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Marheinecke R, Blasberg J, Heilmann K, Imrie H, Wesarg-Menzel C, Engert V. Measuring empathic stress - A systematic review of methodology and practical considerations for future research. Psychoneuroendocrinology 2025; 171:107216. [PMID: 39418692 DOI: 10.1016/j.psyneuen.2024.107216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 10/07/2024] [Accepted: 10/09/2024] [Indexed: 10/19/2024]
Abstract
Aside from stressors that each of us experience directly, we also share the stress of the people around us. Such empathic stress exists on psychological and physiological levels, including subjective, sympathetic, parasympathetic and endocrine activation. The objective of this review is to offer an overview of methodology over the past fifteen years of empathic stress research and derive practical considerations for future research endeavors in the field. We used a keyword search strategy in the databases Web of Science, PsycInfo and PubMed to find empathic stress studies published until December 2023, and included 17 studies into our review. The reviewed laboratory studies provide initial yet consistent evidence for the existence of empathic stress across different populations, in intimate and stranger dyads, with direct and virtual contact, across multiple levels of the stress system, and based on diverse statistical analysis methods. We discuss all findings and derive practical considerations for future empathic stress research. The diversity of methods established provides a solid foundation upon which future studies can expand.
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Affiliation(s)
- Ruth Marheinecke
- Institute for Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller University, Stoystraße 3, Jena 07743, Germany.
| | - Jost Blasberg
- Institute for Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller University, Stoystraße 3, Jena 07743, Germany
| | - Katja Heilmann
- Institute for Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller University, Stoystraße 3, Jena 07743, Germany
| | - Hazel Imrie
- Institute for Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller University, Stoystraße 3, Jena 07743, Germany; School of Psychology and Neuroscience, College of Medical, Veterinary and Life Sciences, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Christiane Wesarg-Menzel
- Institute for Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller University, Stoystraße 3, Jena 07743, Germany
| | - Veronika Engert
- Institute for Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller University, Stoystraße 3, Jena 07743, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Halle-Jena-Magdeburg, Germany; German Center for Mental Health (DZPG), Halle-Jena-Magdeburg, Germany
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Law KC, O'Connell KL, Jacobson SV, Baer MM, Baker PM, Tull MT. Influences of sleep, cortisol reactivity, and risk/reward-based decision-making on suicide. J Behav Ther Exp Psychiatry 2024; 85:101975. [PMID: 38870548 PMCID: PMC11347093 DOI: 10.1016/j.jbtep.2024.101975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/03/2024] [Accepted: 05/25/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Poor sleep quality is a known contributor to suicidal thoughts and behaviors. This study examines whether sleep quality modulates the effect of an individual's stress response and risk/reward-based decision making on suicide risk. METHODS Participants were 160 adults at a residential substance use treatment facility with lifetime exposure to trauma who completed a clinician-administered measure of suicide risk, the Iowa Gambling Task (IGT), and a self-report measure of sleep. Cortisol reactivity (i.e., changes in cortisol before and after a personalized trauma script) was used to measure stress response. We used quantile regression to examine the effects of sleep, cortisol, and risk/reward decision-making on suicide risk. RESULTS We found poor sleep quality to be increasingly salient in individuals at greater risk for suicide than those at lower risk for suicide. Furthermore, individuals with moderate to moderate-high levels of suicide risk seem to have greater cortisol reactivity. In the low-moderate quantile, we found suicide risk to be associated with both high stress reactivity and low-risk, high-reward decision-making, as well as low stress reactivity and high-risk/low-reward decision-making. LIMITATIONS These findings should be interpreted considering several methodological constraints, such as the use of a pre-determined sample and instruments not tailored for our hypotheses, the MINI 'Suicide' Module's limited differentiation between suicidal ideation and behavior, and variably timed cortisol sampling. CONCLUSIONS Despite these limitations, the findings from this study support the use of evidence-based interventions focused on improving sleep quality and managing emotional reactivity to decrease suicide risk.
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Affiliation(s)
- Keyne C Law
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA.
| | | | - Samantha V Jacobson
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Margaret M Baer
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Phillip M Baker
- Department of Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA; Lyra Health Inc., Burlingame, CA, USA
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Heilmann K, Müller TH, Walter M, Engert V. Empathic stress is decreased by prior stressor experience and increased in a position of power. Horm Behav 2024; 165:105617. [PMID: 39190970 DOI: 10.1016/j.yhbeh.2024.105617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 07/02/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024]
Abstract
The observation of a stressed individual can trigger a stress response in a passive observer. Little is known about the mechanisms of this so-termed empathic stress, including the observer's empathic involvement with the stressful situation. In 108 opposite-sex stranger dyads, we expected to increase the observer's empathic involvement with a stressed target performing a standardized laboratory stressor (Trier Social Stress Test, TSST; Kirschbaum et al., 1993) by exposing observers themselves to the TSST one week earlier. Conversely, we intended to decrease empathic involvement by granting observers a powerful position over the targets (by asking them to evaluate the targets' TSST performance and allegedly decide on their financial compensation). A control group without any manipulation was also included. In the preregistered data analysis, two types of empathic stress were investigated: vicarious stress, which evolves irrespective of the target's stress response, and stress resonance, which is proportional to the target's stress response. Irrespective of manipulation, observers exhibited vicarious stress in subjective and high-frequency heart rate variability (HF-HRV), and synchronized with the targets' stress reactivity in cortisol release. Prior TSST experience unexpectedly decreased observers' self-reported empathy and vicarious cortisol stress reactivity. The power manipulation, conversely, led to stronger observer vicarious stress in overall heart rate and HF-HRV reactivity. Based on Wondra and Ellsworth's (2015) appraisal theory, we propose that, due to their prior stressor exposure, observers habituated to said stressor, and consequently changed their evaluation of the target's stressful situation. In contrast, observers in the powerful position may have felt responsible for the targets, triggering a stronger vicarious stressful experience.
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Affiliation(s)
- Katja Heilmann
- Institute for Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich Schiller University, Stoystr. 3, 07740 Jena, Germany; Clinic of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University, Philosophenweg 3, 07743 Jena, Germany.
| | - Theresa Helene Müller
- Institute for Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich Schiller University, Stoystr. 3, 07740 Jena, Germany
| | - Martin Walter
- Clinic of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University, Philosophenweg 3, 07743 Jena, Germany; German Center for Mental Health (DZPG), parter site Halle-Jena-Magdeburg; Center for Intervention and Research in adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Veronika Engert
- Institute for Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich Schiller University, Stoystr. 3, 07740 Jena, Germany; German Center for Mental Health (DZPG), parter site Halle-Jena-Magdeburg; Center for Intervention and Research in adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Halle-Jena-Magdeburg, Germany
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Valk SL, Engert V, Puhlmann L, Linz R, Caldairou B, Bernasconi A, Bernasconi N, Bernhardt BC, Singer T. Differential increase of hippocampal subfield volume after socio-affective mental training relates to reductions in diurnal cortisol. eLife 2024; 12:RP87634. [PMID: 39196261 DOI: 10.7554/elife.87634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
The hippocampus is a central modulator of the HPA-axis, impacting the regulation of stress on brain structure, function, and behavior. The current study assessed whether three different types of 3 months mental Training Modules geared towards nurturing (a) attention-based mindfulness, (b) socio-affective, or (c) socio-cognitive skills may impact hippocampal organization by reducing stress. We evaluated mental training-induced changes in hippocampal subfield volume and intrinsic functional connectivity, by combining longitudinal structural and resting-state fMRI connectivity analysis in 332 healthy adults. We related these changes to changes in diurnal and chronic cortisol levels. We observed increases in bilateral cornu ammonis volume (CA1-3) following the 3 months compassion-based module targeting socio-affective skills (Affect module), as compared to socio-cognitive skills (Perspective module) or a waitlist cohort with no training intervention. Structural changes were paralleled by relative increases in functional connectivity of CA1-3 when fostering socio-affective as compared to socio-cognitive skills. Furthermore, training-induced changes in CA1-3 structure and function consistently correlated with reductions in cortisol output. Notably, using a multivariate approach, we found that other subfields that did not show group-level changes also contributed to changes in cortisol levels. Overall, we provide a link between a socio-emotional behavioural intervention, changes in hippocampal subfield structure and function, and reductions in cortisol in healthy adults.
