Perceived stress, coping, and cortisol reactivity in daily life: A study of adolescents during the first year of college

Greater perceived stress and lower cortisol concentration increase the odds of depressive symptoms among adolescents

BACKGROUND

Adolescent depression is a major public health concern. Although stress has been linked to more severe depression, its association with mild depression among adolescents is not understood. This study assesses the relationship between perceived stress and cortisol (a physiologic measure of stress) and examines the relationships between these stress measures and depressive symptoms among adolescents 13-19 years of age.

METHODS

Stress was measured with the Perceived Stress Scale-10 and through salivary sampling for cortisol four times throughout the day. The Patient Health Questionnaire-9 was used to measure depressive symptoms (range 0-27), where ≥5 indicated the threshold for experiencing at least mild depressive symptoms. Spearman coefficients and multiple logistic regression models were used to examine the relationships between our variables of interest.

RESULTS

The mean age of the 73 participants in our study was 15.82 years. 49 % of the participants reported depressive symptoms (PHQ-9 score ≥ 5). Both higher perceived stress (odds ratio [OR] = 1.11, p = 0.022) and lower cortisol (area-under-the curve; AUCG) (OR = 0.99, p = 0.009) were associated with increased odds of having depressive symptoms.

LIMITATIONS

Few participants had moderate to severe PHQ-9 depression, therefore our study reported findings on mild depression or greater.

CONCLUSIONS

Perceived stress and cortisol appear to reflect distinct, independent components of the stress experience. However, both greater perceived stress and less circulating cortisol may indicate difficulties in regulating stress as potential factors underlying depressive symptoms. Future research should focus on the different types of adolescent stressors and the importance of routine screening of stress and depression, including mild depression.

Genetic Evidence of Endocannabinoid System on Perceived Stress and Restricted Food Intake: The Role of Variants rs324420 in FAAH Gene and rs1049353 in CNR1 Gene

Background: The endocannabinoid system (ECS) is active in brain regions involved in stress, food intake, and emotional regulation. The CB1 receptor and the fatty acid amide hydrolase (FAAH) enzyme regulate the ECS. Genetic variants in the FAAH gene (rs324420) and in the CNR1 gene (rs1049353) have been involved in both chronic stress and obesity. As a maladaptive strategy to evade the stress, three dysfunctional eating patterns may appear: cognitive restriction, disinhibition, and emotional eating. Aim: To evaluate the association of variants rs324420 in the FAAH gene and rs1049353 in the CNR1 gene with perceived stress, dysfunctional eating patterns, and anthropometric and body composition variables. Methods: This cross-sectional study included 189 participants from western Mexico. The Spanish version of the Three-Factor Eating Questionnaire and the Perceived Stress Scale were applied. Genotyping was performed with TaqMan® probes. Results: It was found that subjects with CA/AA genotypes in FAAH had a higher risk of presenting high scores in stress perception than CC genotype carriers (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.007-3.339; p = 0.048); in addition, the CC genotype of this genetic variant was related to higher body weight and body fat, but no association was found with dysfunctional eating patterns. As for the CNR1 single-nucleotide polymorphism, this variant showed no significant association with stress perception scores, but subjects with GA/AA genotypes in CNR1 had a lower risk of presenting high scores of restriction in food intake compared with GG genotype carriers (OR 0.11, 95% CI 0.046-0.322; p < 0.001). Therefore, this study suggests a differential role of the ECS genes FAAH and CNR1 in perceived stress and dysfunctional eating patterns, respectively. Further studies in other populations are required.

Stress and diurnal cortisol among Latino/a college students: A multi-risk model approach

The transition to college is a time of increased opportunity and stress spanning multiple domains. Adolescents who encounter significant stress during this transition may be vulnerable to adverse outcomes due to a "wear and tear" of the hypothalamic pituitary adrenal (HPA) axis. Latino/a students may be particularly at-risk for heightened stress exposure due to experiences of both minority-specific and general life stress. Despite this, little is known regarding the cumulative impact of multiple stressors on Latino/a students' HPA axis functioning. The present study employed a "multi-risk model" approach to examine additive, common, and cumulative effects of multiple stress forms (general, academic, social, financial, bicultural, ethnic/racial discrimination) on diurnal cortisol in a sample of first-year Latino/a college students (N = 196; 64.4% female; Mage = 18.95). Results indicated that no stress forms were additively associated with the cortisol awakening response (CAR), but general stress was associated with a flatter diurnal cortisol slope (DCS) and bicultural stress was linked with a steeper DCS. A college stress latent factor was associated with a lower CAR, whereas a latent factor of discrimination was not associated with diurnal cortisol. Cumulative risk was linked with a lower CAR. Findings highlight the physiological correlates of various stressors experienced by Latino/a college students.

Current and Cumulative Stress Experiences: A Model for Arab American Young Adults

BACKGROUND

The effect of multiple stressors on immigrant young adults' endocrine functioning and health outcomes has not been comprehensively investigated.

AIMS

This study tested a theoretical model of cumulative and current stressor effects on the hypothalamic-pituitary-adrenocortical (HPA) axis functioning and health-related quality of life (HRQL) among Arab American young adults.

METHODS

Using a cross-sectional design, we recruited 160 participants, ages 18 to 24 years, from an urban university in the Midwest. Cumulative stress was assessed by self-report measures of childhood adversity, bullying victimization, and perceived ethnic discrimination. Current perceived stress was measured using the Perceived Stress Scale (PSS) while cortisol levels were measured in participants' hair. Structural equation modeling tested the effects of cumulative and current stress on cortisol and HRQL.

RESULTS

Cumulative stress was negatively associated with HRQL (standardized path coefficient = -.51, p < .05). Interestingly, however, cumulative stress was inversely associated with hair cortisol level (standardized path coefficient = -.51, p < .05). Current stress was positively associated with cortisol level (standardized path coefficient = .43, p < .05) and negatively associated with the mental HRQL (standardized path coefficient < -.37, p < .05).

CONCLUSION

Cumulative stress exhibited a different effect on HPA functioning from current perceived stress. Mental health was significantly impaired by both cumulative and current perceived stress. Implications for mental health nursing practice and research among Arab Americans are discussed.

