences between higher and moderate dynamic resilience groups' vagal reactivity but rejected significant differences between the lower dynamic resilience group. Additionally, differences in vagal reactivity across vmHRV reactivity segments within an amended Three Rs paradigm were partially supported. Together, these findings offer support toward linking dynamic resilience to temporal self-regulating cognitive structures that play a role in mediating physiological adaptations during task engagement.

The relationship between resilience and neurophysiological stress in Special Operations Forces combat service members

Military resilience research is increasing due to the growing literature associating resilience with stress adaptation. This study aimed to investigate which physiological stress adaptation components were associated with resilience in Special Operations Forces combat service members. Special Operations Forces combat service members (n = 117) self-reported resilience (ER89) and lifetime clinician-confirmed mild traumatic brain injury history. Participants also underwent transcranial Doppler ultrasonography to measure middle cerebral artery velocity during rest and a breath-holding task. Neither resilience nor mild traumatic brain injury history was significantly associated with middle cerebral artery velocity percent increase following breath-holding; younger Special Operations Forces combat service members had a higher percent increase in middle cerebral artery velocity following a breath-holding task. Resilience was negatively associated with time to return to baseline middle cerebral artery velocity following peak velocity; whereas, mild traumatic brain injury history did not have a significant association. The Special Operations Forces combat service members that scored higher in resilience tended to return to baseline middle cerebral artery velocity following peak velocity faster than their less resilient counterparts. More resilient Special Operations Forces combat service members recovered faster from physiological stress (breath-holding) than less resilient counterparts. This is the first study to investigate resilience and cerebrovascular stress response and recovery in this population. Our initial findings indicated that the Ego Resiliency Scale may be an optimal resilience psychometric and should be used to evaluate effective military resilience trainings, which aim to improve performance and mental health.

Heart Rate Variability Indices as Possible Biomarkers for the Severity of Post-traumatic Stress Disorder Following Pregnancy Loss

Background: Psychological distress, such as posttraumatic stress disorder (PTSD), is commonly evaluated using subjective questionnaires, a method prone to self-report bias. The study's working hypothesis was that levels of autonomic dysfunction determined by heart rate variability (HRV) measures are associated with the severity of PTSD in women following pregnancy loss. Methods: This was an observational prospective cohort study with 53 patients enrolled. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) PTSD scale (PCL-5) was used to assess the severity of PTSD in women after pregnancy loss. The cardiac autonomic function was assessed using HRV measurements during a deep breathing test using an HRV scanner system with wireless ECG enabling real-time data analysis and visualization. HRV measures were: standard deviation (SD) of normal R-R wave intervals [SDNN, ms], square root of the mean of the sum of the squares of differences between adjacent normal R wave intervals [RMSSD, ms], and the number of all R-R intervals in which the change in consecutive normal sinus intervals exceeds 50 milliseconds divided by the total number of R-R intervals measured [pNN50 = (NN50/n-1)^*100%] [pNN50%]. Results: The PCL-5 scores had a statistically significant association with HRV indices (SDNN; RMSSD, and pNN50%). Patients with PTSD had similar mean heart rate values as compared to patients without PTSD (PCL-5), but significantly higher SDNN [median[IQR, interquartile range]: 90.1 (69.1-112.1) vs. 52.5 (36.8-65.6)], RMSSD [59.4 (37.5-74.9) vs. 31.9 (19.3 - 44.0)], and PNN50% values [25.7 (16.4-37.7) vs. 10.6 (1.5-21.9)]. The SDNN of the deep breathing test HRV was effective at distinguishing between patients with PTSD and those without, with an AUC = 0.83 +/- 0.06 (95 % CI 0.94, p = 0.0001) of the ROC model. Conclusions: In this study, HRV indices as biomarkers of cardiac dysautonomia were found to be significantly related to the severity of PTSD symptoms in women after pregnancy loss.

The Stress of Caring-Resilience and HPA-Axis Activity in Hair Samples of Youth Residential Caregivers