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Affiliation(s)
- Sofie Louise Valk
- Otto Hahn Group Cognitive Neurogenetics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- INM-7, FZ Jülich, Jülich, Germany
- Institute for System Neurosciences, Heinrich Heine University, Düsseldorf, Germany
| | - Veronika Engert
- Institute for Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
- Research Group Social Stress and Family Health, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Lara Puhlmann
- Research Group Social Stress and Family Health, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Leibniz Institute for Resilience Research, Mainz, Germany
| | - Roman Linz
- Research Group Social Stress and Family Health, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Benoit Caldairou
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Andrea Bernasconi
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Tania Singer
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
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Gallistl M, Linz R, Puhlmann LMC, Singer T, Engert V. Evidence for differential associations of distinct trait mindfulness facets with acute and chronic stress. Psychoneuroendocrinology 2024; 166:107051. [PMID: 38678734 DOI: 10.1016/j.psyneuen.2024.107051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
Stress and stress-associated disease are considered the health epidemic of the 21st century. Interestingly, despite experiencing similar amounts of stress than those falling ill, some individuals are protected against the "wear and tear of daily life". Based on the notion that mindfulness training strengthens stress resilience, we explored whether facets of trait mindfulness, prior to training intervention, are linked to acute psychosocial stress reactivity and chronic stress load. To assess different mindfulness facets, over 130 participants completed the Five Facet Mindfulness Questionnaire (FFMQ) and the Freiburg Mindfulness Inventory (FMI). For acute stress induction, a standardized psychosocial stress test was conducted. Subjective stress, sympathetic and parasympathetic activity, and levels of the hypothalamic-pituitary-adrenal axis end hormone cortisol were assessed repeatedly. Additionally, levels of hair cortisol and cortisone as indices of the long-term physiological stress load were collected. We found differential associations of different facets of mindfulness with subjective stress, cortisol, and hair cortisone levels. Specifically, the trait mindfulness facets FMI "Acceptance" and the ability to put one's inner experience into words (FFMQ "Describing") were associated with lower acute subjective and cortisol stress reactivity. Contrarily, monitoring-related trait mindfulness facets (FFMQ "Acting with Awareness" and "Observing") were associated with higher acute cortisol and marginally higher long-term cortisone release. Our results suggest granularity of the mindfulness construct. In accordance with the "Monitor and Acceptance Theory", especially acceptance-related traits buffered against stress, while monitoring-related traits seemed to be maladaptive in the context of stress. The current results give valuable guidance for the conceptualization of mindfulness-based interventions geared towards stress reduction.
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Affiliation(s)
- Mathilde Gallistl
- Independent Research Group "Social Stress and Family Health", Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Roman Linz
- Independent Research Group "Social Stress and Family Health", Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Lara M C Puhlmann
- Independent Research Group "Social Stress and Family Health", Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - Tania Singer
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
| | - Veronika Engert
- Independent Research Group "Social Stress and Family Health", Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Institute for Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany; German Center for Mental Health (DZPG), partner site Halle-Jena-Magdeburg
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Schaefer JK, Engert V, Valk SL, Singer T, Puhlmann LM. Mapping pathways to neuronal atrophy in healthy, mid-aged adults: From chronic stress to systemic inflammation to neurodegeneration? Brain Behav Immun Health 2024; 38:100781. [PMID: 38725445 PMCID: PMC11081785 DOI: 10.1016/j.bbih.2024.100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/27/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
Growing evidence implicates systemic inflammation in the loss of structural brain integrity in natural ageing and disorder development. Chronic stress and glucocorticoid exposure can potentiate inflammatory processes and may also be linked to neuronal atrophy, particularly in the hippocampus and the human neocortex. To improve understanding of emerging maladaptive interactions between stress and inflammation, this study examined evidence for glucocorticoid- and inflammation-mediated neurodegeneration in healthy mid-aged adults. N = 169 healthy adults (mean age = 39.4, 64.5% female) were sampled from the general population in the context of the ReSource Project. Stress, inflammation and neuronal atrophy were quantified using physiological indices of chronic stress (hair cortisol (HCC) and cortisone (HEC) concentration), systemic inflammation (interleukin-6 (IL-6), high-sensitive C-reactive protein (hs-CRP)), the systemic inflammation index (SII), hippocampal volume (HCV) and cortical thickness (CT) in regions of interest. Structural equation models were used to examine evidence for pathways from stress and inflammation to neuronal atrophy. Model fit indices indicated good representation of stress, inflammation, and neurological data through the constructed models (CT model: robust RMSEA = 0.041, robust χ2 = 910.90; HCV model: robust RMSEA <0.001, robust χ2 = 40.95). Among inflammatory indices, only the SII was positively associated with hair cortisol as one indicator of chronic stress (β = 0.18, p < 0.05). Direct and indirect pathways from chronic stress and systemic inflammation to cortical thickness or hippocampal volume were non-significant. In exploratory analysis, the SII was inversely related to mean cortical thickness. Our results emphasize the importance of considering the multidimensionality of systemic inflammation and chronic stress, with various indicators that may represent different aspects of the systemic reaction. We conclude that inflammation and glucocorticoid-mediated neurodegeneration indicated by IL-6 and hs-CRP and HCC and HEC may only emerge during advanced ageing and disorder processes, still the SII could be a promising candidate for detecting associations between inflammation and neurodegeneration in younger and healthy samples. Future work should examine these pathways in prospective longitudinal designs, for which the present investigation serves as a baseline.
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Affiliation(s)
- Julia K. Schaefer
- Cognitive Neuropsychology, Department of Psychology, Ludwig-Maximilians-Universität München, Germany
| | - Veronika Engert
- Research Group “Social Stress and Family Health”, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Clinic, Friedrich-Schiller University, Jena, Germany
| | - Sofie L. Valk
- Otto Hahn Group Cognitive Neurogenetics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, FZ Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tania Singer
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
| | - Lara M.C. Puhlmann
- Research Group “Social Stress and Family Health”, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Leibniz Institute for Resilience Research, Mainz, Germany
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Matthaeus H, Heim C, Voelkle MC, Singer T. Reducing neuroendocrine psychosocial stress response through socio-emotional dyadic but not mindfulness online training. Front Endocrinol (Lausanne) 2024; 15:1277929. [PMID: 38978617 PMCID: PMC11228163 DOI: 10.3389/fendo.2024.1277929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 06/07/2024] [Indexed: 07/10/2024] Open
Abstract
Introduction Stress-related diseases pose significant health risks and show wide prevalence. Empirical evidence suggests that contemplative practices, such as socio-emotional dyadic mental exercises, hold promise in mitigating the adverse effects of stress and promoting psychosocial well-being. This study aimed to investigate the differential effects of two online contemplative mental training programs on the psychosocial stress response: the first involved classic mindfulness practices, while the second incorporated a socio-emotional dyadic approach known as Affect Dyad. Methods The study was conducted as part of the longitudinal CovSocial project's phase 2 in the context of the COVID-19 pandemic. 140 individuals participated in the Trier Social Stress Task (TSST), where the psychosocial stress response was assessed with cortisol saliva samples and subjective stress questionnaires in a cross-sectional design after the active training groups finished their intervention period. Participants were randomly assigned to the socio-emotional training group, mindfulness-based training group, or a control group that did not receive any training. Both training programs consisted of a ten-week intervention period with a daily 12-minute app-based mental training practice and weekly 2-hour online coaching sessions led by mental training teachers. Results Results showed that the socio-emotional Dyad group but not the mindfulness-based group exhibited significantly lower cortisol levels at 10, 20, 30, and 40 minutes after the stressor as well as lower total cortisol output compared to the control group during the TSST, indicating a reduced hormonal stress response to a social stressor. Subjective markers did not show differences between the three groups. Discussion These findings indicate that the daily socio-emotional dyadic practice, which emphasizes non-judgmental and empathic listening as well as the acceptance of challenging emotions in the presence of others within one's daily life context, may serve as a protective factor against the adverse effects of psychosocial stress triggered by the fear of negative social judgments. Given the high prevalence of stress-related diseases, such online mental training programs based on dyadic practices may thus represent an efficient and scalable approach for stress reduction.
