The relationship between self-report and biomarkers of stress in low-income reproductive-age women

Association between psychosocial factors and C-reactive protein across income, race, and sex

OBJECTIVE

A health disparity is a health difference that adversely affects disadvantaged populations, and thus could plausibly be due to social factors. Biopsychosocial processes that contribute to health disparities are not well-understood. Establishing whether candidate biomarkers are similarly associated with biologically relevant psychosocial constructs across health disparity groups is a current gap in our understanding.

METHOD

This study examined associations between perceived stress, depressive symptoms, and social support with C-reactive protein (CRP) and whether associations varied by race, sex, or income in 24,395 Black and White adults aged 45 years or older from the REGARDS population-based national cohort.

RESULTS

The association between depressive symptoms and CRP was slightly larger at higher (vs. lower) income levels and larger for men (vs. women) but did not vary by race. Associations between stress and CRP and social support and CRP were not moderated by income, race, or sex. An interaction between race and income, evidenced that higher income was more strongly associated with lower CRP in White participants compared to Black participants, consistent with the idea of "diminishing returns" of income for the health of Black Americans.

CONCLUSIONS

Basic associations between these psychosocial factors and CRP are small and generally similar across income, race, and sex. Black and lower-income Americans likely evidence higher CRP due to greater exposure to psychosocial risk factors rather than increased biological vulnerability to these exposures. Additionally, given small associations, CRP should not be used as a proxy for the construct of psychosocial stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived income inadequacy is associated with Epstein-Barr Virus latency and mental health outcomes in informal caregivers who are also employed in the healthcare industry

Finances are a prevalent source of stress. In a sample of 799 nursing home workers measured multiple times over 18 months, we found that higher perceived income inadequacy, the perception that one's expenses exceeds one's incomes, was associated with poorer self-reported mental health indicators and Epstein-Barr Virus antibody titers (a marker of cell-mediated immune function). Perceived income inadequacy predicted outcomes over and above the role of other socioeconomic status variables (objective household income and education). Mental health variables were not related to Epstein-Barr Virus antibody titers. Additionally, we found an interaction between perceived income inadequacy and informal caregiver status on our mental health outcomes; informal caregivers with higher perceived income inadequacy had poorer mental health than non-caregivers with the same perceived income inadequacy. Our findings may add nuance to the reserve capacity model, which states that those at lower socioeconomic levels are at higher risk of adverse health outcomes partly because they have fewer resources to address demands and strain. Perceived income inadequacy may significantly predict mental and physical well-being beyond other socioeconomic status variables, especially among lower-income employees. Caregiving stress and perceived income inadequacy may have synergistic effects on mental health.

C-reactive protein and telomerase reverse transcriptase (TERT) associate with chronic disease markers in a sample from low-income neighborhoods in Detroit, Michigan

Racial and ethnic minorities in economically deprived inner cities experience high rates of chronic diseases compared to neighborhoods with higher socioeconomic status (SES). However, these economically deprived populations are understudied in terms of biomarkers associated with chronic disease risk which include C-reactive protein (CRP), telomerase reverse transcriptase (TERT), and glycosylated hemoglobin (A1C). We examined relationships between CRP and TERT and chronic disease indicators (body mass index [BMI] and A1C) in two low-income, predominantly African American (AA) neighborhoods in Detroit, Michigan. Sixty-nine adults (43 females, 26 males, mean age 46 years [y], standard deviation [SD] ​= ​15.9) completed a health survey, anthropometry, and finger stick blood tests. A1C was measured using A1CNow test strips, and CRP and TERT levels were measured using enzyme-linked immunosorbent assay (ELISA) with samples extracted from dried blood spots. We examined CRP (mean ​= ​4.9, SD ​= ​3.1), TERT (mean ​= ​32.5, SD ​= ​15.1), and A1C (mean ​= ​5.4, SD ​= ​1.0) by BMI category. We fitted restricted maximum likelihood regression models to evaluate associations between CRP, TERT, BMI, and A1C, after adjustment for demographics and inclusion of a random effect for the neighborhood. In this predominantly AA sample (91%, 63/69), 68% had levels of CRP (means ​= ​4.8 ​mg/L, SD ​= ​3.0 for AAs; 6.4 ​mg/L, SD ​= ​3.9 for all others) indicative of chronic inflammation (CRP greater than 3 ​mg/L). BMI was significantly associated with CRP (p ​= ​0.004) and TERT (p ​= ​0.026). TERT levels indicate that being overweight is associated with markers of chromosome remodeling, suggestive of chronic disease. CRP followed a similar trend with overweight individuals having higher inflammation and risk of chronic disease. Our findings warrant further exploration of additional factors that may influence CRP and TERT. Furthermore, examining populations in a more ethnically and/or economically diverse, yet still high proportion minority, sample will fill a knowledge gap in this understudied field.