Background: Professional caregivers in youth residential care institutions experience frequent verbal and physical aggression as well as multiple stressors as part of their everyday work, leading to high levels of burnout and staff turnover. Resilience might buffer against psychophysiological stress response and therefore be crucial for well-being in professional caregivers. Objectives: We aimed to investigate if measures related to resilience [sense of coherence (SoC), self-efficacy and self-care] and attachment security of caregivers were cross-sectionally associated with stress markers in hair samples [cortisol and dehydroepiandrosterone (DHEA)]. Method: Participants (n = 134; 64.2% women) reported on individual resilience measures and provided hair samples for cortisol and DHEA assays. Attachment was assessed in a subsample using the Adult Attachment Projective Picture System (AAP, n = 69). Linear regression models were fitted to estimate the association between resilience measures and the Cortisol:DHEA ratio, cortisol and DHEA, controlling for gender and age. Results: SoC was associated with a lower Cortisol:DHEA ratio (β = -0.36, p < 0.001), driven by a positive association between SoC and DHEA levels (β = 0.28, p = 0.002). Self-care was also associated with lower Cortisol:DHEA ratios (β = -0.24, p = 0.005), due to self-care being associated with higher DHEA (β = 0.21, p = 0.016). HPA-axis measures were not associated with self-efficacy nor with attachment patterns in a subsample. Conclusions: Our findings imply that youth residential care institutions might benefit from programs focusing on enhancing SoC and self-care practices. Fostering a meaningful, comprehensible and manageable professional climate in caregiving environments and implementing self-care in routine practices might enhance not only well-being but also physical health of professional caregivers and in this way buffer adverse health effects of chronic stressors.

Locomotion in virtual environments predicts cardiovascular responsiveness to subsequent stressful challenges

Individuals differ in their physiological responsiveness to stressful challenges, and stress potentiates the development of many diseases. Heart rate variability (HRV), a measure of cardiac vagal break, is emerging as a strong index of physiological stress vulnerability. Thus, it is important to develop tools that identify predictive markers of individual differences in HRV responsiveness without exposing subjects to high stress. Here, using machine learning approaches, we show the strong predictive power of high-dimensional locomotor responses during novelty exploration to predict HRV responsiveness during stress exposure. Locomotor responses are collected in two ecologically valid virtual reality scenarios inspired by the animal literature and stress is elicited and measured in a third threatening virtual scenario. Our model's predictions generalize to other stressful challenges and outperforms other stress prediction instruments, such as anxiety questionnaires. Our study paves the way for the development of behavioral digital phenotyping tools for early detection of stress-vulnerable individuals.

Do Dehydroepiandrosterone (DHEA) and Its Sulfate (DHEAS) Play a Role in the Stress Response in Domestic Animals?

In animal husbandry, stress is often associated with poor health and welfare. Stress occurs when a physiological control system detects a state of real or presumptive threat to the animal's homeostasis or a failure to control a fitness-critical variable. The definition of stress has mostly relied on glucocorticoids measurement, even though glucocorticoids represent one stress-response system, the hypothalamus-pituitary-adrenocortical axis, which is not precise enough as it is also related to metabolic regulation and activated in non-stressful situations (pleasure, excitement, and arousal). The mammal adrenal can synthesize the androgenic steroid dehydroepiandrosterone (DHEA) and its sulfate metabolite (DHEAS), which have been associated to the stress response in several studies performed mostly in humans and laboratory animals. Although the functions of these steroids are not fully understood, available data suggest their antagonistic effects on glucocorticoids and, in humans, their secretion is affected by stress. This review explores the scientific literature on DHEA and DHEAS release in domestic animals in response to stressors of different nature (inflammatory, physical, or social) and duration, and the extra-adrenal contribution to circulating DHEA. Then, the potential use of DHEA in conjunction with cortisol to improve the definition of the stress phenotype in farmed animals is discussed. Although the focus of this review is on farmed animals, examples from other species are reported when available.

Therapeutic psychological and biological responses to mindfulness-based art therapy

Stress and anxiety pose a threat to college students' academic performance as well as their long-term mental and physical health, but the time constraints of a rigorous academic schedule make it difficult to offer even brief mental health interventions. A convenience sample of full-time students at a public university was recruited for a 5-week study conducted mostly using an online platform. Participants were randomly assigned to a Mindfulness-Based Art Therapy (MBAT) intervention or a Neutral Clay Task (NCT). Anxiety, perceived stress, and salivary cortisol outcomes were measured. A total of n = 77 participants completed the study. The MBAT group experienced significant reductions in anxiety and perceived stress compared to the NCT group. Significant reductions in salivary cortisol were observed, but only time could be identified as a confounding variable. Art making alone is not enough to induce significant positive responses, but this study suggests MBAT can, and that an online intervention could offer feasible and accessible mental health services on college campuses. Further refinement of biological data collection and analysis is needed to determine what the mediating effects MBAT could have, if any, at the molecular level.