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Affiliation(s)
- Hannah Matthaeus
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christine Heim
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Manuel C. Voelkle
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tania Singer
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
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Jeong D, Lee E, Sung J, Kang S. Relationship between sleep quality and gravitational Tolerance. Sleep Breath 2024; 28:1223-1229. [PMID: 38308752 DOI: 10.1007/s11325-023-02987-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 12/06/2023] [Accepted: 12/27/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between sleep quality and gravitational tolerance because sleep could directly affect physiological variables of the human body. METHODS For the present study, 157 male Korea Air Force Academy cadets were recruited. They were assigned into a gravity (G)-tolerance test pass group (GP, n = 87) and a G-tolerance test fail group (GF, n = 70). All participants were assessed for G-tolerance test and Pittsburgh Sleep Quality Index (PSQI), a self-report questionnaire. Physical fitness test was performed based on the physical fitness test of the Ministry of National Defense of Korea. RESULTS Independent t-test showed that PSQI global score (p < 0.001), PSQI sleep quality (p < 0.001), PSQI sleep onset latency (p = 0.009), PSQI sleep disturbance (p < 0.001), and PSQI daytime dysfunction (p < 0.001) were significantly different between the two groups. Participants with PSQI score less than 5 were more likely to have a longer G-tolerance test time (OR = 4.705, 95% CI = 2.00-11.05). Additionally, associations between those with PSQI score less than 5 (OR = 4.567, 95% CI = 1.94-10.74) were after adjusting (< 30 s and ≥ 30 s) for covariates. A negative correlation was found between G-tolerance test time and PSQI global score (p < 0.001). Negative correlations were found among 3 km running, push-up (p < 0.001), and sit-up (p < 0.001). A positive correlation was found between push-up and sit-up (p < 0.001). CONCLUSION In conclusion, participants with good sleep quality were 4.705 times more likely to have longer G-tolerance test time. Thus, it is important for aircraft pilots to manage their sleep quality. Pre-pilots should also improve their sleep quality to pass the G-tolerance test.
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Affiliation(s)
- Deokhwa Jeong
- Department of Smart Health Science and Technology, Graduate School, Kangwon National University, Gangwon-Do, Republic of Korea
- Department of Aero Fitness, Republic of Korea Air Force Academy, Chungcheongbuk-Do, Republic of Korea
| | - Eunjae Lee
- Waseda Institute for Sport Sciences, Waseda University, Saitama, Japan
- Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon, Republic of Korea
| | - Junyoung Sung
- Department of Aero Fitness, Republic of Korea Air Force Academy, Chungcheongbuk-Do, Republic of Korea
| | - Sunghwun Kang
- Laboratory of Exercise Physiology, College of Art, Culture and Engineering, Kangwon National University, Gangwon-Do, Republic of Korea.
- Interdisciplinary Program in Biohealth-Machinery Convergence Engineering, Kangwon National University, Gangwon-Do, Republic of Korea.
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Konrad AC, Förster K, Stretton J, Dalgleish T, Böckler‐Raettig A, Trautwein F, Singer T, Kanske P. Risk factors for internalizing symptoms: The influence of empathy, theory of mind, and negative thinking processes. Hum Brain Mapp 2024; 45:e26576. [PMID: 38401139 PMCID: PMC10893974 DOI: 10.1002/hbm.26576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 02/26/2024] Open
Abstract
Internalizing symptoms such as elevated stress and sustained negative affect can be important warning signs for developing mental disorders. A recent theoretical framework suggests a complex interplay of empathy, theory of mind (ToM), and negative thinking processes as a crucial risk combination for internalizing symptoms. To disentangle these relationships, this study utilizes neural, behavioral, and self-report data to examine how the interplay between empathy, ToM, and negative thinking processes relates to stress and negative affect. We reanalyzed the baseline data of N = 302 healthy participants (57% female, Mage = 40.52, SDage = 9.30) who participated in a large-scale mental training study, the ReSource project. Empathy and ToM were assessed using a validated fMRI paradigm featuring naturalistic video stimuli and via self-report. Additional self-report scales were employed to measure internalizing symptoms (perceived stress, negative affect) and negative thinking processes (rumination and self-blame). Our results revealed linear associations of self-reported ToM and empathic distress with stress and negative affect. Also, both lower and higher, compared to average, activation in the anterior insula during empathic processing and in the middle temporal gyrus during ToM performance was significantly associated with internalizing symptoms. These associations were dependent on rumination and self-blame. Our findings indicate specific risk constellations for internalizing symptoms. Especially people with lower self-reported ToM and higher empathic distress may be at risk for more internalizing symptoms. Quadratic associations of empathy- and ToM-related brain activation with internalizing symptoms depended on negative thinking processes, suggesting differential effects of cognitive and affective functioning on internalizing symptoms. Using a multi-method approach, these findings advance current research by shedding light on which complex risk combinations of cognitive and affective functioning are relevant for internalizing symptoms.
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Affiliation(s)
- Annika C. Konrad
- Clinical Psychology and Behavioral NeuroscienceTechnische Universität DresdenDresdenGermany
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK
| | - Katharina Förster
- Clinical Psychology and Behavioral NeuroscienceTechnische Universität DresdenDresdenGermany
| | - Jason Stretton
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK
| | | | - Fynn‐Mathis Trautwein
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of MedicineMedical Center—University of FreiburgFreiburg im BreisgauGermany
| | - Tania Singer
- Social Neuroscience LabMax Planck SocietyBerlinGermany
| | - Philipp Kanske
- Clinical Psychology and Behavioral NeuroscienceTechnische Universität DresdenDresdenGermany
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10
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Shangguan F, Chen Z, Lv Y, Zhang XY. Interaction between high interleukin-2 and high cortisol levels is associated with psychopathology in patients with chronic schizophrenia. J Psychiatr Res 2023; 165:255-263. [PMID: 37541091 DOI: 10.1016/j.jpsychires.2023.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/20/2023] [Accepted: 07/29/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Both cortisol and interleukins appear at abnormal levels in schizophrenia. Our previous study has shown that cortisol and interleukins are associated with psychopathology and response to antipsychotic medications in a relatively small sample size of patients with schizophrenia. The current study was designed to investigate how cortisol, interleukins (ILs) and their interactions would correlate with clinical presentation in a relatively large sample size of patients with schizophrenia. METHODS We compared serum cortisol, IL-2, IL-6, and IL-8 levels in 162 medicated schizophrenia patients (including 27 patients in remission) and 62 healthy controls. Serum levels of cortisol and interleukins were measured by radioimmunoassay and quantitative ELISA, respectively. Clinical symptoms were assessed according to the Positive and Negative Syndrome Scale (PANSS). RESULTS Patients with schizophrenia had significantly higher levels of cortisol and IL-2 compared to controls. Patients in remission had higher levels of IL-6 than non-remitting patients. PANSS positive symptoms, general psychopathology, cortisol and IL-2 were the most central nodes in the cortisol-IL-symptom network. The interaction between cortisol and IL-2 was associated with PANSS positive symptoms, general psychopathology and depressive factor. For patients with cortisol level above the median, IL-2 was negatively associated with PANSS positive symptoms and general psychopathology. CONCLUSIONS Our results indicated that the interaction between cytokines and cortisol may be associated with the pathophysiology of some symptoms in chronic schizophrenia. In particular, the interaction between cortisol and IL-2 is associated with the clinical phenotypes of schizophrenia.