The Longitudinal Associations Between Paternal Incarceration and Family Well-Being: Implications for Ethnic/Racial Disparities in Health

OBJECTIVE

Ethnic/racial minority children in the United States are more likely to experience father loss to incarceration than White children, and limited research has examined the health implications of these ethnic/racial disparities. Telomere length is a biomarker of chronic stress that is predictive of adverse health outcomes. This study examined whether paternal incarceration predicted telomere length shortening among offspring from childhood to adolescence, whether maternal depression mediated the link, and whether ethnicity/race moderated results.

METHOD

Research participants included 2,395 families in the Fragile Families and Child Wellbeing study, a national and longitudinal cohort study of primarily low-income families from 20 large cities in the United States. Key constructs were measured when children were on average ages 9 (2007-2010) and 15 (2014-2017).

RESULTS

Children who experienced paternal incarceration exhibited shorter telomere lengths between ages 9 and 15, and changes in maternal depression mediated this finding. Specifically, mothers who experienced a partner's incarceration were more likely to have depression between children's ages 9 and 15. In turn, increases in maternal depression between children's ages 9 and 15 predicted more accelerated telomere length shortening among children during this period. Paternal incarceration was more prevalent and frequent for ethnic/racial minority youth than for White youth.

CONCLUSION

Paternal incarceration is associated with a biomarker of chronic stress among children in low-income families. Rates of paternal incarceration were more prevalent and frequent among Black American and multiethnic/multiracial families than among White Americans. As a result, the mass incarceration crisis of the criminal justice system is likely shaping intergenerational ethnic/racial health disparities.

Using principal component analysis to examine associations of early pregnancy inflammatory biomarker profiles and adverse birth outcomes

OBJECTIVE

Inflammation as a risk factor for preterm birth is well-established. The primary objective of this analysis was to examine whether individual cytokines versus a composite indicator of mid-pregnancy inflammation are significantly associated with risk for adverse birth outcomes.

STUDY DESIGN

A multi-site prospective study was conducted in a socio-demographically diverse cohort of 610 pregnant participants. At a study visit between 12 and 20 6/7 weeks' gestation, low-grade inflammation was measured via log-transformed serum concentrations of the biomarkers IFN-γ, IL-10, IL-13, IL-6, IL-8, TNF-α, and CRP. Principal component analysis (PCA) was used to identify underlying dimensions of inflammatory activity from the seven biomarkers measured. Gestational age and birth weight at delivery were obtained from medical chart review. The associations between inflammatory profiles and birth outcomes were assessed via linear and logistic regression models. Results were compared with those from individual inflammatory biomarkers, and model fit was assessed using Akaike's Information Criterion (AIC).