Parsing inter- and intra-individual variability in key nervous system mechanisms of stress responsivity and across functional domains

Exposure to stressful events is omnipresent in modern human life, yet people show considerable heterogeneity in the impact of stress exposure(s) on their functionality and overall health. Encounter with stressor(s) is counteracted by an intricate repertoire of nervous-system responses. This narrative review starts with a brief summary of the vast evidence that supports heart rate variability, cortisol secretion, and large-scale cortical network interactions as kay physiological, endocrinological, and neural mechanisms of stress responsivity, respectively. The second section highlights potential sources for inter-individual variability in these mechanisms, by focusing on biological, environmental, social, habitual, and psychological factors that may influence stress responsivity patterns and thus contribute to heterogeneity in the impact of stress exposure on functionality and health. The third section introduces intra-individually variability in stress responsivity across functional domains as a novel putative source for heterogeneity in the impact of stress exposure. Challenges and future directions are further discussed. Parsing inter- and intra-individual variability in nervous-system mechanisms of stress responsivity and across functional domains is critical towards potential clinical translation.

Resting high frequency heart rate variability and PTSD symptomatology in Veterans: Effects of respiration, role in elevated heart rate, and extension to spouses

Heart rate variability (HRV) associated with parasympathetic activity (i.e., cardiac vagal tone) is reduced in posttraumatic stress disorder (PTSD), but possible confounding effects of respiration have not been studied sufficiently. Further, reduced parasympathetic inhibition might contribute to elevated heart rate (HR) in PTSD. Finally, reduced HRV in PTSD might extend to intimate partners, given their chronic stress exposure. In 65 couples (male Veterans, female partners), elevated PTSD symptomatology (n = 32; 28 met full DSM IV criteria, 4 fell slightly short) was documented by structured interview and self-reports. Baseline HR, high-frequency HRV (HF-HRV), cardiac pre-ejection period (PEP), and respiration rate and depth were measured via impedance cardiography. Veterans with PTSD symptoms displayed reduced lnHF-HRV, even when adjusting for respiration, but their partners did not. In mediational analyses, elevated resting HR in PTSD was accounted for by lnHF-HRV but not PEP. Results strengthen evidence regarding HF-HRV and elevated HR in PTSD.

Outcomes after traffic injury: mental health comorbidity and relationship with pain interference

BACKGROUND

Mental health symptoms, like depressive mood (DM) and post-traumatic stress (PTS), and pain interference (PI) with daily functioning often co-occur following traffic injury and their comorbidity can complicate recovery. This study aimed to map the course and overlapping trajectories of mental health symptoms, and associations with PI in a traffic injury population.

METHODS

In total, 2019 adults sustaining minor-to-moderate traffic injury were recruited within 28 days post-injury and assessed using phone interviews at 1, 6 and 12-months post-injury. Trajectories of DM, PTS and PI were established and relationships between DM, PTS and PI trajectories were explored using dual trajectory modelling. Bio-psychosocial predictors (e.g. pre-injury health, catastrophizing, acute distress, quality of life, social support) of mental health trajectories were investigated.

RESULTS

Up to five typical post-trauma trajectories were identified for DM, PTS and PI. Most people were in a resilient mental health trajectory (over 60%, DM or PTS), or in a chronic PI trajectory (almost 60%) 12 months post-injury. While recovery/resilient mental health trajectories were strongly interrelated (73.4% joint probability and > 94% conditional probabilities), DM/PTS comorbidity in chronic trajectories was not straightforward, suggesting a possibly asymmetric relationship. That is, persistent DM was more likely associated with persistent PTS (90.4%), than vice versa (31.9%), with a 22.5% probability that persistent PTS was associated with none or milder depression (i.e. following a recovery/resilient DM trajectory). An asymmetrical relationship was also found between mental health and PI. The majority of those with persistent PI were likely to be in a recovery/resilient DM/PTS trajectory (almost 70%), but those in a non-resilient DM/PTS trajectory showed a high risk of persistent PI. Predictors of non-resilient mental health trajectories included poorer pre-injury health and social support, and shared factors like acute psychological distress and pain catastrophizing.

CONCLUSIONS

Strong interrelations were confirmed between mental health symptoms and PI following traffic injury. However, persistent DM was more strongly linked to persistent PTS, than vice versa. Persistent PI was only linked with persistent DM/PTS in vulnerable subgroups. Early psychiatric/psychological interventions should target elevated psychological distress and negative appraisals in vulnerable individuals, to reduce long-term mental health morbidity/comorbidity and PI.

TRIAL REGISTRATION

ACTRN12613000889752.

Hair cortisol as a biomarker of stress and resilience in South African mixed ancestry females

BACKGROUND

Hair cortisol concentrations (HCC) are increasingly used as a biomarker of stress, however limited research exists regarding the relationship between HCC and protective factors, such as resilience. Additionally, studies measuring HCC need to account for possible confounders, and these factors have not been examined in sufficiently diverse settings.