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Affiliation(s)
- Fangfang Shangguan
- Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, 100037, China
| | - Ziwei Chen
- Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, 100037, China
| | - Yue Lv
- Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, 100037, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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11
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Blasberg JU, Gallistl M, Degering M, Baierlein F, Engert V. You look stressed: A pilot study on facial action unit activity in the context of psychosocial stress. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2023; 15:100187. [PMID: 37577295 PMCID: PMC10422124 DOI: 10.1016/j.cpnec.2023.100187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 08/15/2023] Open
Abstract
Quality and quantity of the human stress response are highly individual. Not only are there differences in terms of psychological and physiological stress reactivity, but also with regard to facial muscle stress reactivity. In a first correlative pilot study to decipher the signature of stress as it presents in the physiognomy of a stressed individual, we investigated how stress-induced muscle movement activity in the face is associated with stress marker activation during a standardized laboratory stress test. Female and male participants (N = 62) completed the Trier Social Stress Test and provided multiple measurements of salivary cortisol, subjective experience, heart rate, and high-frequency heart rate variability. In addition, participants were filmed during stress induction to derive the activation of 13 individual muscles or muscle groups, also termed action units (AU). Mean AU intensity and occurrence rates were measured using the opensource software OpenDBM. We found that facial AU activity correlated with different aspects of the psychosocial stress response. Higher stress-induced cortisol release was associated with more frequent upper eyelid raiser (AU05) and upper lip raiser (AU10) occurrences, while more lip corner pulling (AU12) went along with lower cortisol reactivity. More frequent eyelid tightener (AU07) occurrences were linked to higher subjective stress reactivity but decreased heart rate and HF-HRV reactivity. Last, women showed greater stress-induced smiling intensity and occurrence rates than men. We conclude that psychosocial stress reactivity is systematically linked to facial muscle activity, with distinct facial stress profiles emerging for different stress markers. From all the AUs studied, eyelid tightening (AU07) seems to provide the strongest potential for future attempts of diagnosing phases of acute stress via facial activity.
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Affiliation(s)
- Jost U. Blasberg
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Mathilde Gallistl
- Research Group Social Stress and Family Health, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Magdalena Degering
- Research Group Social Stress and Family Health, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Felicitas Baierlein
- Research Group Social Stress and Family Health, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Veronika Engert
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
- Research Group Social Stress and Family Health, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- German Center for Mental Health (DZPG), Germany
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12
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Revisiting the stress recovery hypothesis: Differential associations of cortisol stress reactivity and recovery after acute psychosocial stress with markers of long-term stress and health. Brain Behav Immun Health 2023; 28:100598. [PMID: 36820051 PMCID: PMC9937905 DOI: 10.1016/j.bbih.2023.100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/19/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023] Open
Abstract
Exposure to excessive and long-term stress may result in dysregulation of the stress system, including the acute stress response. In particular, failure to downregulate stress-related reactivity may lead to prolonged stress responses and the accumulation of allostatic load. However, the contribution of altered acute cortisol recovery to chronic stress and associated health impairments has often been neglected. Addressing this lack of research, we explored whether recovery from - more so than reactivity to - acute stress captures the basal stress load of an individual. Using Piecewise Growth Curve Models with Landmark Registration, we analyzed cortisol reactivity and recovery slopes of 130 healthy participants exposed to a standardized psychosocial laboratory stressor. Reactivity and recovery were predicted by measures indicative of long-term stress and its downstream effects, including self-report questionnaires, diurnal cortisol indices [cortisol awakening response (CAR); diurnal cortisol slope], markers of pro-inflammatory activity (interleukin-6; high-sensitive C-reactive protein), and hippocampal volume (HCV). Among these measures, only an increased CAR was specifically and consistently associated with relatively impaired recovery. Since the CAR represents the physiological enhancement needed to meet the anticipated demands of the forthcoming day, this finding may highlight the contribution of cognitive processes in determining both CAR and acute stress recovery. Furthermore, greater cortisol reactivity covaried with smaller HCV, showing that increased acute reactivity translates to health-relevant downstream effects. The lack of further associations between long-term and acute stress measures may arise from biases in self-reported chronic stress and the rigorously health-screened study sample. Overall, our findings suggest that while cortisol stress recovery might not supersede reactivity as an indicator of the long-term stress load or associated health effects, recovery and reactivity have differential utility in describing individuals' allostatic states.
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13
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Blasberg JU, Kanske P, Böckler A, Trautwein FM, Singer T, Engert V. Associations of social processing abilities with psychosocial stress sensitivity. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 12:100159. [PMID: 36164367 PMCID: PMC9508502 DOI: 10.1016/j.cpnec.2022.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022] Open
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14
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Ahrens KF, Neumann RJ, von Werthern NM, Kranz TM, Kollmann B, Mattes B, Puhlmann LMC, Weichert D, Lutz B, Basten U, Fiebach CJ, Wessa M, Kalisch R, Lieb K, Chiocchetti AG, Tüscher O, Reif A, Plichta MM. Association of polygenic risk scores and hair cortisol with mental health trajectories during COVID lockdown. Transl Psychiatry 2022; 12:396. [PMID: 36130942 PMCID: PMC9490720 DOI: 10.1038/s41398-022-02165-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic is a global stressor with inter-individually differing influences on mental health trajectories. Polygenic Risk Scores (PRSs) for psychiatric phenotypes are associated with individual mental health predispositions. Elevated hair cortisol concentrations (HCC) and high PRSs are related to negative mental health outcomes. We analyzed whether PRSs and HCC are related to different mental health trajectories during the first COVID lockdown in Germany. Among 523 participants selected from the longitudinal resilience assessment study (LORA), we previously reported three subgroups (acute dysfunction, delayed dysfunction, resilient) based on weekly mental health (GHQ-28) assessment during COVID lockdown. DNA from blood was collected at the baseline of the original LORA study (n = 364) and used to calculate the PRSs of 12 different psychopathological phenotypes. An explorative bifactor model with Schmid-Leiman transformation was calculated to extract a general genetic factor for psychiatric disorders. Hair samples were collected quarterly prior to the pandemic for determining HCC (n = 192). Bivariate logistic regressions were performed to test the associations of HCC and the PRS factors with the reported trajectories. The bifactor model revealed 1 general factor and 4 sub-factors. Results indicate a significant association between increased values on the general risk factor and the allocation to the acute dysfunction class. The same was found for elevated HCC and the exploratorily tested sub-factor "childhood-onset neurodevelopmental disorders". Genetic risk and long-term cortisol secretion as a potential indicator of stress, indicated by PRSs and HCC, respectively, predicted different mental health trajectories. Results indicate a potential for future studies on risk prediction.