RESULTS

Principal component analysis analysis yielded a two-factor solution, with the first factor (IF1) composed of IL-8, IL-10, IL-13, IFN-ɣ, and TNF-α, and the second factor (IF2) containing IL-6 and CRP. When adjusted for race, education, BMI, smoking status, gestational age at time of blood draw, and study site, a one standard deviation (SD) increase in IF1 remained significantly associated with a decrease in standardized gestational age (β = -.13, 95% CI: -.21, -.05) and an increase in odds of preterm delivery (OR = 1.46, 95% CI: 1.13, 1.88) (Table 3). A one SD increase in IF2 was similarly associated with a decrease in standardized gestational age at delivery (β = -.13, 95% CI: -.23, -.04) and an increase in odds of preterm delivery (OR: 1.46, 95% CI: 1.04, 2.05). Neither IF1 nor IF2 was associated with measures of fetal growth. AIC identified that IL-6 was a slightly better fit for length of gestation compared to either composite measure, though all performed similarly.

CONCLUSION

Independent of known sociodemographic risk factors, an elevated mid-pregnancy inflammatory profile was associated with a nearly 50% increase in odds of preterm delivery. The composite performed similarly to IL-6. These results suggest that maternal low-grade inflammation is a risk factor for preterm delivery, and that mid-pregnancy inflammatory biomarkers may be useful in predicting risk for preterm delivery.

The association of depressive symptoms to sleep-related symptoms during menopausal transition: racial/ethnic differences

OBJECTIVES

Despite an increasing number of studies reporting significant associations of depression to sleep problems in general, few studies have been conducted on racial/ethnic variations in the associations among midlife women in their menopausal transition. The purpose of this study was to determine the associations between depressive symptoms and sleep-related symptoms in a multiethnic group of midlife women while considering the women's race/ethnicity and menopausal status.

METHODS

This was a secondary analysis of the data from 1,054 midlife women in two larger studies. The depression index for midlife women and the sleep index for midlife women were used to measure sleep-related symptoms and depressive symptoms. Descriptive and inferential statistics including hierarchical multiple regression analyses were used for data analyses.

RESULTS

In the regression models by race/ethnicity, the total numbers (0.294 in non-Hispanic [NH] African Americans ≤ β ≤ 0.410 in NH Asians), and total severity scores (0.141 in Hispanic ≤ β ≤ 0.365 in NH Whites) of depressive symptoms were positively associated with the total severity of sleep-related symptoms (all P < 0.01). In the regression models by menopausal status, the total numbers (β = 0.106 in premenopausal and 0.443 in postmenopausal) and total severity scores (0.272 ≤ β ≤ 0.561) of depressive symptoms were positively associated with the total severity scores of sleep-related symptoms (all P < 0.05).

CONCLUSIONS

Further studies with diverse groups of midlife women using objective measurements and biomarkers are warranted to confirm the findings.

Maternal immune activation, central nervous system development and behavioral phenotypes

Maternal immune activation (MIA) refers to a maternal immune system triggered by infectious or infectious-like stimuli. A cascade of cytokines and immunologic alterations are transmitted to the fetus, resulting in adverse phenotypes most notably in the central nervous system. Epidemiologic studies implicate maternal infections in a variety of neuropsychiatric disorders, most commonly autism spectrum disorders and schizophrenia. In animal models, MIA causes neurochemical and anatomic changes in the brain that correspond to those found in humans with the disorders. As our understanding of the interactions between environment, genetics, and immune system grows, the role of alternative, noninfectious risk factors, such as prenatal stress, obesity, and the gut microbiome also becomes clearer. This review considers how infectious and noninfectious etiologies activate the maternal immune system. Their impact on fetal programming and neuropsychiatric disorders in offspring is examined in the context of human and animal studies.

Longitudinal Validity and Reliability of Brief Smartphone Self-Monitoring of Diet, Stress, and Physical Activity in a Diverse Sample of Mothers

BACKGROUND

Multiple strategies can be used when self-monitoring diet, physical activity, and perceived stress, but no gold standards are available. Although self-monitoring is a core element of self-management and behavior change, the success of mHealth behavioral tools depends on their validity and reliability, which lack evidence. African American and Latina mothers in the United States are high-priority populations for apps that can be used for self-monitoring of diet, physical activity, and stress because the body mass index (BMI) of mothers typically increases for several years after childbirth and the risks of obesity and its' sequelae diseases are elevated among minority populations.