OBJECTIVES

Our objectives were to identify determinants of HCC in a sample of mixed ancestry adults and investigate the association of HCC with measures of self-perceived stress and resilience.

METHODS

Our sample comprised 164 females (mean age 46.5 years, SD = 15.0), self-identifying as mixed ancestry, who were control participants in a case-control study (SHARED ROOTS), conducted in Cape Town, South Africa from May 2014 until June 2017. We examined which socio-demographic, hair related, clinical and behavioural factors were associated with HCC in both unadjusted and adjusted linear regression models. Furthermore, the relationship of HCC with self-perceived stress and resilience scores were also examined.

RESULTS

HCC (Mdn 4.4 pg/ml; IQR 2.8; 11.4) were significantly positively associated with hair product use and breastfeeding, and significantly negatively associated with age, level of education, duration of sun exposure, duration of storage, and demonstrated a trend towards significance with frequency of hair washing, in adjusted models. HCC were inversely associated with CD-RISC scores (adj β = -0.179, p =  0.012) but were not significantly associated with PSS scores (adj β = -0.001, p =  0.989).

CONCLUSIONS

We identified specific determinants of HCC in our sample, including the first indication that sun exposure has an effect on HCC under naturalistic conditions. These potential confounders need to be controlled for in the design and analysis of future studies. HCC may be a biomarker of resilience to stress, rather than perceived stress. Further research measuring HCC in more diverse settings and populations and including constructs related to resilience are needed.

Heart rate variability: Can it serve as a marker of mental health resilience?: Special Section on "Translational and Neuroscience Studies in Affective Disorders" Section Editor, Maria Nobile MD, PhD

BACKGROUND

Stress resilience influences mental well-being and vulnerability to psychiatric disorders. Usually, measurement of resilience is based on subjective reports, susceptible to biases. It justifies the need for objective biological/physiological biomarkers of resilience. One promising candidate as biomarker of mental health resilience (MHR) is heart rate variability (HRV). The evidence for its use was reviewed in this study.

METHODS

We focused on the relationship between HRV (as measured through decomposition of RR intervals from electrocardiogram) and responses to laboratory stressors in individuals without medical and psychiatric diseases. We conducted a bibliographic search of publications in the PubMed for January 2010-September 2018.

RESULTS

Eight studies were included. High vagally mediated HRV before and/or during stressful laboratory tasks was associated with enhanced cognitive resilience to competitive/self-control challenges, appropriate emotional regulation during emotional tasks, and better modulation of cortisol, cardiovascular and inflammatory responses during psychosocial/mental tasks.

LIMITATIONS

All studies were cross-sectional, restricting conclusions that can be made. Most studies included only young participants, with some samples of only males or females, and a limited array of HRV indexes. Ecological validity of stressful laboratory tasks remains unclear.

CONCLUSIONS

Vagally mediated HRV may serve as a global index of an individual's flexibility and adaptability to stressors. This supports the idea of HRV as a plausible, noninvasive, and easily applicable biomarker of MHR. In future longitudinal studies, the implementation of wearable health devices, able to record HRV in naturalistic contexts of real-life, may be a valuable strategy to gain more reliable insight into this topic.

Inflammation in Post-Traumatic Stress Disorder (PTSD): A Review of Potential Correlates of PTSD with a Neurological Perspective

Post-traumatic stress disorder (PTSD) is a chronic condition characterized by symptoms of physiological and psychosocial burden. While growing research demonstrated signs of inflammation in PTSD, specific biomarkers that may be representative of PTSD such as the detailed neural correlates underlying the inflammatory responses in relation to trauma exposure are seldom discussed. Here, we review recent studies that explored alterations in key inflammatory markers in PTSD, as well as neuroimaging-based studies that further investigated signs of inflammation within the brain in PTSD, as to provide a comprehensive summary of recent literature with a neurological perspective. A search was conducted on studies published from 2009 through 2019 in PubMed and Web of Science. Fifty original articles were selected. Major findings included elevated levels of serum proinflammatory cytokines in individuals with PTSD across various trauma types, as compared with those without PTSD. Furthermore, neuroimaging-based studies demonstrated that altered inflammatory markers are associated with structural and functional alterations in brain regions that are responsible for the regulation of stress and emotion, including the amygdala, hippocampus, and frontal cortex. Future studies that utilize both central and peripheral inflammatory markers are warranted to elucidate the underlying neurological pathway of the pathophysiology of PTSD.