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Affiliation(s)
- Kira F. Ahrens
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt, Germany
| | - Rebecca J. Neumann
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt, Germany
| | - Nina M. von Werthern
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt, Germany
| | - Thorsten M. Kranz
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt, Germany
| | - Bianca Kollmann
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany ,grid.509458.50000 0004 8087 0005Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - Björn Mattes
- grid.6546.10000 0001 0940 1669Institute of Psychology, Technical University of Darmstadt, Darmstadt, Germany
| | - Lara M. C. Puhlmann
- grid.509458.50000 0004 8087 0005Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - Danuta Weichert
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Beat Lutz
- grid.509458.50000 0004 8087 0005Leibniz Institute for Resilience Research (LIR), Mainz, Germany ,grid.410607.4Institute of Physiological Chemistry, University Medical Center Mainz, Mainz, Germany
| | - Ulrike Basten
- grid.7839.50000 0004 1936 9721Department of Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany ,grid.7839.50000 0004 1936 9721Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Christian J. Fiebach
- grid.7839.50000 0004 1936 9721Department of Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany ,grid.7839.50000 0004 1936 9721Brain Imaging Center, Goethe University, Frankfurt, Germany
| | - Michèle Wessa
- grid.509458.50000 0004 8087 0005Leibniz Institute for Resilience Research (LIR), Mainz, Germany ,grid.5802.f0000 0001 1941 7111Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Raffael Kalisch
- grid.509458.50000 0004 8087 0005Leibniz Institute for Resilience Research (LIR), Mainz, Germany ,grid.410607.4Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Klaus Lieb
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany ,grid.509458.50000 0004 8087 0005Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - Andreas G. Chiocchetti
- grid.7839.50000 0004 1936 9721Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Oliver Tüscher
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany ,grid.509458.50000 0004 8087 0005Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - Andreas Reif
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt, Germany
| | - Michael M. Plichta
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt, Germany
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15
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Linz R, Puhlmann LMC, Engert V, Singer T. Investigating the impact of distinct contemplative mental trainings on daily life stress, thoughts and affect-Evidence from a nine-month longitudinal ecological momentary assessment study. Psychoneuroendocrinology 2022; 142:105800. [PMID: 35598494 DOI: 10.1016/j.psyneuen.2022.105800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/31/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
Mindfulness-based mental training interventions have become a popular means to alleviate stress and stress-associated health risks. Previous scientific investigations emphasize the importance of exploring the effects of such interventions in naturalistic settings to evaluate their implementation into daily life. Therefore, the current study examined the effects of three distinct mental training modules on a range of measures of daily life experience in the scope of the ReSource Project, a 9-month longitudinal mental training study comparing modules targeting attention and interoception (Presence), socio-affective (Affect) or socio-cognitive abilities (Perspective). We used ecological momentary assessment (EMA) to repeatedly probe levels of stress and stress-coping efficacy combined with stress-reactive cortisol levels, and further explored arousal, affective states, and thought patterns in the daily lives of 289 healthy adults (172 women; 20-55 years). We found increased presence-focused thought and heightened arousal after a training duration of 3-6 months, independent of the type of prior training. Increased coping efficacy emerged specifically after socio-cognitive Perspective training, following 6-9 months of training duration. No training effects were found for subjective stress, stress-reactive cortisol levels, or daily life affect. Our findings corroborate and add ecological validity to previous ReSource findings by showing that they replicate in participants' everyday environment. Regarding endocrine and subjective stress markers, our results suggest caution in generalizing acute laboratory findings to individuals' everyday routines. Overall, the current study provides substantiated insights into how cultivating one's mind through contemplative mental training translates to daily life experience, enhances stress-coping, and may ultimately aide in maintaining health.
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Affiliation(s)
- R Linz
- Research Group Social Stress and Family Health, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - L M C Puhlmann
- Research Group Social Stress and Family Health, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - V Engert
- Research Group Social Stress and Family Health, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - T Singer
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
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16
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Zhu M, Yuan L, Wu Y, Chu L, Wang W, Zhang H, Liao W, Peng X, Deng H. Simultaneous LC-MS/MS quantification of glucocorticoids, melatonin and its metabolites in hair. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1196:123217. [DOI: 10.1016/j.jchromb.2022.123217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/21/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
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17
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van der Valk E, Abawi O, Mohseni M, Abdelmoumen A, Wester V, van der Voorn B, Iyer A, van den Akker E, Hoeks S, van den Berg S, de Rijke Y, Stalder T, van Rossum E. Cross-sectional relation of long-term glucocorticoids in hair with anthropometric measurements and their possible determinants: A systematic review and meta-analysis. Obes Rev 2022; 23:e13376. [PMID: 34811866 PMCID: PMC9285618 DOI: 10.1111/obr.13376] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Long-term glucocorticoids (HairGC) measured in scalp hair have been associated with body mass index (BMI), waist circumference (WC), and waist-hip-ratio (WHR) in several cross-sectional studies. We aimed to investigate the magnitude, strength, and clinical relevance of these relations across all ages. METHODS We performed a systematic review and meta-analysis (PROSPERO registration CRD42020205187) searching for articles relating HairGC to measures of obesity. Main outcomes were bivariate correlation coefficients and unadjusted simple linear regression coefficients relating hair cortisol (HairF) and hair cortisone (HairE) to BMI, WC, and WHR. RESULTS We included k = 146 cohorts (n = 34,342 individuals). HairGC were positively related to all anthropometric measurements. The strongest correlation and largest effect size were seen for HairE-WC: pooled correlation 0.18 (95%CI 0.11-0.24; k = 7; n = 3,158; I2 = 45.7%) and pooled regression coefficient 11.0 cm increase in WC per point increase in 10-log-transformed HairE (pg/mg) on liquid-chromatography-(tandem) mass spectrometry (LC-MS) (95%CI 10.1-11.9 cm; k = 6; n = 3,102). Pooled correlation for HairF-BMI was 0.10 (95%CI 0.08-0.13; k = 122; n = 26,527; I2 = 51.2%) and pooled regression coefficient 0.049 kg/m2 per point increase in 10-log-transformed HairF (pg/mg) on LC-MS (95%CI 0.045-0.054 kg/m2 ; k = 26; n = 11,635). DISCUSSION There is a consistent positive association between HairGC and BMI, WC, and WHR, most prominently and clinically relevant for HairE-WC. These findings overall suggest an altered setpoint of the hypothalamic-pituitary-adrenal axis with increasing central adiposity.
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Affiliation(s)
- Eline van der Valk
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ozair Abawi
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, division of Endocrinology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mostafa Mohseni
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Amir Abdelmoumen
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent Wester
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bibian van der Voorn
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, division of Endocrinology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anand Iyer
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erica van den Akker
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, division of Endocrinology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sanne Hoeks
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sjoerd van den Berg
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yolanda de Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tobias Stalder
- Department of Clinical Psychology, University of Siegen, Siegen, Germany
| | - Elisabeth van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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18
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Egger ST, Knorr M, Bobes J, Bernstein A, Seifritz E, Vetter S. Real-Time Assessment of Stress and Stress Response Using Digital Phenotyping: A Study Protocol. Front Digit Health 2021; 2:544418. [PMID: 34713030 PMCID: PMC8521792 DOI: 10.3389/fdgth.2020.544418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Stress is a complex phenomenon that may have a negative influence on health and well-being; consequently, it plays a pivotal role in mental health. Although the incidence of mental disorders has been continuously rising, development of prevention and treatment methods has been rather slow. Through the ubiquitous presence of smartphones and wearable devices, people can monitor stress parameters in everyday life. However, the reliability and validity of such monitoring are still unsatisfactory. Methods: The aim of this trial is to find a relationship between psychological stress and saliva cortisol levels on the one hand and physiological parameters measured by smartphones in combination with a commercially available wearable device on the other. Participants include cohorts of individuals with and without a psychiatric disorder. The study is conducted in two settings: one naturalistic and one a controlled laboratory environment, combining ecological momentary assessment (EMA) and digital phenotyping (DP). EMA is used for the assessment of challenging and stressful situations coincidentally happening during a whole observation week. DP is used during a controlled stress situation with the Trier Social Stress Test (TSST) as a standardized psychobiological paradigm. Initially, participants undergo a complete psychological screening and profiling using a standardized psychometric test battery. EMA uses a smartphone application, and the participants keep a diary about their daily routine, activities, well-being, sleep, and difficult and stressful situations they may encounter. DP is conducted through wearable devices able to continuously monitor physiological parameters (i.e., heart rate, heart rate variability, skin conductivity, temperature, movement and acceleration). Additionally, saliva cortisol samples are repeatedly taken. The TSST is conducted with continuous measurement of the same parameters measured during the EMA. Discussion: We aim to identify valid and reliable digital biomarkers for stress and stress reactions. Furthermore, we expect to find a way of early detection of psychological stress in order to evolve new opportunities for interventions reducing stress. That may allow us to find new ways of treating and preventing mental disorders. Trial Registration: The competing ethics committee of the Canton of Zurich, Switzerland, approved the study protocol V05.1 May 28, 2019 [BASEC: 2019-00814]; the trial was registered at ClinicalTrials.gov [NCT04100213] on September 19, 2019.