OBJECTIVE

To examine the intermethod reliability and concurrent validity of smartphone-based self-monitoring via ecological momentary assessments (EMAs) and use of daily diaries for diet, stress, and physical activity compared with brief recall measures, anthropometric biomeasures, and bloodspot biomarkers.

METHODS

A purposive sample (n=42) of primarily African American (16/42, 39%) and Latina (18/42, 44%) mothers was assigned Android smartphones for using Ohmage apps to self-monitor diet, perceived stress, and physical activity over 6 months. Participants were assessed at 3- and 6-month follow-ups. Recall measures included brief food frequency screeners, physical activity assessments adapted from the National Health and Nutrition Examination Survey, and the nine-item psychological stress measure. Anthropometric biomeasures included BMI, body fat, waist circumference, and blood pressure. Bloodspot assays for Epstein-Barr virus and C-reactive protein were used as systemic load and stress biomarkers. EMAs and daily diary questions assessed perceived quality and quantity of meals, perceived stress levels, and moderate, vigorous, and light physical activity. Units of analysis were follow-up assessments (n=29 to n=45 depending on the domain) of the participants (n=29 with sufficient data for analyses). Correlations, R2 statistics, and multivariate linear regressions were used to assess the strength of associations between variables.

RESULTS

Almost all participants (39/42, 93%) completed the study. Intermethod reliability between smartphone-based EMAs and diary reports and their corresponding recall reports was highest for stress and diet; correlations ranged from .27 to .52 (P<.05). However, it was unexpectedly low for physical activity; no significant associations were observed. Concurrent validity was demonstrated for diet EMAs and diary reports on systolic blood pressure (r=-.32), C-reactive protein level (r=-.34), and moderate and vigorous physical activity recalls (r=.35 to.48), suggesting a covariation between healthy diet and physical activity behaviors. EMAs and diary reports on stress were not associated with Epstein-Barr virus and C-reactive protein level. Diary reports on moderate and vigorous physical activity were negatively associated with BMI and body fat (r=-.35 to -.44, P<.05).

CONCLUSIONS

Brief smartphone-based EMA use may be valid and reliable for long-term self-monitoring of diet, stress, and physical activity. Lack of intermethod reliability for physical activity measures is consistent with prior research, warranting more research on the efficacy of smartphone-based self-monitoring of self-management and behavior change support.

Biological Risk and Infection Profiles of Young Adult Male Mexican American Gang Members

OBJECTIVES

Little research has examined the long-term health consequences of gang affiliation among Mexican Americans. The objectives of this study were to (1) measure biological indicators of cardiovascular and metabolic risk, as well as prevalence of sexually transmitted infections (STIs), in a sample of Mexican American men aged 25-40 who were affiliated with gangs as adolescents and (2) compare those indicators with a comparable national sample of Latino men.

METHODS

Using bivariate analyses, we compared blood pressure, body mass index, 4 metabolic and cardiovascular indicators, and 4 infections for 179 Mexican American formerly gang-affiliated men in San Antonio, Texas, and 155 Mexican American men from the National Health and Nutrition Examination Survey. We used multivariate models to estimate adjusted risk scores for each sample controlling for age, marital status, and education.

RESULTS

Compared with men in the national sample, the unadjusted results showed that men in the gang-affiliated sample had significantly higher mean systolic blood pressure (125.6 vs 120.0  mm Hg, P = .001), diastolic blood pressure (81.4 vs 71.1 mm Hg, P < .001), and C-reactive protein (5.9 vs 3.6 mg/L, P = .04), and a significantly lower mean total cholesterol (164.2 vs 205.5 mg/dL, P < .001) and low-density lipoprotein cholesterol (91.1 vs 120.1 mg/dL, P < .001). Compared with men in the national sample, more men in the gang-affiliated sample had herpes simplex virus type 2 (64/174 [36.8%] vs 18/147 [12.2%], P < .001), chlamydia (10/176 [5.7%] vs 1/135 [0.7%], P = .02), and hepatitis C virus (85/173 [49.1%] vs 0, P < .001). The gang-affiliated sample had a significantly higher adjusted risk score than the national sample (1.5 vs 1.1, P = .003).