A multimethod approach examining the relative contributions of optimism and pessimism to cardiovascular disease risk markers

Although dispositional optimism and pessimism are associated with cardiovascular disease (CVD), their relative independence and unique contributions to CVD risk are unclear. This study addressed these issues by using multiple indicators of optimism and pessimism and linking them to objective risk factors for CVD. A diverse sample of adults (N = 300) completed baseline assessments (including global reports of optimism and pessimism), a 2-day/1-night EMA protocol with ambulatory blood pressure (BP) at 45-min intervals, and had inflammatory markers and carotid intima media imaging collected. EMA reports of momentary positive and negative expectations were averaged to form intraindividual (person) means of optimism and pessimism, respectively. Optimism and pessimism were only modestly correlated between- and within-assessment methods. Higher pessimism, regardless of assessment method, predicted both lower odds of whether BP dipping occurred and a smaller degree of dipping, but was unrelated to other biomarkers. Optimism was not uniquely predictive of CVD risk factors. Pessimism thus appears to exhibit stronger relative contribution to risk indicators of CVD than optimism.

Neurocognitive Mechanism of Human Resilience: A Conceptual Framework and Empirical Review

Resilience is an innate human capacity that holds the key to uncovering why some people rebound after trauma and others never recover. Various theories have debated the mechanisms underlying resilience at the psychological level but have not yet incorporated neurocognitive concepts/findings. In this paper, we put forward the idea that cognitive flexibility moderates how well people adapt to adverse experiences, by shifting attention resources between cognition–emotion regulation and pain perception. We begin with a consensus on definitions and highlight the role of cognitive appraisals in mediating this process. Shared concepts among appraisal theories suggest that cognition–emotion, as well as pain perception, are cognitive mechanisms that underlie how people respond to adversity. Frontal brain circuitry sub-serves control of cognition and emotion, connecting the experience of physical pain. This suggests a substantial overlap between these phenomena. Empirical studies from brain imaging support this notion. We end with a discussion of how the role of the frontal brain network in regulating human resilience, including how the frontal brain network interacts with cognition–emotion–pain perception, can account for cognitive theories and why cognitive flexibilities’ role in these processes can create practical applications, analogous to the resilience process, for the recovery of neural plasticity.

Modelling resilience in adolescence and adversity: a novel framework to inform research and practice

Recent conceptualisations of resilience have advanced the notion that it is a dynamic and multifaceted construct. However, its adaptive components, especially those forged by adversity, have not been fully realised, and its neurobiological and psychosocial underpinnings are yet to be meaningfully integrated. In part, this is because a developmental perspective is often neglected in the formulation of resilience. In this review, we consider the findings of resilience research, with a specific emphasis on the developmental period of adolescence. To bridge the gaps in our current understanding, we propose a model of resilience that is predicated on experiencing adversity. Specifically, our model provides a sophisticated insight into the components of resilience, which, together with intrinsic features, involves facilitation of, and skill acquisition via strengthening processes we term tempering and fortification. The model also points to the potential trajectories of adversity-driven resilience and forms the basis of a framework that allows for individual variance in resilience, and the identification of both neurobiological and psychosocial targets for prevention and therapeutic interventions.

Stress Resilience Measurement With Heart-Rate Variability During Mental And Physical Stress

Stress management is particularly important for healthcare of modern people. In stress research, heart-rate variability (HRV), indicating the change of time intervals in successive heart beats, significantly contributed due to its close relationship with autonomic nervous system. However, the adaptive response to stress, also known as stress resilience, has not been studied much yet. We collected electrocardiogram during mental and physical stress, experimentally designed by mental arithmetic tasks and physical activities for 14 healthy subjects. As a result, we found that resting HRV parameters, particularly associated with the parasympathetic activity, had significant positive correlations with reactivity and recovery from mental and physical stress. These HRV parameters can be used as a measure of stress resilience quantitatively. Our findings suggest that these parameters can help one's stress management by enabling to predict the adaptive response to upcoming stressful events.

Heart Rate Variability Biofeedback Based on Slow-Paced Breathing With Immersive Virtual Reality Nature Scenery

This study investigated the benefits of using a virtual nature environment to administer immersive heart rate variability biofeedback (HRV-BF) based on slow-paced breathing. We compared the virtual reality (VR)-based HRV-BF with a standard implementation in a randomized controlled experiment with 60 healthy employees. After a cognitive stress induction, the participants performed a single-session of HRV-BF before repeating the cognitive stressor task. VR-based versus standard HRV-BF was comparable in terms of biofeedback performance (cardiac coherence and cardiac vagal tone). However, the VR-based implementation buffered perceived stress in the subsequent stressor task, increased relaxation self-efficacy more, reduced mind wandering, helped participants focus on the present moment, and helped preserve attentional resources. Potential long-term effects and generalizability need to be assessed in future research.