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Affiliation(s)
- Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Marius Knorr
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Abraham Bernstein
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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19
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Puhlmann LM, Vrtička P, Linz R, Stalder T, Kirschbaum C, Engert V, Singer T. Contemplative Mental Training Reduces Hair Glucocorticoid Levels in a Randomized Clinical Trial. Psychosom Med 2021; 83:894-905. [PMID: 34259441 PMCID: PMC8505163 DOI: 10.1097/psy.0000000000000970] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/24/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the effect of regular contemplative mental training on endocrine and psychological indices of long-term stress. METHODS An open-label efficacy trial that comprised three distinct 3-month long modules targeting attention and interoception, socioaffective, or sociocognitive abilities through dyadic exercises and secularized meditation practices was conducted with healthy adults. Participants underwent the training for 3 or 9 months, or were assigned to a retest control cohort. Chronic stress indices were assayed at four time points: pretraining and after 3, 6, and 9 months. The main outcome measures were cortisol (HC) and cortisone (HE) concentration in hair and self-reported long-term stress. RESULTS Of 362 initially randomized individuals, 30 dropped out before study initiation (n = 332; mean [SD] age = 40.7 [9.2] years; 197 women). Hair-based glucocorticoid assays were available from n = 227, and questionnaire data from n = 326. Results from three separate training cohorts (TC1-3) revealed consistent decreases in HC and HE levels over the first three (TC3) to 6 months (TC1 and TC2) of training, with no further reduction at the final 9-month mark (baseline to end of training differences, HC, TC1: t(355) = 2.59, p = .010, contrast estimate (est.) [SE] = 0.35 [0.14]; HC, TC2: t(363) = 4.06, p < .001, est. = 0.48 [0.12]; HC, TC3: t(368) = 3.18, p = .002, est. = 0.41 [0.13]; HE, TC1: t(435) = 3.23, p = .001, est. = 0.45 [0.14]; HE, TC2: t(442) = 2.60, p = .010, est. = 0.33 [0.13]; HE, TC3: t(446) = 4.18, p < .001, est. = 0.57 [0.14]). Training effects on HC increased with individual compliance (practice frequency), and effects on both HC and HE were independent of training content and unrelated to change in self-reported chronic stress. Self-reported stress, and cortisol-to-dehydroepiandrosterone ratios as an exploratory endpoint, were also reduced, albeit less consistently. CONCLUSIONS Our results point to the reduction of long-term cortisol exposure as a mechanism through which meditation-based mental training may exert positive effects on practitioners' health.Trial Registration: ClinicalTrials.gov identifier: NCT01833104.
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20
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Resilience and personality as predictors of the biological stress load during the first wave of the Covid-19 pandemic in Germany. Transl Psychiatry 2021; 11:443. [PMID: 34455419 PMCID: PMC8401367 DOI: 10.1038/s41398-021-01569-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/01/2021] [Accepted: 08/17/2021] [Indexed: 12/16/2022] Open
Abstract
Since the Covid-19 outbreak, pandemic-specific stressors have potentiated the-already severe-stress load across the world. However, stress is more than an adverse state, and chronic exposure is causally involved in the development of mental and physical disease. We ask the question whether resilience and the Big Five personality traits predict the biological stress response to the first lockdown in Germany. In a prospective, longitudinal, observational study, N = 80 adult volunteers completed an internet-based survey prior to the first Covid-19-related fatality in Germany (T0), during the first lockdown period (T1), and during the subsequent period of contact restrictions (T2). Hair strands for the assessment of systemic cortisol and cortisone levels were collected at T2. Higher neuroticism predicted higher hair cortisol, cortisone and subjective stress levels. Higher extraversion predicted higher hair cortisone levels. Resilience showed no effects on subjective or physiological stress markers. Our study provides longitudinal evidence that neuroticism and extraversion have predictive utility for the accumulation of biological stress over the course of the pandemic. While in pre-pandemic times individuals high in neuroticism are typically at risk for worse health outcomes, extraverted individuals tend to be protected. We conclude that, in the pandemic context, we cannot simply generalize from pre-pandemic knowledge. Neurotic individuals may currently suffer due to their general emotional lability. Extraverted individuals may primarily be socially stressed. Individualized stress management programs need to be developed, and offered in a lockdown-friendly format, to minimize the stress burden caused by Covid-19 or future pandemics and to protect the most severely affected individuals from the development of stress-associated disease.
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Stress Management as an Effective Complementary Therapeutic Strategy for Weight Loss in Children and Adolescents with Obesity: A Systematic Review of Randomized Controlled Trials. CHILDREN-BASEL 2021; 8:children8080670. [PMID: 34438561 PMCID: PMC8391124 DOI: 10.3390/children8080670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/25/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022]
Abstract
Lifestyle intervention programs, including mindfulness and stress management/emotional control training techniques have been infrequently studied in children. The aim of this systematic review was to assess whether implementing stress management/emotional control training strategies in the context of a body weight loss program in children and adolescents is associated with improved body weight outcome in this age group. A systematic literature search was conducted to identify relevant studies published before 31 December 2020 in the following databases: Medline (PubMed), Scopus, and Cochrane Central Registry of Controlled Trials. Only randomized clinical trials (RCTs) on mindfulness or stress management in children and adolescents with obesity were included in this systematic review. Six RCTs fulfilled the study inclusion criteria and included intervention (112 subjects) and control (137 subjects) groups. The interventions used were Mindfulness-Based Stress Reduction therapy for 8 weeks (three studies), a mindfulness-based group program for adolescents (one study), and Mindful Eating Intervention for 6 weeks (one study) and 10 weeks (one study). The intervention group demonstrated reduced adiposity markers as compared to controls in four of the six included studies. The presented studies support the hypothesis that a structured, mindfulness-based intervention program may lead to a decrease in the biomarkers of obesity.
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22
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Ostinelli G, Scovronec A, Iceta S, Ouellette AS, Lemieux S, Biertho L, Bégin C, Michaud A, Tchernof A. Deciphering the Association Between Hypothalamus-Pituitary-Adrenal Axis Activity and Obesity: A Meta-Analysis. Obesity (Silver Spring) 2021; 29:846-858. [PMID: 33783120 DOI: 10.1002/oby.23125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/17/2020] [Accepted: 12/31/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Both the cortisol awakening response (CAR; corresponding to the state measurement) and hair cortisol concentration (HCC; corresponding to the trait measurement) are considered reliable markers of hypothalamus-pituitary-adrenal axis activity. Because cortisol has long been associated with adiposity, this systematic review and meta-analysis aims to summarize and compare the literature around CAR and HCC and their association with obesity or fat distribution indices. METHODS The PubMed, Web of Science (Web of Science Core Collection and Medline), EBSCO Information Services, Embase, and PsycNET databases were searched, and full-text articles investigating the association between CAR or HCC and markers of adiposity in humans were included. Meta-analyses were then performed to compare studies associating CAR or HCC with BMI (a marker of general adiposity) and waist circumference (a marker of fat distribution). RESULTS The results of this review highlight inconsistencies in cortisol sampling and CAR computation, which makes comparisons between studies difficult. It was found that adiposity indices are not associated with CAR but that they correlate significantly and positively with HCC. The subgroup analysis hinted to possible age differences in the magnitude of the association between HCC and BMI. CONCLUSIONS Trait rather than state measurement of the hypothalamus-pituitary-adrenal axis activity is associated with increased general and abdominal adiposity in humans.