CONCLUSIONS

Gang-affiliated Mexican American men had significant disparities in biological risk indicators and STIs, which can lead to long-term health implications and highlight the need for tailored prevention strategies. Long-term exposure to psychosocial stressors and subsequent systemic inflammation may also increase the risk for physiological and psychological dysregulation and detrimental chronic health conditions in this population.

Adherence to self-monitoring healthy lifestyle behaviours through mobile phone-based ecological momentary assessments and photographic food records over 6 months in mostly ethnic minority mothers

OBJECTIVE

Mobile phones can replace traditional self-monitoring tools through cell phone-based ecological momentary assessment (CEMA) of lifestyle behaviours and camera phone-based images of meals, i.e. photographic food records (PFR). Adherence to mobile self-monitoring needs to be evaluated in real-world treatment settings. Towards this goal, we examine CEMA and PFR adherence to the use of a mobile app designed to help mothers self-monitor lifestyle behaviours and stress. Design/Setting In 2012, forty-two mothers recorded CEMA of diet quality, exercise, sleep, stress and mood four times daily and PFR during meals over 6 months in Los Angeles, California, USA.

SUBJECTS

A purposive sample of mothers from mixed ethnicities.

RESULTS

Adherence to recording CEMA at least once daily was higher compared with recording PFR at least once daily over the study period (74 v. 11 %); adherence to both types of reports decreased over time. Participants who recorded PFR for more than a day (n 31) were more likely to be obese v. normal- to overweight and to have higher blood pressure, on average (all P<0·05). Based on random-effects regression, CEMA and PFR adherence was highest during weekdays (both P<0·01). Additionally, PFR adherence was associated with older age (P=0·04). CEMA adherence was highest in the morning (P<0·01). PFR recordings occurred throughout the day.

CONCLUSIONS

Variations in population and temporal characteristics should be considered for mobile assessment schedules. Neither CEMA nor PFR alone is ideal over extended periods.

Using item response theory to optimize measurement of chronic stress in pregnancy

OBJECTIVE

Utilize Rasch analysis to develop an optimized self-reported measure of stress in pregnancy and examine the association with patient demographics and biologic measures of stress.

STUDY DESIGN

Measured self-reported stress in pregnant women using 12 existing scales. Collected blood for biologic measures of stress (Epstein Barr Virus [EBV], C-Reactive Protein [CRP], Corticotropin Reactive Hormone [pCRH], and Adenocorticotropin Hormone [ACTH]). Used multidimensional scaling and Rasch analysis to produce an item reduced self-report measure.

RESULTS

Enrolled 112 women. Survey items reduced to two factors: perceived stressors and buffers of stress. Women with a domestic partner had lower perceived stress (p = 0.003). Caucasian women reported higher buffers of stress (p = 0.045), as did women with private insurance (p < 0.001), a planned pregnancy (p < 0.01), and a domestic partner (p < 0.001). Women with higher buffers of stress had lower levels of pCRH (adjusted p = 0.01).

CONCLUSION

Item reduced, optimized measures of stress were associated with significant differences in patient demographics and biologic measures of stress.

Association of Depressed Mood With Herpes Simplex Virus-2 Immunoglobulin-G Levels in Pregnancy

OBJECTIVE

Depressed mood is common in pregnancy, is associated with stress, and could result in immune suppression that may lead to latent herpes viral reactivation. This study investigated whether depressed mood is associated with higher herpes viral IgG levels in pregnant women.

METHODS

Complete cross-sectional data from 247 pregnant women were available for this substudy. The data included demographics, scores on the Perceived Stress Scale and Profile of Mood States (POMS), and a panel of serum IgG levels for human herpesviruses.