Psychological resilience is linked to motor strength and gait endurance in early multiple sclerosis

BACKGROUND

Psychologically resilient persons persist despite obstacles and bounce back after adversity, leading to better outcomes in non-neurologic populations. It is unknown whether psychological resilience relates to objective functional outcomes in multiple sclerosis (MS).

OBJECTIVE

To determine whether psychological resilience explains differential objective cognitive and motor functioning in persons with early MS.

METHODS

Psychological resilience was assessed in 185 patients with early MS and 50 matched healthy controls with the Connors-Davidson Resilience Scale (CDRS-10). Subjects completed the MS Functional Composite (MSFC) and a comprehensive neurobehavioral evaluation. Correlations assessed links between CDRS-10 and MSFC, motor indices (Total, Fine Motor, Gross Motor), and cognitive indices (Total, Cognitive Efficiency, Memory).

RESULTS

Higher CDRS-10 among patients was linked to better MSFC and motor outcomes (but not cognition), with the most robust relationships for gross motor function (grip strength, gait endurance). Findings were independent of mood and fatigue. CDRS-10 was unrelated to MS disease burden. CDRS-10 was also specifically linked to motor outcomes in healthy controls.

CONCLUSION

Functional outcomes vary across persons with MS, even when disease burden and neurologic disability are low. These findings identify high psychological resilience as a non-disease-specific contributor to motor strength and endurance, which may explain differential outcomes across patients.

Resilient Phenotype in Chronic Mild Stress Paradigm Is Associated with Altered Expression Levels of miR-18a-5p and Serotonin 5-HT1a Receptor in Dorsal Part of the Hippocampus

Disturbed serotonergic signaling in the hippocampus observed in many individuals vulnerable to stress has been suggested as one of the primary factors contributing to the development of depression. However, little is known about the physiology of the brain in the resilient phenotype. Resilient subjects maintain a positive mood and psychological balance despite being under the stress influence. In our study, we generated stress-vulnerable and resilient rats by using a chronic mild stress (CMS) paradigm. Using different molecular approaches, we revealed that resilient animals exhibited a significantly decreased expression level of miR-18a-5p and, in the same time, an elevated level of 5-HT1AR in dorsal, but not ventral, part of the hippocampus. Described biochemical changes were not observed in animals behaviorally vulnerable to stress. Further, in vitro analysis showed that miR-18a-5p may be a negative epigenetic regulator of 5-HT1AR since the treatment of adult hippocampal neurons with miR-18a-5p mimic significantly lowered the expression level of mRNA encoding 5-HT1AR. Moreover, bioinformatic analysis of potential target genes expressed in the hippocampus and being regulated by miR-18a-5p showed that this microRNA may regulate biological processes, such as axonogenesis, which are important in the functioning of the hippocampus in both rats and humans. All these molecular features may contribute to serotonergic homeostatic balance at the level of serotonin turnover observed in hippocampi of resilient but not stress-vulnerable rats. Delineation of further molecular and biochemical markers underlying resilience to stress may contribute to the development of new antidepressant strategies which will restore resilient phenotype in depressed patients.

Resilience as a protective factor in pregnancy and puerperium: Its relationship with the psychological state, and with Hair Cortisol Concentrations

PURPOSE

Stress is considered an important risk factor for the physical and psychological health of pregnant women. Hence, it is very important to study those protective factors that attenuate the negative effects of stress, such as resilience. The objective of this study was to verify the role of resilience as a stress-reducing factor during pregnancy.

METHODS

A total of 151 pregnant women were assessed in this study: high resilience (n = 55) and low resilience (n = 96). Assessment consisted on perceived stress, pregnancy-specific stress, psychopathological symptoms, psychological wellbeing and Hair Cortisol Concentrations (HCC) during the third trimester of pregnancy and the puerperium, as well as postpartum depression.

RESULTS

The results show that there were statistically significant differences between women with high and low resilience in: perceived stress [F (1,150) = 8.40; p = .005)], HCC [F (1,150) = 9.70; p = .002], pregnancy-specific stress [F (1,150) = 9.62; p = .002], and various subscales of psychopathological symptoms. Specifically, women with high resilience had lower levels of perceived stress, pregnancy-specific stress, psychopathological symptoms, psychological wellbeing, and Hair Cortisol Concentrations during the third trimester. During the puerperium, women in the high resilience group showed higher psychological wellbeing, lower psychopathological symptoms, and lower postpartum depression scores.

CONCLUSIONS

These results highlight the protective role of resilience when pregnant women are confronted by the negative effects of stress, and therefore the potential utility of resilience to improve the health of pregnant women and their neonates.