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Affiliation(s)
- Giada Ostinelli
- Québec Heart and Lung Institute Research Center, Québec City, Québec, Canada
- School of Nutrition, Université Laval, Québec City, Québec, Canada
| | - Anaïs Scovronec
- Québec Heart and Lung Institute Research Center, Québec City, Québec, Canada
- School of Nutrition, Université Laval, Québec City, Québec, Canada
| | - Sylvain Iceta
- Québec Heart and Lung Institute Research Center, Québec City, Québec, Canada
- School of Nutrition, Université Laval, Québec City, Québec, Canada
| | | | - Simone Lemieux
- School of Nutrition, Université Laval, Québec City, Québec, Canada
| | - Laurent Biertho
- Québec Heart and Lung Institute Research Center, Québec City, Québec, Canada
| | - Catherine Bégin
- School of Psychology, Université Laval, Québec City, Québec, Canada
| | - Andréanne Michaud
- Québec Heart and Lung Institute Research Center, Québec City, Québec, Canada
- School of Nutrition, Université Laval, Québec City, Québec, Canada
| | - André Tchernof
- Québec Heart and Lung Institute Research Center, Québec City, Québec, Canada
- School of Nutrition, Université Laval, Québec City, Québec, Canada
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23
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Fiore V, De Vito A, Fanelli C, Geremia N, Princic E, Nivoli A, Maida I, Lorettu L, Madeddu G, Babudieri S. Mood Reactive Disorders among COVID-19 Inpatients: Experience from a Monocentric Cohort. Med Princ Pract 2021; 30:535-541. [PMID: 34818250 PMCID: PMC8739625 DOI: 10.1159/000518490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/13/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We aimed to investigate the presence and severity of depressive symptoms among coronavirus disease 2019 (COVID-19) inpatients and any possible changes after their discharge. SUBJECT AND METHODS We collected data of patients admitted to the Infectious Disease Unit in Sassari, Italy, for COVID-19, from March 8 to May 8, 2020. The Beck Depression Inventory-II (BDI-II) was performed 1 week after admission (T0) and 1 week after discharge (T1). The cutoff point chosen to define the clinical significance of depressive symptoms was 20 (at least moderate). RESULTS Forty-eight subjects were included. Mean age was 64.3 ± 17.6 years, and 32 (66.7%) were male. Most frequent comorbidities were cardiovascular diseases (19; 39.6%) and hypertension (17; 35.4%). When performing BDI-II at T0, 21 (43.7%) patients reported depressive symptoms at T0, according to the chosen cutoff point (BDI-II = 20). Eight (16.7%) patients had minimal symptoms. Mild mood disturbance and moderate and severe depressive symptoms were found in 24 (50%), 14 (29.2%), and 2 (4.2%) patients, respectively, at T0. The comparison of the BDI-II questionnaire at T0 with T1 showed a significant improvement in the total score (p < 0.0001), as well as in 4 out of the 5 selected questions of interest (p < 0.05). Univariate analysis showed that kidney failure and the death of a roommate were significantly associated with severity of mood disorders. CONCLUSION Mood disturbances and depressive symptoms commonly occur among COVID-19 inpatients. Our results show that COVID-19 inpatients might be at higher risk for developing depressive reactive disorders and could benefit from an early psychological evaluation and strategies improving sleep quality.
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Affiliation(s)
- Vito Fiore
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- *Vito Fiore,
| | - Andrea De Vito
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Chiara Fanelli
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Nicholas Geremia
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Elija Princic
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandra Nivoli
- Psychiatric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Ivana Maida
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Liliana Lorettu
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giordano Madeddu
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- Psychiatric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- Mediterranean Center for Disease Control, Sassari, Italy
| | - Sergio Babudieri
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Psychological stress and cortisol during pregnancy: An ecological momentary assessment (EMA)-Based within- and between-person analysis. Psychoneuroendocrinology 2020; 121:104848. [PMID: 32927180 PMCID: PMC7895320 DOI: 10.1016/j.psyneuen.2020.104848] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although the linkage between psychological stress and cortisol is believed to mediate the association of stress with health outcomes, several studies have been unable to demonstrate this association. We suggest this inability may be a consequence of limitations in the measurement approach and/or reliance on analytic strategies that focus on associations across, rather than within individuals. The link between psychological stress and cortisol is of particular interest in the context of pregnancy and fetal development. Using an ecological momentary assessment (EMA) design, we examined the association between psychological stress and cortisol at the between- and the within-person level. METHODS 152 participants completed a 4-day long EMA protocol serially in early, mid and late pregnancy to provide momentary stress appraisals (average of 150 measures/subject) and saliva samples (average of 55 samples/subject) for quantification of cortisol. The association between stress and cortisol was estimated using linear mixed models. RESULTS After accounting for the effects of key determinants of variation in cortisol, momentary stress was significantly and positively associated with cortisol at the within-person level (B = .030, p = .031), but not at the between-person level. No association was evident for traditional retrospective measures of stress with cortisol at either the between- or the within-person level. CONCLUSIONS Our study highlights the value of EMA methods and linear mixed-modeling approaches in linking maternal psychological and physiological states across pregnancy. These findings may have important implications for the development of personalized risk identification and "just-in-time" intervention strategies to optimize maternal and child health.
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25
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Hao F, Tam W, Hu X, Tan W, Jiang L, Jiang X, Zhang L, Zhao X, Zou Y, Hu Y, Luo X, McIntyre RS, Quek T, Tran BX, Zhang Z, Pham HQ, Ho CSH, Ho RC. A quantitative and qualitative study on the neuropsychiatric sequelae of acutely ill COVID-19 inpatients in isolation facilities. Transl Psychiatry 2020; 10:355. [PMID: 33077738 PMCID: PMC7570419 DOI: 10.1038/s41398-020-01039-2] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/12/2020] [Accepted: 10/01/2020] [Indexed: 12/18/2022] Open
Abstract
This study examined the neuropsychiatric sequelae of acutely ill patients with coronavirus disease 2019 (COVID-19) infection who received treatment in hospital isolation wards during the COVID-19 pandemic. Ten COVID-19 patients who received treatment in various hospitals in Chongqing, China; 10 age- and gender-matched psychiatric patients; and 10 healthy control participants residing in the same city were recruited. All participants completed a survey that collected information on demographic data, physical symptoms in the past 14 days and psychological parameters. Face-to-face interviews with COVID-19 patients were also performed using semi-structured questions. Among the COVID-19 patients, 40% had abnormal findings on the chest computed topography scan, 20% had dysosmia, 10% had dysgeusia, and 80% had repeated positivity on COVID-19 reverse-transcription polymerase chain reaction testing. COVID-19 and psychiatric patients were significantly more worried about their health than healthy controls (p = 0.019). A greater proportion of COVID-19 patients experienced impulsivity (p = 0.016) and insomnia (p = 0.039) than psychiatric patients and healthy controls. COVID-19 patients reported a higher psychological impact of the outbreak than psychiatric patients and healthy controls, with half of them having clinically significant symptoms of posttraumatic stress disorder. COVID-19 and psychiatric patients had higher levels of depression, anxiety and stress than healthy controls. Three themes emerged from the interviews with COVID-19 patients: (i) The emotions experienced by patients after COVID-19 infection (i.e., shock, fear, despair, hope, and boredom); (ii) the external factors that affected patients' mood (i.e., discrimination, medical expenses, care by healthcare workers); and (iii) coping and self-help behavior (i.e., distraction, problem-solving and online support). The future direction in COVID-19 management involves the development of a holistic inpatient service to promote immune and psychological resilience.