RESULTS

Only the herpes simplex virus type 2 (HSV-2) (genital herpes) IgG level was associated with Perceived Stress Scale and POMS-Depression/Dejection (POMS-D) score. Hierarchical multiple regression analysis was used to examine the association of POMS-D with herpesviral IgG levels adjusting for demographic variables. In the final model, African American race (β = .251, p < .001), older age (β = .199, p = .002), single marital status (β = -.304, p < .001), and depressed mood (β = .122, p = .04) were associated with HSV-2 IgG levels. In logistic regression, the strongest correlates of HSV IgG positivity were single marital status, followed by POMS-D scores and African American race.

CONCLUSION

Genital herpes is a concern in pregnancy. Antibody titers may indicate asymptomatic viral shedding, viral reactivation, or primary viral infection. Antibody levels may be higher because of the immune changes during pregnancy and potential immune effects of depressed mood causing reactivation of latent HSV-2.

Racial/ethnic differences in self-reported and biologic measures of chronic stress in pregnancy

OBJECTIVE

Racial differences in chronic maternal stress may contribute to disparities in pregnancy outcomes. The objective is to identify racial and ethnic differences in self-reported and biologic measures of stress between non-Hispanic black (NHB) and non-Hispanic white (NHW) pregnant women.

STUDY DESIGN

NHB and NHW pregnant women were enrolled before 23 weeks of gestation in this prospective cohort study. Equal numbers of women were recruited with public vs private insurance in each racial group. Self-reported stress was measured and blood samples collected in the second and third trimesters were analyzed for serum Epstein-Barr virus antibody, C-reactive protein (CRP), corticotropin-releasing hormone (CRH) and adenocorticotropic hormone (ACTH).

RESULTS

One hundred and twelve women were enrolled. NHW women reported more buffers against stress (P=0.04) and neighborhood satisfaction (P=0.02). NHB women reported more discrimination (P<0.001), food insecurity (P=0.04) and had significantly higher mean CRP levels and mean ACTH levels in the second and third trimesters.

CONCLUSION

Significant differences in self-reported and biologic measures of chronic stress were identified between NHB and NHW pregnant women with similar economic characteristics. Future studies should investigate mechanisms underlying these differences and their relationship to pregnancy outcomes.

Stress and Immune Function during Pregnancy: An Emerging Focus in Mind-Body Medicine

Maternal psychosocial stress during pregnancy is associated with risks to maternal health, birth outcomes, as well as adverse health and behavioral outcomes in offspring. Maternal immune dysregulation, particularly disruption of inflammatory processes, is also implicated in adverse perinatal health outcomes, with the greatest evidence in relation to preterm birth. Increasingly, the extent to which psychosocial stress induces dysregulation of inflammatory processes during pregnancy is being considered. In this article, I describe studies linking stress to immune function during pregnancy, with an emphasis on studies from our group on inflammation. As will be reviewed, research utilizing psychoneuroimmunology models in pregnancy is a rapidly developing area with abundant opportunities to address questions of clinical relevance for both maternal and child health.

Elevated C-reactive protein and self-reported disease activity in systemic lupus erythematosus

C-reactive protein (CRP), a biomarker of inflammation, has been associated with increased disease activity in rheumatoid arthritis. However, the association in systemic lupus erythematosus (SLE) remains unclear. We examined the association of CRP with self-reported disease activity in the Carolina Lupus Study and described differences by sociodemographic characteristics. The study included baseline and three-year follow-up data on 107 African-American and 69 Caucasian SLE patients enrolled at a median 13 months since diagnosis. Models estimated prevalence differences in the association of baseline CRP with self-reported flares, adjusting for age, sex, race and education. Active disease or flare was reported by 59% at baseline and 58% at follow-up. Higher CRP (>10 µg/ml vs. <3 µg/ml) was associated with a 17% (95% confidence interval (CI): -20, 53%) higher prevalence of flare at baseline and a 26% (95% CI: -9, 62%) higher prevalence of flare at follow-up. These CRP-flare associations were notably stronger in patients with lower education at baseline and in African-Americans at follow-up. These findings suggest that CRP may be a useful marker in studies of SLE health disparities.

