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Yan S, Xu R, Stratton TD, Kavcic V, Luo D, Hou F, Bi F, Jiao R, Song K, Jiang Y. Sex differences and psychological stress: responses to the COVID-19 pandemic in China. BMC Public Health 2021; 21:79. [PMID: 33413224 DOI: 10.1101/2020.04.29.20084061] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/16/2020] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND About 83,000 COVID-19 patients were confirmed in China up to May 2020. Amid the well-documented threats to physical health, the effects of this public health crisis - and the varied efforts to contain its spread - have altered individuals' "normal" daily functioning. These impacts on social, psychological, and emotional well-being remain relatively unexplored - in particular, the ways in which Chinese men and women experience and respond to potential behavioral stressors. Our study investigated sex differences in psychological stress, emotional reactions, and behavioral responses to COVID-19 and related threats among Chinese residents. METHODS In late February (2020), an anonymous online questionnaire was disseminated via WeChat, a popular social media platform in China. The cross-sectional study utilized a non-probabilistic "snowball" or convenience sampling of residents from various provinces and regions of China. Basic demographic characteristics (e.g., age and gender) - along with residential living arrangements and conditions - were measured along with psychological stress and emotional responses to the COVID-19 pandemic. RESULTS Three thousand eighty-eight questionnaires were returned: 1749 females (56.6%) and 1339 males (43.4%). The mean stress level,as measured by a visual analog scale, was 3.4 (SD = 2.4) - but differed significantly by sex. Besides sex, factors positively associated with stress included: age (< 45 years), employment (unsteady income, unemployed), risk of infection (exposureto COVID-19, completed medical observation), difficulties encountered (diseases, work/study, financial, mental), and related behaviors (higher desire for COVID-19 knowledge, more time concerning on the COVID-19 outbreak). "Protective" factors included frequent contact with colleagues, calmness of mood comparing with the pre-pandemic, and psychological resilience. Males and females also differed significantly in adapting to current living/working, conditions, responding to run a fever, and needing psychological support services. CONCLUSIONS The self-reported stress of Chinese residents related to the COVID-19 pandemic was significantly related to sex, age, employment, resilience and coping styles. Future responses to such public health threats may wish to provide sex- and/or age-appropriate supports for psychological health and emotional well-being to those at greatest risk of experiencing stress.
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Affiliation(s)
- Shiyan Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Rui Xu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
| | - Terry D Stratton
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, 40536, USA
| | - Voyko Kavcic
- Institute of Gerontology, Wayne State University, Detroit, MI, 48202, USA
| | - Dan Luo
- School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Fengsu Hou
- Shenzhen Kangning Hospital, Guangzhou, 518020, China
| | - Fengying Bi
- School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Rong Jiao
- The First Clinical College, Hainan Meidical University, Haikou, 570100, China
| | - Kangxing Song
- The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Yang Jiang
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, 40536, USA
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152
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Yan S, Xu R, Stratton TD, Kavcic V, Luo D, Hou F, Bi F, Jiao R, Song K, Jiang Y. Sex differences and psychological stress: responses to the COVID-19 pandemic in China. BMC Public Health 2021; 21:79. [PMID: 33413224 PMCID: PMC7789895 DOI: 10.1186/s12889-020-10085-w] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/16/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND About 83,000 COVID-19 patients were confirmed in China up to May 2020. Amid the well-documented threats to physical health, the effects of this public health crisis - and the varied efforts to contain its spread - have altered individuals' "normal" daily functioning. These impacts on social, psychological, and emotional well-being remain relatively unexplored - in particular, the ways in which Chinese men and women experience and respond to potential behavioral stressors. Our study investigated sex differences in psychological stress, emotional reactions, and behavioral responses to COVID-19 and related threats among Chinese residents. METHODS In late February (2020), an anonymous online questionnaire was disseminated via WeChat, a popular social media platform in China. The cross-sectional study utilized a non-probabilistic "snowball" or convenience sampling of residents from various provinces and regions of China. Basic demographic characteristics (e.g., age and gender) - along with residential living arrangements and conditions - were measured along with psychological stress and emotional responses to the COVID-19 pandemic. RESULTS Three thousand eighty-eight questionnaires were returned: 1749 females (56.6%) and 1339 males (43.4%). The mean stress level,as measured by a visual analog scale, was 3.4 (SD = 2.4) - but differed significantly by sex. Besides sex, factors positively associated with stress included: age (< 45 years), employment (unsteady income, unemployed), risk of infection (exposureto COVID-19, completed medical observation), difficulties encountered (diseases, work/study, financial, mental), and related behaviors (higher desire for COVID-19 knowledge, more time concerning on the COVID-19 outbreak). "Protective" factors included frequent contact with colleagues, calmness of mood comparing with the pre-pandemic, and psychological resilience. Males and females also differed significantly in adapting to current living/working, conditions, responding to run a fever, and needing psychological support services. CONCLUSIONS The self-reported stress of Chinese residents related to the COVID-19 pandemic was significantly related to sex, age, employment, resilience and coping styles. Future responses to such public health threats may wish to provide sex- and/or age-appropriate supports for psychological health and emotional well-being to those at greatest risk of experiencing stress.