Consequences of high school bullying on stress and health of Arab American college students

PROBLEM

Existing bullying research among Arab Americans is limited, focusing mainly on school-age adolescents and victimization. There is a lack of studies that examine retrospective bullying perpetration, bullying victimization, and physical fights during high school and their effect on current Arab American college students' stress and health outcomes. This study examines if bullying perpetration, bullying victimization, and physical fights during high school predict current stress and the physical and mental health of Arab American college students. In addition, we examined if perceived psychological stress mediates the relationships between bullying and fighting involvement and health.

METHODS

One hundred and sixty-two undergraduate Arab American college students were recruited from a Midwestern university and completed self-report measures of bullying, stress, and health (both physical and mental).

FINDINGS

Controlling for demographic variables, only high school victimization was significantly associated with current stress and physical and mental health. Stress fully mediated the relationship between victimization and health (both physical and mental).

CONCLUSIONS

Victimization during high school years may result in serious physical and mental health consequences during college years. However, perpetration and fighting may not have similar effects. Addressing stress among bullying victims may reduce the negative impact of this experience on immigrant Arab American college students. Implications for practice and future research are discussed.

Religious Coping Is Differentially Associated with Physiological and Subjective Distress Indicators: Comparing Cortisol and Self-Report Patterns

Use of religious coping in response to life stress is associated with improved mental and physical health outcomes. The aim of this study was to examine the influence of religious coping on conscious self-reported and non-conscious physiological stress responses to an acute, real-world stressor to better understand how this benefit may be conferred. This study examined the trajectory of subjective distress and cortisol patterns leading up to and following a stressful college exam using daily diary and ambulatory saliva samples, respectively (N students = 246). Religious coping was not significantly associated with subjective reports of distress. However, prior to the exam, greater use of religious coping was associated with an ostensibly more adaptive accelerated return to a cortisol baseline. This protective effect was no longer significant when the exam was over, suggesting that religious coping acts as a protective buffer against physiological stress responses rather than aiding in subjective recovery from stress.

Dispositional Active Coping Predicts Patterns of Adolescents' Cortisol Responsivity in the Context of School-related Stressors

OBJECTIVE

The goal of this study was to examine the direct and conditional effects of active coping and prior exposure to school-related stressors on cortisol reactivity and recovery in response to an academically salient, social stress task.

METHOD

Participants included N= 758 adolescents (50% male; M age = 12.03 years, SD = .49) enrolled in the 7th grade in Title 1 middle schools. Adolescents were predominantly ethnic minorities (62% Hispanic, 12% non-Hispanic White, 11% non-Hispanic Black, 7% Native American, and 8% "other"). Youth completed self-reported assessments of their dispositional use of active coping strategies, prior exposure to school hassles, pubertal status, medication use, and relevant demographic information. In addition, youth engaged in an academically salient group public speaking task adapted for adolescents and provided salivary cortisol sample pre-task, immediately post-task, 15-, and 30-minutes post-task.

RESULTS

Results from piecewise latent growth curve modeling revealed that active coping independently predicted lower cortisol reactivity to the stress task. Furthermore, active coping was associated with slower cortisol recovery when adolescents reported not having experienced any school hassles in the past three months and faster recovery when having experienced several school hassles in the past three months. Results from multinomial logistic regressions revealed that greater use of active coping strategies was less likely to predict a hyper-reactive pattern of cortisol responding compared to other patterns.

CONCLUSION

Findings provide support for active coping as a way to promote adaptive physiological responding to school-related stressors among ethnically diverse youth residing in low-income communities.

Association between stress and eating behaviour among Malaysian adolescents prior to examination

Studies have shown the prevalence of mental health and obesity among adolescents is at increasing trend due to urbanisation and changes in lifestyle. This study is to investigate the level of stress and its impact on eating behaviour among Malaysian adolescents. A total of 797 multi-ethnic Malaysian secondary school student participated in this cross-sectional study. Data was collected two weeks prior to final year examination. A validated Cohen Perceived Stress Scale questionnaire was used to assess the stress level with subsample analysis of 261 participants' saliva cortisol level. A validated Child Eating Behaviour questionnaire was used to explore eating behaviours. There were 29.1% adolescents having high stress with the mean saliva cortisol 3.8 nmol/L. A positive correlation was observed between perceived stress and emotional overeating; stronger among urban (r = 0.32), female (r = 0.31), underweight (r = 0.34) and moderately stressed adolescents (r = 0.24). In addition, a positive correlation was found between perceived stress and food responsiveness; strongest among Malay (r = 0.23), male (r = 0.24), underweight (r = 0.30) and adolescents with high perceived stress (r = 0.24). The perceived stress level prior to exam period affects the emotional eating and external eating patterns of adolescents.

Increased affective reactivity to daily social stressors is associated with more severe psychotic symptoms in youths with 22q11.2 deletion syndrome

BACKGROUND

Increased reactivity to minor stressors is considered a risk factor for psychosis, especially in vulnerable individuals. In the present study, we investigated affective and psychotic stress reactivity as well as its link with psychotic symptoms and psychopathology in youths with 22q11.2 deletion syndrome (22q11DS), a neurogenetic condition associated with a high risk for psychosis.

METHODS

A 6-day ecological momentary assessment protocol was used to assess perceived daily-life stress as well as affective and psychotic reactivity to stress in participants with 22q11DS (n = 38, age = 18.4) and healthy controls (HC; n = 53, age = 19.1). Psychotic symptoms, general psychopathology, and coping strategies were also assessed through clinical interviews and questionnaires.

RESULTS

Participants with 22q11DS reported higher levels of perceived social stress (b = 0.21, p = 0.036) but lower levels of activity-related stress (b = -0.31, p = 0.003) in their daily lives compared to HC. The groups did not differ in affective or psychotic reactivity to stress, but individuals with 22q11DS who reported increased affective reactivity to social stressors showed more severe positive psychotic symptoms (rs = 0.505, p = 0.008). Finally, avoidance coping strategies moderated the association between stress and negative affects.

CONCLUSIONS

Our results suggest an increased vulnerability for daily social stress in youths with 22q11DS, and link elevated social stress reactivity to heightened psychotic symptom severity. Given the high risk for psychosis in 22q11DS, interventions should focus on reducing social stress and developing adaptive coping strategies.

Predictors of stress in college students during the COVID-19 pandemic

Background

College students experience high stress levels during emergency remote classes in the COVID-19 pandemic. However, it is not clear whether this is due to the summation effect of both stressors (classes and pandemic). Therefore, the aim of this study was to investigate predictors of stress in college students before and during remote classes five months after the beginning of the COVID-19 pandemic.