Childhood adversity and cell-mediated immunity in young adulthood: does type and timing matter?

Childhood adversity can have powerful effects on health over the life course. Persistent changes in cell-mediated immune function may be one pathway linking adverse childhood experiences with later disease risk. However, limited research has examined childhood adversity in relation to cell-mediated immune function, and in particular, immune response to latent viruses in adulthood. The present study investigated the association of two types of childhood adversity, socioeconomic disadvantage during adolescence and abuse prior to age 18, with Epstein-Barr Virus (EBV) antibody titers in a large nationally representative sample of young adults aged 24-32years. Data were drawn from the National Longitudinal Study on Adolescent Health, Wave 4 (n=13,162). We examined the associations of three indicators of adolescent SES (parental education, household income, and occupational status) and frequency and timing of physical and sexual abuse with EBV antibodies, controlling for age, sex, race/ethnicity, and presence of a smoker in the household during adolescence. Lower parental occupational status and some categories of lower education were associated with elevated EBV antibodies (p<.05), and individuals who reported sexual abuse that occurred more than 10times had elevated EBV antibodies relative to individuals who were not sexually abused (p=0.03). Among individuals exposed to physical abuse, those who were first abused at age 3-5years had heightened EBV antibodies relative to those first abused during adolescence (p=0.004). This study extends prior research linking early adversity and immune function, and provides initial evidence that childhood adversity has a persistent influence on immune responses to latent infection in adulthood.

Epstein-Barr virus reactivation during pregnancy and postpartum: effects of race and racial discrimination

OBJECTIVE

Adverse pregnancy outcomes, including preterm birth, are markedly higher among African-Americans versus Whites. Stress-induced immune dysregulation may contribute to these effects. Epstein-Barr virus (EBV) reactivation provides a robust model for examining cellular immune competence. This study examined associations of EBV virus capsid antigen immunoglobulin G (VCA IgG) with gestational stage, race, and racial discrimination in women during pregnancy and postpartum.

METHODS

Fifty-six women (38 African-American, 18 White) were included. African-Americans and Whites did not differ in age, education, income, parity, or body mass index (ps ≥ .51). During the 1st, 2nd, and 3rd trimester and ~5 weeks postpartum, women completed measures of racial discrimination, perceived stress, anxiety, depressive symptoms and health behaviors. EBV VCA IgG antibody titers were measured via ELISA in serum collected at each visit.

RESULTS

In the overall sample, EBV VCA IgG antibody titers were lower in the 3rd versus 1st trimester (p=.002). At every timepoint (1st, 2nd, 3rd trimester and postpartum), African-American women exhibited higher serum EBV VCA IgG antibody titers than Whites (ps<.001). This effect was most pronounced among African-Americans reporting greater racial discrimination [p=.03 (1st), .04 (2nd), .12 (3rd), .06 (postpartum)]. Associations of race and racial discrimination with EBV VCA IgG antibody titers were not accounted for by other measures of stress or health behaviors.

CONCLUSIONS

Compared to Whites, African-American women showed higher EBV VCA IgG antibody titers, indicative of impaired cellular immune competence, across pregnancy and postpartum. This effect was particularly pronounced among African-American women reporting greater racial discrimination, supporting a role for chronic stress in this association. In women overall, EBV antibody titers declined during late as compared to early pregnancy. This may be due to pregnancy-related changes in cell-mediated immune function, humoral immune function, and/or antibody transfer to the fetus in late gestation. As a possible marker of stress-induced immune dysregulation during pregnancy, the role of EBV reactivation in racial disparities in perinatal health warrants further attention.