Biomarkers of autonomic regulation for predicting psychological distress and functional recovery following road traffic injuries: protocol for a prospective cohort study

INTRODUCTION

Psychological distress is a prevalent condition often overlooked following a motor vehicle crash (MVC), particularly when injuries are not severe. The aim of this study is to examine whether biomarkers of autonomic regulation alone or in combination with other factors assessed shortly after MVC could predict risk of elevated psychological distress and poor functional recovery in the long term, and clarify links between mental and physical health consequences of traffic injury.

METHODS AND ANALYSIS

This is a controlled longitudinal cohort study, with follow-up occurring at 3, 6 and 12 months. Participants include up to 120 mild to moderately injured MVC survivors who consecutively present to the emergency departments of two hospitals in Sydney and who agree to participate, and a group of up to 120 non-MVC controls, recruited with matched demographic characteristics, for comparison. WHO International Classification of Functioning is used as the framework for study assessment. The primary outcomes are the development of psychological distress (depressive mood and anxiety, post-traumatic stress symptoms, driving phobia, adjustment disorder) and biomarkers of autonomic regulation. Secondary outcomes include indicators of physical health (presence of pain/fatigue, physical functioning) and functional recovery (quality of life, return to function, participation) as well as measures of emotional and cognitive functioning. For each outcome, risk will be described by the frequency of occurrence over the 12 months, and pathways determined via latent class mixture growth modelling. Regression models will be used to identify best predictors/biomarkers and to study associations between mental and physical health.

ETHICS AND DISSEMINATION

Ethical approvals were obtained from the Sydney Local Health District and the research sites Ethics Committees. Study findings will be disseminated to health professionals, related policy makers and the community through peer-reviewed journals, conference presentations and health forums.

TRIAL REGISTRATION NUMBER

ACTRN12616001445460.

Greater Lifetime Stress Exposure Predicts Blunted Cortisol but Heightened DHEA Responses to Acute Stress

Although prior research has examined how early adversity and chronic stress exposure relate to hypothalamic-pituitary-adrenal (HPA) axis responses to acute stress, to date, no studies have examined how stressors occurring over the entire lifespan predict such responses. To address this issue, we recruited 61 healthy young adults and measured their exposure to 55 different types of acute life events and chronic difficulties occurring over the lifespan. In addition, we characterized differences in participants' HPA axis responses to acute stress by measuring their salivary cortisol and DHEA responses to the Trier Social Stress Test for Groups. Greater cumulative stress exposure was associated with a blunted cortisol response, but a heightened DHEA response, to the acute stressor. Moreover, it was participants' exposure to these stressors (i.e., lifetime count), not their perceived severity, which predicted their cortisol and DHEA responses to acute stress. Furthermore, differential effects were observed by stress exposure domain. Notably, only adulthood and marital/partner stressors significantly predicted cortisol responses to acute stress, whereas stress was more uniformly associated with DHEA responses to the acute stressor. These results thus reveal how cumulative stress exposure is associated with HPA axis responsivity to acute stress, while highlighting the fact that different stressors may have substantially different associations with these biological outcomes.

Habituation of the electrodermal response - A biological correlate of resilience?

Current approaches to quantifying resilience make extensive use of self-reported data. Problematically, this type of scales is plagued by response distortions–both deliberate and unintentional, particularly in occupational populations. The aim of the current study was to develop an objective index of resilience. The study was conducted in 30 young healthy adults. Following completion of the Connor-Davidson Resilience Scale (CD-RISC) and Depression/Anxiety/Stress Scale (DASS), they were subjected to a series of 15 acoustic startle stimuli (95 dB, 50 ms) presented at random intervals, with respiration, skin conductance and ECG recorded. As expected, resilience (CD-RISC) significantly and negatively correlated with all three DASS subscales–Depression (r = -0.66, p<0.0001), Anxiety (r = -0.50, p<0.005) and Stress (r = -0.48, p<0.005). Acoustic stimuli consistently provoked transient skin conductance (SC) responses, with SC slopes indexing response habituation. This slope significantly and positively correlated with DASS-Depression (r = 0.59, p<0.005), DASS-Anxiety (r = 0.35, p<0.05) and DASS-Total (r = 0.50, p<0.005) scores, and negatively with resilience score (r = -0.47; p = 0.006), indicating that high-resilience individuals are characterized by steeper habituation slopes compared to low-resilience individuals. Our key finding of the connection between habituation of the skin conductance responses to repeated acoustic startle stimulus and resilience-related psychometric constructs suggests that response habituation paradigm has the potential to characterize important attributes of cognitive fitness and well-being–such as depression, anxiety and resilience. With steep negative slopes reflecting faster habituation, lower depression/anxiety and higher resilience, and slower or no habituation characterizing less resilient individuals, this protocol may offer a distortion-free method for objective assessment and monitoring of psychological resilience.