Methods

The study was conducted before (BRC, July-August 2020) and during remote classes (DRC, October-November 2020). The sample consisted of 177 individuals (80 in BRC, 97 in DRC). Students were asked to self-collect saliva for cortisol analysis at each moment of the study, and to fill out a form to characterize the individual and assess the chronotype (Morningness-Eveningness Questionnaire), sleep quality (Pittsburgh Sleep Quality Index) and the stress (Perceived Stress Scale–10).

Results

There was no difference between the evaluated periods for cortisol, perceived stress or sleep quality. Predictors for cortisol levels were gender, academic semester, chronotype, sleep quality and sadness due to pandemic (p<0.001).

Limitations

Short interval between BRC and DRC assessments of perceived stress and salivary cortisol.

Conclusions

Age, sex, income, academic semester, chronotype, and the impact of the pandemic on mood are predictors of stress among college students. In addition, emergency remote classes and sleep quality contribute to less perceived stress.

A dual-system, machine-learning approach reveals how daily pubertal hormones relate to psychological well-being in everyday life

The two studies presented in this paper seek to resolve mixed findings in research linking activity of pubertal hormones to daily adolescent outcomes. In study 1 we used a series of Confirmatory Factor Analyses to compare the fit of one and two-factor models of seven steroid hormones (n = 994 participants, 8084 samples) of the HPA and HPG axes, using data from a field study (https://www.icpsr.umich.edu/web/ICPSR/studies/38180) collected over ten consecutive weekdays in a representative sample of teens starting high school. In study 2, we fit a Bayesian model to our large dataset to explore how hormone activity was related to outcomes that have been demonstrated to be linked to mental health and wellbeing (self-reports of daily affect and stress coping). Results reveal, first that a two-factor solution of adolescent hormones showed good fit to our data, and second, that HPG activity, rather than the more often examined HPA activity, was associated with improved daily affect ratios and stress coping. These findings suggest that field research, when it is combined with powerful statistical techniques, may help to improve our understanding of the relationship between adolescent hormones and daily measures of well-being.

Investigating social connection as a protective factor against exam stress in college students

Objective: To examine social connection as a protective factor against exam stress. Participants: 55 undergraduate students at two universities. Methods: Students were evaluated on an exam day for their hardest class and at baseline, a day in a week where they had no exams. Social connection, salivary cortisol, perceived stress, and cognitive control (measured with the Stroop test) were assessed. Exam scores were later reported. Results: Higher social connection was associated with lower perceived stress on exam day. At a small liberal arts school, higher levels of social connection were associated with higher Stroop scores. This correlation with cognitive control was not significant at a large public university. Conclusions: These findings indicate that social connection may be a protective factor in mitigating perceived stress and cognitive control capabilities may help facilitate reduced exam stress in some school environments.

Physiological reactions to acute stressors and subjective stress during daily life: A systematic review on ecological momentary assessment (EMA) studies

Objective

This review aims to provide an overview of ecological momentary assessment (EMA) studies analyzing stress reactivity during daily life in terms of direct and moderated influence of acute stress on physiological responses.

Materials and methods

A systematic literature search was performed on November 29, 2021 using Web of Science, MEDLINE and PsycINFO to identify prospective EMA studies targeting acute stressors or stress under naturalistic conditions, without restrictions of publication date or population. Study quality was assessed for multiple EMA-specific sources of bias.

Results

Out of 4285 non-duplicate records, 107 publications involving 104 unique studies were included. The majority of studies assessed acute physiological stress responses primarily through salivary cortisol (n = 59) and cardiovascular outcomes (n = 32). Most studies performed at least three measurements per day (n = 59), and had a moderate risk of recall bias (n = 68) and confounding (n = 85). Fifty-four studies reported a compliance of ≥80%. Direct, non-moderated positive associations were observed between acute stress exposure and concurrent cortisol levels (44%, n = 11/25), systolic (44%, 8/18) and diastolic blood pressure (53%, 8/15) and heart rate (53%, 9/17). Several inter- and intra-individual moderators were identified, such as age, gender, health status, chronic stress, work-related resources, physical activity and stress coping indicators.

Conclusions

About half of the reviewed EMA studies demonstrated direct associations between everyday acute stress exposure and physiological responses, including increased cortisol levels, blood pressure and heart rate. Results further suggested various moderator variables that could help develop tailored prevention strategies and identify groups at higher risk for dysfunctional stress responses.

Registration

PROSPERO—Reg.-No.: PROSPERO 2020 CRD42020163178.

Integrative Brain Dynamics in Childhood Bullying Victimization: Cognitive and Emotional Convergence Associated With Stress Psychopathology

Bullying victimization is a form of psychological stress that is associated with poor outcomes in the areas of mental health and learning. Although the emotional maladjustment and memory impairment following interpersonal stress are well documented, the mechanisms of complex cerebral dysfunctions have neither been outlined nor studied in depth in the context of childhood bullying victimization. As a contribution to the cross-disciplinary field of developmental psychology and neuroscience, we review the neuropathophysiology of early life stress, as well as general psychological stress to synthesize the data and clarify the versatile dynamics within neuronal networks linked to bullying victimization. The stress-induced neuropsychological cascade and associated cerebral networks with a focus on cognitive and emotional convergence are described. The main findings are that stress-evoked neuroendocrine reactivity relates to neuromodulation and limbic dysregulation that hinder emotion processing and executive functioning such as semantic cognition, cognitive flexibility, and learning. Developmental aspects and interacting neural mechanisms linked to distressed cognitive and emotional processing are pinpointed and potential theory-of-mind nuances in targets of bullying are presented. The results show that childhood stress psychopathology is associated with a complex interplay where the major role belongs to, but is not limited to, the amygdala, fusiform gyrus, insula, striatum, and prefrontal cortex. This interplay contributes to the sensitivity toward facial expressions, poor cognitive reasoning, and distress that affect behavioral modulation and emotion regulation. We integrate the data on major brain dynamics in stress neuroactivity that can be associated with childhood psychopathology to help inform future studies that are focused on the treatment and prevention of psychiatric disorders and learning problems in bullied children and adolescents.