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Affiliation(s)
- Shiyan Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Rui Xu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
| | - Terry D Stratton
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, 40536, USA
| | - Voyko Kavcic
- Institute of Gerontology, Wayne State University, Detroit, MI, 48202, USA
| | - Dan Luo
- School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Fengsu Hou
- Shenzhen Kangning Hospital, Guangzhou, 518020, China
| | - Fengying Bi
- School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Rong Jiao
- The First Clinical College, Hainan Meidical University, Haikou, 570100, China
| | - Kangxing Song
- The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Yang Jiang
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, 40536, USA
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153
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McLoughlin E, Fletcher D, Slavich GM, Arnold R, Moore LJ. Cumulative lifetime stress exposure, depression, anxiety, and well-being in elite athletes: A mixed-method study. PSYCHOLOGY OF SPORT AND EXERCISE 2021; 52:101823. [PMID: 33281503 PMCID: PMC7710337 DOI: 10.1016/j.psychsport.2020.101823] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Research suggests that elite athletes are at increased risk of poor mental health, partly due to the intense demands associated with top-level sport. Despite growing interest in the topic, the factors that influence the mental health and well-being of elite athletes remain unclear. From a theoretical perspective, the accumulation of stress and adversity experienced over the life course may be an important factor. To investigate this possibility, we employed a mixed-method design to: (a) examine whether cumulative lifetime stress predicted depression, anxiety, and well-being in elite athletes; and (b) help explain why cumulative lifetime stress exposure might have resulted in poor mental health and well-being. Ninety-five elite athletes (M age = 29.81, SD = 10.88) completed the Stress and Adversity Inventory, Patient Health Questionnaire, Generalized Anxiety Disorder 7-item scale, and the Scales of General Well-Being. Hierarchical regression analyses revealed that total count and severity of lifetime stressor exposure significantly predicted greater depression (β = .42, p < .001; β = .46, p < .001) and anxiety symptoms (β = .34, p = .003; β = .28, p = .018), and worse well-being (β = -.42, p < .001; β = -.30, p = .015). Semi-structured interviews were then conducted with six athletes. Thematic analysis revealed that cumulative lifetime stress exposure fostered poor mental health and well-being by promoting maladaptive long-term coping strategies, increasing susceptibility to future stress, and limiting interpersonal relationships. We believe these findings can help practitioners identify, and intervene accordingly with, elite athletes at risk of experiencing stress-related mental health problems.
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Affiliation(s)
- Ella McLoughlin
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
- Corresponding author. Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom. (E. McLoughlin)
| | - David Fletcher
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
| | - George M. Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Rachel Arnold
- Department for Health, University of Bath, United Kingdom
| | - Lee J. Moore
- Department for Health, University of Bath, United Kingdom
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154
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Gilbert P. Compassion: From Its Evolution to a Psychotherapy. Front Psychol 2020; 11:586161. [PMID: 33362650 PMCID: PMC7762265 DOI: 10.3389/fpsyg.2020.586161] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022] Open
Abstract
The concept, benefits and recommendations for the cultivation of compassion have been recognized in the contemplative traditions for thousands of years. In the last 30 years or so, the study of compassion has revealed it to have major physiological and psychological effects influencing well-being, addressing mental health difficulties, and promoting prosocial behavior. This paper outlines an evolution informed biopsychosocial, multicomponent model to caring behavior and its derivative "compassion" that underpins newer approaches to psychotherapy. The paper explores the origins of caring motives and the nature and biopsychosocial functions of caring-attachment behavior. These include providing a secure base (sources of protection, validation, encouragement and guidance) and safe haven (source of soothing and comfort) for offspring along with physiological regulating functions, which are also central for compassion focused therapy. Second, it suggests that it is the way recent human cognitive competencies give rise to different types of "mind awareness" and "knowing intentionality" that transform basic caring motives into potentials for compassion. While we can care for our gardens and treasured objects, the concept of compassion is only used for sentient beings who can "suffer." As psychotherapy addresses mental suffering, cultivating the motives and competencies of compassion to self and others can be a central focus for psychotherapy.