Victims of War: Dehydroepiandrosterone Concentrations in Hair and Their Associations with Trauma Sequelae in Palestinian Adolescents Living in the West Bank

Due to its anti-glucocorticoid properties, the steroid hormone dehydroepiandrosterone (DHEA) might play a role for coping with traumatic stress and posttraumatic stress disorder (PTSD). The majority of studies report elevated DHEA secretion and decreased cortisol/DHEA ratio associated with traumatic stress, however, contrasting results have also been published. One reason for this heterogeneity might be that in past studies, DHEA has been measured in plasma or saliva samples reflecting acute hormone levels. In comparison, the current study assessed the hair levels of DHEA and cortisol as long-term markers along with self-reported data on psychopathology and coping in 92 female adolescents aged 11–16 from the West Bank affected by the Israeli–Palestinian conflict. Results showed that trauma-exposed individuals had significantly higher DHEA levels (p = 0.013) and lower cortisol/DHEA ratios (p = 0.036) than participants from the non-trauma group. Furthermore, DHEA and cortisol/DHEA ratio emerged as associated with trauma load and timing, but not with coping. By applying the novel method of DHEA analysis from hair samples, this study adds to the growing literature on the interplay of DHEA, cortisol, traumatic stress and coping, and provides valuable starting points for further research.

The Differential Effect of Ego-Resiliency on the Relationship between Emotional Labor and Salivary Cortisol Level in Bank Clerks

Elevated stress levels in emotional laborers has been documented in a number of studies. To minimize the negative effects of stress, the need to examine potential protective factors has been highlighted. The primary purpose of this study was to investigate the differential moderating effect of ego-resiliency on the relationship between emotional labor and salivary cortisol level by comparing two groups of bank clerks deemed to experience different degree of emotional labor. Twenty-four bank clerks working in regional branch offices who provided face-to-face customer service (customer service group) and 33 administrative-duty bank clerks who work without face-to-face customer service (administrative work group) were recruited to participate in the study. Participants were asked to draw saliva into a specimen tube at an identical time during a work day and complete self-report scales measuring emotional labor and ego-resiliency. Hierarchical multiple regression analyses were conducted to examine the interaction effect of ego-resiliency on the relationship between emotional labor and salivary cortisol level by controlling for gender, age and education level as covariates. The results demonstrated that the degree of emotional labor reported by the customer service group was higher than that of the administrative work group. Furthermore, ego-resiliency moderated the relationship between emotional labor and cortisol levels in the customer service group but not in the administrative work group. The implications and limitations of this study are discussed along with suggestions for future research.

A Systematic Review of Genetic Influence on Psychological Resilience

When exposed to adversity, some individuals are at an increased risk of posttraumatic stress disorder, experiencing persistent biopsychosocial disturbances, whereas others adapt well, described as resilience. Resilience is a complex biopsychosocial phenomenon conceptualized as adaptation to adversity influenced by an individual’s genetic variants, epistasis, epigenetics, and gene-by-environment interactions. Studies on psychological resilience have focused on behavioral and psychosocial variables with far less examination of the genetic contributions. The purpose of this review is to identify specific genetic variants contributing to the biological capacity for psychological resilience. PubMed and PsycINFO were searched using the following key words: psychological resilience AND genotype(s). Additional articles were identified from the Human Genome Epidemiology Navigator using the term resilience, psychological. Ten studies met the criteria. Six genes were empirically associated with psychological resilience: serotonin-transporter-linked polymorphic region ( 5-HTTLPR), dopamine receptor D4, brain-derived neurotrophic factor ( BDNF), corticotropin-releasing hormone receptor 1, oxytocin receptor and regulator of G-protein signaling 2 . The findings of this systematic review suggest that the L/L or L’/L’ genotype of 5-HTTLPR and rs25531 in children/adolescents and the S/S or S’/S’ genotype in adults are most frequently related to resilience. Additionally, the Val/Val genotype of rs6265 in BDNF in Caucasians was also associated with resilience. There are numerous factors contributing to the complexity of determining the genetic influence on resilience including analysis of rs25531, assumptions of the mode of inheritance, operationalization of resilience, demographic and population characteristics, sample size, and other types of genetic influence including epistasis and epigenetics. While current evidence is supportive, further investigation of the genetic influence on resilience is required.