A 14-day ecological momentary assessment study on whether resilience and early family risk moderate daily stress and affect on cortisol diurnal slope

This study examined whether resilience capacity moderates the association of daily perceived stress and affect with cortisol diurnal slope among relocated emerging adults. Relocated undergraduates (N = 98; aged 18-25 years) were recruited from three groups: Resilient, Vulnerable, and Control. The Resilient group required Risky Family Questionnaire (RFQ) scores ≥ 29 and Brief Resilience Scale (BRS) scores ≥ 3.6. The Vulnerable group required RFQ scores ≥ 29 and BRS scores ≤ 3. The comparison Control group required RFQ scores ≤ 21 and T-scores < 60 on PROMIS anxiety and depression symptoms. Mixed-effects models were used to test the unique associations of perceived stress, negative affect, and positive affect x group interactions (predictors) on diurnal cortisol slope (outcome) across 14 consecutive days. The Resilient group did not moderate the associations between daily stress or affect on cortisol diurnal slope. Instead, both the Resilient and Vulnerable groups with early family risk, showed a steeper diurnal slope unique to higher stress and a flatter slope unique to higher negative affect. Results suggest that riskier early family life was significantly associated with altered cortisol diurnal slope outcomes to stress (i.e., demand) and negative affect (i.e., distress). These associations were not attenuated by current resilience capacity.

Negative Events, Coping and Biological Markers: An Application of Transactional Model of Stress,

Abstract Based on the importance of the stress phenomenon, this research sought to evaluate the relationship between stress, coping strategies, negative life events and biological markers, based on the Transactional Stress Model. A general hypothesis of mediation was formulated: coping strategies would mediate the relationship between negative life events and biological markers. The sample consisted of 96 users of a biomedical school laboratory, in which 77.78% were female. Participants answered the Brief COPE questionnaire, as well as a questionnaire on negative life events. Laboratory tests were collected shortly after the application of the questionnaires. Mediations were found between Venting, Red Blood Cells and Hemoglobin. The research aimed to contribute to the knowledge in the field of stress and coping, as well as to serve as a possible empirical study of the Transactional Stress model.

Association between distinct coping styles and heart rate variability changes to an acute psychosocial stress task

Modern life comprises a myriad of stressful situations, ranging from life-threatening ones to others not so deadly, all of which activate a physiologic stress response. Engaging in healthy ways to cope can prevent us from wearing out our physiological systems. Heart rate variability (HRV) is often used as an index of emotion regulation response. Hence, our goal is to investigate whether the habitual use of coping strategies is related to a distinct pattern of HRV changes when the individual is exposed to a moderate psychosocial stressor. In this study, 60 female participants performed a psychosocial stress task-oral speech preparation-while ECG signals were collected during the whole experimental procedure. Heart rate (HR), HRV parameters (SDNN, RMSSD, LF, HF) and coping strategies (Brief COPE) were registered. Participants were divided into two groups (low and high groups) as a function of their scores on the maladaptive and adaptive coping strategies of the Brief COPE. As expected, the task alone induced increases in heart rate and reductions in HRV parameters. Additionally, the analyses revealed a different pattern of HRV (SDNN, RMSSD, LF and HF) changes in response to the stressor, with participants using less maladaptive strategies being able to maintain the HRV at baseline levels when confronting the stressor, while those using more maladaptive strategies reducing HRV during the task. These results show a different pattern of HRV changes as a function of the coping style, suggesting a possible autonomic advantage, namely, the maintenance of HRV, in individuals who use maladaptive coping strategies less frequently.

Coping with Relationship Stress in Adolescence: A Decade in Review

At a moment in history when stress levels among adolescents are high and coping capacities are taxed, it seems timely and important to review a decade's accomplishments in elucidating how, and with what effects, adolescents cope with relationship stress. We provide an update on research about coping with parent, peer, and romantic stress and discuss the effectiveness of coping strategies across cultures, developmental periods, and levels of social stress. We explore relations between coping and other automatic and reflective responses to stress and highlight innovations in lab-based and ambulatory assessments. We recommend studies of variability in the success of coping at different intensities of relationship stress and research with real-time and repeated assessments to capture the process of coping.

School commute time, chronotype, and altered HPA axis functioning during adolescence

Hypothalamic pituitary adrenal gland (HPA) axis functioning has been linked with daily demands during adolescence. A ubiquitous, yet understudied daily demand in the lives of youth is the commute to school, which may be associated with the diurnal rhythm of cortisol as demonstrated in prior research among adults. The current study hypothesized that longer school commute times would be associated with altered HPA axis functioning as demonstrated by a heightened cortisol awakening response (CAR) and flatter diurnal slope. Additionally, given that the HPA axis follows a diurnal rhythm and adolescence is marked by changes in the circadian rhythm, adolescents with a more evening chronotype were hypothesized to evince even more altered HPA axis functioning in the face of long school commute times. A total of 269 adolescents (M = 16.38 years, SD = 0.74) provided saliva samples at wake, 15-min. post-wake, and 30-min. post-wake for the calculation of CAR and at dinnertime and bedtime for the calculation of diurnal slope, completed up to 8 nights of sleep actigraphy, and self-reported school commute time. Results suggest that more evening chronotype youth with longer school commute times evince a higher CAR, but not an altered diurnal slope. The present findings may have implications for adolescent mental health as higher CAR has been associated poor mental health and heightened stress.

The Frustration Social Stressor for Adolescents (FSS-A): A newly adapted psychosocial stressor

The role of stress on adolescents and its impact on development and mental health is of significant psychological concern. Previous research has investigated physiological changes, stressor characteristics and individual differences in stress responding. Experimental procedures that closely simulate naturally occurring psychosocial stressors have primarily been achievement-related (e.g., test taking, competitive tasks and psychomotor performance) and anxiety-provoking tasks (e.g., public speaking, improvisation and invasive medical-procedures) but few seek to elicit frustration. To address this gap, a new experimental procedure was developed and validated against the Trier Social Stress Test for Teens, with a Low Stress condition as a control. Conflict-related stressors, such as parent- and peer-related debates, have been found to be effective in provoking frustration in adolescents. The Frustration Social Stressor for Adolescents (FSS-A), a moderate frustration-provoking stressor involves a peer debate on a 'hot' topic, followed by a serial subtraction task with still-faced judges. The FSS-A procedure effectively elicited reliable and valid physiological (cortisol, heart rate) stress responses and was an effective stressor for both sexes. This new, stress protocol mirrors frustrating- and anxiety-provoking stressful situations that adolescents commonly encounter and affords a more detailed study of differential stress response patterns, increased understanding of adolescent stress, and potential for psychoeducational programming, such as directions for education and therapeutic intervention.