Repayment flexibility can reduce financial stress: a randomized control trial with microfinance clients in India

Financial stress is widely believed to cause health problems. However, policies seeking to relieve financial stress by limiting debt levels of poor households may directly worsen their economic well-being. We evaluate an alternative policy - increasing the repayment flexibility of debt contracts. A field experiment randomly assigned microfinance clients to a monthly or a traditional weekly installment schedule (N=200). We used cell phones to gather survey data on income, expenditure, and financial stress every 48 hours over seven weeks. Clients repaying monthly were 51 percent less likely to report feeling "worried, tense, or anxious" about repaying, were 54 percent more likely to report feeling confident about repaying, and reported spending less time thinking about their loan compared to weekly clients. Monthly clients also reported higher business investment and income, suggesting that the flexibility encouraged them to invest their loans more profitably, which ultimately reduced financial stress.

Maternal depression and Epstein-Barr virus reactivation in early pregnancy

OBJECTIVE

Recent evidence suggests a link between Epstein-Barr virus reactivation and chronic stress due to decreased cellular immune responses. Maternal depression complicates 10% to 20% of pregnancies and is accompanied by stress. We sought to estimate the association of Epstein-Barr virus reactivation with depression in pregnancy.

METHODS

In this cohort study, prevalence of Epstein-Barr virus reactivation was compared between 100 pregnant women with depression before pregnancy and a computer-generated referent group of 100 healthy women not known to be depressed. We included only those women with documented Diagnostic and Statistical Manual of Mental Disorders depression diagnoses in the current pregnancy. Serum samples were analyzed for presence of Epstein-Barr virus viral capsid antigen, nuclear antigen, and early antigen antibodies. Epstein-Barr virus reactivation was defined by presence of viral capsid antigen or nuclear antigen immunoglobulin (Ig) G, along with early antigen IgG, viral capsid antigen IgM, or both early antigen IgG and viral capsid antigen IgM.

RESULTS

Maternal demographics were similar between the groups except for older age (34.1 compared with 32.7 years, P=.05), and lower body mass index (27.3 compared with 28.9, P=.03) among the depressed individuals. Ninety-five percent of the women were seropositive for Epstein-Barr virus. Women with depression were more likely to have Epstein-Barr virus reactivation (48% compared with 30%, P=.01) when compared with referent participants. Epstein-Barr virus reactivation remained associated with maternal depression (adjusted odds ratio 1.97, 95% confidence interval 1.10-3.77, P=.03) after controlling for potential confounders.

CONCLUSION

Women with depression have higher prevalence of Epstein-Barr virus reactivation, possibly due to increased stress.

LEVEL OF EVIDENCE

II.

Psychoneuroimmunology in pregnancy: immune pathways linking stress with maternal health, adverse birth outcomes, and fetal development

It is well-established that psychological stress promotes immune dysregulation in nonpregnant humans and animals. Stress promotes inflammation, impairs antibody responses to vaccination, slows wound healing, and suppresses cell-mediated immune function. Importantly, the immune system changes substantially to support healthy pregnancy, with attenuation of inflammatory responses and impairment of cell-mediated immunity. This adaptation is postulated to protect the fetus from rejection by the maternal immune system. Thus, stress-induced immune dysregulation during pregnancy has unique implications for both maternal and fetal health, particularly preterm birth. However, very limited research has examined stress-immune relationships in pregnancy. The application of psychoneuroimmunology research models to the perinatal period holds great promise for elucidating biological pathways by which stress may affect adverse pregnancy outcomes, maternal health, and fetal development.

Stress and breast cancer: from epidemiology to molecular biology

Stress exposure has been proposed to contribute to the etiology of breast cancer. However, the validity of this assertion and the possible mechanisms involved are not well established. Epidemiologic studies differ in their assessment of the relative contribution of stress to breast cancer risk, while physiological studies propose a clear connection but lack the knowledge of intracellular pathways involved. The present review aims to consolidate the findings from different fields of research (including epidemiology, physiology, and molecular biology) in order to present a comprehensive picture of what we know to date about the role of stress in breast cancer development.