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Affiliation(s)
- Paul Gilbert
- Centre for Compassion Research and Training, College of Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
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155
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Yue JL, Yan W, Sun YK, Yuan K, Su SZ, Han Y, Ravindran AV, Kosten T, Everall I, Davey CG, Bullmore E, Kawakami N, Barbui C, Thornicroft G, Lund C, Lin X, Liu L, Shi L, Shi J, Ran MS, Bao YP, Lu L. Mental health services for infectious disease outbreaks including COVID-19: a rapid systematic review. Psychol Med 2020; 50:2498-2513. [PMID: 33148347 PMCID: PMC7642960 DOI: 10.1017/s0033291720003888] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/05/2020] [Accepted: 09/28/2020] [Indexed: 12/27/2022]
Abstract
The upsurge in the number of people affected by the COVID-19 is likely to lead to increased rates of emotional trauma and mental illnesses. This article systematically reviewed the available data on the benefits of interventions to reduce adverse mental health sequelae of infectious disease outbreaks, and to offer guidance for mental health service responses to infectious disease pandemic. PubMed, Web of Science, Embase, PsycINFO, WHO Global Research Database on infectious disease, and the preprint server medRxiv were searched. Of 4278 reports identified, 32 were included in this review. Most articles of psychological interventions were implemented to address the impact of COVID-19 pandemic, followed by Ebola, SARS, and MERS for multiple vulnerable populations. Increasing mental health literacy of the public is vital to prevent the mental health crisis under the COVID-19 pandemic. Group-based cognitive behavioral therapy, psychological first aid, community-based psychosocial arts program, and other culturally adapted interventions were reported as being effective against the mental health impacts of COVID-19, Ebola, and SARS. Culturally-adapted, cost-effective, and accessible strategies integrated into the public health emergency response and established medical systems at the local and national levels are likely to be an effective option to enhance mental health response capacity for the current and for future infectious disease outbreaks. Tele-mental healthcare services were key central components of stepped care for both infectious disease outbreak management and routine support; however, the usefulness and limitations of remote health delivery should also be recognized.
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Affiliation(s)
- Jing-Li Yue
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Wei Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yan-Kun Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Kai Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Si-Zhen Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ying Han
- National Institute on Drug Dependence, Peking University, Beijing, China
| | | | - Thomas Kosten
- Division of Alcohol and Addiction Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Ian Everall
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Bullmore
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Research and Development, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Xiao Lin
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Lin Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jie Shi
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
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156
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Epel ES. The geroscience agenda: Toxic stress, hormetic stress, and the rate of aging. Ageing Res Rev 2020; 63:101167. [PMID: 32979553 PMCID: PMC7520385 DOI: 10.1016/j.arr.2020.101167] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
Geroscience offers a counterpoint to the challenged pursuit of curing diseases of aging, by focusing on slowing the biological aging process for extended healthspan earlier in life. Remarkable progress has led this field toward animal trials and the next challenge lies with translation to humans. There is an emerging number of small human trials that can take advantage of new models integrating behavioral and social factors. Understanding dynamic aging mechanisms, given the powerful social determinants of aging (Crimmins, 2020) and human variability and environmental contexts (Moffitt, 2020), will be critical. Behavioral and social factors are intrinsic to aging. Toxic stressors broadly defined can lead to stress-acceleration of aging, either directly impacting aging processes or by shaping poor behavioral health, and underlie the socioeconomic disparities of aging. In contrast, hormetic stressors, acute intermittent stressors of moderate intensity, can produce stress resilience, the ability for quick recovery and possibly rejuvenation of cells and tissues. Although health research usually examines static biomarkers, aging is reflected in dynamic ability to recover from challenges pointing to new interventions and targets for examining mechanisms. A fuller model incorporating stress resilience provides innovative biobehavioral interventions, both for bolstering response to challenges, such as COVID-19, and for improving healthspan.