Mental Resilience and Coping With Stress: A Comprehensive, Multi-level Model of Cognitive Processing, Decision Making, and Behavior

Aversive events can evoke strong emotions that trigger cerebral neuroactivity to facilitate behavioral and cognitive shifts to secure physiological stability. However, upon intense and/or chronic exposure to such events, the neural coping processes can be maladaptive and disrupt mental well-being. This maladaptation denotes a pivotal point when psychological stress occurs, which can trigger subconscious, "automatic" neuroreactivity as a defence mechanism to protect the individual from potential danger including overwhelming unpleasant feelings and disturbing or threatening thoughts.The outcomes of maladaptive neural activity are cognitive dysfunctions such as altered memory, decision making, and behavior that impose a risk for mental disorders. Although the neurocognitive phenomena associated with psychological stress are well documented, the complex neural activity and pathways related to stressor detection and stress coping have not been outlined in detail. Accordingly, we define acute and chronic stress-induced pathways, phases, and stages in relation to novel/unpredicted, uncontrollable, and ambiguous stressors. We offer a comprehensive model of the stress-induced alterations associated with multifaceted pathophysiology related to cognitive appraisal and executive functioning in stress.

Dynamic association between perceived conflict and communication behavior in intimate relationships: The moderating effect of traumatic experience

Many individuals may face traumatic events throughout their lives. For intimate relationship partners, early traumatic experiences can have a specific effect on their interpersonal communication. This study examined the moderating effect of traumatic experiences at early ages between perceived conflict and communication behavior among individuals in an intimate relationship. A total of 186 college students in intimate relationships reported their perceived conflict and communication behaviors with their partners three times a day for 14 days using ambulatory assessment. Findings from the multilevel model showed that a higher level of perceived conflict significantly positively associated with negative communication and negatively correlated with positive communication at the within-person level. Traumatic experiences at the between-person level moderated the within-person level associations between the dynamic perceived conflict and negative and positive communication behavior. However, the moderating effect of traumatic experiences on the association between perceived conflict and positive communication was contrary to the hypothesis. Daily perceived conflict was associated with daily communication behavior. For those with early traumatic experiences, the relationship between negative communication and conflict was stronger than for those who had not experienced such trauma.

Perceived Stress and Cyberloafing among College Students: The Mediating Roles of Fatigue and Negative Coping Styles

Cyberloafing has increasingly attracted the attention of scholars because of the widespread use of digital devices in educational environments. This research was conducted to investigate the roles of fatigue and negative coping styles in mediating the relationship between perceived stress and cyberloafing. A total of 730 undergraduates (reduced to 716 due to incomplete data) completed self-report questionnaires measuring perceived stress, fatigue, negative coping styles, and cyberloafing. Perceived stress was shown to be a significant predictor of cyberloafing. Furthermore, negative coping styles played a unique mediating role and fatigue and negative coping styles exerted a sequential mediating effect on the association between perceived stress and cyberloafing. We envision the findings as being helpful in guiding educators develop interventions for minimizing cyberloafing by college students and its disrupting effects.

Stress coping strategies and stress reactivity in adolescents with overweight/obesity

This study explored the associations between the frequency and effectiveness of habitual stress coping strategies on physiological and psychological stress responses to an acute laboratory stressor in adolescents with overweight/obesity (51 adolescents; 47% female; ages 14-19 years). Coping strategies were assessed using the Schoolager's Coping Strategies Inventory. Acute physiological stress responses were measured as salivary cortisol and α-amylase output during the Trier Social Stress Test and during a control condition. Acute psychological stress was measured using a Likert-type scale, and systolic blood pressure (SBP) and heart rate were measured at baseline. Results revealed that higher coping effectiveness was associated with lower log-based α-amylase during the stress (β = -0.025, p = 0.018) and control (β = -0.030, p = 0.005) conditions, but not with cortisol across either condition (all ps > 0.05). SBP moderated the association between coping effectiveness and α-amylase during the stress condition, with higher coping effectiveness associated with lower α-amylase only among individuals with lower SBP (β = 0.002, p = 0.027). Coping frequency was not associated with cortisol responses, neither was habitual stress coping strategies associated with psychological stress (all ps > 0.05). These findings provide preliminary evidence that effective use of stress coping strategies may provide a dampening effect on sympathetic activity in an at-risk adolescent population.

Stress, Sleep, and Coping Self-Efficacy in Adolescents

Adults are thought to show a sleep-stress spiral in which greater stress worsens sleep quality, which amplifies stress, which leads to worse sleep. This study examined whether adolescents show a similar spiral, and if so, whether coping self-efficacy-believing one can cope with stress-interrupts the spiral. Temporal dynamics of perceived stress, sleep quality, and coping self-efficacy were tracked in 381 9th graders (49% female, mean age 14.43, age range 14-16) using daily surveys across two school weeks (3184 observations). Though expected associations were evident between individuals, only a unidirectional path was found within individuals from sleep quality to perceived stress via coping self-efficacy. This challenges the conventional bidirectional understanding of sleep-stress relations and suggests coping self-efficacy as an intervention target.

Early life stress sensitizes youth to the influence of stress-induced cortisol on memory for affective words

Early life stress (ELS) is a well-established risk factor for psychopathology across the lifespan. Cognitive vulnerability to stress-induced cortisol may explain risk and resilience. The current study aimed to elucidate a psychobiological pathway linking stress to altered memory for affective words among youth with and without exposure to ELS. One hundred and fifteen youth (ages 9-16, 47% female) were randomized either to a psychosocial stressor or a control condition. Immediately following the stress or control condition, participants completed a memory task for affective words. Change in salivary cortisol from immediately before to 25 min after stress onset were used to predict memory for affective words. Exposure to the acute laboratory stressor led to activation of the HPA axis. Greater cortisol reactivity was associated with less accurate recognition of negative valence words. Among youth exposed to ELS, greater cortisol reactivity to acute stress was associated with poorer recognition of dysphoric and neutral words. Acute increases in cortisol may interfere with negatively-valenced information processing that has implications for memory. Youth exposed to high ELS may be particularly vulnerable to the effects of cortisol, which may explain one pathway through which stress leads to psychopathology among at-risk youth.