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Affiliation(s)
- Fengyi Hao
- grid.440187.eThe First People’s Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Wilson Tam
- grid.4280.e0000 0001 2180 6431Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Xiaoyu Hu
- grid.452206.7First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wanqiu Tan
- National University of Singapore (Chongqing) Research Institute, Chongqing, China
| | - Li Jiang
- grid.440187.eThe First People’s Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Xiaojiang Jiang
- grid.440187.eThe First People’s Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Ling Zhang
- grid.440187.eThe First People’s Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Xinling Zhao
- grid.440187.eThe First People’s Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Yiran Zou
- grid.440187.eThe First People’s Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Yirong Hu
- grid.440187.eThe First People’s Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Xi Luo
- grid.414048.d0000 0004 1799 2720Department of Neurology, Daping Hospital, Army Medical University, Chongqing, 400042 China
| | - Roger S. McIntyre
- grid.17063.330000 0001 2157 2938Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada
| | - Travis Quek
- grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077 Singapore
| | - Bach Xuan Tran
- grid.56046.310000 0004 0642 8489Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000 Vietnam ,grid.21107.350000 0001 2171 9311Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Zhisong Zhang
- grid.440755.70000 0004 1793 4061Faculty of Education, Huaibei Normal University, Huaibei, 235000 China
| | - Hai Quang Pham
- grid.444918.40000 0004 1794 7022Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam ,grid.444918.40000 0004 1794 7022Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Cyrus S. H. Ho
- grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077 Singapore ,grid.410759.e0000 0004 0451 6143Department of Psychological Medicine, National University Health System, Singapore, Singapore
| | - Roger C.M. Ho
- grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077 Singapore ,grid.4280.e0000 0001 2180 6431Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 119077 Singapore
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26
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Abstract
Behavioral medicine research from across the globe has been catalyzed by the quest to understand the interactions between psychological, social, and physiological factors underlying disparities in human health. A more complete biopsychosocial model increasingly integrates advanced clinical and laboratory assessments of relevant environmental chemicals, biological mediators of inflammation, cardiometabolic and endocrine markers, infectious disease exposure, and genetic polymorphisms determined from saliva specimens. The overarching aims are to identify mechanisms, decode moderating processes that translate adversity into risk, and verify the impact of clinical intervention. This special issue of the International Journal of Behavioral Medicine highlights novel contributions of salivary bioscience with emphasis on research utilizing varied research designs (i.e., experimental, longitudinal, dyadic), incorporating a broad array of salivary analytes, and investigating the influence of psychological and social factors on human health.
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Affiliation(s)
- Michael A Hoyt
- Population Health and Disease Prevention and the Chao Family Comprehensive Cancer Center, University of California Irvine, 653 E Peltason Drive, Irvine, CA, 95697-3957, USA. .,Interdisciplinary Institute for Salivary Bioscience Research, University of California Irvine, Irvine, CA, USA.
| | - Douglas A Granger
- Interdisciplinary Institute for Salivary Bioscience Research, University of California Irvine, Irvine, CA, USA
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27
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Salomon RE, Tan KR, Vaughan A, Adynski H, Muscatell KA. Minimally-invasive methods for examining biological changes in response to chronic stress: A scoping review. Int J Nurs Stud 2020; 103:103419. [PMID: 31945603 DOI: 10.1016/j.ijnurstu.2019.103419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nurse researchers are increasingly interested in incorporating biological indicators related to chronic stress, or repeated or constant exposure to psychological stressors. Minimally invasive collection methods may improve access to vulnerable populations. OBJECTIVE To map biological indicators measured through minimally invasive methods investigating biological changes in response to chronic stress. DESIGN, DATA SOURCES, AND METHODS The paper seeks to answer two questions: What are the characteristics of the minimally-invasive methods used to measure the biological correlates of chronic stress? What are the limitations regarding the use of the minimally-invasive methods and/or biological indicators identified above? Authors completed a scoping review following guidelines from the Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. A literature search was completed in PubMed, PsycINFO, and Scopus. 2518 articles were screened and 145 studies were included. Data were extracted using a standardized extraction tool, compiled, and coded. RESULTS Studies included minimally-invasive methods to measure the hypothalamic-adrenal-pituitary axis (N = 173), immune and inflammatory markers (N = 118), and adult neurogenesis (N = 6). Cortisol was most frequently measured (N = 136), usually in saliva (N = 86). Studies included a variety of limitations for the methods and indicators, including concerns about timing and accuracy of collection, frequency of sampling, and controlling for acute stressors. CONCLUSIONS Nurse researchers have access to many minimally-invasive methods to measure altered biological processes related to chronic stress. A gap identified by this review is the paucity of minimally-invasive methods for investigating neurogenesis; the measurement of brain derived neurotrophic factor in plasma is a distal proxy and further research is needed to test the response of peripheral levels to psychosocial stress interventions. Additionally, while this scoping review allows nurse researchers to consider possible biological indicators to include in their research, future research is still needed on some of the basic premises of stress research, including agreement on the conceptualization of chronic stress.
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Affiliation(s)
- Rebecca E Salomon
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Kelly R Tan
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Ashley Vaughan
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Harry Adynski
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Keely A Muscatell
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Campus Box #3270, 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Campus Box #7295, 450 West Drive, Chapel Hill, NC 27599-7295, USA.
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28
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Puhlmann LMC, Engert V, Apostolakou F, Papassotiriou I, Chrousos GP, Vrtička P, Singer T. Only vulnerable adults show change in chronic low-grade inflammation after contemplative mental training: evidence from a randomized clinical trial. Sci Rep 2019; 9:19323. [PMID: 31852916 PMCID: PMC6920474 DOI: 10.1038/s41598-019-55250-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 11/06/2019] [Indexed: 12/18/2022] Open
Abstract
Growing evidence suggests that chronic low-grade inflammation can be reduced through mindfulness-based mental training interventions. However, these results are inconsistent and based on patient populations with heterogeneous conditions. Similar research in healthy adults is lacking. Moreover, common intervention protocols involve varying combinations of different contemplative practices, such that it remains unclear which types of training most effectively influence biomarkers of inflammation. The present study investigated the effect of three distinct 3-month training modules cultivating a) interoception and present-moment focus (Presence), b) socio-affective skills (Affect), or c) socio-cognitive skills (Perspective) on the inflammatory biomarkers interleukin-6 (IL-6) and high sensitive C-reactive protein (hs-CRP) in 298 healthy adults. We observed no group-level effect of training on either biomarker, but trend-level interactions of training type and participant sex. In additionally exploring the influence of participants' baseline inflammation, a selective training effect emerged: Following the Presence module, participants with relatively higher inflammatory load showed stronger reduction in IL-6 on average, and in hs-CRP if they were male. Mindfulness- and attention-based mental practice thus appears most effective when targeting chronic low-grade inflammation in healthy adults, particularly in men. Overall, our data point to a floor effect in the reduction of inflammatory markers through contemplative mental training, suggesting that mental training may be less effective in improving basal biological health outcomes in healthy, low-stressed adults than in vulnerable populations.
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Affiliation(s)
- Lara M C Puhlmann
- Research Group "Social Stress and Family Health", Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Veronika Engert
- Research Group "Social Stress and Family Health", Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Department of Social Neuroscience, Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany
| | - Filia Apostolakou
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - George P Chrousos
- First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Pascal Vrtička
- Research Group "Social Stress and Family Health", Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Tania Singer
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
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29
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Singer T, Engert V. It matters what you practice: differential training effects on subjective experience, behavior, brain and body in the ReSource Project. Curr Opin Psychol 2018; 28:151-158. [PMID: 30684917 DOI: 10.1016/j.copsyc.2018.12.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Abstract
Mindfulness interventions have gained much attraction, also due to their promise to improve health and wellbeing. However, not enough attention is devoted to the differentiation between various mental practice types. Here, we summarize findings from the ReSource Project, a 9-month longitudinal mental training study comparing practices focusing on (a) present-moment attention and interoception, (b) socio-emotional processes such as compassion and loving kindness and (c) meta-cognitive processes and perspective-taking on self and others. We find evidence for differential training effects of these practice types on all levels of observation, ranging from distinct phenomenological fingerprints and structural brain plasticity to selective improvements in social cognition, altruism and peripheral physiology, including the cortisol response to psychosocial stress. We argue for a more differentiated view on the concept of mindfulness and meditation.
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Affiliation(s)
- Tania Singer
- Department of Social Neuroscience, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Social Neuroscience Lab, Max Planck Society, Berlin, Germany.
| | - Veronika Engert
- Department of Social Neuroscience, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Max Planck Research Group Social Stress and Family Health, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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30
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Nater UM. The multidimensionality of stress and its assessment. Brain Behav Immun 2018; 73:159-160. [PMID: 30041012 DOI: 10.1016/j.bbi.2018.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Urs M Nater
- Clinical Psychology, Department of Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria.
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