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Affiliation(s)
- Elissa S Epel
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, & Center for Health and Community, University of California, 3333 California St, Ste 465, San Francisco, CA, 94122, United States.
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157
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Malat J, Johns-Wolfe E, Smith T, Shields GS, Jacquez F, Slavich GM. Associations between lifetime stress exposure, race, and first-birth intendedness in the United States. J Health Psychol 2020; 27:765-777. [PMID: 33111552 DOI: 10.1177/1359105320963210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This study examined how lifetime stress exposure and race are associated with first-birth intendedness, and whether these associations differ based on stress exposure timing. Greater lifetime stress exposure was related to increased first-birth intendedness for black women but was unrelated or even associated with decreased first-birth intendedness for white women, depending on stress exposure timing. These effects were robust while controlling for age, partner status, household income, and education, and they differed based on the timing of participants' stress exposure. These data thus provide evidence that first-birth intendedness is influenced by both lifetime stress exposure and race in the United States.
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158
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Nelson B, Kaminsky DB. COVID-19's multipronged attack on mental health: Months of uncertainty and threats to health, social, and financial security have contributed to intense anxiety, depression, posttraumatic stress disorder, and even suicide. Here, in part 2 of a 2-part series, we investigate the pandemic's growing mental health toll on the general public and efforts to address it. Cancer Cytopathol 2020; 128:679-680. [PMID: 33006815 PMCID: PMC7537285 DOI: 10.1002/cncy.22364] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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159
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Uchino BN, Rook KS. Emotions, relationships, health and illness into old age. Maturitas 2020; 139:42-48. [PMID: 32747039 PMCID: PMC7403529 DOI: 10.1016/j.maturitas.2020.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 02/06/2023]
Abstract
There is strong evidence linking relationships and emotions to physical health outcomes. What is critically missing is a more comprehensive understanding of how these important psychosocial factors influence disease over the lifespan. In this narrative review, existing lifespan models of social support and emotion regulation are reviewed and integrated into a general conceptual framework in the health domain. This integrated model takes into account bidirectional links between relationships and emotions, as well as health behaviors, biological pathways, and health. Evidence is consistent with the utility of an integrative model attempting to understand its links to health-relevant pathways and outcomes in older adults. Future work that examines multiple pathways using prospective designs will be necessary for this work to reach its full potential, including intervention and policy opportunities.
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Affiliation(s)
- Bert N Uchino
- Department of Psychology and Health Psychology Program, University of Utah, United States.
| | - Karen S Rook
- Department of Psychological Science, University of California, Irvine, United States
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160
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Seiler A, von Känel R, Slavich GM. The Psychobiology of Bereavement and Health: A Conceptual Review From the Perspective of Social Signal Transduction Theory of Depression. Front Psychiatry 2020; 11:565239. [PMID: 33343412 PMCID: PMC7744468 DOI: 10.3389/fpsyt.2020.565239] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022] Open
Abstract
Losing a spouse is considered one of the most stressful life events a person can experience. Particularly in the immediate weeks and months after the loss, bereavement is associated with a significantly increased risk of morbidity and mortality. Despite an abundance of research aimed at identifying risk factors for adverse health outcomes following marital death, the mechanisms through which mental and physical health problems emerge following bereavement remain poorly understood. To address this issue, the present review examines several pathways that may link bereavement and health, including inflammation and immune dysregulation, genetic and epigenetic changes, gut microbiota activity, and biological aging. We then describe how these processes may be viewed from the perspective of the Social Signal Transduction Theory of Depression to provide a novel framework for understanding individual differences in long-term trajectories of adjustment to interpersonal loss. Finally, we discuss several avenues for future research on psychobiological mechanisms linking bereavement with mental and physical health outcomes.
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Affiliation(s)
- Annina Seiler
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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