Stress perception following childhood adversity: Unique associations with adversity type and sex

Childhood adversity is associated with poor mental and physical health outcomes across the life span. Alterations in the hypothalamic-pituitary-adrenal axis are considered a key mechanism underlying these associations, although findings have been mixed. These inconsistencies suggest that other aspects of stress processing may underlie variations in this these associations, and that differences in adversity type, sex, and age may be relevant. The current study investigated the relationship between childhood adversity, stress perception, and morning cortisol, and examined whether differences in adversity type (generalized vs. threat and deprivation), sex, and age had distinct effects on these associations. Salivary cortisol samples, daily hassle stress ratings, and retrospective measures of childhood adversity were collected from a large sample of youth at risk for serious mental illness including psychoses (n = 605, mean age = 19.3). Results indicated that childhood adversity was associated with increased stress perception, which subsequently predicted higher morning cortisol levels; however, these associations were specific to threat exposures in females. These findings highlight the role of stress perception in stress vulnerability following childhood adversity and highlight potential sex differences in the impact of threat exposures.

Negative affect reactivity to stress and internalizing symptoms over the transition to college for Latinx adolescents: Buffering role of family support

Affect reactivity to stress may play a role in the development of internalizing symptoms during the college transition, a critical developmental juncture for Latinx adolescents, the largest ethnic minority group on college campuses. This study examined whether affect reactivity during high school is associated with internalizing symptoms in college and explored two potential protective factors, perceived family and peer support. Participants were 209 Latinx adolescents (Mage = 18.10; 64.4% female) who completed standard surveys and four diary assessments per day over 7 days (N > 4,500 momentary observations). First, to measure affect reactivity, we assessed whether perceived stress was associated with negative affect at the momentary level during high school (senior year). Second, we tested whether affect reactivity predicted internalizing symptoms during the first year of college. Third, we tested whether perceived family or peer support buffered the negative consequences of affect reactivity. Results indicated statistically significant within- and between-person associations between stress and negative affect. Moreover, affect reactivity significantly predicted depressive, but not anxiety, symptoms. Buffering was found for family, but not peer, support. Findings extend previous research by detecting associations between momentary affect reactivity and internalizing symptoms during a sociocultural shift in Latinx adolescents' lives and have implications for culturally appropriate programs to prevent depressive symptoms.

Neuroendocrine coordination and youth behavior problems: A review of studies assessing sympathetic nervous system and hypothalamic-pituitary adrenal axis activity using salivary alpha amylase and salivary cortisol

Externalizing and internalizing behavior problems can have deleterious psychosocial consequences for youth. Both sympathetic nervous system (SNS) and hypothalamic-pituitary adrenal (HPA) axis activity and reactivity may contribute to behavior problems but have largely been studied separately, with inconsistent findings. Because the SNS and HPA axis interact to carry out physiological processes (e.g., responding to stressors), considering SNS and HPA axis activity jointly may elucidate disparate findings. This review discusses studies that simultaneously assessed SNS and HPA axis (re)activity and youth behavior problems using measures of salivary alpha amylase (sAA) and salivary cortisol. Multiple patterns of SNS and HPA axis coordination were associated with problem behaviors, especially when considering individual differences and youth's psychosocial context. Importantly, many study findings may be artifacts of widespread methodological differences. The reviewed studies lay the foundation for future research on neuroendocrine coordination as a contributing factor to youth problem behaviors and some recommendations for future research are discussed.

Reducing cultural mismatch: Latino students' neuroendocrine and affective stress responses following cultural diversity and inclusion reminder

Cultural mismatch theory suggests that a poor fit between the cultural values endorsed by individuals and the institutions to which they belong results in emotional distress and activation of physiological stress processes, particularly for underrepresented groups. To test a novel paradigm for reducing perceptions of this cultural mismatch, the current experiment evaluated whether reminding first-year Latino university students (N = 84; M_age = 18.56; SD = 0.35; 63.1% female; 85.7% Mexican descent; 65.5% first-generation college students) about institutional support for cultural diversity and inclusion would reduce neuroendocrine and affective responses to psychosocial stress. Prior to completing a modified version of the Trier Social Stress Test, participants were randomly assigned to view either a video conveying university commitment to cultural diversity and inclusion (n = 45) or a control video (n = 39) depicting a campus tour. Five saliva samples assayed for cortisol and corresponding negative affect measures were collected to assess stress reactivity and recovery patterns (pre-task baseline, post-task +30 min, +45 min, +60 min, +75 min). Repeated measures data were analyzed using bilinear spline growth models. Viewing the culture video (compared to control) significantly reduced cortisol reactivity to the TSST and post-task negative affect levels, specifically for students endorsing higher Latino cultural values (e.g., familism, respect). Post-task cortisol levels were also reduced for students endorsing higher U.S. mainstream cultural values (e.g., self-reliance, competition). Results provide novel evidence for cultural diversity in stress responsivity and individual variation in approaches to reduce perceived cultural mismatch.

Daily rumination about stress, sleep, and diurnal cortisol activity

Rumination is an involuntary cognitive process theorized to prolong arousal and inhibit proper emotion regulation. Most available research has examined individual differences in cognitive dispositions to ruminate about stress as a risk marker for psychopathology and other health problems. This intensive longitudinal study extended previous research by examining day-to-day associations of rumination about stress with objectively-measured actigraph-based sleep and diurnal salivary cortisol activity. Sixty-one healthy participants (Mage = 20.91) completed up to five ecological momentary assessments (EMA) each day and wore actigraph wristwatches for eight days (N = 488). On three of these days, participants provided five saliva samples assayed for cortisol (N = 910). On average, greater daily stress levels were associated with shorter sleep duration and higher waking cortisol levels. In day-to-day analyses, greater daily stress levels, when combined with ruminating about daily stress more than usual, was associated with higher waking cortisol levels the following morning. Ruminating more than usual about daily stress, in the context of low-stress days, was also associated with flatter diurnal cortisol slopes the next day. These findings highlight the potential influences of daily stress, and rumination about stress, on sleep and diurnal cortisol activity - two important markers of health and well-being.

Does hair cortisol really reflect perceived stress? Findings from low-income mother-preschooler dyads

Hair cortisol concentration (HCC) has emerged as an objective biological measure of stress in humans, but findings on the relationships between perceived stress and HCC and between mothers' HCC and children's HCC are inconsistent. To advance the understanding of HCC and its relationship with perceived stress, this study aimed to examine the relationships among mothers' HCC, perceived stress, distress, coping, and preschoolers' HCC in a low-income population. A correlational study was conducted with 35 Head Start mother-preschooler dyads. Mothers' mean HCC was 6.97 pg/mg, and preschoolers' mean HCC was 32.02 pg/mg. The receiver operating characteristic analysis identified an optimal HCC cutoff of 4.1 pg/mg based on the 10-item Perceived Stress Scale to divide mothers into low and high HCC groups. Mothers' perceived stress was negatively related to their HCC (ρ = -0.49, p = 0.005). While there were no statistically significant relationships between mothers' HCC and their perceived distress or coping in the low HCC group, mothers' HCC in the high HCC group was positively related to their perceived coping (ρ = 0.53, p = 0.036). Mothers' HCC was positively correlated with preschoolers' HCC (ρ = 0.39, p = 0.030). In the high HCC group, mothers' perceived stress and distress had very small correlations with preschoolers' HCC. In contrast, in the low HCC group, mothers' perceived stress and distress had very large correlations with preschoolers' HCC (ρ = 0.83, p < 0.001; ρ = 0.74, p = 0.001, respectively). The findings suggest mothers' coping ability plays a significant buffering role in modifying the influence of mothers' perceived stress on preschoolers' stress; however, considering the limited sample size, this conclusion warrants further investigation. This study provides an important foundation for studying HCC in low-income mothers and their preschoolers.

Latino adolescents' cultural values associated with diurnal cortisol activity

Hypothalamic-pituitary-adrenal (HPA) axis activity has been identified as a mechanism through which daily life stress contributes to health problems and racial/ethnic health disparities. Stress-related changes in neuroendocrine function are evident as early as adolescence, but the ways in which promotive cultural factors may also contribute to variation in diurnal HPA activity have received little empirical attention. Grounded in cultural models of resilience, dual dimensions of Latino adolescents' cultural values (ethnic heritage and U.S. mainstream) were examined as promotive and protective factors in relation to their diurnal salivary cortisol patterns using ecological momentary assessment (N = 209; M_age = 18.10; 64.4% female). Participants provided 5 daily saliva samples for 3 days while completing corresponding electronic diary reports and using time-sensitive compliance devices (track caps, actigraphs). Results from 3-level growth curve models indicated that higher U.S. mainstream cultural values (e.g., self-reliance, competition, material success) were associated with higher average waking cortisol levels and a more rapid rate of diurnal cortisol decline (i.e., "steeper" slope). Regarding situational deviations from the diurnal rhythm (within-person differences), cortisol levels were higher in relation to diary-reported ongoing stress (vs. completed). Accounting for these situational differences in stress timing, a cross-level interaction (i.e., between-person difference in within-person process) indicated that higher perceived stress than usual was associated with lower cortisol levels for adolescents with stronger alignment to Latino ethnic heritage values (e.g., familism, respect, religiosity), compared to relatively higher cortisol levels for those with less alignment to these values. Results were consistent adjusting for participants' sex, immigrant generation, parents' education level, depressive symptoms, medication use, sleep duration, and other self-reported health behaviors. These findings join the growing science of cultural neurobiology by demonstrating the promotive and potentially regulating influence of cultural values in the daily HPA functioning of Latino adolescents.

Does higher-than-usual stress predict nonsuicidal self-injury? Evidence from two prospective studies in adolescent and emerging adult females

BACKGROUND

Nonsuicidal self-injury (NSSI) is highly prevalent among adolescent and emerging adult females. Most studies examining the relationship between stress and NSSI largely have relied on aggregate self-report measures of stress and between-person models. Using data from two prospective samples, this manuscript tests the hypothesis that within-person models of NSSI provide better clinical markers of risk for NSSI than between-person models of NSSI.

METHODS

Two samples (Sample 1: 220 high-risk girls, M age = 14.68, SD = 1.36, baseline assessment and 3-month follow-ups for 18 months; Sample 2: 40 emerging adult females with a history of NSSI, M age = 21.55, SD = 2.14, 14 days with daily retrospective reports) were followed prospectively and completed validated measures of stress and NSSI. Models were adjusted for age and depression.

RESULTS

In Sample 1, a within-person model demonstrated that higher-than-usual (but not average) stress levels predicted NSSI within the same 3-month wave. In Sample 2, results from a within-person model with daily diary assessment data showed that higher-than-usual stress (but not average daily stress) predicted same-day NSSI.

CONCLUSIONS

Together, our results suggest that higher-than-usual stress, relative to one's typical stress level, but not average stress levels, signals times of enhanced risk for NSSI. These results highlight the clinical utility of repeated assessments of stress.

Investigating associations between momentary stress and cortisol in daily life: What have we learned so far?

Since cortisol measurement in saliva has been established, it has been used as an indicator of stress-related hypothalamic-pituitary-adrenocortical axis activity. Concurrent development of methodological frameworks such as ambulatory assessment, ecological momentary assessment, and experience sampling have provided opportunities to combine both approaches in daily life research. The current review provides a summary of basic methodological principles and recommendations, as well as abstracts of findings of studies investigating momentary associations between stress and cortisol in daily life with an emphasis on within-subject associations (i.e. average covariance in repeated momentary assessments of stress and cortisol, and individual-specific deviations from the average covariance). Methodological challenges related to stress measurement, sampling principles, and appropriate statistical modeling are discussed, followed by a description of the historical development of studies on within-subject associations between momentary daily life stress and cortisol. The review concludes with a discussion of controversial methodological characteristics of these studies regarding operationalizations of stress, compliance, timing and frequency of stress and cortisol sampling, and reporting of effect sizes. Future research in this area would benefit from automated cortisol assessment, broadening of the scope of stress response measures, use of advanced statistical models that better account for dynamics in the stress process in daily life, and attempts to replicate findings. While previous studies of momentary stress and concurrent cortisol assessments have reliably confirmed some fundamental predictions from stress theory in daily life, future studies should aim at providing progress by testing innovative research questions and utilizing new technological developments.

Adolescent stress reactivity: Examining physiological, psychological and peer relationship measures with a group stress protocol in a school setting

INTRODUCTION

Adolescents experience enhanced social sensitivity and biopsychosocial changes that can be challenging. Much remains unknown about the effect of psychological characteristics and peer relationships on adolescents' physiological responses to stress, due in part to methodological limitations.

METHODS

To test how adolescents' peer relationships and psychological characteristics are associated with their physiological and psychological response to stress, we administered the Group Public Speaking Task for Adolescents (GPST-A) to 54 adolescents (n = 40 girls; Mage = 16.6 years) in two high schools in the United States. Salivary cortisol and alpha-amylase (sAA), and positive and negative affect were measured six times. Relationships among group members were measured, resulting in whole-network data. State and trait rumination, five factors of coping, and emotional reappraisal and suppression were measured along with symptoms of depression and anxiety.

RESULTS

Greater levels of negative evaluation and victimization among group members were associated with a steeper increase and decline in the negative affect response, yet not associated with the physiological response to stress. Greater positive affect was associated with decreased cortisol reactivity, whereas negative affect was associated with steeper cortisol and sAA reactivity. Rumination, disengagement coping, and depression symptoms were related to the physiological response to stress.

CONCLUSIONS

The GPST-A is feasible to administer in a school context with adolescents to collect both physiological and psychological stress responses. Findings from the present study suggest peer relationships are important for understanding adolescents' psychological response to stressors while psychological characteristics are important for adolescents' physiological response to stress.

Correlates of Stress in the College Environment Uncovered by the Application of Penalized Generalized Estimating Equations to Mobile Sensing Data

BACKGROUND

Stress levels among college students have been on the rise for the last few decades. Currently, rates of reported stress among college students are at an all-time high. Traditionally, the dominant way to assess stress levels has been through pen-and-paper surveys.

OBJECTIVE

The aim of this study is to use passive sensing data collected via mobile phones to obtain a rich and potentially less-biased source of data that can be used to help better understand stressors in the college experience.

METHODS

We used a mobile sensing app, StudentLife, in tandem with a pictorial mobile phone-based measure of stress, the Mobile Photographic Stress Meter, to investigate the situations and contexts that are more likely to precipitate stress.

RESULTS

Using recently developed methods for handling high-dimensional longitudinal data, penalized generalized estimating equations, we identified a set of mobile sensing features (absolute values of beta >0.001 and robust z>1.96) across the domains of social activity, movement, location, and ambient noise that were predictive of student stress levels.

CONCLUSIONS

By combining recent statistical methods and mobile phone sensing, we have been able to study stressors in the college experience in a way that is more objective, detailed, and less intrusive than past research. Future work can leverage information gained from passive sensing and use that to develop real-time, targeted interventions for students experiencing a stressful time.

Cognitive-affective strategies and cortisol stress reactivity in children and adolescents: Normative development and effects of early life stress

This study examined cognitive-affective strategies as predictors of hypothalamic-pituitary-adrenal (HPA) axis responses to a social-evaluative stressor in adolescence as compared to late childhood as a function of early life experiences. Participants included 159 children (9-10 years) and adolescents (15-16 years) divided into two groups based on early care experiences: non-adopted youth raised in their birth families (n = 81) and post-institutionalized youth internationally adopted from orphanage care (n = 78). Youth completed a version of the Trier Social Stress Test modified for use with children and reported on their trait emotion regulation and coping strategies. Children reported more use of suppression and disengagement than adolescents, while adolescents reported more engagement coping strategies. Non-adopted and post-institutionalized youth did not differ in reported strategies. Cognitive reappraisal predicted higher cortisol reactivity in non-adopted children and adolescents, and was not associated with reactivity in the post-institutionalized group. This study has implications for efforts aimed at promoting self-regulation and adaptive stress responses during the transition to adolescence for both typically developing children and children who experienced adverse early care.

Multimorbidity and perceived stress: a population-based cross-sectional study among older adults across six low- and middle-income countries

BACKGROUND

Stress in chronic conditions or multimorbidity (≥2 chronic conditions) has been reported to affect clinical outcomes but there are no studies on the association between stress and chronic conditions/multimorbidity among older adults in low- and middle-income countries (LMICs). Thus, we investigated this association among adults aged ≥50 years across six LMICs.

METHODS

A cross-sectional analysis using data from the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) was conducted. A perceived stress score [range 0 (lowest stress) -100 (highest stress)] was computed based on two questions from the Perceived Stress Scale. Thirteen chronic conditions were assessed. Multivariable linear regression analyses were conducted.

RESULTS

34,129 adults with a mean age of 62.4 (SD=16.0)years (52.1% females) were included. Overall, 56.6% (95% CI=55.0%-58.2%) had multimorbidity. In the adjusted model including all countries, compared with those with no chronic conditions, higher numbers of chronic conditions were significantly associated with higher stress levels, dose dependently. In a countrywide meta-analysis, multimorbidity was associated with significantly higher stress levels in all countries (especially India and Ghana) although characterized by moderate heterogeneity (I²=54.6%). For single chronic conditions, notably high stress scores were observed for depression, stroke, and hearing problems.

CONCLUSION

Chronic conditions and multimorbidity are associated with higher levels of stress in older adults in LMICs. Given that perceived stress and chronic conditions are collectively associated with worse health outcomes, low-cost, population-level integrated interventions to address stress among those with chronic conditions are urgently needed.

Perceived Stress and Its Relationship With Chronic Medical Conditions and Multimorbidity Among 229,293 Community-Dwelling Adults in 44 Low- and Middle-Income Countries

In this study, we assessed the association of chronic medical conditions and multimorbidity with perceived stress among community-dwelling adults in 44 low- and middle-income countries. Data from the World Health Survey (2002-2004), including 229,293 adults, were analyzed. A perceived stress score (range, 0 (lowest stress)-100 (highest stress)) was computed on the basis of 2 questions from the Perceived Stress Scale. Eleven chronic conditions were assessed. Multivariable linear regression analyses were conducted to explore the associations. All chronic conditions were associated with significantly higher mean perceived stress scores, with the exception of edentulism. The associations were particularly strong for depression (β = 14.71, 95% confidence interval (CI): 13.68, 15.74), visual impairment (β = 10.66, 95% CI: 8.09, 13.23), and schizophrenia (β = 9.98, 95% CI: 7.71, 12.24). Compared with no chronic conditions, the β coefficients for perceived stress with the presence of 1, 2, 3, and ≥4 chronic conditions were 5.58 (95% CI: 4.94, 6.23), 9.58 (95% CI: 8.67, 10.49), 14.15 (95% CI: 12.63, 15.67), and 20.17 (95% CI: 18.29, 22.05), respectively. The associations with perceived stress were significantly stronger among the poorest individuals for arthritis, asthma, diabetes, edentulism, and ≥4 chronic conditions. Our data suggest that a range of chronic conditions and multimorbidity are associated with greatly increased perceived stress among people in low- and middle-income countries, and that the poorest persons may be a particularly vulnerable group.